SF 969

as introduced - 88th Legislature (2013 - 2014) Posted on 03/05/2013 08:32am

A bill for an act
relating to education; authorizing medical assistance reimbursement for school
social work and school psychological services included in a child's individualized
education program; amending Minnesota Statutes 2012, section 256B.0625,
subdivision 26.

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

Section 1.

Minnesota Statutes 2012, section 256B.0625, subdivision 26, is amended to
read:

Subd. 26.

Special education services.

(a) Medical assistance covers medical
services identified in a recipient's individualized education program 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 orders,
documentation, personnel qualifications, and prior authorization requirements. new text begin In order
to receive reimbursement for the individual education program health-related mental
health services, school districts may use the evaluation or assessment used for emotional
or behavioral disorder, as defined in Minnesota Rules, part 3525.1329, in lieu of the
diagnostic assessment required as part of the children's therapeutic services and supports.
School districts may use the individualized education program, behavior intervention plan,
and student progress reviews in lieu of the individual treatment plan, crisis plan, and
90-day review required by children's therapeutic services and supports. new text end 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 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, as defined in the practice of social work in
section 148E.010, subdivision 15, and provided as an individualized education program
health-related service, are eligible for medical assistance payment. School social work
services include those services provided to assist the student or family members in
understanding the nature of the disability, the special needs of the student, and the student's
development. The services, as identified and described in the individualized education
program include, but are not limited to: evaluations; social work services provided to
children and youth with social, psychological, or behavioral problems; and unscheduled
activities for the purpose of resolving an immediate crisis situation. School social work
services are provided to youth and children with conditions that may impair or limit
behavioral, cognitive, emotional, mental, or social functioning. School social work
service, as an individualized education program health-related service, shall be billed as a
separate service and not require children's therapeutic services and supports certification.
School social work services shall be provided by a social worker that possesses both a
social work license from the Board of Social Work and a school social work license
from the Board of Teaching.
new text end

new text begin (j) School psychological services, as defined in Minnesota Rules, part 8710.6200,
and provided as an individualized education program health-related service, are eligible
for medical assistance payment. School psychological services include those services
provided to assist the student or family members in understanding the nature of the
disability, the special needs of the student, and the student's development. The services,
as identified and described in the individualized education program include, but are
not limited to: evaluations; psychological services provided to children and youth
with social, psychological, or behavioral problems; and unscheduled activities for the
purpose of resolving an immediate crisis situation. School psychological services are
provided to youth and children with conditions that may impair or limit behavioral,
cognitive, emotional, mental, or social functioning. School psychological service, as an
individualized education program health-related service, shall be billed as a separate
service and not require children's therapeutic services and supports certification. School
psychological services shall be provided by a school psychologist that possesses a school
psychological license from the Board of Teaching.
new text end