1.1 	A bill for an act
1.2 	relating to human services; setting requirements for medical assistance coverage 
1.3 	of oral health assessments; clarifying criteria for enhanced dental payment 
1.4 	rates;amending Minnesota Statutes 2014, section 256B.0625, subdivision 14; 
1.5 	Minnesota Statutes 2015 Supplement, section 256B.76, subdivision 2.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2014, section 256B.0625, subdivision 14, is amended to 
1.8 	read:
1.9 		Subd. 14.Diagnostic, screening, and preventive services. (a) Medical assistance 
1.10 	covers diagnostic, screening, and preventive services.
1.11 	(b) "Preventive services" include services related to pregnancy, including:
1.12 	(1) services for those conditions which may complicate a pregnancy and which may 
1.13 	be available to a pregnant woman determined to be at risk of poor pregnancy outcome;
1.14 	(2) prenatal HIV risk assessment, education, counseling, and testing; and
1.15 	(3) alcohol abuse assessment, education, and counseling on the effects of alcohol 
1.16 	usage while pregnant. Preventive services available to a woman at risk of poor pregnancy 
1.17 	outcome may differ in an amount, duration, or scope from those available to other 
1.18 	individuals eligible for medical assistance.
1.19 	(c) "Screening services" include, but are not limited to, blood lead tests, and oral 
1.20 	health assessments meeting the criteria in this paragraph. An oral health assessment must 
1.21 	use the risk factors established by the American Academies of Pediatrics and Pediatric 
1.22 	Dentistry to determine a patient's need to be seen by a dentist for diagnosis and assessment 
1.23 	to identify possible signs of oral or systemic disease, malformation, or injury. An oral 
1.24 	health assessment must be conducted by a licensed dental provider in collaborative 
1.25 	practice under section 150A.10, subdivision 1a; 150A.105; or 150A.106. The provider 
2.1 	performing the assessment must have an agreement with a licensed dentist that ensures 
2.2 	that patients needing necessary follow-up services will be able to receive the services in 
2.3 	a timely manner. Prior to submitting a claim for an oral health assessment under this 
2.4 	subdivision, the provider completing the assessment must document in the patient's record 
2.5 	that arrangements were made for the patient to receive follow-up services, or that the 
2.6 	patient did not require follow-up services. Coverage of oral health assessments under this 
2.7 	subdivision is limited to one assessment per patient per year.
2.8 	(d) The commissioner shall encourage, at the time of the child and teen checkup or 
2.9 	at an episodic care visit, the primary care health care provider to perform primary caries 
2.10 	preventive services. Primary caries preventive services include, at a minimum:
2.11 	(1) a general visual examination of the child's mouth without using probes or other 
2.12 	dental equipment or taking radiographs;
2.13 	(2) a risk assessment using the factors established by the American Academies 
2.14 	of Pediatrics and Pediatric Dentistry; and
2.15 	(3) the application of a fluoride varnish beginning at age one to those children 
2.16 	assessed by the provider as being high risk in accordance with best practices as defined by 
2.17 	the Department of Human Services. The provider must obtain parental or legal guardian 
2.18 	consent before a fluoride varnish is applied to a minor child's teeth.
2.19 	At each checkup, if primary caries preventive services are provided, the provider must 
2.20 	provide to the child's parent or legal guardian: information on caries etiology and 
2.21 	prevention; and information on the importance of finding a dental home for their child 
2.22 	by the age of one. The provider must also advise the parent or legal guardian to contact 
2.23 	the child's managed care plan or the Department of Human Services in order to secure a 
2.24 	dental appointment with a dentist. The provider must indicate in the child's medical record 
2.25 	that the parent or legal guardian was provided with this information and document any 
2.26 	primary caries prevention services provided to the child.

2.27 	Sec. 2. Minnesota Statutes 2015 Supplement, section 256B.76, subdivision 2, is 
2.28 	amended to read:
2.29 		Subd. 2.Dental reimbursement.  (a) Effective for services rendered on or after 
2.30 	October 1, 1992, the commissioner shall make payments for dental services as follows:
2.31 	(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 
2.32 	percent above the rate in effect on June 30, 1992; and
2.33 	(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th 
2.34 	percentile of 1989, less the percent in aggregate necessary to equal the above increases.
3.1 	(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments 
3.2 	shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.
3.3 	(c) Effective for services rendered on or after January 1, 2000, payment rates for 
3.4 	dental services shall be increased by three percent over the rates in effect on December 
3.5 	31, 1999.
3.6 	(d) Effective for services provided on or after January 1, 2002, payment for 
3.7 	diagnostic examinations and dental x-rays provided to children under age 21 shall be the 
3.8 	lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.
3.9 	(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 
3.10 	2000, for managed care.
3.11 	(f) Effective for dental services rendered on or after October 1, 2010, by a 
3.12 	state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based 
3.13 	on the Medicare principles of reimbursement. This payment shall be effective for services 
3.14 	rendered on or after January 1, 2011, to recipients enrolled in managed care plans or 
3.15 	county-based purchasing plans.
3.16 	(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics 
3.17 	in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal 
3.18 	year, a supplemental state payment equal to the difference between the total payments 
3.19 	in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated 
3.20 	services for the operation of the dental clinics.
3.21 	(h) If the cost-based payment system for state-operated dental clinics described in 
3.22 	paragraph (f) does not receive federal approval, then state-operated dental clinics shall be 
3.23 	designated as critical access dental providers under subdivision 4, paragraph (b), and shall 
3.24 	receive the critical access dental reimbursement rate as described under subdivision 4, 
3.25 	paragraph (a).
3.26 	(i) Effective for services rendered on or after September 1, 2011, through June 30, 
3.27 	2013, payment rates for dental services shall be reduced by three percent. This reduction 
3.28 	does not apply to state-operated dental clinics in paragraph (f).
3.29 	(j) Effective for services rendered on or after January 1, 2014, payment rates for 
3.30 	dental services shall be increased by five percent from the rates in effect on December 
3.31 	31, 2013. This increase does not apply to state-operated dental clinics in paragraph (f), 
3.32 	federally qualified health centers, rural health centers, and Indian health services. Effective 
3.33 	January 1, 2014, payments made to managed care plans and county-based purchasing 
3.34 	plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase 
3.35 	described in this paragraph.
4.1 	(k) Effective for services rendered on or after July 1, 2015, the commissioner shall 
4.2 	increase payment rates for dental services ~~furnished by dental providers~~provided at 
4.3 	sites located outside of the seven-county metropolitan area by the maximum percentage 
4.4 	possible above the rates in effect on June 30, 2015, while remaining within the limits of 
4.5 	funding appropriated for this purpose. This increase does not apply to state-operated 
4.6 	dental clinics in paragraph (f), federally qualified health centers, rural health centers, and 
4.7 	Indian health services. Effective January 1, 2016, payments to managed care plans and 
4.8 	county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect the 
4.9 	payment increase described in this paragraph. The commissioner shall require managed 
4.10 	care and county-based purchasing plans to pass on the full amount of the increase, in the 
4.11 	form of higher payment rates ~~to~~ for dental ~~providers~~ services provided at sites located 
4.12 	outside of the seven-county metropolitan area.