HF 1175

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/13/2023 03:50pm

A bill for an act
relating to human services; modifying medical assistance coverage for special
education school social work services; amending Minnesota Statutes 2022, section 256B.0625, subdivision 26.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2022, section 256B.0625, subdivision 26, is amended to
read:

Subd. 26.

Special education services.

(a) Medical assistance covers evaluations necessary
in making a determination for eligibility for individualized education program and
individualized family service plan services and for medical services identified in a recipient's
individualized education program and individualized family service plan and covered under
the medical assistance state plan. Covered services include occupational therapy, physical
therapy, speech-language therapy, clinical psychological services, nursing services, school
psychological services, school social work services, personal care assistants serving as
management aides, assistive technology devices, transportation services, health assessments,
and other services covered under the medical assistance state plan. Mental health services
eligible for medical assistance reimbursement must be provided or coordinated through a
children's mental health collaborative where a collaborative exists if the child is included
in the collaborative operational target population. The provision or coordination of services
does not require that the individualized education program be developed by the collaborative.

The services may be provided by a Minnesota school district that is enrolled as a medical
assistance provider or its subcontractor, and only if the services meet all the requirements
otherwise applicable if the service had been provided by a provider other than a school
district, in the following areas: medical necessity; physician's, advanced practice registered
nurse's, or physician assistant's orders; documentation; personnel qualifications; and prior
authorization requirements. The nonfederal share of costs for services provided under this
subdivision is the responsibility of the local school district as provided in section 125A.74.
Services listed in a child's individualized education program are eligible for medical
assistance reimbursement only if those services meet criteria for federal financial participation
under the Medicaid program.

(b) Approval of health-related services for inclusion in the individualized education
program does not require prior authorization for purposes of reimbursement under this
chapter. The commissioner may require physician, advanced practice registered nurse, or
physician assistant review and approval of the plan not more than once annually or upon
any modification of the individualized education program that reflects a change in
health-related services.

(c) Services of a speech-language pathologist provided under this section are covered
notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:

(1) holds a masters degree in speech-language pathology;

(2) is licensed by the Professional Educator Licensing and Standards Board as an
educational speech-language pathologist; and

(3) either has a certificate of clinical competence from the American Speech and Hearing
Association, has completed the equivalent educational requirements and work experience
necessary for the certificate or has completed the academic program and is acquiring
supervised work experience to qualify for the certificate.

(d) Medical assistance coverage for medically necessary services provided under other
subdivisions in this section may not be denied solely on the basis that the same or similar
services are covered under this subdivision.

(e) The commissioner shall develop and implement package rates, bundled rates, or per
diem rates for special education services under which separately covered services are grouped
together and billed as a unit in order to reduce administrative complexity.

(f) The commissioner shall develop a cost-based payment structure for payment of these
services. Only costs reported through the designated Minnesota Department of Education
data systems in distinct service categories qualify for inclusion in the cost-based payment
structure. The commissioner shall reimburse claims submitted based on an interim rate, and
shall settle at a final rate once the department has determined it. The commissioner shall
notify the school district of the final rate. The school district has 60 days to appeal the final
rate. To appeal the final rate, the school district shall file a written appeal request to the
commissioner within 60 days of the date the final rate determination was mailed. The appeal
request shall specify (1) the disputed items and (2) the name and address of the person to
contact regarding the appeal.

(g) Effective July 1, 2000, medical assistance services provided under an individualized
education program or an individual family service plan by local school districts shall not
count against medical assistance authorization thresholds for that child.

(h) Nursing services as defined in section 148.171, subdivision 15, and provided as an
individualized education program health-related service, are eligible for medical assistance
payment if they are otherwise a covered service under the medical assistance program.
Medical assistance covers the administration of prescription medications by a licensed nurse
who is employed by or under contract with a school district when the administration of
medications is identified in the child's individualized education program. The simple
administration of medications alone is not covered under medical assistance when
administered by a provider other than a school district or when it is not identified in the
child's individualized education program.

new text begin (i) School social work services provided by a mental health professional, as defined in
section 245I.04, subdivision 2, or mental health practitioner, as defined in section 245I.04,
subdivision 4, under the supervision of a mental health professional, are eligible for medical
assistance payment. A mental health practitioner performing school social work services
under this section must provide services within the mental health practitioner's licensure
scope of practice, if applicable, and within the mental health practitioner scope of practice
under section 245I.04, subdivision 5.
new text end

new text begin (j) Notwithstanding Minnesota Rules, part 9505.0371, a special education evaluation,
individualized education program, or individual family service plan may be used to determine
medical necessity and eligibility for school social work services under paragraph (i) instead
of a diagnostic assessment if the special education evaluation, individualized education
program, or individual family service plan includes a sign, symptom, or condition
ICD-10-CM code for the student.
new text end

new text begin (k) A school social worker or school providing mental health services under paragraph
(i) is not required to be certified to provide children's therapeutic services and supports
under section 256B.0943.
new text end

new text begin (l) Covered mental health services provided by a school social worker under paragraph
(i) include but are not limited to:
new text end

new text begin (1) administering and reporting standardized measures;
new text end

new text begin (2) care coordination;
new text end

new text begin (3) children's mental health crisis assistance, planning, and response services;
new text end

new text begin (4) children's mental health clinical care consultation;
new text end

new text begin (5) dialectical behavioral therapy for adolescents;
new text end

new text begin (6) direction of mental health behavioral aides;
new text end

new text begin (7) family psychoeducation;
new text end

new text begin (8) individual, family, and group psychotherapy;
new text end

new text begin (9) mental health behavioral aide services;
new text end

new text begin (10) skills training; and
new text end

new text begin (11) treatment plan development and review.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end