| 1 | 1 | | 1.1 A bill for an act |
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| 2 | 2 | | 1.2 relating to human services; expanding medical assistance coverage for adult dental |
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| 3 | 3 | | 1.3 services; amending Minnesota Statutes 2022 Supplement, section 256B.0625, |
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| 4 | 4 | | 1.4 subdivision 9, as amended. |
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| 5 | 5 | | 1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
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| 6 | 6 | | 1.6 Section 1. Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read: |
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| 7 | 7 | | 1.7 Subd. 9.Dental services.(a) Medical assistance covers medically necessary dental |
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| 8 | 8 | | 1.8services. |
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| 9 | 9 | | 1.9 (b) Medical assistance dental coverage for nonpregnant adults is limited to the following |
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| 10 | 10 | | 1.10services: |
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| 11 | 11 | | 1.11 (1) comprehensive exams, limited to once every five years; |
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| 12 | 12 | | 1.12 (2) periodic exams, limited to one per year; |
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| 13 | 13 | | 1.13 (3) limited exams; |
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| 14 | 14 | | 1.14 (4) bitewing x-rays, limited to one per year; |
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| 15 | 15 | | 1.15 (5) periapical x-rays; |
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| 16 | 16 | | 1.16 (6) panoramic x-rays, limited to one every five years except (1) when medically necessary |
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| 17 | 17 | | 1.17for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once |
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| 18 | 18 | | 1.18every two years for patients who cannot cooperate for intraoral film due to a developmental |
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| 19 | 19 | | 1.19disability or medical condition that does not allow for intraoral film placement; |
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| 20 | 20 | | 1.20 (7) prophylaxis, limited to one per year; |
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| 21 | 21 | | 1.21 (8) application of fluoride varnish, limited to one per year; |
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| 22 | 22 | | 1Section 1. |
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| 23 | 23 | | 23-01885 as introduced01/06/23 REVISOR AGW/AK |
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| 24 | 24 | | SENATE |
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| 25 | 25 | | STATE OF MINNESOTA |
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| 26 | 26 | | S.F. No. 782NINETY-THIRD SESSION |
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| 27 | 27 | | (SENATE AUTHORS: BOLDON, Utke and Morrison) |
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| 28 | 28 | | OFFICIAL STATUSD-PGDATE |
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| 29 | 29 | | Introduction and first reading01/26/2023 |
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| 30 | 30 | | Referred to Health and Human Services 2.1 (9) posterior fillings, all at the amalgam rate; |
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| 31 | 31 | | 2.2 (10) anterior fillings; |
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| 32 | 32 | | 2.3 (11) endodontics, limited to root canals on the anterior and premolars only; |
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| 33 | 33 | | 2.4 (12) removable prostheses, each dental arch limited to one every six years; |
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| 34 | 34 | | 2.5 (13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses; |
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| 35 | 35 | | 2.6 (14) palliative treatment and sedative fillings for relief of pain; |
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| 36 | 36 | | 2.7 (15) full-mouth debridement, limited to one every five years; and |
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| 37 | 37 | | 2.8 (16) nonsurgical treatment for periodontal disease, including scaling and root planing |
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| 38 | 38 | | 2.9once every two years for each quadrant, and routine periodontal maintenance procedures. |
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| 39 | 39 | | 2.10 (c) In addition to the services specified in paragraph (b), medical assistance covers the |
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| 40 | 40 | | 2.11following services for adults, if provided in an outpatient hospital setting or freestanding |
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| 41 | 41 | | 2.12ambulatory surgical center as part of outpatient dental surgery: |
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| 42 | 42 | | 2.13 (1) periodontics, limited to periodontal scaling and root planing once every two years; |
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| 43 | 43 | | 2.14 (2) general anesthesia; and |
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| 44 | 44 | | 2.15 (3) full-mouth survey once every five years. |
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| 45 | 45 | | 2.16 (d) Medical assistance covers medically necessary dental services for children and |
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| 46 | 46 | | 2.17pregnant women. The following guidelines apply: |
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| 47 | 47 | | 2.18 (1) posterior fillings are paid at the amalgam rate; |
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| 48 | 48 | | 2.19 (2) application of sealants are covered once every five years per permanent molar for |
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| 49 | 49 | | 2.20children only; |
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| 50 | 50 | | 2.21 (3) application of fluoride varnish is covered once every six months; and |
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| 51 | 51 | | 2.22 (4) orthodontia is eligible for coverage for children only. |
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| 52 | 52 | | 2.23 (e) (b) In addition to the services specified in paragraphs (b) and (c) paragraph (a), |
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| 53 | 53 | | 2.24medical assistance covers the following services for adults: |
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| 54 | 54 | | 2.25 (1) house calls or extended care facility calls for on-site delivery of covered services; |
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| 55 | 55 | | 2.26 (2) behavioral management when additional staff time is required to accommodate |
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| 56 | 56 | | 2.27behavioral challenges and sedation is not used; |
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| 57 | 57 | | 2Section 1. |
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| 58 | 58 | | 23-01885 as introduced01/06/23 REVISOR AGW/AK 3.1 (3) oral or IV sedation, if the covered dental service cannot be performed safely without |
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| 59 | 59 | | 3.2it or would otherwise require the service to be performed under general anesthesia in a |
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| 60 | 60 | | 3.3hospital or surgical center; and |
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| 61 | 61 | | 3.4 (4) prophylaxis, in accordance with an appropriate individualized treatment plan, but |
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| 62 | 62 | | 3.5no more than four times per year. |
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| 63 | 63 | | 3.6 (f) (c) The commissioner shall not require prior authorization for the services included |
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| 64 | 64 | | 3.7in paragraph (e) (b), clauses (1) to (3), and shall prohibit managed care and county-based |
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| 65 | 65 | | 3.8purchasing plans from requiring prior authorization for the services included in paragraph |
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| 66 | 66 | | 3.9(e) (b), clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12. |
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| 67 | 67 | | 3Section 1. |
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| 68 | 68 | | 23-01885 as introduced01/06/23 REVISOR AGW/AK |
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