Minnesota Legislature
SF 2670
as introduced - 86th Legislature (2009 - 2010) Posted on 02/16/2010 01:44pm
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A bill for an act
relating to education finance; making the K-12 special education third-party
billing process more cost effective; amending Minnesota Statutes 2008,
section 125A.21, subdivision 2; Minnesota Statutes 2009 Supplement, section
256B.0625, subdivision 26; Laws 2009, chapter 79, article 5, section 60.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2008, section 125A.21, subdivision 2, is amended to
read:
Subd. 2.
Third party reimbursement.
(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
written notice to the enrolled child's parent or legal representative of its intent to seek
reimbursement from medical assistance or MinnesotaCare for the individual education
plan health-related services provided by the district.
(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 individual education plan health-related services provided by the
district;
(2) the right of the parent or legal representative to request a copy of all records
concerning individual education 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 consequencenew text begin , including consent that was initially
given as a part of the application process for MinnesotaCare or medical assistance under
section 256B.0625, subdivision 26new text end .
The written notice shall be provided as part of the written notice required by Code of
Federal Regulations, title 34, section 300.504.
(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 individual education 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 individual education 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 EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2009 Supplement, 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 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 individual education plan 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
individual education plan 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 individual education plan
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 individual education plan 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. 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 deleted text begin thedeleted text end new text begin anew text end final ratenew text begin that has been established prior to April 1. If the final rate
is set after April 1, the school district has 120 days to appeal the final ratenew text end . 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 individual
education plan 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 individual education plan 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 plan. 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 plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for rates set after April 1, 2010.
new text end
Sec. 3.
Laws 2009, chapter 79, article 5, section 60, is amended to read:
Sec. 60.
Minnesota Statutes 2008, section 256L.05, is amended by adding a
subdivision to read:
Subd. 1c.
Open enrollment and streamlined application and enrollment
process.
(a) The commissioner and local agencies working in partnership must develop a
streamlined and efficient application and enrollment process for medical assistance and
MinnesotaCare enrollees that meets the criteria specified in this subdivision.
(b) The commissioners of human services and education shall provide
recommendations to the legislature by January 15, 2010, on the creation of an open
enrollment process for medical assistance and MinnesotaCare that is coordinated with
the public education system. The recommendations must:
(1) be developed in consultation with medical assistance and MinnesotaCare
enrollees and representatives from organizations that advocate on behalf of children and
families, low-income persons and minority populations, counties, school administrators
and nurses, health plans, and health care providers;
(2) be based on enrollment and renewal procedures best practices, including express
lane eligibility as required under subdivision 1d;
(3) simplify the enrollment and renewal processes wherever possible; deleted text begin and
deleted text end
(4) establish a process:
(i) to disseminate information on medical assistance and MinnesotaCare to all
children in the public education system, including prekindergarten programs; and
(ii) for the commissioner of human services to enroll children and other household
members who are eligiblenew text begin ; and
new text end
new text begin (5) require the enrollment forms to contain authorization for the consent for coverage
and payment required under section 125A.21new text end .
The commissioner of human services in coordination with the commissioner of
education shall implement an open enrollment process by August 1, 2010, to be effective
beginning with the 2010-2011 school year.
(c) The commissioner and local agencies shall develop an online application process
for medical assistance and MinnesotaCare.
(d) The commissioner shall develop an application that is easily understandable
and does not exceed four pages in length.
(e) The commissioner of human services shall present to the legislature, by January
15, 2010, an implementation plan for the open enrollment period and online application
process.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2010, or upon federal
approval, which must be requested by the commissioner, whichever is later.
new text end
Sec. 4. new text begin INITIAL AND CONTINUING WAIVER; THIRD-PARTY BILLING.
new text end
new text begin
The commissioner of human services must summarize and document the prior
efforts of school districts to secure reimbursement from legally liable third parties and
request an initial and continuing waiver from the Centers for Medicare and Medicaid
Services to allow the cost-effective billing of medical assistance for covered services that
are not reimbursed by other legally liable third parties.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end