SF 3542

as introduced - 89th Legislature (2015 - 2016) Posted on 04/15/2016 08:56am

A bill for an act
relating to human services; increasing medical assistance payment rates for
certain dental services; amending Minnesota Statutes 2015 Supplement, section
256B.76, subdivision 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2015 Supplement, section 256B.76, subdivision 2, is
amended to read:

Subd. 2.

Dental reimbursement.

(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
percent above the rate in effect on June 30, 1992; and

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases.

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

(c) Effective for services rendered on or after January 1, 2000, payment rates for
dental services shall be increased by three percent over the rates in effect on December
31, 1999.

(d) Effective for services provided on or after January 1, 2002, payment for
diagnostic examinations and dental x-rays provided to children under age 21 shall be the
lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
2000, for managed care.

(f) Effective for dental services rendered on or after October 1, 2010, by a
state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
on the Medicare principles of reimbursement. This payment shall be effective for services
rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
county-based purchasing plans.

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
year, a supplemental state payment equal to the difference between the total payments
in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
services for the operation of the dental clinics.

(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for dental services shall be reduced by three percent. This reduction
does not apply to state-operated dental clinics in paragraph (f).

(j) Effective for services rendered on or after January 1, 2014, payment rates for
dental services shall be increased by five percent from the rates in effect on December
31, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
federally qualified health centers, rural health centers, and Indian health services. Effective
January 1, 2014, payments made to managed care plans and county-based purchasing
plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
described in this paragraph.

(k) Effective for services rendered on or after July 1, 2015, the commissioner shall
increase payment rates for services furnished by dental providers located outside of the
seven-county metropolitan area by the maximum percentage possible above the rates in
effect on June 30, 2015, while remaining within the limits of funding appropriated for this
purpose. This increase does not apply to state-operated dental clinics in paragraph (f),
federally qualified health centers, rural health centers, and Indian health services. Effective
January 1, 2016, payments to managed care plans and county-based purchasing plans
under sections 256B.69 and 256B.692 shall reflect the payment increase described in this
paragraph. The commissioner shall require managed care and county-based purchasing
plans to pass on the full amount of the increase, in the form of higher payment rates to
dental providers located outside of the seven-county metropolitan area.

new text begin (l) Effective for services provided on or after January 1, 2017, the commissioner
shall increase payment rates by 9.65 percent above the rates in effect on June 30, 2015, for
dental services provided at a nonprofit community clinic located within the seven-county
metropolitan area where at least 90 percent of the clinic's patient encounters per year are
with patients who are uninsured, or covered by medical assistance or MinnesotaCare.
This increase does not apply to state-operated dental clinics in paragraph (f), federally
qualified health centers, rural health centers, or Indian health services. Effective January 1,
2017, payments to managed care plans and county-based purchasing plans under sections
256B.69 and 256B.692 shall reflect the payment increase described in this paragraph. The
commissioner shall require managed care and county-based purchasing plans to pass on
the full amount of the increase in the form of higher payment rates to dental providers for
the dental services that are identified for the rate increase in this paragraph.
new text end