Bill Text: MN SF2143 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Medical assistance (MA) dental services for disabled adults reimbursement coverage expansion
Spectrum: Slight Partisan Bill (Republican 3-1)
Status: (Introduced - Dead) 2012-03-01 - Referred to Health and Human Services [SF2143 Detail]
Download: Minnesota-2011-SF2143-Introduced.html
1.2relating to human services; expanding dental services for the disabled;amending
1.3Minnesota Statutes 2010, section 256B.0625, subdivision 9.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 256B.0625, subdivision 9, is amended to
1.6read:
1.7 Subd. 9. Dental services. (a) Medical assistance covers dental services.
1.8(b) Medical assistance dental coverage for nonpregnant adults is limited to the
1.9following services:
1.10(1) comprehensive exams, limited to once every five years;
1.11(2) periodic exams, limited to one per year;
1.12(3) limited exams;
1.13(4) bitewing x-rays, limited to one per year;
1.14(5) periapical x-rays;
1.15(6) panoramic x-rays, limited to one every five years except (1) when medically
1.16necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
1.17or (2) once every two years for patients who cannot cooperate for intraoral film due to
1.18a developmental disability or medical condition that does not allow for intraoral film
1.19placement;
1.20(7) prophylaxis, limited to one per year;
1.21(8) application of fluoride varnish, limited to one per year;
1.22(9) posterior fillings, all at the amalgam rate;
1.23(10) anterior fillings;
1.24(11) endodontics, limited to root canals on the anterior and premolars only;
2.1(12) removable prostheses, each dental arch limited to one every six years;
2.2(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
2.3abscesses;
2.4(14) palliative treatment and sedative fillings for relief of pain; and
2.5(15) full-mouth debridement, limited to one every five years.
2.6(c) In addition to the services specified in paragraph (b), medical assistance
2.7covers the following services for adults, if provided in an outpatient hospital setting or
2.8freestanding ambulatory surgical center as part of outpatient dental surgery:
2.9(1) periodontics, limited to periodontal scaling and root planing once every two
2.10years;
2.11(2) general anesthesia; and
2.12(3) full-mouth survey once every five years.
2.13(d) Medical assistance covers medically necessary dental services for children and
2.14pregnant women. The following guidelines apply:
2.15(1) posterior fillings are paid at the amalgam rate;
2.16(2) application of sealants are covered once every five years per permanent molar for
2.17children only;
2.18(3) application of fluoride varnish is covered once every six months; and
2.19(4) orthodontia is eligible for coverage for children only.
2.20(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
2.21covers the following services for disabled adults who are served by residential services
2.22licensed on January 1, 2012, under section 256B.097:
2.23(1) house calls or extended care facility calls for on-site delivery of covered services;
2.24(2) behavioral management when additional staff time is required to accommodate
2.25behavioral challenges and sedation is not used;
2.26(3) oral or IV conscious sedation, if the covered dental service cannot be performed
2.27safely without it or would otherwise require the service to be performed under general
2.28anesthesia in a hospital or surgical center; and
2.29(4) prophylaxis, in accordance with an appropriate individualized treatment plan
2.30formulated by a licensed dentist, but no more than four times per year.
1.3Minnesota Statutes 2010, section 256B.0625, subdivision 9.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 256B.0625, subdivision 9, is amended to
1.6read:
1.7 Subd. 9. Dental services. (a) Medical assistance covers dental services.
1.8(b) Medical assistance dental coverage for nonpregnant adults is limited to the
1.9following services:
1.10(1) comprehensive exams, limited to once every five years;
1.11(2) periodic exams, limited to one per year;
1.12(3) limited exams;
1.13(4) bitewing x-rays, limited to one per year;
1.14(5) periapical x-rays;
1.15(6) panoramic x-rays, limited to one every five years except (1) when medically
1.16necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
1.17or (2) once every two years for patients who cannot cooperate for intraoral film due to
1.18a developmental disability or medical condition that does not allow for intraoral film
1.19placement;
1.20(7) prophylaxis, limited to one per year;
1.21(8) application of fluoride varnish, limited to one per year;
1.22(9) posterior fillings, all at the amalgam rate;
1.23(10) anterior fillings;
1.24(11) endodontics, limited to root canals on the anterior and premolars only;
2.1(12) removable prostheses, each dental arch limited to one every six years;
2.2(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
2.3abscesses;
2.4(14) palliative treatment and sedative fillings for relief of pain; and
2.5(15) full-mouth debridement, limited to one every five years.
2.6(c) In addition to the services specified in paragraph (b), medical assistance
2.7covers the following services for adults, if provided in an outpatient hospital setting or
2.8freestanding ambulatory surgical center as part of outpatient dental surgery:
2.9(1) periodontics, limited to periodontal scaling and root planing once every two
2.10years;
2.11(2) general anesthesia; and
2.12(3) full-mouth survey once every five years.
2.13(d) Medical assistance covers medically necessary dental services for children and
2.14pregnant women. The following guidelines apply:
2.15(1) posterior fillings are paid at the amalgam rate;
2.16(2) application of sealants are covered once every five years per permanent molar for
2.17children only;
2.18(3) application of fluoride varnish is covered once every six months; and
2.19(4) orthodontia is eligible for coverage for children only.
2.20(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
2.21covers the following services for disabled adults who are served by residential services
2.22licensed on January 1, 2012, under section 256B.097:
2.23(1) house calls or extended care facility calls for on-site delivery of covered services;
2.24(2) behavioral management when additional staff time is required to accommodate
2.25behavioral challenges and sedation is not used;
2.26(3) oral or IV conscious sedation, if the covered dental service cannot be performed
2.27safely without it or would otherwise require the service to be performed under general
2.28anesthesia in a hospital or surgical center; and
2.29(4) prophylaxis, in accordance with an appropriate individualized treatment plan
2.30formulated by a licensed dentist, but no more than four times per year.
