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Minnesota Legislature

Office of the Revisor of Statutes

Chapter 256B

Section 256B.76

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Recent History

256B.76 PHYSICIAN AND DENTAL REIMBURSEMENT.
(a) Effective for services rendered on or after October 1, 1992, the commissioner shall make
payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common procedural
coding system codes titled "office and other outpatient services," "preventive medicine new
and established patient," "delivery, antepartum, and postpartum care," "critical care," cesarean
delivery and pharmacologic management provided to psychiatric patients, and level three codes
for enhanced services for prenatal high risk, shall be paid at the lower of (i) submitted charges, or
(ii) 25 percent above the rate in effect on June 30, 1992. If the rate on any procedure code within
these categories is different than the rate that would have been paid under the methodology in
section 256B.74, subdivision 2, then the larger rate shall be paid;
(2) payments for all other services shall be paid at the lower of (i) submitted charges, or (ii)
15.4 percent above the rate in effect on June 30, 1992;
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases except that
payment rates for home health agency services shall be the rates in effect on September 30, 1992;
(4) effective for services rendered on or after January 1, 2000, payment rates for physician
and professional services shall be increased by three percent over the rates in effect on December
31, 1999, except for home health agency and family planning agency services; and
(5) the increases in clause (4) shall be implemented January 1, 2000, for managed care.
(b) Effective for services rendered on or after October 1, 1992, the commissioner shall
make payments for dental services as follows:
(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent above
the rate in effect on June 30, 1992;
(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile of
1989, less the percent in aggregate necessary to equal the above increases;
(3) effective for services rendered on or after January 1, 2000, payment rates for dental
services shall be increased by three percent over the rates in effect on December 31, 1999;
(4) the commissioner shall award grants to community clinics or other nonprofit community
organizations, political subdivisions, professional associations, or other organizations that
demonstrate the ability to provide dental services effectively to public program recipients. Grants
may be used to fund the costs related to coordinating access for recipients, developing and
implementing patient care criteria, upgrading or establishing new facilities, acquiring furnishings
or equipment, recruiting new providers, or other development costs that will improve access to
dental care in a region. In awarding grants, the commissioner shall give priority to applicants that
plan to serve areas of the state in which the number of dental providers is not currently sufficient
to meet the needs of recipients of public programs or uninsured individuals. The commissioner
shall consider the following in awarding the grants:
(i) potential to successfully increase access to an underserved population;
(ii) the ability to raise matching funds;
(iii) the long-term viability of the project to improve access beyond the period of initial
funding;
(iv) the efficiency in the use of the funding; and
(v) the experience of the proposers in providing services to the target population.
The commissioner shall monitor the grants and may terminate a grant if the grantee does not
increase dental access for public program recipients. The commissioner shall consider grants for
the following:
(i) implementation of new programs or continued expansion of current access programs that
have demonstrated success in providing dental services in underserved areas;
(ii) a pilot program for utilizing hygienists outside of a traditional dental office to provide
dental hygiene services; and
(iii) a program that organizes a network of volunteer dentists, establishes a system to refer
eligible individuals to volunteer dentists, and through that network provides donated dental care
services to public program recipients or uninsured individuals;
(5) beginning October 1, 1999, the payment for tooth sealants and fluoride treatments shall
be the lower of (i) submitted charge, or (ii) 80 percent of median 1997 charges;
(6) the increases listed in clauses (3) and (5) shall be implemented January 1, 2000, for
managed care; and
(7) effective for services provided on or after January 1, 2002, payment for diagnostic
examinations and dental x-rays provided to children under age 21 shall be the lower of (i) the
submitted charge, or (ii) 85 percent of median 1999 charges.
(c) Effective for dental services rendered on or after January 1, 2002, the commissioner may,
within the limits of available appropriation, increase reimbursements to dentists and dental clinics
deemed by the commissioner to be critical access dental providers. Reimbursement to a critical
access dental provider may be increased by not more than 50 percent above the reimbursement
rate that would otherwise be paid to the provider. Payments to health plan companies shall be
adjusted to reflect increased reimbursements to critical access dental providers as approved by the
commissioner. In determining which dentists and dental clinics shall be deemed critical access
dental providers, the commissioner shall review:
(1) the utilization rate in the service area in which the dentist or dental clinic operates for
dental services to patients covered by medical assistance, general assistance medical care, or
MinnesotaCare as their primary source of coverage;
(2) the level of services provided by the dentist or dental clinic to patients covered by
medical assistance, general assistance medical care, or MinnesotaCare as their primary source
of coverage; and
(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within the service area.
In the absence of a critical access dental provider in a service area, the commissioner may
designate a dentist or dental clinic as a critical access dental provider if the dentist or dental
clinic is willing to provide care to patients covered by medical assistance, general assistance
medical care, or MinnesotaCare at a level which significantly increases access to dental care in
the service area.
The commissioner shall annually establish a reimbursement schedule for critical access dental
providers and provider-specific limits on total reimbursement received under the reimbursement
schedule, and shall notify each critical access dental provider of the schedule and limit.
(d) An entity that operates both a Medicare certified comprehensive outpatient rehabilitation
facility and a facility which was certified prior to January 1, 1993, that is licensed under Minnesota
Rules, parts 9570.2000 to 9570.3600, and for whom at least 33 percent of the clients receiving
rehabilitation services in the most recent calendar year are medical assistance recipients, shall be
reimbursed by the commissioner for rehabilitation services at rates that are 38 percent greater than
the maximum reimbursement rate allowed under paragraph (a), clause (2), when those services
are (1) provided within the comprehensive outpatient rehabilitation facility and (2) provided to
residents of nursing facilities owned by the entity.
(e) Effective for services rendered on or after January 1, 2007, the commissioner shall
make payments for physician and professional services based on the Medicare relative value
units (RVU's). This change shall be budget neutral and the cost of implementing RVU's will be
incorporated in the established conversion factor.
History: 1992 c 513 art 7 s 131; 1Sp1993 c 1 art 5 s 123; 1999 c 245 art 4 s 78; 1Sp2001 c
9 art 2 s 54; 2002 c 277 s 32; 2002 c 375 art 2 s 44; 2002 c 379 art 1 s 113; 1Sp2003 c 14
art 2 s 39; art 12 s 67; 2006 c 282 art 16 s 9