HF 1962

as introduced - 87th Legislature (2011 - 2012) Posted on 01/26/2012 02:34pm

A bill for an act
relating to human services; modifying dental coverage for certain medical
assistance enrollees; amending Minnesota Statutes 2010, section 256B.0625,
subdivision 9.

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

Section 1.

Minnesota Statutes 2010, section 256B.0625, subdivision 9, is amended to
read:

Subd. 9.

Dental services.

(a) Medical assistance covers dental services.

(b) Medical assistance dental coverage for nonpregnant adults new text begin who are not described
in paragraph (e) new text end is limited to the following services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one per year;

(5) periapical x-rays;

(6) panoramic x-rays, limited to one every five years except (1) when medically
necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
or (2) once every two years for patients who cannot cooperate for intraoral film due to
a developmental disability or medical condition that does not allow for intraoral film
placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars only;

(12) removable prostheses, each dental arch limited to one every six years;

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;

(14) palliative treatment and sedative fillings for relief of pain; and

(15) full-mouth debridement, limited to one every five years.

(c) In addition to the services specified in paragraph (b), medical assistance
covers the following services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two
years;

(2) general anesthesia; and

(3) full-mouth survey once every five years.

(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants are covered once every five years per permanent molar for
children only;

(3) application of fluoride varnish is covered once every six months; and

(4) orthodontia is eligible for coverage for children only.

new text begin (e) Medical assistance dental coverage for nonpregnant adults with a diagnosis of
developmental disability, severe and persistent mental illness, or traumatic brain injury is
as provided in paragraph (b), except that prophylaxis is not limited to one per year, if the
additional prophylaxis is medically necessary.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2012, or upon federal
approval, whichever is later.
new text end

Sec. 2. new text begin CONTINGENT ESTABLISHMENT OF BENCHMARK BENEFIT SET.
new text end

new text begin If the federal Center for Medicare and Medicaid Services does not approve
the amendment to Minnesota Statutes, section 256B.0625, subdivision 9, related to
elimination of the medical assistance annual limit on prophylaxis for certain nonpregnant
adults, the commissioner of human services shall establish a benchmark benefit set
under the authority of section 1937 of the Social Security Act as a coverage option for
nonpregnant adults with a diagnosis of developmental disability, severe and persistent
mental illness, or traumatic brain injury that expands current medical assistance coverage
for these individuals to be consistent with the amendment changes.
new text end