HF 3070

as introduced - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; modifying consent 
  1.3             requirements for billing medical assistance and 
  1.4             MinnesotaCare for covered individual education plan 
  1.5             services; amending Minnesota Statutes 2000, sections 
  1.6             125A.21, subdivision 2; 256B.0625, subdivision 26; 
  1.7             Minnesota Statutes 2001 Supplement, sections 
  1.8             256B.0625, subdivision 19a; 256B.0627, subdivision 1. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2000, section 125A.21, 
  1.11  subdivision 2, is amended to read: 
  1.12     Subd. 2.  [THIRD-PARTY REIMBURSEMENT.] (a) Beginning July 
  1.13  1, 2000, districts shall seek reimbursement from insurers and 
  1.14  similar third parties for the cost of services provided by the 
  1.15  district whenever the services provided by the district are 
  1.16  otherwise covered by the child's health coverage.  Districts 
  1.17  shall request, but may not require, the child's family to 
  1.18  provide information about the child's health coverage when a 
  1.19  child with a disability begins to receive services from the 
  1.20  district of a type that may be reimbursable, and shall request, 
  1.21  but may not require, updated information after that as needed.  
  1.22     (b) For children eligible for medical assistance under 
  1.23  section 256B.055 or MinnesotaCare under chapter 256L and who 
  1.24  have no other health coverage, districts shall provide a written 
  1.25  notice to the enrolled child's parent or legal representative, 
  1.26  or its intent to seek reimbursement from medical assistance or 
  1.27  MinnesotaCare for the eligible health care services provided in 
  2.1   school. 
  2.2      (c) The district shall give the parent, legal 
  2.3   representative, or surrogate parent annual written notice of: 
  2.4      (1) the district's intent to bill medical assistance or 
  2.5   MinnesotaCare for medicaid covered services provided by the 
  2.6   district; 
  2.7      (2) the parent's right to request a copy of all records 
  2.8   disclosed by the district to any third party; and 
  2.9      (3) the parent's right to withdraw consent for billing of 
  2.10  medicaid or disclosure of a child's records at any time without 
  2.11  consequence. 
  2.12  The notice required in paragraph (c) shall be provided as part 
  2.13  of the written notice required by the Code of Federal 
  2.14  Regulations, title 34, section 300.503. 
  2.15     (d) For children whose health care is paid by private 
  2.16  insurance, in whole or in part, districts shall request, but may 
  2.17  not require, the child's parent or legal representative to sign 
  2.18  a consent form, permitting the school district to apply for and 
  2.19  receive reimbursement directly from the insurer or other similar 
  2.20  third party, to the extent permitted by the insurer or other 
  2.21  third party and subject to their networking credentialing, prior 
  2.22  authorization, and determination of medical necessity criteria.  
  2.23     (e) If the commissioner of human services obtains federal 
  2.24  approval to exempt covered individual education plan health care 
  2.25  services from the requirement that private health care coverage 
  2.26  must refuse payment before medical assistance may be billed, 
  2.27  then paragraphs (b) and (c) shall also apply to students with a 
  2.28  combination of private health care coverage and health care 
  2.29  coverage through medical assistance or MinnesotaCare. 
  2.30     [EFFECTIVE DATE.] This section is effective the day 
  2.31  following final enactment. 
  2.32     Sec. 2.  Minnesota Statutes 2001 Supplement, section 
  2.33  256B.0625, subdivision 19a, is amended to read: 
  2.34     Subd. 19a.  [PERSONAL CARE ASSISTANT SERVICES.] Medical 
  2.35  assistance covers personal care assistant services in a 
  2.36  recipient's home.  To qualify for personal care assistant 
  3.1   services, recipients or responsible parties must be able to 
  3.2   identify the recipient's needs, direct and evaluate task 
  3.3   accomplishment, and provide for health and safety.  Approved 
  3.4   hours may be used outside the home when normal life activities 
  3.5   take them outside the home.  To use personal care assistant 
  3.6   services at school, the recipient or responsible party must 
  3.7   provide written authorization in the care plan identifying the 
  3.8   chosen provider and the daily amount of services to be used at 
  3.9   school.  Total hours for services, whether actually performed 
  3.10  inside or outside the recipient's home, cannot exceed that which 
  3.11  is otherwise allowed for personal care assistant services in an 
  3.12  in-home setting according to section 256B.0627.  Medical 
  3.13  assistance does not cover personal care assistant services for 
  3.14  residents of a hospital, nursing facility, intermediate care 
  3.15  facility, health care facility licensed by the commissioner of 
  3.16  health, or unless a resident who is otherwise eligible is on 
  3.17  leave from the facility and the facility either pays for the 
  3.18  personal care assistant services or forgoes the facility per 
  3.19  diem for the leave days that personal care assistant services 
  3.20  are used.  All personal care assistant services must be provided 
  3.21  according to section 256B.0627.  Personal care assistant 
  3.22  services may not be reimbursed if the personal care assistant is 
  3.23  the spouse or legal guardian of the recipient or the parent of a 
  3.24  recipient under age 18, or the responsible party or the foster 
  3.25  care provider of a recipient who cannot direct the recipient's 
  3.26  own care unless, in the case of a foster care provider, a county 
  3.27  or state case manager visits the recipient as needed, but not 
  3.28  less than every six months, to monitor the health and safety of 
  3.29  the recipient and to ensure the goals of the care plan are met.  
  3.30  Parents of adult recipients, adult children of the recipient or 
  3.31  adult siblings of the recipient may be reimbursed for personal 
  3.32  care assistant services, if they are granted a waiver under 
  3.33  section 256B.0627.  Notwithstanding the provisions of section 
  3.34  256B.0627, subdivision 4, paragraph (b), clause (4), the 
  3.35  noncorporate legal guardian or conservator of an adult, who is 
  3.36  not the responsible party and not the personal care provider 
  4.1   organization, may be granted a hardship waiver under section 
  4.2   256B.0627, to be reimbursed to provide personal care assistant 
  4.3   services to the recipient, and shall not be considered to have a 
  4.4   service provider interest for purposes of participation on the 
  4.5   screening team under section 256B.092, subdivision 7. 
  4.6      [EFFECTIVE DATE.] This section is effective the day 
  4.7   following final enactment. 
  4.8      Sec. 3.  Minnesota Statutes 2000, section 256B.0625, 
  4.9   subdivision 26, is amended to read: 
  4.10     Subd. 26.  [SPECIAL EDUCATION SERVICES.] (a) Medical 
  4.11  assistance covers medical services identified in a recipient's 
  4.12  individualized education plan and covered under the medical 
  4.13  assistance state plan.  Covered services include occupational 
  4.14  therapy, physical therapy, speech-language therapy, clinical 
  4.15  psychological services, nursing services, school psychological 
  4.16  services, school social work services, personal care assistants 
  4.17  serving as management aides, assistive technology devices, 
  4.18  transportation services, health assessments, and other services 
  4.19  covered under the medical assistance state plan.  Mental health 
  4.20  services eligible for medical assistance reimbursement must be 
  4.21  provided or coordinated through a children's mental health 
  4.22  collaborative where a collaborative exists if the child is 
  4.23  included in the collaborative operational target population.  
  4.24  The provision or coordination of services does not require that 
  4.25  the individual education plan be developed by the collaborative. 
  4.26     The services may be provided by a Minnesota school district 
  4.27  that is enrolled as a medical assistance provider or its 
  4.28  subcontractor, and only if the services meet all the 
  4.29  requirements otherwise applicable if the service had been 
  4.30  provided by a provider other than a school district, in the 
  4.31  following areas:  medical necessity, physician's orders, 
  4.32  documentation, personnel qualifications, and prior authorization 
  4.33  requirements.  The nonfederal share of costs for services 
  4.34  provided under this subdivision is the responsibility of the 
  4.35  local school district as provided in section 125A.74.  Services 
  4.36  listed in a child's individual education plan are eligible for 
  5.1   medical assistance reimbursement only if those services meet 
  5.2   criteria for federal financial participation under the Medicaid 
  5.3   program.  
  5.4      (b) Approval of health-related services for inclusion in 
  5.5   the individual education plan does not require prior 
  5.6   authorization for purposes of reimbursement under this chapter.  
  5.7   The commissioner may require physician review and approval of 
  5.8   the plan not more than once annually or upon any modification of 
  5.9   the individual education plan that reflects a change in 
  5.10  health-related services. 
  5.11     (c) Services of a speech-language pathologist provided 
  5.12  under this section are covered notwithstanding Minnesota Rules, 
  5.13  part 9505.0390, subpart 1, item L, if the person: 
  5.14     (1) holds a masters degree in speech-language pathology; 
  5.15     (2) is licensed by the Minnesota board of teaching as an 
  5.16  educational speech-language pathologist; and 
  5.17     (3) either has a certificate of clinical competence from 
  5.18  the American Speech and Hearing Association, has completed the 
  5.19  equivalent educational requirements and work experience 
  5.20  necessary for the certificate or has completed the academic 
  5.21  program and is acquiring supervised work experience to qualify 
  5.22  for the certificate. 
  5.23     (d) Medical assistance coverage for medically necessary 
  5.24  services provided under other subdivisions in this section may 
  5.25  not be denied solely on the basis that the same or similar 
  5.26  services are covered under this subdivision. 
  5.27     (e) The commissioner shall develop and implement package 
  5.28  rates, bundled rates, or per diem rates for special education 
  5.29  services under which separately covered services are grouped 
  5.30  together and billed as a unit in order to reduce administrative 
  5.31  complexity.  
  5.32     (f) The commissioner shall develop a cost-based payment 
  5.33  structure for payment of these services.  
  5.34     (g) Effective July 1, 2000, medical assistance services 
  5.35  provided under an individual education plan or an individual 
  5.36  family service plan by local school districts shall not count 
  6.1   against medical assistance authorization thresholds for that 
  6.2   child. 
  6.3      (h) Nursing services as defined in section 148.171, 
  6.4   subdivision 15, are eligible for medical assistance payment. 
  6.5      (i) By July 1, 2003, the commissioner shall develop and 
  6.6   implement a fixed billing process for special education 
  6.7   transportation services on a per-trip or per-day rate based on 
  6.8   actual cost data. 
  6.9      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
  6.10     Sec. 4.  Minnesota Statutes 2001 Supplement, section 
  6.11  256B.0627, subdivision 1, is amended to read: 
  6.12     Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
  6.13  living" includes eating, toileting, grooming, dressing, bathing, 
  6.14  transferring, mobility, and positioning.  
  6.15     (b) "Assessment" means a review and evaluation of a 
  6.16  recipient's need for home care services conducted in person.  
  6.17  Assessments for private duty nursing shall be conducted by a 
  6.18  registered private duty nurse.  Assessments for home health 
  6.19  agency services shall be conducted by a home health agency 
  6.20  nurse.  Assessments for personal care assistant services shall 
  6.21  be conducted by the county public health nurse or a certified 
  6.22  public health nurse under contract with the county.  A 
  6.23  face-to-face assessment must include:  documentation of health 
  6.24  status, determination of need, evaluation of service 
  6.25  effectiveness, identification of appropriate services, service 
  6.26  plan development or modification, coordination of services, 
  6.27  referrals and follow-up to appropriate payers and community 
  6.28  resources, completion of required reports, recommendation of 
  6.29  service authorization, and consumer education.  Once the need 
  6.30  for personal care assistant services is determined under this 
  6.31  section, the county public health nurse or certified public 
  6.32  health nurse under contract with the county is responsible for 
  6.33  communicating this recommendation to the commissioner and the 
  6.34  recipient.  A face-to-face assessment for personal care 
  6.35  assistant services is conducted on those recipients who have 
  6.36  never had a county public health nurse assessment.  A 
  7.1   face-to-face assessment must occur at least annually or when 
  7.2   there is a significant change in the recipient's condition or 
  7.3   when there is a change in the need for personal care assistant 
  7.4   services.  A service update may substitute for the annual 
  7.5   face-to-face assessment when there is not a significant change 
  7.6   in recipient condition or a change in the need for personal care 
  7.7   assistant service.  A service update or review for temporary 
  7.8   increase includes a review of initial baseline data, evaluation 
  7.9   of service effectiveness, redetermination of service need, 
  7.10  modification of service plan and appropriate referrals, update 
  7.11  of initial forms, obtaining service authorization, and on going 
  7.12  consumer education.  Assessments for medical assistance home 
  7.13  care services for mental retardation or related conditions and 
  7.14  alternative care services for developmentally disabled home and 
  7.15  community-based waivered recipients may be conducted by the 
  7.16  county public health nurse to ensure coordination and avoid 
  7.17  duplication.  Assessments must be completed on forms provided by 
  7.18  the commissioner within 30 days of a request for home care 
  7.19  services by a recipient or responsible party. 
  7.20     (c) "Care plan" means a written description of personal 
  7.21  care assistant services developed by the qualified professional 
  7.22  or the recipient's physician with the recipient or responsible 
  7.23  party to be used by the personal care assistant with a copy 
  7.24  provided to the recipient or responsible party. 
  7.25     (d) "Complex and regular private duty nursing care" means: 
  7.26     (1) complex care is private duty nursing provided to 
  7.27  recipients who are ventilator dependent or for whom a physician 
  7.28  has certified that were it not for private duty nursing the 
  7.29  recipient would meet the criteria for inpatient hospital 
  7.30  intensive care unit (ICU) level of care; and 
  7.31     (2) regular care is private duty nursing provided to all 
  7.32  other recipients. 
  7.33     (e) "Health-related functions" means functions that can be 
  7.34  delegated or assigned by a licensed health care professional 
  7.35  under state law to be performed by a personal care attendant. 
  7.36     (f) "Home care services" means a health service, determined 
  8.1   by the commissioner as medically necessary, that is ordered by a 
  8.2   physician and documented in a service plan that is reviewed by 
  8.3   the physician at least once every 60 days for the provision of 
  8.4   home health services, or private duty nursing, or at least once 
  8.5   every 365 days for personal care.  Home care services are 
  8.6   provided to the recipient at the recipient's residence that is a 
  8.7   place other than a hospital or long-term care facility or as 
  8.8   specified in section 256B.0625.  
  8.9      (g) "Instrumental activities of daily living" includes meal 
  8.10  planning and preparation, managing finances, shopping for food, 
  8.11  clothing, and other essential items, performing essential 
  8.12  household chores, communication by telephone and other media, 
  8.13  and getting around and participating in the community. 
  8.14     (h) "Medically necessary" has the meaning given in 
  8.15  Minnesota Rules, parts 9505.0170 to 9505.0475.  
  8.16     (i) "Personal care assistant" means a person who:  
  8.17     (1) is at least 18 years old, except for persons 16 to 18 
  8.18  years of age who participated in a related school-based job 
  8.19  training program or have completed a certified home health aide 
  8.20  competency evaluation; 
  8.21     (2) is able to effectively communicate with the recipient 
  8.22  and personal care provider organization; 
  8.23     (3) effective July 1, 1996, has completed one of the 
  8.24  training requirements as specified in Minnesota Rules, part 
  8.25  9505.0335, subpart 3, items A to D; 
  8.26     (4) has the ability to, and provides covered personal care 
  8.27  assistant services according to the recipient's care plan, 
  8.28  responds appropriately to recipient needs, and reports changes 
  8.29  in the recipient's condition to the supervising qualified 
  8.30  professional or physician; 
  8.31     (5) is not a consumer of personal care assistant services; 
  8.32  and 
  8.33     (6) is subject to criminal background checks and procedures 
  8.34  specified in section 245A.04.  
  8.35     (j) "Personal care provider organization" means an 
  8.36  organization enrolled to provide personal care assistant 
  9.1   services under the medical assistance program that complies with 
  9.2   the following:  (1) owners who have a five percent interest or 
  9.3   more, and managerial officials are subject to a background study 
  9.4   as provided in section 245A.04.  This applies to currently 
  9.5   enrolled personal care provider organizations and those agencies 
  9.6   seeking enrollment as a personal care provider organization.  An 
  9.7   organization will be barred from enrollment if an owner or 
  9.8   managerial official of the organization has been convicted of a 
  9.9   crime specified in section 245A.04, or a comparable crime in 
  9.10  another jurisdiction, unless the owner or managerial official 
  9.11  meets the reconsideration criteria specified in section 245A.04; 
  9.12  (2) the organization must maintain a surety bond and liability 
  9.13  insurance throughout the duration of enrollment and provides 
  9.14  proof thereof.  The insurer must notify the department of human 
  9.15  services of the cancellation or lapse of policy; and (3) the 
  9.16  organization must maintain documentation of services as 
  9.17  specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
  9.18  as evidence of compliance with personal care assistant training 
  9.19  requirements. 
  9.20     (k) "Responsible party" means an individual residing with a 
  9.21  recipient of personal care assistant services who is capable of 
  9.22  providing the supportive care necessary to assist the recipient 
  9.23  to live in the community, is at least 18 years old, and is not a 
  9.24  personal care assistant.  Responsible parties who are parents of 
  9.25  minors or guardians of minors or incapacitated persons may 
  9.26  delegate the responsibility to another adult during a temporary 
  9.27  absence of at least 24 hours but not more than six months.  The 
  9.28  person delegated as a responsible party must be able to meet the 
  9.29  definition of responsible party, except that the delegated 
  9.30  responsible party is required to reside with the recipient only 
  9.31  while serving as the responsible party.  Foster care license 
  9.32  holders may be designated the responsible party for residents of 
  9.33  the foster care home if case management is provided as required 
  9.34  in section 256B.0625, subdivision 19a.  For persons who, as of 
  9.35  April 1, 1992, are sharing personal care assistant services in 
  9.36  order to obtain the availability of 24-hour coverage, an 
 10.1   employee of the personal care provider organization may be 
 10.2   designated as the responsible party if case management is 
 10.3   provided as required in section 256B.0625, subdivision 19a. 
 10.4   Recipients receiving personal care services under section 
 10.5   256B.0625, subdivision 26, may have an appropriate district 
 10.6   staff person who is not providing personal care services 
 10.7   designated as the responsible party during school hours. 
 10.8      (l) "Service plan" means a written description of the 
 10.9   services needed based on the assessment developed by the nurse 
 10.10  who conducts the assessment together with the recipient or 
 10.11  responsible party.  The service plan shall include a description 
 10.12  of the covered home care services, frequency and duration of 
 10.13  services, and expected outcomes and goals.  The recipient and 
 10.14  the provider chosen by the recipient or responsible party must 
 10.15  be given a copy of the completed service plan within 30 calendar 
 10.16  days of the request for home care services by the recipient or 
 10.17  responsible party. 
 10.18     (m) "Skilled nurse visits" are provided in a recipient's 
 10.19  residence under a plan of care or service plan that specifies a 
 10.20  level of care which the nurse is qualified to provide.  These 
 10.21  services are: 
 10.22     (1) nursing services according to the written plan of care 
 10.23  or service plan and accepted standards of medical and nursing 
 10.24  practice in accordance with chapter 148; 
 10.25     (2) services which due to the recipient's medical condition 
 10.26  may only be safely and effectively provided by a registered 
 10.27  nurse or a licensed practical nurse; 
 10.28     (3) assessments performed only by a registered nurse; and 
 10.29     (4) teaching and training the recipient, the recipient's 
 10.30  family, or other caregivers requiring the skills of a registered 
 10.31  nurse or licensed practical nurse. 
 10.32     (n) "Telehomecare" means the use of telecommunications 
 10.33  technology by a home health care professional to deliver home 
 10.34  health care services, within the professional's scope of 
 10.35  practice, to a patient located at a site other than the site 
 10.36  where the practitioner is located. 
 11.1      [EFFECTIVE DATE.] This section is effective the day 
 11.2   following final enactment. 
 11.3      Sec. 5.  [CONTINGENT REPEALER.] 
 11.4      (a) In the event that Congress, any federal agency, the 
 11.5   Minnesota legislature, or any state agency establishes lifetime 
 11.6   limits, limits for any health care services, cost-sharing 
 11.7   provisions, or otherwise provides that individual education plan 
 11.8   health services effect benefits for persons enrolled in medical 
 11.9   assistance or MinnesotaCare, the section 1 amendments to 
 11.10  Minnesota Statutes, section 125A.21, subdivision 2, are repealed 
 11.11  on the effective date of any federal or state law that imposes 
 11.12  the limits. 
 11.13     (b) In that event, districts must seek informed consent 
 11.14  consistent with section 1, paragraph (d), and Minnesota 
 11.15  Statutes, section 125A.21, subdivision 5, before seeking 
 11.16  reimbursement for children eligible for medical assistance under 
 11.17  Minnesota Statutes, section 256B.055, or MinnesotaCare under 
 11.18  Minnesota Statutes, chapter 256L, and who have no other health 
 11.19  care coverage. 
 11.20     [EFFECTIVE DATE.] This section is effective July 1, 2002.