Minnesota Session Laws - 2000, Regular Session

                            CHAPTER 410-S.F.No. 2363 
                  An act relating to health; regulating dental benefit 
                  plans; proposing coding for new law in Minnesota 
                  Statutes, chapter 62Q. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  [62Q.76] [DEFINITIONS.] 
           Subdivision 1.  [APPLICABILITY.] For purposes of sections 
        62Q.76 to 62Q.79, the terms defined in this section have the 
        meanings given them. 
           Subd. 2.  [DENTAL CARE SERVICES.] "Dental care services" 
        means services performed by a licensed dentist or any person 
        working under the dentist's supervision as permitted under 
        chapter 150A, which an enrollee might reasonably require to 
        maintain good dental health, including preventive services, 
        diagnostic services, emergency dental care, and restorative 
        services. 
           Subd. 3.  [DENTAL PLAN.] "Dental plan" means a policy, 
        contract, or certificate offered by a dental organization for 
        the coverage of dental care services.  Dental plan means 
        individual or group coverage. 
           Subd. 4.  [DENTIST.] "Dentist" means a person licensed to 
        practice dentistry under chapter 150A. 
           Subd. 5.  [EMERGENCY DENTAL CARE.] "Emergency dental care" 
        means the provision of dental care services for a sudden, acute 
        dental condition that would lead a prudent layperson to 
        reasonably expect that the absence of immediate care would 
        result in serious impairment to the dentition or would place the 
        person's oral health in serious jeopardy. 
           Subd. 6.  [ENROLLEE.] "Enrollee" means an individual 
        covered by a dental organization and includes an insured, 
        policyholder, subscriber, contract holder, member, covered 
        person, or certificate holder. 
           Subd. 7.  [DENTAL ORGANIZATION.] "Dental organization" 
        means a health insurer licensed under chapter 60A; a health 
        service plan corporation licensed under chapter 62C; a health 
        maintenance organization licensed under chapter 62D; a community 
        integrated service network licensed under chapter 62N; or a 
        third party administrator that: 
           (i) provides, either directly or through contracts with 
        providers or other persons, dental care services; 
           (ii) arranges for the provision of these services to 
        enrollees on the basis of a fixed prepaid sum without regard to 
        the frequency or extent of services furnished to any particular 
        enrollee; or 
           (iii) administers dental plans. 
           Sec. 2.  [62Q.77] [TERMS OF COVERAGE DISCLOSURE.] 
           A dental organization shall make available to an enrollee, 
        upon request, a clear and concise description of the following 
        terms of coverage: 
           (1) the dental care services and other benefits to which 
        the enrollee is entitled under the dental plan; 
           (2) any exclusions or limitation on the services, kind of 
        services, benefits, or kind of benefits to be provided, 
        including any deductible or copayment features and any 
        requirements for referrals to specialists; 
           (3) a description as to how services, including emergency 
        dental care and out-of-area service, may be obtained; 
           (4) a general description of payment and copayment amounts, 
        if any, for dental care services, which the enrollee is 
        obligated to pay; and 
           (5) a telephone number by which the enrollee may obtain 
        additional information regarding coverage. 
           Sec. 3.  [62Q.78] [DENTAL BENEFIT PLAN REQUIREMENTS.] 
           Subdivision 1.  [UTILIZATION PROFILING.] (a) A dental 
        organization that uses utilization profiling as a method of 
        differentiating provider reimbursement or as a requirement for 
        continued participation in the organization's provider network 
        shall, upon request, make available to participating dentists 
        the following information: 
           (i) a description of the methodology used in profiling so 
        that dentists can clearly understand why and how they are 
        affected; and 
           (ii)(A) a list of the codes measured; (B) a dentist's 
        personal frequency data within each code so that the accuracy of 
        the data can be verified; and (C) an individual dentist's 
        representation of scoring compared to classification points and 
        how the dentist compares with peers in each category including 
        the cutoff point of the score impacting qualification in order 
        to inform the dentist about how the dentist may qualify or 
        retain qualification for differentiated provider reimbursement 
        or continued participation in the dental organization's provider 
        network. 
           (b) A dental organization that uses utilization profiling 
        as a method of differentiating provider reimbursement or as a 
        requirement for continued participation in the organization's 
        provider network shall, upon request, provide a clear and 
        concise description of the methodology of the utilization 
        profiling on dental benefits to group purchasers and enrollees. 
           (c) A dental organization shall not be considered to be 
        engaging in the practice of dentistry pursuant to chapter 150A, 
        to the extent it releases utilization profiling information as 
        required by sections 62Q.76 to 62Q.79. 
           Subd. 2.  [REIMBURSEMENT CODES.] (a) Unless the federal 
        government requires the use of other procedural codes, for all 
        dental care services in which a procedural code is used by the 
        dental organization to determine coverage or reimbursement, the 
        organization must use the most recent American Dental 
        Association current dental terminology code that is available, 
        within a year of its release.  Current dental terminology codes 
        must be used as specifically defined, must be listed separately, 
        and must not be altered or changed by either the dentist or the 
        dental organization. 
           (b) Enrollee benefits must be determined on the basis of 
        individual codes subject to provider and group contracts. 
           (c) This subdivision does not prohibit or restrict dental 
        organizations from setting reimbursement and pricing with 
        groups, purchasers, and participating providers or addressing 
        issues of fraud or errors in claims submissions. 
           Subd. 3.  [TREATMENT OPTIONS.] No contractual provision 
        between a dental organization and a dentist shall in any way 
        prohibit or limit a dentist from discussing all clinical options 
        for treatment with the patient. 
           Sec. 4.  [62Q.79] [LIMITATIONS.] 
           (a) The provisions contained in section 62Q.77 shall not 
        require a dental organization to disclose information which the 
        dental organization is already obligated to disclose under 
        applicable Minnesota law governing the operation of the dental 
        organization. 
           (b) Any information a dental organization is required to 
        disclose or communicate under section 62Q.77 to its subscribers, 
        enrollees, participating providers, contracting groups, or 
        dentists may be accomplished by electronic communication 
        including, but not limited to, e-mail, the Internet, Web sites, 
        and employer electronic bulletin boards. 
           Sec. 5.  [EFFECTIVE DATE.] 
           Section 62Q.78, subdivision 2, is effective August 1, 2001. 
           Presented to the governor April 12, 2000 
           Signed by the governor April 14, 2000, 2:53 p.m.