1.1                          A bill for an act 
  1.2             relating to health care; providing dental access 
  1.3             grants; creating a dental access advisory committee; 
  1.4             increasing the reimbursement rate for certain dental 
  1.5             care providers; appropriating money; amending 
  1.6             Minnesota Statutes 2000, sections 256B.0644; 256B.69, 
  1.7             by adding a subdivision; 256B.76; proposing coding for 
  1.8             new law in Minnesota Statutes, chapters 144; 256B. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  [144.1498] [DENTIST LOAN FORGIVENESS.] 
  1.11     Subdivision 1.  [DEFINITIONS.] For the purposes of this 
  1.12  section, "qualified educational loan" means a government, 
  1.13  commercial, or foundation loan for the actual costs paid for 
  1.14  tuition, reasonable education expenses, and reasonable living 
  1.15  expenses related to graduate or undergraduate education of a 
  1.16  dentist.  
  1.17     Subd. 2.  [CREATION OF ACCOUNT.] A dental education account 
  1.18  is established in the general fund.  The commissioner shall use 
  1.19  money from the account to establish a loan forgiveness program 
  1.20  for dentists agreeing to provide services for a substantial 
  1.21  number of state public assistance program participants and other 
  1.22  low- to moderate-income uninsured patients, as defined by the 
  1.23  commissioner of health.  
  1.24     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
  1.25  the program, a dental student must submit an application to the 
  1.26  commissioner of health while attending a program of study 
  1.27  designed to prepare the student to become a licensed dentist.  
  2.1   To be eligible to participate in the program, a licensed dentist 
  2.2   must submit an application to the commissioner of health within 
  2.3   three years of graduation from a dental school or completion of 
  2.4   a graduate dental program.  An applicant who is accepted must 
  2.5   sign a contract to agree to serve: 
  2.6      (1) a minimum three-year service obligation during which at 
  2.7   least 15 percent of the dentist's yearly patient encounters are 
  2.8   provided to public assistance program enrollees or patients 
  2.9   receiving sliding fee schedule discounts through a formal 
  2.10  sliding fee schedule that meets the standards established in 
  2.11  Code of Federal Regulations, title 42, section 51c.303; or 
  2.12     (2) a minimum three-year service obligation in a designated 
  2.13  rural area, as defined by the commissioner under section 
  2.14  144.1494.  
  2.15  The service obligation for applicants who are dental students 
  2.16  shall begin no later than March 31 of the first year following 
  2.17  completion of training.  The service obligation for applicants 
  2.18  who are licensed dentists shall begin no later than 12 months 
  2.19  following the date on which an application is submitted. 
  2.20     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
  2.21  may accept up to 14 applicants per year for participation in the 
  2.22  loan forgiveness program.  Applicants are responsible for 
  2.23  securing their own qualified educational loan.  Applicants 
  2.24  chosen to participate in the loan forgiveness program may 
  2.25  designate, for each year of dentistry study up to a maximum of 
  2.26  four years, an agreed amount, not to exceed $10,000, as a 
  2.27  qualified educational loan.  For each year that a participant 
  2.28  meets the service obligation required under subdivision 3, up to 
  2.29  a maximum of four years, the commissioner shall make annual 
  2.30  disbursements directly to the participant in an amount equal to 
  2.31  $10,000 per year of service, not to exceed $40,000 or the 
  2.32  balance of the qualified educational loan, whichever is less.  
  2.33  The total amount of all disbursements must not exceed the 
  2.34  principal and accrued interest of the qualified educational 
  2.35  loan.  Before receiving loan repayment disbursements, the 
  2.36  participant must complete and return to the commissioner an 
  3.1   affidavit of practice form provided by the commissioner 
  3.2   verifying that the participant's practice meets the requirements 
  3.3   described in subdivision 3.  After each disbursement, the 
  3.4   participant must provide the commissioner with verification that 
  3.5   the full amount of a loan repayment disbursement received by the 
  3.6   participant has been applied toward the qualified educational 
  3.7   loan before the next loan repayment disbursement is made.  
  3.8   Participants who move their practice remain eligible for loan 
  3.9   repayment if the requirements of subdivision 3 continue to be 
  3.10  met.  
  3.11     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
  3.12  does not fulfill the service commitment as required under 
  3.13  subdivision 3, the commissioner of health shall collect from the 
  3.14  participant 100 percent of any payments made for the qualified 
  3.15  educational loan and interest at a rate established under 
  3.16  section 270.75.  The commissioner shall deposit the money 
  3.17  collected in the dental education account established under 
  3.18  subdivision 2.  
  3.19     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
  3.20  service obligations cancel in the event of a participant's 
  3.21  death.  The commissioner of health may waive or suspend payment 
  3.22  or service obligations in cases of total and permanent 
  3.23  disability or long-term temporary disability lasting for more 
  3.24  than two years.  The commissioner shall evaluate all other 
  3.25  requests for suspension or waivers on a case-by-case basis and 
  3.26  may grant a waiver of all or part of the money owed as a result 
  3.27  of a nonfulfillment penalty if emergency circumstances prevented 
  3.28  fulfillment of the required service commitment. 
  3.29     Sec. 2.  Minnesota Statutes 2000, section 256B.0644, is 
  3.30  amended to read: 
  3.31     256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
  3.32  OTHER STATE HEALTH CARE PROGRAMS.] 
  3.33     A vendor of medical care, as defined in section 256B.02, 
  3.34  subdivision 7, and a health maintenance organization, as defined 
  3.35  in chapter 62D, must participate as a provider or contractor in 
  3.36  the medical assistance program, general assistance medical care 
  4.1   program, and MinnesotaCare as a condition of participating as a 
  4.2   provider in health insurance plans and programs or contractor 
  4.3   for state employees established under section 43A.18, the public 
  4.4   employees insurance program under section 43A.316, for health 
  4.5   insurance plans offered to local statutory or home rule charter 
  4.6   city, county, and school district employees, the workers' 
  4.7   compensation system under section 176.135, and insurance plans 
  4.8   provided through the Minnesota comprehensive health association 
  4.9   under sections 62E.01 to 62E.19.  The limitations on insurance 
  4.10  plans offered to local government employees shall not be 
  4.11  applicable in geographic areas where provider participation is 
  4.12  limited by managed care contracts with the department of human 
  4.13  services.  For providers other than health maintenance 
  4.14  organizations, participation in the medical assistance program 
  4.15  means that (1) the provider accepts new medical assistance, 
  4.16  general assistance medical care, and MinnesotaCare patients or 
  4.17  (2) at least 20 percent of the provider's patients are covered 
  4.18  by medical assistance, general assistance medical care, and 
  4.19  MinnesotaCare as their primary source of coverage.  Patients 
  4.20  seen on a volunteer basis by the provider at a location other 
  4.21  than the provider's usual place of practice may be considered in 
  4.22  meeting this participation requirement.  The commissioner shall 
  4.23  establish participation requirements for health maintenance 
  4.24  organizations.  The commissioner shall provide lists of 
  4.25  participating medical assistance providers on a quarterly basis 
  4.26  to the commissioner of employee relations, the commissioner of 
  4.27  labor and industry, and the commissioner of commerce.  Each of 
  4.28  the commissioners shall develop and implement procedures to 
  4.29  exclude as participating providers in the program or programs 
  4.30  under their jurisdiction those providers who do not participate 
  4.31  in the medical assistance program.  The commissioner of employee 
  4.32  relations shall implement this section through contracts with 
  4.33  participating health and dental carriers. 
  4.34     Sec. 3.  [256B.53] [DENTAL ACCESS GRANTS.] 
  4.35     (a) The commissioner shall award grants to community 
  4.36  clinics or other nonprofit community organizations, political 
  5.1   subdivisions, professional associations, or other organizations 
  5.2   that demonstrate the ability to provide dental services 
  5.3   effectively to public program recipients.  Grants may be used to 
  5.4   fund the costs related to coordinating access for recipients, 
  5.5   developing and implementing patient care criteria, upgrading or 
  5.6   establishing new facilities, acquiring furnishings or equipment, 
  5.7   recruiting new providers, or other development costs that will 
  5.8   improve access to dental care in a region.  
  5.9      (b) In awarding grants, the commissioner shall give 
  5.10  priority to applicants that plan to serve areas of the state in 
  5.11  which the number of dental providers is not currently sufficient 
  5.12  to meet the needs of recipients of public programs or uninsured 
  5.13  individuals.  The commissioner shall consider the following in 
  5.14  awarding the grants:  
  5.15     (1) potential to successfully increase access to an 
  5.16  underserved population; 
  5.17     (2) the long-term viability of the project to improve 
  5.18  access beyond the period of initial funding; 
  5.19     (3) the efficiency in the use of the funding; and 
  5.20     (4) the experience of the applicants in providing services 
  5.21  to the target population. 
  5.22     (c) The commissioner shall consider grants for the 
  5.23  following: 
  5.24     (1) implementation of new programs or continued expansion 
  5.25  of current access programs that have demonstrated success in 
  5.26  providing dental services in underserved areas; 
  5.27     (2) a program for mobile or other types of outreach dental 
  5.28  clinics in underserved geographic areas; 
  5.29     (3) a program for school-based dental clinics in schools 
  5.30  with high numbers of children receiving medical assistance; 
  5.31     (4) a program testing new models of care that are sensitive 
  5.32  to the cultural needs of the recipients; 
  5.33     (5) a program creating new educational campaigns that 
  5.34  inform individuals of the importance of good oral health and the 
  5.35  link between dental disease and overall health status; 
  5.36     (6) a program that organizes a network of volunteer 
  6.1   dentists to provide dental services to public program recipients 
  6.2   or uninsured individuals; and 
  6.3      (7) a program that tests new delivery models by creating 
  6.4   partnerships between local providers and county public health 
  6.5   agencies.  
  6.6      (d) The commissioner shall evaluate the effects of the 
  6.7   dental access initiatives funded through the dental access 
  6.8   grants and submit a report to the legislature by January 15, 
  6.9   2003.  
  6.10     Sec. 4.  [256B.55] [DENTAL ACCESS ADVISORY COMMITTEE.] 
  6.11     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
  6.12  establish a dental access advisory committee to monitor the 
  6.13  purchasing, administration, and coverage of dental care services 
  6.14  for the public health care programs to ensure dental care access 
  6.15  and quality for public program recipients.  
  6.16     Subd. 2.  [MEMBERSHIP.] (a) The membership of the advisory 
  6.17  committee shall include, but is not limited to, representatives 
  6.18  of dentists, including a dentist practicing in the seven-county 
  6.19  metropolitan area and a dentist practicing outside the 
  6.20  seven-county metropolitan area; oral surgeons; pediatric 
  6.21  dentists; dental hygienists; community clinics; client advocacy 
  6.22  groups; public health; health service plans; the University of 
  6.23  Minnesota school of dentistry and the department of pediatrics; 
  6.24  and the commissioner of health.  
  6.25     (b) The advisory committee is governed by section 15.059 
  6.26  for membership terms and removal of members.  
  6.27     Subd. 3.  [DUTIES.] The advisory committee shall provide 
  6.28  recommendations on the following: 
  6.29     (1) how to reduce the administrative burden governing 
  6.30  dental care coverage policies in order to promote administrative 
  6.31  simplification, including prior authorization, coverage limits, 
  6.32  and co-payment collections; 
  6.33     (2) developing and implementing an action plan to improve 
  6.34  the oral health of children and persons with special needs in 
  6.35  the state; 
  6.36     (3) exploring alternative ways of purchasing and improving 
  7.1   access to dental services; 
  7.2      (4) developing ways to foster greater responsibility among 
  7.3   health care program recipients in seeking and obtaining dental 
  7.4   care, including initiatives to keep dental appointments and 
  7.5   comply with dental care plans; 
  7.6      (5) exploring innovative ways for dental providers to 
  7.7   schedule public program patients in order to reduce or minimize 
  7.8   the effect of appointment no shows; 
  7.9      (6) exploring ways to meet the barriers that may be present 
  7.10  in providing dental services to health care program recipients 
  7.11  such as language, culture, disability, and lack of 
  7.12  transportation; and 
  7.13     (7) exploring the possibility of pediatricians, family 
  7.14  physicians, and nurse practitioners providing basic oral health 
  7.15  screenings and basic preventive dental services.  
  7.16     Subd. 4.  [REPORT.] The commissioner shall submit an annual 
  7.17  report beginning February 1, 2002, summarizing the activities 
  7.18  and recommendations of the advisory committee. 
  7.19     Subd. 5.  [SUNSET.] Notwithstanding section 15.059, 
  7.20  subdivision 5, this section expires June 30, 2003.  
  7.21     Sec. 5.  Minnesota Statutes 2000, section 256B.69, is 
  7.22  amended by adding a subdivision to read: 
  7.23     Subd. 6c.  [DENTAL SERVICES DEMONSTRATION PROJECT.] The 
  7.24  commissioner shall establish a dental services demonstration 
  7.25  project in Crow Wing, Todd, Morrison, Wadena, and Cass counties 
  7.26  for provision of dental services to medical assistance, general 
  7.27  assistance medical care, and MinnesotaCare recipients.  The 
  7.28  commissioner may contract on a prospective per capita payment 
  7.29  basis for these dental services with an organization licensed 
  7.30  under chapter 62C, 62D, or 62N in accordance with section 
  7.31  256B.037 or may establish and administer a fee-for-service 
  7.32  system for the reimbursement of dental services.  
  7.33     Sec. 6.  Minnesota Statutes 2000, section 256B.76, is 
  7.34  amended to read: 
  7.35     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  7.36     (a) Effective for services rendered on or after October 1, 
  8.1   1992, the commissioner shall make payments for physician 
  8.2   services as follows: 
  8.3      (1) payment for level one Health Care Finance 
  8.4   Administration's common procedural coding system (HCPCS) codes 
  8.5   titled "office and other outpatient services," "preventive 
  8.6   medicine new and established patient," "delivery, antepartum, 
  8.7   and postpartum care," "critical care," ~~Caesarean~~ cesarean 
  8.8   delivery and pharmacologic management provided to psychiatric 
  8.9   patients, and HCPCS level three codes for enhanced services for 
  8.10  prenatal high risk, shall be paid at the lower of (i) submitted 
  8.11  charges, or (ii) 25 percent above the rate in effect on June 30, 
  8.12  1992.  If the rate on any procedure code within these categories 
  8.13  is different than the rate that would have been paid under the 
  8.14  methodology in section 256B.74, subdivision 2, then the larger 
  8.15  rate shall be paid; 
  8.16     (2) payments for all other services shall be paid at the 
  8.17  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  8.18  rate in effect on June 30, 1992; 
  8.19     (3) all physician rates shall be converted from the 50th 
  8.20  percentile of 1982 to the 50th percentile of 1989, less the 
  8.21  percent in aggregate necessary to equal the above increases 
  8.22  except that payment rates for home health agency services shall 
  8.23  be the rates in effect on September 30, 1992; 
  8.24     (4) effective for services rendered on or after January 1, 
  8.25  2000, payment rates for physician and professional services 
  8.26  shall be increased by three percent over the rates in effect on 
  8.27  December 31, 1999, except for home health agency and family 
  8.28  planning agency services; and 
  8.29     (5) the increases in clause (4) shall be implemented 
  8.30  January 1, 2000, for managed care. 
  8.31     (b) Effective for services rendered on or after October 1, 
  8.32  1992, the commissioner shall make payments for dental services 
  8.33  as follows: 
  8.34     (1) dental services shall be paid at the lower of (i) 
  8.35  submitted charges, or (ii) 25 percent above the rate in effect 
  8.36  on June 30, 1992; 
  9.1      (2) dental rates shall be converted from the 50th 
  9.2   percentile of 1982 to the 50th percentile of 1989, less the 
  9.3   percent in aggregate necessary to equal the above increases; 
  9.4      (3) effective for services rendered on or after January 1, 
  9.5   2000, payment rates for dental services shall be increased by 
  9.6   three percent over the rates in effect on December 31, 1999; 
  9.7      (4) ~~the commissioner shall award grants to community~~ 
  9.8   ~~clinics or other nonprofit community organizations, political~~ 
  9.9   ~~subdivisions, professional associations, or other organizations~~ 
  9.10  ~~that demonstrate the ability to provide dental services~~ 
  9.11  ~~effectively to public program recipients.  Grants may be used to~~ 
  9.12  ~~fund the costs related to coordinating access for recipients,~~ 
  9.13  ~~developing and implementing patient care criteria, upgrading or~~ 
  9.14  ~~establishing new facilities, acquiring furnishings or equipment,~~ 
  9.15  ~~recruiting new providers, or other development costs that will~~ 
  9.16  ~~improve access to dental care in a region.  In awarding grants,~~ 
  9.17  ~~the commissioner shall give priority to applicants that plan to~~ 
  9.18  ~~serve areas of the state in which the number of dental providers~~ 
  9.19  ~~is not currently sufficient to meet the needs of recipients of~~ 
  9.20  ~~public programs or uninsured individuals.  The commissioner~~ 
  9.21  ~~shall consider the following in awarding the grants:  (i)~~ 
  9.22  ~~potential to successfully increase access to an underserved~~ 
  9.23  ~~population; (ii) the ability to raise matching funds; (iii) the~~ 
  9.24  ~~long-term viability of the project to improve access beyond the~~ 
  9.25  ~~period of initial funding; (iv) the efficiency in the use of the~~ 
  9.26  ~~funding; and (v) the experience of the proposers in providing~~ 
  9.27  ~~services to the target population.~~ 
  9.28     ~~The commissioner shall monitor the grants and may terminate~~ 
  9.29  ~~a grant if the grantee does not increase dental access for~~ 
  9.30  ~~public program recipients.  The commissioner shall consider~~ 
  9.31  ~~grants for the following:~~ 
  9.32     ~~(i) implementation of new programs or continued expansion~~ 
  9.33  ~~of current access programs that have demonstrated success in~~ 
  9.34  ~~providing dental services in underserved areas;~~ 
  9.35     ~~(ii) a pilot program for utilizing hygienists outside of a~~ 
  9.36  ~~traditional dental office to provide dental hygiene services;~~ 
 10.1   ~~and~~ 
 10.2      ~~(iii) a program that organizes a network of volunteer~~ 
 10.3   ~~dentists, establishes a system to refer eligible individuals to~~ 
 10.4   ~~volunteer dentists, and through that network provides donated~~ 
 10.5   ~~dental care services to public program recipients or uninsured~~ 
 10.6   ~~individuals.~~ 
 10.7      ~~(5)~~ beginning October 1, 1999, the payment for tooth 
 10.8   sealants and fluoride treatments shall be the lower of (i) 
 10.9   submitted charge, or (ii) 80 percent of median 1997 charges; ~~and~~ 
 10.10     ~~(6)~~ (5) the increases listed in clauses (3) and ~~(5)~~ (4) 
 10.11  shall be implemented January 1, 2000, for managed care; and 
 10.12     (6) effective for services provided on or after October 1, 
 10.13  2001, payment for diagnostic examinations and dental x-rays 
 10.14  provided to children under age 21 shall be the lower of: 
 10.15     (i) the submitted charge; or 
 10.16     (ii) 85 percent of median 1999 charges. 
 10.17     (c) An entity that operates both a Medicare certified 
 10.18  comprehensive outpatient rehabilitation facility and a facility 
 10.19  which was certified prior to January 1, 1993, that is licensed 
 10.20  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 10.21  whom at least 33 percent of the clients receiving rehabilitation 
 10.22  services in the most recent calendar year are medical assistance 
 10.23  recipients, shall be reimbursed by the commissioner for 
 10.24  rehabilitation services at rates that are 38 percent greater 
 10.25  than the maximum reimbursement rate allowed under paragraph (a), 
 10.26  clause (2), when those services are (1) provided within the 
 10.27  comprehensive outpatient rehabilitation facility and (2) 
 10.28  provided to residents of nursing facilities owned by the entity. 
 10.29     (d) Effective for dental services provided on or after July 
 10.30  1, 2001, the commissioner may increase reimbursement to dentists 
 10.31  or dental clinics designated by the commissioner as critical 
 10.32  access providers.  The commissioner may increase reimbursement 
 10.33  to a critical access provider by up to 50 percent more than 
 10.34  would otherwise be paid to that provider.  In determining 
 10.35  critical access provider status, the commissioner shall review: 
 10.36     (1) the utilization rate for dental services by Minnesota 
 11.1   health care program patients in the service area; 
 11.2      (2) the level of service provided to Minnesota health care 
 11.3   program patients by the dentist or dental clinic; and 
 11.4      (3) whether the level of services provided by the dentist 
 11.5   or clinic is critical to maintaining an adequate level of access 
 11.6   for patients in the service area. 
 11.7   If no provider in a service area is designated a critical access 
 11.8   provider upon review, the commissioner may designate a dentist 
 11.9   or dental clinic as a critical access provider if the dentist or 
 11.10  clinic is willing to provide care to Minnesota health care 
 11.11  program patients at a level that significantly increases access 
 11.12  to dental care within the service area.  The commissioner shall 
 11.13  adjust payments to prepaid health plans to reflect increased 
 11.14  reimbursement to critical access providers under this paragraph 
 11.15  effective January 1, 2002. 
 11.16     Sec. 7.  [APPROPRIATION.] 
 11.17     (a) $....... is appropriated for each year in the biennium 
 11.18  beginning July 1, 2001, from the general fund to the 
 11.19  commissioner of health for the dentist loan forgiveness program 
 11.20  created under Minnesota Statutes, section 144.1498. 
 11.21     (b) $....... is appropriated from the general fund to the 
 11.22  commissioner of human services for the biennium beginning July 
 11.23  1, 2001, for the increases in dental rates provided in Minnesota 
 11.24  Statutes, section 256B.76. 
 11.25     (c) $....... is appropriated for the biennium beginning 
 11.26  July 1, 2001, from the general fund to the commissioner of human 
 11.27  services for the dental access grant program.  This 
 11.28  appropriation shall be available until expended.