1.1                          A bill for an act 
  1.2             relating to health; increasing the medical assistance 
  1.3             reimbursement rate for certain dentists; permitting 
  1.4             dental hygienists to practice certain services with 
  1.5             limited supervision; establishing a grant program for 
  1.6             community clinics providing dental services; 
  1.7             appropriating money; amending Minnesota Statutes 2000, 
  1.8             sections 150A.10, subdivision 1; and 256B.76; 
  1.9             proposing coding for new law in Minnesota Statutes, 
  1.10            chapter 144. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  [144.1499] [DENTAL SERVICE EXPANSION GRANT 
  1.13  PROGRAM.] 
  1.14     (a) The commissioner of health shall establish a grant 
  1.15  program to award grants to nonprofit community clinics that 
  1.16  provide dental services on a sliding fee scale basis and that do 
  1.17  not restrict access to services because of a client's financial 
  1.18  limitations. 
  1.19     (b) Grant funds must be used for capital needs expenses for 
  1.20  the expansion of dental services to different settings. 
  1.21     (c) The commissioner shall establish application guidelines 
  1.22  and procedures that allow the commissioner to assess relative 
  1.23  need and the applicant's plan to expand. 
  1.24     Sec. 2.  Minnesota Statutes 2000, section 150A.10, 
  1.25  subdivision 1, is amended to read: 
  1.26     Subdivision 1.  [DENTAL HYGIENISTS.] (a) Any licensed 
  1.27  dentist, public institution, or school authority may obtain 
  1.28  services from a licensed dental hygienist.  Such licensed dental 
  2.1   hygienist may provide those services defined in section 150A.05, 
  2.2   subdivision 1a.  Such services shall not include the 
  2.3   establishment of a final diagnosis or treatment plan for a 
  2.4   dental patient.  Such services shall be provided under 
  2.5   supervision of a licensed dentist.  Any licensed dentist who 
  2.6   shall permit any dental service by a dental hygienist other than 
  2.7   those authorized by the board of dentistry, shall be deemed to 
  2.8   be violating the provisions of sections 150A.01 to 150A.12, and 
  2.9   any such unauthorized dental service by a dental hygienist shall 
  2.10  constitute a violation of sections 150A.01 to 150A.12.  
  2.11     (b) Notwithstanding paragraph (a), a licensed dental 
  2.12  hygienist may provide those services defined in section 150A.05, 
  2.13  subdivision 1a, clauses (1) and (2), and in Minnesota Rules, 
  2.14  part 3100.8700, subpart 1, without the supervision of a licensed 
  2.15  dentist if the following circumstances are met: 
  2.16     (1) the services are authorized by a licensed dentist; 
  2.17     (2) the services are performed on a limited access patient; 
  2.18  and 
  2.19     (3) a licensed dentist reviews the dental hygienist's 
  2.20  findings. 
  2.21  For purposes of this paragraph, "limited access patient" means a 
  2.22  patient who, due to age, disability, or geographic location, is 
  2.23  unable to receive regular dental services in a dental office.  
  2.24  Services that are authorized by a licensed dentist under this 
  2.25  paragraph may be performed by a licensed dental hygienist 
  2.26  without the presence of a dentist and may be performed at a 
  2.27  location other than the usual place of practice of the dentist 
  2.28  or dental hygienist.  
  2.29     Sec. 3.  Minnesota Statutes 2000, section 256B.76, is 
  2.30  amended to read: 
  2.31     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  2.32     (a) Effective for services rendered on or after October 1, 
  2.33  1992, the commissioner shall make payments for physician 
  2.34  services as follows: 
  2.35     (1) payment for level one Health Care Finance 
  2.36  Administration's common procedural coding system (HCPCS) codes 
  3.1   titled "office and other outpatient services," "preventive 
  3.2   medicine new and established patient," "delivery, antepartum, 
  3.3   and postpartum care," "critical care," Caesarean delivery and 
  3.4   pharmacologic management provided to psychiatric patients, and 
  3.5   HCPCS level three codes for enhanced services for prenatal high 
  3.6   risk, shall be paid at the lower of (i) submitted charges, or 
  3.7   (ii) 25 percent above the rate in effect on June 30, 1992.  If 
  3.8   the rate on any procedure code within these categories is 
  3.9   different than the rate that would have been paid under the 
  3.10  methodology in section 256B.74, subdivision 2, then the larger 
  3.11  rate shall be paid; 
  3.12     (2) payments for all other services shall be paid at the 
  3.13  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  3.14  rate in effect on June 30, 1992; 
  3.15     (3) all physician rates shall be converted from the 50th 
  3.16  percentile of 1982 to the 50th percentile of 1989, less the 
  3.17  percent in aggregate necessary to equal the above increases 
  3.18  except that payment rates for home health agency services shall 
  3.19  be the rates in effect on September 30, 1992; 
  3.20     (4) effective for services rendered on or after January 1, 
  3.21  2000, payment rates for physician and professional services 
  3.22  shall be increased by three percent over the rates in effect on 
  3.23  December 31, 1999, except for home health agency and family 
  3.24  planning agency services; and 
  3.25     (5) the increases in clause (4) shall be implemented 
  3.26  January 1, 2000, for managed care. 
  3.27     (b) Effective for services rendered on or after October 1, 
  3.28  1992, the commissioner shall make payments for dental services 
  3.29  as follows: 
  3.30     (1) dental services shall be paid at the lower of (i) 
  3.31  submitted charges, or (ii) 25 percent above the rate in effect 
  3.32  on June 30, 1992; 
  3.33     (2) dental rates shall be converted from the 50th 
  3.34  percentile of 1982 to the 50th percentile of 1989, less the 
  3.35  percent in aggregate necessary to equal the above increases; 
  3.36     (3) effective for services rendered on or after January 1, 
  4.1   2000, payment rates for dental services shall be increased by 
  4.2   three percent over the rates in effect on December 31, 1999; 
  4.3      (4) the commissioner shall award grants to community 
  4.4   clinics or other nonprofit community organizations, political 
  4.5   subdivisions, professional associations, or other organizations 
  4.6   that demonstrate the ability to provide dental services 
  4.7   effectively to public program recipients.  Grants may be used to 
  4.8   fund the costs related to coordinating access for recipients, 
  4.9   developing and implementing patient care criteria, upgrading or 
  4.10  establishing new facilities, acquiring furnishings or equipment, 
  4.11  recruiting new providers, or other development costs that will 
  4.12  improve access to dental care in a region.  In awarding grants, 
  4.13  the commissioner shall give priority to applicants that plan to 
  4.14  serve areas of the state in which the number of dental providers 
  4.15  is not currently sufficient to meet the needs of recipients of 
  4.16  public programs or uninsured individuals.  The commissioner 
  4.17  shall consider the following in awarding the grants:  (i) 
  4.18  potential to successfully increase access to an underserved 
  4.19  population; (ii) the ability to raise matching funds; (iii) the 
  4.20  long-term viability of the project to improve access beyond the 
  4.21  period of initial funding; (iv) the efficiency in the use of the 
  4.22  funding; and (v) the experience of the proposers in providing 
  4.23  services to the target population. 
  4.24     The commissioner shall monitor the grants and may terminate 
  4.25  a grant if the grantee does not increase dental access for 
  4.26  public program recipients.  The commissioner shall consider 
  4.27  grants for the following: 
  4.28     (i) implementation of new programs or continued expansion 
  4.29  of current access programs that have demonstrated success in 
  4.30  providing dental services in underserved areas; 
  4.31     (ii) a pilot program for utilizing hygienists outside of a 
  4.32  traditional dental office to provide dental hygiene services; 
  4.33  and 
  4.34     (iii) a program that organizes a network of volunteer 
  4.35  dentists, establishes a system to refer eligible individuals to 
  4.36  volunteer dentists, and through that network provides donated 
  5.1   dental care services to public program recipients or uninsured 
  5.2   individuals. 
  5.3      (5) beginning October 1, 1999, the payment for tooth 
  5.4   sealants and fluoride treatments shall be the lower of (i) 
  5.5   submitted charge, or (ii) 80 percent of median 1997 charges; and 
  5.6      (6) the increases listed in clauses (3) and (5) shall be 
  5.7   implemented January 1, 2000, for managed care. 
  5.8      (c) Effective for dental services rendered on or after July 
  5.9   1, 2001, the commissioner shall increase reimbursement by 20 
  5.10  percent above the reimbursement rate in effect on June 30, 2001, 
  5.11  to dentists whose practice has a disproportionate share of 
  5.12  patients covered under a public assistance program.  For the 
  5.13  purpose of this paragraph, "disproportionate share" means 20 
  5.14  percent or more of the dentist's patients are covered by medical 
  5.15  assistance, general assistance medical care, or the 
  5.16  MinnesotaCare program as their primary source of coverage.  By 
  5.17  June 1, 2001, and annually thereafter, any dentist interested in 
  5.18  reimbursement under this paragraph must submit a signed 
  5.19  affidavit verifying the percentage of patients covered under a 
  5.20  public assistance program.  
  5.21     (d) Effective for dental services rendered on or after July 
  5.22  1, 2002, the commissioner shall increase reimbursement by five 
  5.23  percent above the reimbursement rate in effect on June 30, 2002, 
  5.24  to dentists whose share of patients covered under medical 
  5.25  assistance, general assistance medical care, or MinnesotaCare as 
  5.26  their primary source of coverage has increased by five percent 
  5.27  from the previous year.  For purposes of this subdivision, a 
  5.28  dentist's share of patients covered under medical assistance, 
  5.29  general assistance medical care, or MinnesotaCare must be at 
  5.30  least ten percent to be eligible for the increase in 
  5.31  reimbursement under this paragraph.  By June 15, 2002, and 
  5.32  annually thereafter, any dentist interested in the increased 
  5.33  reimbursement under this paragraph must submit a signed 
  5.34  affidavit verifying the percentage of the dentist's patients 
  5.35  covered under a public assistance program. 
  5.36     (e) An entity that operates both a Medicare certified 
  6.1   comprehensive outpatient rehabilitation facility and a facility 
  6.2   which was certified prior to January 1, 1993, that is licensed 
  6.3   under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
  6.4   whom at least 33 percent of the clients receiving rehabilitation 
  6.5   services in the most recent calendar year are medical assistance 
  6.6   recipients, shall be reimbursed by the commissioner for 
  6.7   rehabilitation services at rates that are 38 percent greater 
  6.8   than the maximum reimbursement rate allowed under paragraph (a), 
  6.9   clause (2), when those services are (1) provided within the 
  6.10  comprehensive outpatient rehabilitation facility and (2) 
  6.11  provided to residents of nursing facilities owned by the entity. 
  6.12     Sec. 4.  [APPROPRIATIONS.] 
  6.13     $....... is appropriated for the biennium ending June 30, 
  6.14  2003, from the general fund to the commissioner of human 
  6.15  services for the reimbursement rate increases described in 
  6.16  Minnesota Statutes, section 256B.76, paragraphs (c) and (d). 
  6.17     $....... is appropriated for the biennium ending June 30, 
  6.18  2003, from the general fund to the commissioner of health for 
  6.19  the grants described in Minnesota Statutes, section 144.1499. 
  6.20     Sec. 5.  [EFFECTIVE DATE.] 
  6.21     Section 3 is effective the day following final enactment.