HF4931

Purpose

This bill aims to delay the rollout of a single dental administrator for Minnesota’s medical assistance program and, if performance benchmarks are not met, create a contingent process to move to a centralized dental administrator later. It sets conditions under which a dental administrator would be required to manage dental services for MA and MinnesotaCare, including timelines, duties, and monitoring.

Main Provisions

• Contingent contract with a dental administrator
  • The commissioner will assess how well managed care plans and county-based purchasing plans meet a defined performance benchmark for coverage year 2024.
  • If the aggregate plans fail to meet the benchmark, the commissioner, after requesting information and proposals, must contract with a dental administrator to run dental services beginning January 1, 2028 or 2030 for:
  • Recipients of medical assistance
  • MinnesotaCare enrollees served under fee-for-service
  • People receiving services through managed care plans
• Duties of the dental administrator
  • Administrative services such as provider recruitment and contracting
  • Recipient outreach and assistance
  • Utilization management and reviews of medical necessity for dental services
  • Dental claims processing
  • Coordination of dental care with other services
  • Fraud and abuse management
  • Monitoring statewide access to dental services
  • Performance measurement, quality improvement, and evaluation
  • Management of third-party liability requirements
  • Establishment of grievance and appeals processes for providers and enrollees
• Provider payments
  • Payments to contracted dental providers must be based on rates recommended by the dental access working group.
  • If those rates aren’t established in law by July 1, 2027 (or 2029), payments must use the rates already set in law for MA dental services.
• Recipient provider choice
  • Recipients must have a choice of dental providers, including any provider who agrees to participate and accept the established payment rates.
• Network adequacy and geographic access
  • The dental administrator must meet network adequacy and geographic access requirements for dental services that apply to managed care plans.

• Accountability and contract terms

  • The contract must include performance benchmarks, accountability measures, and progress rewards based on the dental access working group’s recommendations.
  • The commissioner may extend the implementation contract for the single dental administrator by up to three years and may renew with the same contractor for up to five years beginning in 2028 or 2030.

• Dental utilization reporting (annual report)

  • Beginning March 15, 2022, through March 15, 2028, annual reports to committee chairs and minority members will cover:
  • The percentage of adults and children aged 1–20 who had at least one dental visit (for both fee-for-service and prepaid MA programs).
  • Statewide utilization for fee-for-service and the prepaid MA program.
  • Utilization by county.
  • Utilization by children receiving services through fee-for-service and through managed care or CBP plans.
  • Utilization by adults through fee-for-service and through managed care or CBP plans.
  • The report must describe corrective actions required under subdivision 2 (not shown in excerpt).
  • The initial report must include 2017–2020 data.
  • Beginning with the 2023 report (and annually thereafter), the commissioner must include:
  • The number of dentists enrolled as MA dental providers and their congressional districts.
  • The number of enrolled dentists who provided fee-for-service dental services to MA or MinnesotaCare patients, broken into 1–9, 10–100, and over 100 patients.
  • The number of enrolled dentists who provided services to MA or MinnesotaCare patients through managed care or CBP plans, broken into 1–9, 10–100, and over 100 patients.
  • The number of dentists who served a new patient enrolled in MA or MinnesotaCare in the previous year.
  • The 2023 report must include metrics for 2017–2021 data.

Significant Changes to Existing Law

• Amendments to Minnesota Statutes 2025 Supplement section 256B.0371 subdivision 3
  • Adds a contingent contract mechanism for a dental administrator if current managed care and CBP plans do not meet the performance benchmark for 2024.
  • Sets terms for implementing a single dental administrator beginning in 2028 or 2030, including duties, payments, and provider access requirements.
• Amendments to Minnesota Statutes 2024 section 256B.0371 subdivision 4
  • Establishes annual dental utilization reporting requirements, including historical data and ongoing metrics, with specific data points on provider enrollment, utilization by program and plan type, and new patient services.

Implementation Timeline and Impact

• Contingent deployment
  • If performance benchmarks are met, the current path remains (no mandatory switch to a single dental administrator).
  • If not, a dental administrator would be contracted to start providing services on January 1, 2028 or 2030, with phased responsibilities and defined payment rates.
• Contract duration
  • Initial implementation contract could be extended up to three years; the same contractor could be used for up to five years starting in 2028 or 2030.
• Reporting cadence
  • Annual utilization reports begin March 15 and cover the previous year, with initial historical data requested for earlier years.

Why This Matters (Plain-English Summary)

• The bill would create or delay a centralized dental administrator for Minnesota’s MA and MinnesotaCare dental services, depending on how well current plans perform.
• It places strict duties on the dental administrator to ensure providers are recruited, services are properly managed and paid, and patients have access to care.
• It emphasizes accountability through benchmarks and regular reporting on how dental services are used across the state.
• If performance falls short, Minnesota would shift to a centralized administrator within a few years, affecting how dental care is delivered and monitored.

Relevant Terms - dental administrator - medical assistance (MA) program - MinnesotaCare - fee-for-service (fee-for-service) - managed care plans - county-based purchasing plans (CBP) - network adequacy - geographic access - dental access working group - rates (provider payment rates) - utilization management - medical necessity - fraud and abuse - grievance and appeals - third-party liability - provider recruitment - recipient outreach - claims processing - quality improvement and evaluation - performance benchmarks - RFI (request for information) - RFP (request for proposals) - contract extension - annual dental utilization report - congressional district (for dentist enrollment data)