1.1 A bill for an act
1.2 relating to human services; expanding medical assistance coverage for adult dental
1.3 services; amending Minnesota Statutes 2022 Supplement, section 256B.0625,
1.4 subdivision 9, as amended.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read:
1.7 Subd. 9.Dental services.(a) Medical assistance covers medically necessary dental
1.8services.
1.9 (b) Medical assistance dental coverage for nonpregnant adults is limited to the following
1.10services:
1.11 (1) comprehensive exams, limited to once every five years;
1.12 (2) periodic exams, limited to one per year;
1.13 (3) limited exams;
1.14 (4) bitewing x-rays, limited to one per year;
1.15 (5) periapical x-rays;
1.16 (6) panoramic x-rays, limited to one every five years except (1) when medically necessary
1.17for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
1.18every two years for patients who cannot cooperate for intraoral film due to a developmental
1.19disability or medical condition that does not allow for intraoral film placement;
1.20 (7) prophylaxis, limited to one per year;
1.21 (8) application of fluoride varnish, limited to one per year;
1Section 1.
23-01885 as introduced01/06/23 REVISOR AGW/AK
SENATE
STATE OF MINNESOTA
S.F. No. 782NINETY-THIRD SESSION
(SENATE AUTHORS: BOLDON, Utke and Morrison)
OFFICIAL STATUSD-PGDATE
Introduction and first reading01/26/2023
Referred to Health and Human Services 2.1 (9) posterior fillings, all at the amalgam rate;
2.2 (10) anterior fillings;
2.3 (11) endodontics, limited to root canals on the anterior and premolars only;
2.4 (12) removable prostheses, each dental arch limited to one every six years;
2.5 (13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
2.6 (14) palliative treatment and sedative fillings for relief of pain;
2.7 (15) full-mouth debridement, limited to one every five years; and
2.8 (16) nonsurgical treatment for periodontal disease, including scaling and root planing
2.9once every two years for each quadrant, and routine periodontal maintenance procedures.
2.10 (c) In addition to the services specified in paragraph (b), medical assistance covers the
2.11following services for adults, if provided in an outpatient hospital setting or freestanding
2.12ambulatory surgical center as part of outpatient dental surgery:
2.13 (1) periodontics, limited to periodontal scaling and root planing once every two years;
2.14 (2) general anesthesia; and
2.15 (3) full-mouth survey once every five years.
2.16 (d) Medical assistance covers medically necessary dental services for children and
2.17pregnant women. The following guidelines apply:
2.18 (1) posterior fillings are paid at the amalgam rate;
2.19 (2) application of sealants are covered once every five years per permanent molar for
2.20children only;
2.21 (3) application of fluoride varnish is covered once every six months; and
2.22 (4) orthodontia is eligible for coverage for children only.
2.23 (e) (b) In addition to the services specified in paragraphs (b) and (c) paragraph (a),
2.24medical assistance covers the following services for adults:
2.25 (1) house calls or extended care facility calls for on-site delivery of covered services;
2.26 (2) behavioral management when additional staff time is required to accommodate
2.27behavioral challenges and sedation is not used;
2Section 1.
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
3.2it or would otherwise require the service to be performed under general anesthesia in a
3.3hospital or surgical center; and
3.4 (4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
3.5no more than four times per year.
3.6 (f) (c) The commissioner shall not require prior authorization for the services included
3.7in paragraph (e) (b), clauses (1) to (3), and shall prohibit managed care and county-based
3.8purchasing plans from requiring prior authorization for the services included in paragraph
3.9(e) (b), clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
3Section 1.
23-01885 as introduced01/06/23 REVISOR AGW/AK