as introduced - 90th Legislature (2017 - 2018) Posted on 03/23/2017 04:34pm
|Introduction||Posted on 02/16/2017|
A bill for an act
relating to education; third-party reimbursement for special education evaluation;
amending Minnesota Statutes 2016, sections 125A.21, subdivision 2; 125A.74,
subdivision 1; 256B.0625, subdivision 26.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2016, section 125A.21, subdivision 2, is amended to read:
(a) Beginning July 1, 2000, districts shall seek
reimbursement from insurers and similar third parties for the cost of services provided by
the district whenever the services provided by the district are otherwise covered by the
child's health coverage. Districts shall request, but may not require, the child's family to
provide information about the child's health coverage when a child with a disability begins
to receive services from the district of a type that may be reimbursable, and shall request,
but may not require, updated information after that as needed.
(b) For children enrolled in medical assistance under chapter 256B or MinnesotaCare
under chapter 256L who have no other health coverage, a district shall provide an initial
and annual written notice to the enrolled child's parent or legal representative of its intent
to seek reimbursement from medical assistance or MinnesotaCare fornew text beginnew text end
new text beginnew text end the individualized education program new text beginnew text endor
individualized family service plannew text beginnew text end
new text beginnew text end health-related services provided by the districtnew text beginnew text end.
The initial notice must give the child's parent or legal representative the right to request a
copy of the child's education records on the health-related services that the district provided
to the child and disclosed to a third-party payer.
(c) The district shall give the parent or legal representative annual written notice of:
(1) the district's intent to seek reimbursement from medical assistance or MinnesotaCare
for new text beginnew text endindividualized education programnew text beginnew text end or
individualized family service plannew text beginnew text end health-related services provided by the
districtnew text beginnew text end;
(2) the right of the parent or legal representative to request a copy of all records
concerning individualized education program or individualized family service plan
health-related services disclosed by the district to any third party; and
(3) the right of the parent or legal representative to withdraw consent for disclosure of
a child's records at any time without consequence.
The written notice shall be provided as part of the written notice required by Code of Federal
Regulations, title 34, section 300.504 or 303.520. The district must ensure that the parent
of a child with a disability is given notice, in understandable language, of federal and state
procedural safeguards available to the parent under this paragraph and paragraph (b).
(d) In order to access the private health care coverage of a child who is covered by private
health care coverage in whole or in part, a district must:
(1) obtain annual written informed consent from the parent or legal representative, in
compliance with subdivision 5; and
(2) inform the parent or legal representative that a refusal to permit the district or state
Medicaid agency to access their private health care coverage does not relieve the district of
its responsibility to provide all services necessary to provide free and appropriate public
education at no cost to the parent or legal representative.
(e) If the commissioner of human services obtains federal approval to exempt covered
individualized education program or individualized family service plan health-related
services from the requirement that private health care coverage refuse payment before
medical assistance may be billed, paragraphs (b), (c), and (d) shall also apply to students
with a combination of private health care coverage and health care coverage through medical
assistance or MinnesotaCare.
(f) In the event that Congress or any federal agency or the Minnesota legislature or any
state agency establishes lifetime limits, limits for any health care services, cost-sharing
provisions, or otherwise provides that individualized education program or individualized
family service plan health-related services impact benefits for persons enrolled in medical
assistance or MinnesotaCare, the amendments to this subdivision adopted in 2002 are
repealed on the effective date of any federal or state law or regulation that imposes the
limits. In that event, districts must obtain informed consent consistent with this subdivision
as it existed prior to the 2002 amendments and subdivision 5, before seeking reimbursement
for children enrolled in medical assistance under chapter 256B or MinnesotaCare under
chapter 256L who have no other health care coverage.
new text begin new text end
Minnesota Statutes 2016, section 125A.74, subdivision 1, is amended to read:
A district may enroll as a provider in the medical assistance
program and receive medical assistance payments for covered new text beginnew text endspecial
education services provided to persons eligible for medical assistance under chapter 256B.
To receive medical assistance payments, the district must pay the nonfederal share of medical
assistance services provided according to section 256B.0625, subdivision 26, and comply
with relevant provisions of state and federal statutes and regulations governing the medical
new text begin new text end
Minnesota Statutes 2016, section 256B.0625, subdivision 26, is amended to read:
(a) Medical assistance covers new text beginnew text endmedical services identified in a recipient's
individualized education program new text beginnew text endand 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 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 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 Minnesota Board of Teaching as an educational speech-language
(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 new text end