Bill Text: MN SF982 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Medical assistance (MA) dental coverage expansion for adults
Sponsorship: Partisan Bill (Democrat 2)
Status: (Introduced - Dead) 2011-03-21 - Referred to Health and Human Services [SF982 Detail]
Download: Minnesota-2011-SF982-Introduced.html
1.2relating to human services; expanding medical assistance dental coverage for
1.3adults;amending Minnesota 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 appropriate and necessary
1.8dental services.
1.9(b) Medical assistance dental coverage for nonpregnant adults is limited to the
1.10following services:
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) full-mouth survey, limited to once every five years;
1.17(7) panoramic x-rays, limited to one every five years except(1) (i) when medically
1.18necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
1.19or(2) (ii) once every two years for patients who cannot cooperate for intraoral film due
1.20to a developmental disability or medical condition that does not allow for intraoral film
1.21placement;
1.22(7) (8) prophylaxis, limited to one per year;, except for patients with a major medical
1.23or dental risk factor, who are limited to a maximum of four per year based upon the
1.24severity of their medical or dental risk factors, such as:
2.1(i) diabetes;
2.2(ii) heart disease; and
2.3(iii) other similar oral and systemic conditions designated by the commissioner;
2.4(9) periodontal scaling and root planing, limited to a maximum of four quadrants
2.5per year;
2.6(8) (10) application of fluoride varnish, limited to one per year;
2.7(9) (11) posterior fillings, all at the amalgam rate;
2.8(10) (12) anterior fillings;
2.9(11) (13) endodontics, limited to root canals on the anterior and premolars only;
2.10(12) (14) removable prostheses, each dental arch limited to one every six years;
2.11(13) (15) oral surgery, limited to extractions, biopsies, and incision and drainage
2.12of abscesses;
2.13(14) (16) palliative treatment and sedative fillings for relief of pain; and
2.14(15) (17) full-mouth debridement, limited to one every five years.
2.15(c) In addition to the services specified in paragraph (b), medical assistance
2.16covers the following services for adults, if provided in an outpatient hospital setting or
2.17freestanding ambulatory surgical center as part of outpatient dental surgery:
2.18(1) periodontics, limited to periodontal scaling and root planing once every two
2.19years;
2.20(2) general anesthesia; and
2.21(3) full-mouth survey once every five years.
2.22(d) Medical assistance covers medically necessary dental services for children and
2.23pregnant women. The following guidelines apply:
2.24(1) posterior fillings are paid at the amalgam rate;
2.25(2) application of sealants are covered once every five years per permanent molar for
2.26children only;
2.27(3) application of fluoride varnish is covered once every six months;and
2.28(4) pediatric prophylaxis, limited to one per year for patients without a major
2.29medical or dental risk factor, paid at 50 percent of the applicable medical assistance
2.30payment rate in effect on June 30, 2011; and
2.31(5) orthodontia is eligible for coverage for children only.
2.32EFFECTIVE DATE.This section is effective July 1, 2011.
1.3adults;amending Minnesota 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 appropriate and necessary
1.8dental services.
1.9(b) Medical assistance dental coverage for nonpregnant adults is limited to the
1.10following services:
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) full-mouth survey, limited to once every five years;
1.17(7) panoramic x-rays, limited to one every five years except
1.18necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
1.19or
1.20to a developmental disability or medical condition that does not allow for intraoral film
1.21placement;
1.22
1.23or dental risk factor, who are limited to a maximum of four per year based upon the
1.24severity of their medical or dental risk factors, such as:
2.1(i) diabetes;
2.2(ii) heart disease; and
2.3(iii) other similar oral and systemic conditions designated by the commissioner;
2.4(9) periodontal scaling and root planing, limited to a maximum of four quadrants
2.5per year;
2.6
2.7
2.8
2.9
2.10
2.11
2.12of abscesses;
2.13
2.14
2.15(c) In addition to the services specified in paragraph (b), medical assistance
2.16covers the following services for adults, if provided in an outpatient hospital setting or
2.17freestanding ambulatory surgical center as part of outpatient dental surgery:
2.18(1) periodontics, limited to periodontal scaling and root planing once every two
2.19years;
2.20(2) general anesthesia; and
2.21(3) full-mouth survey once every five years.
2.22(d) Medical assistance covers medically necessary dental services for children and
2.23pregnant women. The following guidelines apply:
2.24(1) posterior fillings are paid at the amalgam rate;
2.25(2) application of sealants are covered once every five years per permanent molar for
2.26children only;
2.27(3) application of fluoride varnish is covered once every six months;
2.28(4) pediatric prophylaxis, limited to one per year for patients without a major
2.29medical or dental risk factor, paid at 50 percent of the applicable medical assistance
2.30payment rate in effect on June 30, 2011; and
2.31(5) orthodontia is eligible for coverage for children only.
2.32EFFECTIVE DATE.This section is effective July 1, 2011.
