1.1 	A bill for an act
1.2 	relating to health care; expanding medical assistance coverage for adult dental 
1.3 	services;amending Minnesota Statutes 2018, section 256B.0625, subdivision 9.
1.4 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.5 	Section 1. Minnesota Statutes 2018, section 256B.0625, subdivision 9, is amended to read:
1.6 		Subd. 9.Dental services. (a) Medical assistance covers medically necessary dental 
1.7 	services.
1.8 	~~(b) Medical assistance dental coverage for nonpregnant adults is limited to the following~~ 
1.9 	~~services:~~
1.10 	~~(1) comprehensive exams, limited to once every five years;~~
1.11 	~~(2) periodic exams, limited to one per year;~~
1.12 	~~(3) limited exams;~~
1.13 	~~(4) bitewing x-rays, limited to one per year;~~
1.14 	~~(5) periapical x-rays;~~
1.15 	~~(6) panoramic x-rays, limited to one every five years except (1) when medically necessary~~ 
1.16 	~~for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once~~ 
1.17 	~~every two years for patients who cannot cooperate for intraoral film due to a developmental~~ 
1.18 	~~disability or medical condition that does not allow for intraoral film placement;~~
1.19 	~~(7) prophylaxis, limited to one per year;~~
1.20 	~~(8) application of fluoride varnish, limited to one per year;~~
2.1 	~~(9) posterior fillings, all at the amalgam rate;~~
2.2 	~~(10) anterior fillings;~~
2.3 	~~(11) endodontics, limited to root canals on the anterior and premolars only;~~
2.4 	~~(12) removable prostheses, each dental arch limited to one every six years;~~
2.5 	~~(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;~~
2.6 	~~(14) palliative treatment and sedative fillings for relief of pain; and~~
2.7 	~~(15) full-mouth debridement, limited to one every five years.~~
2.8 	~~(c) In addition to the services specified in paragraph (b), medical assistance covers the~~ 
2.9 	~~following services for adults, if provided in an outpatient hospital setting or freestanding~~ 
2.10 	~~ambulatory surgical center as part of outpatient dental surgery:~~
2.11 	~~(1) periodontics, limited to periodontal scaling and root planing once every two years;~~
2.12 	~~(2) general anesthesia; and~~
2.13 	~~(3) full-mouth survey once every five years.~~
2.14 	~~(d) Medical assistance covers medically necessary dental services for children and~~ 
2.15 	~~pregnant women.~~ The following guidelines apply:
2.16 	(1) posterior fillings are paid at the amalgam rate;
2.17 	(2) application of sealants are covered once every five years per permanent molar for 
2.18 	children only;
2.19 	(3) application of fluoride varnish is covered once every six months; and
2.20 	(4) orthodontia is eligible for coverage for children only.
2.21 	~~(e)~~ (b) In addition to the services specified in ~~paragraphs (b) and (c)~~ paragraph (a), 
2.22 	medical assistance covers the following services for adults:
2.23 	(1) house calls or extended care facility calls for on-site delivery of covered services;
2.24 	(2) behavioral management when additional staff time is required to accommodate 
2.25 	behavioral challenges and sedation is not used;
2.26 	(3) oral or IV sedation, if the covered dental service cannot be performed safely without 
2.27 	it or would otherwise require the service to be performed under general anesthesia in a 
2.28 	hospital or surgical center; and
3.1 	(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but 
3.2 	no more than four times per year.
3.3 	~~(f)~~ (c) The commissioner ~~shall~~ must not require prior authorization for the services 
3.4 	included in paragraph ~~(e)~~ (b), clauses (1) to (3), and ~~shall~~ must prohibit managed care and 
3.5 	county-based purchasing plans from requiring prior authorization for the services included 
3.6 	in paragraph ~~(e)~~ (b), clauses (1) to (3), when provided under sections 256B.69, 256B.692, 
3.7 	and 256L.12.