1.1 A bill for an act
1.2 relating to human services;
modifying medical assistance reimbursement rates for
1.3 dental services and critical
access dental providers;amending Minnesota Statutes
1.4 2024, section 256B.76,
subdivisions 2, 4.
1.5 BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes
2024, section 256B.76, subdivision 2, is amended to read:
1.7 Subd. 2.Dental
reimbursement. (a) Effective for
services rendered on or after October
1.8 1, 1992, the commissioner
shall make payments for dental services as follows:
1.9 (1) dental services shall be
paid at the lower of (i) submitted charges, or (ii) 25 percent
1.10 above the rate in effect on
June 30, 1992; and
1.11 (2) dental rates shall be
converted from the 50th percentile of 1982 to the 50th percentile
1.12 of 1989, less the percent in
aggregate necessary to equal the above increases.
1.13 (b) Beginning October 1, 1999,
the payment for tooth sealants and fluoride treatments
1.14 shall be the lower of (1)
submitted charge, or (2) 80 percent of median 1997 charges.
1.15 (c) Effective for services
rendered on or after January 1, 2000, payment rates for dental
1.16 services shall be increased by
three percent over the rates in effect on December 31, 1999.
1.17 (d) Effective for services
provided on or after January 1, 2002, payment for diagnostic
1.18 examinations and dental x-rays
provided to children under age 21 shall be the lower of (1)
1.19 the submitted charge, or (2) 85
percent of median 1999 charges.
1.20 (e) The increases listed in
paragraphs (b) and (c) shall be implemented January 1, 2000,
1.21 for managed care.
2.1 (f) Effective for dental
services rendered on or after October 1, 2010, by a state-operated
2.2 dental clinic, payment shall
be paid on a reasonable cost basis that is based on the Medicare
2.3 principles of reimbursement.
This payment shall be effective for services rendered on or
2.4 after January 1, 2011, to
recipients enrolled in managed care plans or county-based
2.5 purchasing plans.
2.6 (g) Beginning in fiscal year
2011, if the payments to state-operated dental clinics in
2.7 paragraph (f), including
state and federal shares, are less than $1,850,000 per fiscal year, a
2.8 supplemental state payment
equal to the difference between the total payments in paragraph
2.9 (f) and $1,850,000 shall be
paid from the general fund to state-operated services for the
2.10 operation of the dental
clinics.
2.11 (h) Effective for services
rendered on or after January 1, 2014, through December 31,
2.12 2021, payment rates for dental
services shall be increased by five percent from the rates in
2.13 effect on December 31, 2013.
This increase does not apply to state-operated dental clinics
2.14 in paragraph (f), federally
qualified health centers, rural health centers, and Indian health
2.15 services. Effective January 1,
2014, payments made to managed care plans and county-based
2.16 purchasing plans under sections
256B.69, 256B.692, and 256L.12 shall reflect the payment
2.17 increase described in this
paragraph.
2.18 (i) Effective for services
provided on or after January 1, 2017, through December 31,
2.19 2021, the commissioner shall
increase payment rates by 9.65 percent for dental services
2.20 provided outside of the
seven-county metropolitan area. This increase does not apply to
2.21 state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health
2.22 centers, or Indian health
services. Effective January 1, 2017, payments to managed care
2.23 plans and county-based
purchasing plans under sections 256B.69 and 256B.692 shall reflect
2.24 the payment increase described
in this paragraph.
2.25 (j) Effective for services
provided on or after July 1, 2017, through December 31, 2021,
2.26 the commissioner shall increase
payment rates by 23.8 percent for dental services provided
2.27 to enrollees under the age of
21. This rate increase does not apply to state-operated dental
2.28 clinics in paragraph (f),
federally qualified health centers, rural health centers, or Indian
2.29 health centers. This rate
increase does not apply to managed care plans and county-based
2.30 purchasing plans.
2.31 (k) Effective for services
provided on or after January 1, 2022, the commissioner shall
2.32 exclude from medical assistance
and MinnesotaCare payments for dental services to public
2.33 health and community health
clinics the 20 percent increase authorized under Laws 1989,
2.34 chapter 327, section 5,
subdivision 2, paragraph (b).
3.1 (l) Effective for services
provided on or after January 1, 2022, the commissioner shall
3.2 increase payment rates by 98
percent for all dental services. This rate increase does not
3.3 apply to state-operated
dental clinics, federally qualified health centers, rural health centers,
3.4 or Indian health services.
3.5 (m) Effective for services
provided on or after January 1, 2028, or on or after federal
3.6 approval, whichever is
later, payment rates for dental services shall be ....... percent of the
3.7 ....... percentile of
the median charges for coverage year 2024. This rate increase does not
3.8 apply to
state-operated dental clinics, federally qualified health centers, rural health
centers,
3.9 or Indian health
services.
3.10 (m) (n)
Managed care plans and county-based purchasing plans shall reimburse providers
3.11 at a level that is at least
equal to the rate paid under fee-for-service for dental services. If,
3.12 for any coverage year, federal
approval is not received for this paragraph, the commissioner
3.13 must adjust the capitation
rates paid to managed care plans and county-based purchasing
3.14 plans for that contract year to
reflect the removal of this provision. Contracts between
3.15 managed care plans and
county-based purchasing plans and providers to whom this paragraph
3.16 applies must allow recovery of
payments from those providers if capitation rates are adjusted
3.17 in accordance with this
paragraph. Payment recoveries must not exceed an amount equal
3.18 to any increase in rates that
results from this provision. If, for any coverage year, federal
3.19 approval is not received for
this paragraph, the commissioner shall not implement this
3.20 paragraph for subsequent
coverage years.
3.21 EFFECTIVE DATE. This
section is effective the day following final enactment.
3.22 Sec. 2. Minnesota Statutes
2024, section 256B.76, subdivision 4, is amended to read:
3.23 Subd. 4.Critical
access dental providers. (a) The
commissioner shall increase
3.24 reimbursements to dentists and
dental clinics deemed by the commissioner to be critical
3.25 access dental providers. For
dental services rendered on or after July 1, 2016, through
3.26 December 31, 2021, the
commissioner shall increase reimbursement by 37.5 percent above
3.27 the reimbursement rate that
would otherwise be paid to the critical access dental provider,
3.28 except as specified under paragraph
(b). The commissioner shall pay the managed care
3.29 plans and county-based
purchasing plans in amounts sufficient to reflect increased
3.30 reimbursements to critical
access dental providers as approved by the commissioner.
3.31 (b) For dental services
rendered on or after July 1, 2016, through December 31, 2021,
3.32 by a dental clinic or dental
group that meets the critical access dental provider designation
3.33 under paragraph (f), clause
(4), and is owned and operated by a health maintenance
3.34 organization licensed under
chapter 62D, the commissioner shall increase reimbursement
4.1 by 35 percent above the
reimbursement rate that would otherwise be paid to the critical
4.2 access provider.
4.3 (c) The commissioner shall
increase reimbursement to dentists and dental clinics deemed
4.4 by the commissioner to be
critical access dental providers. For dental services provided on
4.5 or after January 1, 2022, by
a dental provider deemed to be a critical access dental provider
4.6 under paragraph (f), the
commissioner shall increase reimbursement by 20 percent above
4.7 the reimbursement rate that
would otherwise be paid to the critical access dental provider.
4.8 For dental services
provided on or after January 1, 2028, or on or after federal approval,
4.9 whichever is later, by
a dental provider deemed to be a critical access dental provider under
4.10 paragraph (f), the
commissioner shall increase reimbursement by ....... percent above the
4.11 reimbursement rate that
would otherwise be paid to the critical access dental provider. This
4.12 paragraph does not apply to
federally qualified health centers, rural health centers,
4.13 state-operated dental clinics,
or Indian health centers.
4.14 (d) Managed care plans and
county-based purchasing plans shall increase reimbursement
4.15 to critical access dental
providers by at least the amount specified in paragraph (c). If, for
4.16 any coverage year, federal
approval is not received for this paragraph, the commissioner
4.17 must adjust the capitation
rates paid to managed care plans and county-based purchasing
4.18 plans for that contract year to
reflect the removal of this provision. Contracts between
4.19 managed care plans and
county-based purchasing plans and providers to whom this paragraph
4.20 applies must allow recovery of
payments from those providers if capitation rates are adjusted
4.21 in accordance with this
paragraph. Payment recoveries must not exceed an amount equal
4.22 to any increase in rates that
results from this provision. If, for any coverage year, federal
4.23 approval is not received for
this paragraph, the commissioner shall not implement this
4.24 paragraph for subsequent
coverage years.
4.25 (e) Critical access dental payments
made under this subdivision for dental services
4.26 provided by a critical access
dental provider to an enrollee of a managed care plan or
4.27 county-based purchasing plan
must not reflect any capitated payments or cost-based payments
4.28 from the managed care plan or
county-based purchasing plan. The managed care plan or
4.29 county-based purchasing plan
must base the additional critical access dental payment on
4.30 the amount that would have been
paid for that service had the dental provider been paid
4.31 according to the managed care
plan or county-based purchasing plan's fee schedule that
4.32 applies to dental providers
that are not paid under a capitated payment or cost-based payment.
4.33 (f) The commissioner shall
designate the following dentists and dental clinics as critical
4.34 access dental providers:
5.1 (1) nonprofit community
clinics that:
5.2 (i) have nonprofit status in
accordance with chapter 317A;
5.3 (ii) have tax exempt status
in accordance with the Internal Revenue Code, section
5.4 501(c)(3);
5.5 (iii) are established to
provide oral health services to patients who are low income,
5.6 uninsured, have special
needs, and are underserved;
5.7 (iv) have professional staff
familiar with the cultural background of the clinic's patients;
5.8 (v) charge for services on a
sliding fee scale designed to provide assistance to low-income
5.9 patients based on current
poverty income guidelines and family size;
5.10 (vi) do not restrict access or
services because of a patient's financial limitations or public
5.11 assistance status; and
5.12 (vii) have free care available
as needed;
5.13 (2) federally qualified health
centers, rural health clinics, and public health clinics;
5.14 (3) hospital-based dental clinics
owned and operated by a city, county, or former state
5.15 hospital as defined in section
62Q.19, subdivision 1, paragraph (a), clause (4);
5.16 (4) a dental clinic or dental
group owned and operated by a nonprofit corporation in
5.17 accordance with chapter 317A
with more than 10,000 patient encounters per year with
5.18 patients who are uninsured or
covered by medical assistance or MinnesotaCare;
5.19 (5) a dental clinic owned and
operated by the University of Minnesota or the Minnesota
5.20 State Colleges and Universities
system; and
5.21 (6) private practicing dentists
if:
5.22 (i) the dentist's office is
located within the seven-county metropolitan area and more
5.23 than 50 percent of the
dentist's patient encounters per year are with patients who are uninsured
5.24 or covered by medical
assistance or MinnesotaCare; or
5.25 (ii) the dentist's office is
located outside the seven-county metropolitan area and more
5.26 than 25 percent of the
dentist's patient encounters per year are with patients who are uninsured
5.27 or covered by medical
assistance or MinnesotaCare.
5.28 EFFECTIVE DATE. This
section is effective the day following final enactment.
