1.1.................... moves to amend H.F. No. 961, the first engrossment, as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 144.121, subdivision 2, is amended to
1.4read:
1.5    Subd. 2. Inspections. (a) Periodic radiation safety inspections of the sources of
1.6ionizing radiation shall be made by the state commissioner of health. The frequency of
1.7safety inspections shall be prescribed by the commissioner on the basis of the frequency
1.8of use of the source of ionizing radiation; provided that each source shall be inspected at
1.9least once every four years.
1.10(b) Notwithstanding paragraph (a), the commissioner is not required to inspect
1.11x-ray machines at dental offices. Every four years, x-ray machines at dental offices must
1.12be inspected and calibrated by an x-ray machine service provider. Dental offices must
1.13provide documentation to the commissioner of compliance with this requirement.

1.14    Sec. 2. Minnesota Statutes 2008, section 256.963, is amended by adding a subdivision
1.15to read:
1.16    Subd. 3. Urgent dental care services. The commissioner of human services shall
1.17authorize pilot projects to reduce the total costs to the state for dental services provided
1.18to persons enrolled in Minnesota health care programs by reducing hospital emergency
1.19room costs for preventable and nonemergency dental services. The commissioner may
1.20provide start-up funding and establish special payment rates for urgent dental care services
1.21provided as an alternative to emergency room services and may change or waive existing
1.22payment policies in order to adequately reimburse providers for providing cost-effective
1.23alternative services in outpatient or urgent care settings. The commissioner may establish
1.24a project in conjunction with the initiative authorized under subdivisions 1 and 2, or
1.25establish new initiatives, or may implement both approaches.

2.1    Sec. 3. Minnesota Statutes 2008, section 256B.0625, subdivision 3c, is amended to
2.2read:
2.3    Subd. 3c. Health Services Policy Committee. (a) The commissioner, after
2.4receiving recommendations from professional physician associations, professional
2.5associations representing licensed nonphysician health care professionals, and consumer
2.6groups, shall establish a 13-member Health Services Policy Committee, which consists of
2.712 voting members and one nonvoting member. The Health Services Policy Committee
2.8shall advise the commissioner regarding health services pertaining to the administration
2.9of health care benefits covered under the medical assistance, general assistance medical
2.10care, and MinnesotaCare programs. The Health Services Policy Committee shall meet at
2.11least quarterly. The Health Services Policy Committee shall annually elect a physician
2.12chair from among its members, who shall work directly with the commissioner's medical
2.13director, to establish the agenda for each meeting. The Health Services Policy Committee
2.14shall also recommend criteria for verifying centers of excellence for specific aspects of
2.15medical care where a specific set of combined services, a volume of patients necessary to
2.16maintain a high level of competency, or a specific level of technical capacity is associated
2.17with improved health outcomes.
2.18(b) The commissioner shall establish a dental subcommittee, to operate under the
2.19Health Services Policy Committee. The dental subcommittee consists of general dentists,
2.20dental specialists, safety net providers, dental hygienists, health plan company and county
2.21and public health representatives, health researchers, consumers, and the Minnesota
2.22Department of Health oral health director. The dental subcommittee shall advise the
2.23commissioner regarding:
2.24(1) criteria for designating critical access dental providers under section 256B.76,
2.25subdivision 4;
2.26(2) any changes to the critical access dental provider program necessary to comply
2.27with program expenditure limits;
2.28(3) dental coverage policy based on evidence, quality, continuity of care, and best
2.29practices;
2.30(4) the development of dental delivery models; and
2.31(5) dental services to be added or eliminated from section 256B.0625, subdivision 9,
2.32paragraph (b).

2.33    Sec. 4. Minnesota Statutes 2008, section 256B.0625, subdivision 9, is amended to read:
3.1    Subd. 9. Dental services. (a) Medical assistance covers dental services. Dental
3.2services include, with prior authorization, fixed bridges that are cost-effective for persons
3.3who cannot use removable dentures because of their medical condition.
3.4(b) Medical assistance dental coverage for nonpregnant adults is limited to the
3.5following services:
3.6(1) comprehensive exams, limited to once every five years;
3.7(2) periodic exams, limited to one per year;
3.8(3) limited exams;
3.9(4) bitewing x-rays, limited to one per year;
3.10(5) periapical x-rays;
3.11(6) panoramic x-rays, limited to one every five years, and only if provided in
3.12conjunction with a posterior extraction or scheduled outpatient facility procedure, or as
3.13medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology
3.14and trauma. Panoramic x-rays may be taken once every two years for patients who cannot
3.15cooperate for intra-oral film due to a developmental disability or medical condition that
3.16does not allow for intra-oral film placement;
3.17(7) prophylaxis, limited to one per year;
3.18(8) application of fluoride varnish, limited to one per year;
3.19(9) posterior fillings, all at the amalgam rate;
3.20(10) anterior fillings;
3.21(11) endodontics, limited to root canals on the anterior and premolars only;
3.22(12) removable prostheses, each dental arch limited to one every six years;
3.23(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
3.24abscesses;
3.25(14) palliative treatment and sedative fillings for relief of pain; and
3.26(15) full mouth debridement, limited to one every five years.
3.27(c) In addition to the services specified in paragraph (b), medical assistance
3.28covers the following services for adults, if provided in an outpatient hospital setting or
3.29freestanding ambulatory surgical center as part of outpatient dental surgery:
3.30(1) periodontics, limited to periodontal scaling and root planing once every two
3.31years;
3.32(2) general anesthesia; and
3.33(3) full mouth survey once every five years.
3.34(d) Medical assistance covers dental services for children that are medically
3.35necessary. The following guidelines apply:
3.36(1) posterior fillings are paid at the amalgram rate;
4.1(2) application of sealants once every five years per permanent molar; and
4.2(3) application of fluoride varnish once every six months.
4.3EFFECTIVE DATE.This section is effective January 1, 2010.

4.4    Sec. 5. Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:
4.5    Subd. 4. Critical access dental providers. Effective for dental services rendered
4.6on or after January 1, 2002, the commissioner shall increase reimbursements to dentists
4.7and dental clinics deemed by the commissioner to be critical access dental providers.
4.8For dental services rendered on or after July 1, 2007, the commissioner shall increase
4.9reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to
4.10the critical access dental provider. The commissioner shall pay the health plan companies
4.11in amounts sufficient to reflect increased reimbursements to critical access dental providers
4.12as approved by the commissioner. In determining which dentists and dental clinics shall
4.13be deemed critical access dental providers, the commissioner shall review:
4.14    (1) the utilization rate in the service area in which the dentist or dental clinic operates
4.15for dental services to patients covered by medical assistance, general assistance medical
4.16care, or MinnesotaCare as their primary source of coverage;
4.17    (2) the level of services provided by the dentist or dental clinic to patients covered
4.18by medical assistance, general assistance medical care, or MinnesotaCare as their primary
4.19source of coverage; and
4.20    (3) whether the level of services provided by the dentist or dental clinic is critical to
4.21maintaining adequate levels of patient access within the service area.
4.22In the absence of a critical access dental provider in a service area, the commissioner may
4.23designate a dentist or dental clinic as a critical access dental provider if the dentist or
4.24dental clinic is willing to provide care to patients covered by medical assistance, general
4.25assistance medical care, or MinnesotaCare at a level which significantly increases access
4.26to dental care in the service area. The commissioner shall administer this subdivision
4.27within the limits of available appropriations.

4.28    Sec. 6. Minnesota Statutes 2008, section 256B.76, is amended by adding a subdivision
4.29to read:
4.30    Subd. 4a. Designation and termination of critical access dental providers. (a)
4.31The commissioner shall not designate an individual dentist or clinic as a critical access
4.32dental provider under subdivision 4 or section 256L.11, subdivision 7, when the owner or
4.33any dentist employed by or under contract with the practice:
5.1(1) has been subject to a corrective or disciplinary action by the Minnesota Board of
5.2Dentistry within the past five years or is currently subject to a corrective or disciplinary
5.3action by the board. Designation shall not be made until the provider is no longer subject
5.4to a corrective or disciplinary action;
5.5(2) does not bill on a clinic-specific location basis;
5.6(3) has been subject, within the past five years, to a post investigation action by
5.7the commissioner of human services or contracted health plan including administrative
5.8sanctions, monetary recovery, referral to state regulatory agency, referral to the state
5.9attorney general or county attorney general, or issuance of a warning as specified in
5.10Minnesota Rules, parts 9505.2160 to 9505.2245. Designation shall not be considered
5.11until the January of the year following documentation that the activity that resulted in
5.12post investigative action has stopped; or
5.13(4) has not completed the application for critical access dental provider designation,
5.14has submitted the application after the due date, provided incorrect information, or has
5.15knowingly and willfully submitted a fraudulent designation form.
5.16(b) The commissioner shall terminate a critical access designation of an individual
5.17dentist or clinic, if the owner or any dentist employed by or under contract with the
5.18practice:
5.19(1) becomes subject to a disciplinary or corrective action by the Minnesota Board of
5.20Dentistry. The provider shall not be considered for critical access designation until the
5.21January following the year in which the action has ended; or
5.22(2) becomes subject to a post investigation action by the commissioner of human
5.23services or contracted health plan including administrative sanctions, monetary recovery,
5.24referral to state regulatory agency, referral to the state attorney general or county attorney
5.25general, or issuance of a warning as specified in Minnesota Rules, parts 9505.2160 to
5.269505.2245. Designation shall not be considered until the January of the year following
5.27documentation that the activity that resulted in post investigative action has stopped.
5.28(c) Any termination is retroactive to the date of the:
5.29(1) post investigative action; or
5.30(2) disciplinary or corrective action by the Minnesota Board of Dentistry.
5.31(d) A provider who has been terminated or not designated may appeal through the
5.32contested hearing process under section 256.045.
5.33EFFECTIVE DATE.This section is effective the day following final enactment.

5.34    Sec. 7. Minnesota Statutes 2008, section 256L.11, subdivision 7, is amended to read:
6.1    Subd. 7. Critical access dental providers. Effective for dental services provided
6.2to MinnesotaCare enrollees on or after January 1, 2007 2010, the commissioner shall
6.3increase payment rates to dentists and dental clinics deemed by the commissioner to be
6.4critical access providers under section 256B.76, subdivision 4 subdivisions 4 and 4a, by
6.550 30 percent above the payment rate that would otherwise be paid to the provider. The
6.6commissioner shall pay the prepaid health plans under contract with the commissioner
6.7amounts sufficient to reflect this rate increase. The prepaid health plan must pass this rate
6.8increase to providers who have been identified by the commissioner as critical access
6.9dental providers under section 256B.76, subdivision 4. The commissioner shall administer
6.10this subdivision within the limits of available appropriations.

6.11    Sec. 8. EXPENDITURE LIMIT.
6.12For calendar years beginning on or after January 1, 2010, the commissioner of
6.13human services shall limit annual expenditures for the critical access dental provider
6.14program under Minnesota Statutes, sections 256B.76, subdivisions 4 and 4a, and 256L.11,
6.15subdivision 7, to 75 percent of the expenditure level for the calendar year ending
6.16December 31, 2008."
6.17Amend the title accordingly