Purpose

This bill would change how Minnesota Medical Assistance (MA) reimbursement payments for dental services are calculated and paid. It focuses on increasing and restructuring rates for dental care, including payments to state-operated clinics, community health centers, and plans that provide MA benefits through managed care or county-based purchasing. The goal is to adjust pay levels over time to better compensate dental providers and address access to dental care for MA recipients.

Key Provisions (Main Provisions and What They Do)

• Amends Minnesota Statutes 2024 section 256B.76, subdivision 2, to revise how dental services are reimbursed.
• Historical payment framework updated: several prior rules determine how payment rates are set (e.g., lower of submitted charges or a percentage above old base rates, and percentile-based adjustments using older year medians). The bill continues using a mix of “lower of charge” and percentile/median-based calculations but with new targets and percentages in various years.
• Specific rate adjustments over time:
  • Sealants and fluoride treatments: begin at a rate “lower of submitted charge or 80% of median 1997 charges.”
  • 2000: general dental payments increased by 3% over the 1999 rates.
  • Children under 21: diagnostic exams and dental X-rays paid at the lower of charge or 85% of median 1999 charges (effective for services after 2002).
  • 2010–2011: state-operated dental clinics paid on a reasonable cost basis using Medicare principles; includes recipients in managed care or county-based purchasing plans.
  • Supplemental payment: if annual payments to state-operated clinics fall below $1,850,000, a supplement from the general fund covers the difference.
  • 2014–2021: general rate increase of 5% (not applied to state-operated clinics, federally qualified health centers, rural health centers, or Indian health services). Managed care and county purchasing plans must reflect this increase.
  • 2017–2021: a 9.65% increase for dental services provided outside the seven-county metropolitan area; not applied to certain exempt facilities; plans must reflect this increase.
  • 2017–2021: a 23.8% increase for dental services provided to enrollees under age 21; not applied to exempt facilities or to managed care/county purchasing plans.
  • 2022: exclude from MA and MinnesotaCare payments the 20% increase authorized in a 1989 law for dental services at public health and community health clinics.
  • 2022 onward: a 98% increase for all dental services (with exemptions for state-operated clinics, FQHCs, rural centers, and IHS); managed care and county purchasing plans must reflect this increase unless federal approval is not obtained.
  • 2028 or later (or after federal approval, whichever is later): move to a payment rate expressed as a percent of the percentile of the median charges for coverage year 2024. Excludes for state-operated clinics, FQHCs, rural centers, or IHS. If federal approval is not obtained for this provision in any year, it may be removed or not implemented for subsequent years.
• Managed care and capitation requirements:
  • Managed care plans and county-based purchasing plans must reimburse providers at least at the fee-for-service rate for dental services.
  • If federal approval for the 2028+ provision is not obtained for a given year, capitation rates must be adjusted to reflect the removal of the increased payment provision for that year.
  • Contracts between plans and providers must permit recovery of any overpayments if capitation rates are adjusted; such recoveries cannot exceed the amount of the rate increases.
  • If federal approval is not obtained in a given year, the increased provision is not implemented for subsequent years.

Significant Changes to Existing Law

• Shifts several dental payment rules from historic base rates and percentile calculations toward more aggressive and year-specific increases (including a large 98% increase starting in 2022 for all dental services, with certain exclusions).
• Expands or clarifies the role of state-operated dental clinics and how they are reimbursed (including a potential supplemental payment if funding falls short).
• Introduces a future move (2028 or later) to tie payments to a percentile-based target using 2024 charges, subject to federal approval.
• Strengthens protections and requirements for managed care and county-based purchasing plans to ensure they reimburse at or above fee-for-service levels, with contingencies if federal approval is not obtained.

Implementation and Oversight Considerations

• The commissioner (agency head) would implement these rate changes and monitor federal approval where required.
• Several increases are contingent on federal approvals; without such approvals, certain increases may not be implemented and capitation rates adjusted accordingly.
• A mix of state funding (General Fund) and MA payments would fund new supplemental payments when required.

Potential Impacts

• For dentists and dental clinics serving MA recipients, the bill could substantially increase reimbursement in certain years, potentially improving access to dental care for MA enrollees.
• State-operated dental clinics and certain nationwide groups (FQHCs, rural health centers, IHS) would experience targeted exclusions from some increases.
• Managed care organizations and county-based purchasing plans would need to adjust capitation rates and contract terms to align with the new payment structures and federal approval conditions.

Relevant Terms - Medical Assistance (MA), MinnesotaCare - Dental services, dental reimbursement, state-operated dental clinics - Fee-for-service, capitation rates, managed care plans, county-based purchasing plans - Medicare principles of reimbursement - 80% of median 1997 charges; 85% of median 1999 charges; 98% increase - 5% increase (2014–2021), 9.65% increase (2017–2021 outside seven-county metro), 23.8% increase (under 21, 2017–2021) - 20% increase authorized under Laws 1989 chapter 327 section 5 subdivision 2 paragraph b (excluded in MA/MinnesotaCare payments for certain clinics) - 2028 target: percent of the percentile of the median charges for coverage year 2024 - Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), Indian Health Services (IHS) - Public health clinics, community health clinics - Supplemental state payment; General Fund - Federal approval requirement and implications for implementation

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