1.1.................... moves to amend H.F. No. 3269, the first engrossment, as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9,
1.4is amended to read:
1.5    Subd. 9. Dental services. (a) Medical assistance covers dental services.
1.6(b) Medical assistance dental coverage for nonpregnant adults is limited to the
1.7following services:
1.8(1) comprehensive exams, limited to once every five years;
1.9(2) periodic exams, limited to one per year;
1.10(3) limited exams;
1.11(4) bitewing x-rays, limited to one set per year;
1.12(5) periapical x-rays;
1.13(6) panoramic x-rays or full-mouth radiographs, limited to one every five years,
1.14and only if provided in conjunction with a posterior extraction or scheduled outpatient
1.15facility procedure, or as medically necessary for the diagnosis and follow-up of oral and
1.16maxillofacial pathology and trauma. Panoramic x-rays may be taken once every two years
1.17for patients who cannot cooperate for intraoral film due to a developmental disability or
1.18medical condition that does not allow for intraoral film placement;
1.19(7) prophylaxis, limited to one per year;
1.20(8) application of fluoride varnish, limited to one per year;
1.21(9) posterior fillings, all at the amalgam rate;
1.22(10) anterior fillings;
1.23(11) endodontics, limited to root canals on the anterior and premolars only, and
1.24molar root canal therapy as deemed medically necessary for patients that are at high risk
1.25of osteonecrosis from molar extractions;
1.26(12) removable prostheses, each dental arch limited to one every six years; including:
1.27(i) relines of full dentures once every six years per dental arch;
2.1(ii) repair of acrylic bases of full dentures and acrylic partial dentures, limited to one
2.2per year; and
2.3(iii) adding a maximum of two denture teeth and two wrought wire clasps per year to
2.4partial dentures per dental arch;
2.5(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
2.6abscesses;
2.7(14) palliative treatment and sedative fillings for relief of pain; and
2.8(15) full-mouth debridement periodontal scaling and root planing, limited to one
2.9every five years; and
2.10(16) moderate sedation, deep sedation, and general anesthesia, limited to when
2.11provided by an oral maxillofacial surgeon who is board-certified, or actively participating
2.12in the American Board of Oral and Maxillofacial Surgery certification process, when
2.13medically necessary to allow the surgical management of acute oral and maxillofacial
2.14pathology which cannot be accomplished safely with local anesthesia alone and would
2.15otherwise require operating room services.
2.16(c) In addition to the services specified in paragraph (b), medical assistance
2.17covers the following services for adults, if provided in an outpatient hospital setting or
2.18freestanding ambulatory surgical center as part of outpatient dental surgery:
2.19(1) periodontics, limited to periodontal scaling and root planing once every two
2.20years;
2.21(2) general anesthesia; and
2.22(3) full-mouth survey once every five two years.
2.23(d) Medical assistance covers dental services for children that are medically
2.24necessary. The following guidelines apply:
2.25(1) posterior fillings are paid at the amalgam rate;
2.26(2) application of sealants once every five years per permanent molar; and
2.27(3) application of fluoride varnish once every six months.

2.28    Sec. 2. Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:
2.29    Subd. 4. Critical access dental providers. Effective for dental services rendered
2.30on or after January 1, 2002, the commissioner shall increase reimbursements to dentists
2.31and dental clinics deemed by the commissioner to be critical access dental providers.
2.32For dental services rendered on or after July 1, 2007, the commissioner shall increase
2.33reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to
2.34the critical access dental provider. The commissioner shall pay the health plan companies
2.35in amounts sufficient to reflect increased reimbursements to critical access dental providers
3.1as approved by the commissioner. In determining which dentists and dental clinics shall
3.2be deemed critical access dental providers, the commissioner shall review:
3.3    (1) the utilization rate in the service area in which the dentist or dental clinic operates
3.4for dental services to patients covered by medical assistance, general assistance medical
3.5care, or MinnesotaCare as their primary source of coverage;
3.6    (2) the level of services provided by the dentist or dental clinic to patients covered
3.7by medical assistance, general assistance medical care, or MinnesotaCare as their primary
3.8source of coverage; and. The commissioner shall pay critical access dental provider
3.9payments to a dentist or dental clinic that meets any one of the following criteria:
3.10    (i) at least 40 percent of patient encounters are with patients who are uninsured or
3.11covered by medical assistance, general assistance medical care, or MinnesotaCare;
3.12    (ii) the dental clinic or dental group is owned and operated by a nonprofit operation
3.13under chapter 317A with more than 10,000 patient encounters per year with patients
3.14who are uninsured or covered by medical assistance, general assistance medical care, or
3.15MinnesotaCare; or
3.16    (iii) the dental clinic is associated with an oral health or dental education program
3.17operated by the University of Minnesota or an institution within the Minnesota State
3.18Colleges Universities system;
3.19    (3) whether the level of services provided by the dentist or dental clinic is critical to
3.20maintaining adequate levels of patient access within the a geographic service area, and
3.21to ensure that the maximum travel distance or travel time is the lesser of 60 miles or 60
3.22minutes;
3.23    (4) whether the provider has completed the application for critical access dental
3.24provider designation by the due date, and has provided correct information;
3.25    (5) whether the dentist or dental clinic meets the quality and continuity of care
3.26criteria recommended by the dental services advisory committee and adopted by the
3.27department; or
3.28(6) whether the dentist or dental clinic serves people in all Minnesota health care
3.29programs.
3.30In the absence of a critical access dental provider in a service area, the commissioner may
3.31designate a dentist or dental clinic as a critical access dental provider if the dentist or
3.32dental clinic is willing to provide care to patients covered by medical assistance, general
3.33assistance medical care, or MinnesotaCare at a level which significantly increases access
3.34to dental care in the service area.
3.35EFFECTIVE DATE.This section is effective January 1, 2011.

4.1    Sec. 3. Minnesota Statutes 2008, section 256B.76, is amended by adding a subdivision
4.2to read:
4.3    Subd. 4a. Designation and termination of critical access dental providers. (a)
4.4Notwithstanding the provisions in subdivision 4, the commissioner may review and not
4.5designate an individual dentist or dental clinic as a critical access dental provider under
4.6subdivision 4 or section 256L.11, subdivision 7, when the dentist or clinic:
4.7(1) has been subject to a corrective or disciplinary action by the Minnesota Board
4.8of Dentistry related to fraud or direct patient care. Designation shall not be made until
4.9the provider is no longer subject to a corrective or disciplinary action related to fraud
4.10or direct patient care; or;
4.11(2) has been subject, within the past three years, to a postinvestigation action by the
4.12commissioner of human services or issuance of a warning as specified in Minnesota Rules,
4.13parts 9505.2160 to 9505.2245. The provider shall not be considered for critical access
4.14dental designation until the January following the year in which the action has ended.
4.15(b) The commissioner may terminate a critical access designation of an individual
4.16dentist or clinic if the dentist or clinic:
4.17(1) becomes subject to a disciplinary or corrective action by the Minnesota Board
4.18of Dentistry related to fraud or direct patient care. The provider shall not be considered
4.19for critical access designation until the January following the year in which the action
4.20has ended;
4.21(2) becomes subject to a postinvestigation action by the commissioner of human
4.22services or issuance of a warning as specified in Minnesota Rules, parts 9505.2160
4.23to 9505.2245;
4.24(3) does not meet the quality and continuity of care criteria that have been
4.25recommended by the Dental Services Advisory Committee and adopted by the department;
4.26or
4.27(4) does not serve people in all Minnesota public health care programs.
4.28(c) Any termination is effective on the date of notification of the:
4.29(1) postinvestigative action;
4.30(2) disciplinary or corrective action by the Minnesota Board of Dentistry; or
4.31(3) determination of not meeting quality and continuity of care criteria.
4.32The commissioner may review post-investigative actions taken by a health plan
4.33under contract to provide dental services to Minnesota health care program enrollees.
4.34After an investigation conducted by the Department of Human Services surveillance unit,
4.35the findings of the health plan may be incorporated to determine if a provider will be
4.36designated or terminated from the program.
5.1(d) A provider who has been terminated or not designated under this section may
5.2appeal only through the contested hearing process as defined in section 14.02, subdivision
5.33, by filing with the commissioner a written request of appeal. The appeal request must
5.4be received by the commissioner no later than 30 days after notification of termination
5.5or nondesignation.
5.6(e) The commissioner may make an exception to paragraphs (a) and (b) if an action
5.7taken by the Board of Dentistry or the commissioner is the result of events not directly
5.8related to patient care or that will not affect direct patient care to Minnesota health care
5.9program enrollees.
5.10EFFECTIVE DATE.This section is effective the day following final enactment.

5.11    Sec. 4. APPROPRIATION.
5.12    $3,000,000 is appropriated from the general fund for the fiscal year beginning July
5.131, 2010, to the commissioner of human services for medical assistance payments to
5.14critical access dental providers."
5.15Amend the title accordingly