1.1                          A bill for an act 
  1.2             relating to education; modifying provisions relating 
  1.3             to medical assistance reimbursement for special 
  1.4             education services; amending Minnesota Statutes 1998, 
  1.5             sections 125A.08; 125A.21, subdivision 1; 125A.74, 
  1.6             subdivisions 1 and 2; 256B.0625, subdivision 26; and 
  1.7             256B.69, by adding a subdivision; proposing coding for 
  1.8             new law in Minnesota Statutes, chapter 214. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 1998, section 125A.08, is 
  1.11  amended to read: 
  1.12     125A.08 [SCHOOL DISTRICT OBLIGATIONS.] 
  1.13     (a) As defined in this section, to the extent required by 
  1.14  federal law as of July 1, ~~1999~~ 2000, every district must ensure 
  1.15  the following: 
  1.16     (1) all students with disabilities are provided the special 
  1.17  instruction and services which are appropriate to their needs.  
  1.18  Where the individual education plan team has determined 
  1.19  appropriate goals and objectives based on the student's needs, 
  1.20  including the extent to which the student can be included in the 
  1.21  least restrictive environment, and where there are essentially 
  1.22  equivalent and effective instruction, related services, or 
  1.23  assistive technology devices available to meet the student's 
  1.24  needs, cost to the district may be among the factors considered 
  1.25  by the team in choosing how to provide the appropriate services, 
  1.26  instruction, or devices that are to be made part of the 
  1.27  student's individual education plan.  The individual education 
  2.1   plan team shall consider and may authorize services covered by 
  2.2   medical assistance according to section 256B.0625, subdivision 
  2.3   26.  The student's needs and the special education instruction 
  2.4   and services to be provided must be agreed upon through the 
  2.5   development of an individual education plan.  The plan must 
  2.6   address the student's need to develop skills to live and work as 
  2.7   independently as possible within the community.  By grade 9 or 
  2.8   age 14, the plan must address the student's needs for transition 
  2.9   from secondary services to post-secondary education and 
  2.10  training, employment, community participation, recreation, and 
  2.11  leisure and home living.  In developing the plan, districts must 
  2.12  inform parents of the full range of transitional goals and 
  2.13  related services that should be considered.  The plan must 
  2.14  include a statement of the needed transition services, including 
  2.15  a statement of the interagency responsibilities or linkages or 
  2.16  both before secondary services are concluded; 
  2.17     (2) children with a disability under age five and their 
  2.18  families are provided special instruction and services 
  2.19  appropriate to the child's level of functioning and needs; 
  2.20     (3) children with a disability and their parents or 
  2.21  guardians are guaranteed procedural safeguards and the right to 
  2.22  participate in decisions involving identification, assessment 
  2.23  including assistive technology assessment, and educational 
  2.24  placement of children with a disability; 
  2.25     (4) eligibility and needs of children with a disability are 
  2.26  determined by an initial assessment or reassessment, which may 
  2.27  be completed using existing data under United States Code, title 
  2.28  20, section 33, et seq.; 
  2.29     (5) to the maximum extent appropriate, children with a 
  2.30  disability, including those in public or private institutions or 
  2.31  other care facilities, are educated with children who are not 
  2.32  disabled, and that special classes, separate schooling, or other 
  2.33  removal of children with a disability from the regular 
  2.34  educational environment occurs only when and to the extent that 
  2.35  the nature or severity of the disability is such that education 
  2.36  in regular classes with the use of supplementary services cannot 
  3.1   be achieved satisfactorily; 
  3.2      (6) in accordance with recognized professional standards, 
  3.3   testing and evaluation materials, and procedures used for the 
  3.4   purposes of classification and placement of children with a 
  3.5   disability are selected and administered so as not to be 
  3.6   racially or culturally discriminatory; and 
  3.7      (7) the rights of the child are protected when the parents 
  3.8   or guardians are not known or not available, or the child is a 
  3.9   ward of the state. 
  3.10     (b) For paraprofessionals employed to work in programs for 
  3.11  students with disabilities, the school board in each district 
  3.12  shall ensure that: 
  3.13     (1) before or immediately upon employment, each 
  3.14  paraprofessional develops sufficient knowledge and skills in 
  3.15  emergency procedures, building orientation, roles and 
  3.16  responsibilities, confidentiality, vulnerability, and 
  3.17  reportability, among other things, to begin meeting the needs of 
  3.18  the students with whom the paraprofessional works; 
  3.19     (2) annual training opportunities are available to enable 
  3.20  the paraprofessional to continue to further develop the 
  3.21  knowledge and skills that are specific to the students with whom 
  3.22  the paraprofessional works, including understanding 
  3.23  disabilities, following lesson plans, and implementing follow-up 
  3.24  instructional procedures and activities; and 
  3.25     (3) a districtwide process obligates each paraprofessional 
  3.26  to work under the ongoing direction of a licensed teacher and, 
  3.27  where appropriate and possible, the supervision of a school 
  3.28  nurse. 
  3.29     Sec. 2.  Minnesota Statutes 1998, section 125A.21, 
  3.30  subdivision 1, is amended to read: 
  3.31     Subdivision 1.  [OBLIGATION TO PAY.] Nothing in sections 
  3.32  125A.03 to 125A.24 and 125A.65 relieves an insurer or similar 
  3.33  third party from an otherwise valid obligation to pay, or 
  3.34  changes the validity of an obligation to pay, for services 
  3.35  rendered to a child with a disability, and the child's family.  
  3.36  A school district shall pay the nonfederal share of medical 
  4.1   assistance services provided according to section 256B.0625, 
  4.2   subdivision 26.  Eligible expenditures must not be made from 
  4.3   federal funds or funds used to match other federal funds.  Any 
  4.4   federal disallowances are the responsibility of the school 
  4.5   district.  A school district may pay or reimburse copayments, 
  4.6   coinsurance, deductibles, and other enrollee cost-sharing 
  4.7   amounts, on behalf of the student or family, in connection with 
  4.8   health and related services provided under an individual 
  4.9   educational plan.  
  4.10     Sec. 3.  Minnesota Statutes 1998, section 125A.74, 
  4.11  subdivision 1, is amended to read: 
  4.12     Subdivision 1.  [ELIGIBILITY.] A district may enroll as a 
  4.13  provider in the medical assistance program and receive medical 
  4.14  assistance payments for covered special education services 
  4.15  provided to persons eligible for medical assistance under 
  4.16  chapter 256B.  To receive medical assistance payments, the 
  4.17  district must pay the nonfederal share of medical assistance 
  4.18  services provided according to section 256B.0625, subdivision 
  4.19  26, and comply with relevant provisions of state and federal 
  4.20  statutes and regulations governing the medical assistance 
  4.21  program. 
  4.22     Sec. 4.  Minnesota Statutes 1998, section 125A.74, 
  4.23  subdivision 2, is amended to read: 
  4.24     Subd. 2.  [FUNDING.] A district that provides a covered 
  4.25  service to an eligible person and complies with relevant 
  4.26  requirements of the medical assistance program is entitled to 
  4.27  receive payment for the ~~service provided, including that~~ portion 
  4.28  of the ~~payment~~ services that will subsequently be reimbursed by 
  4.29  the federal government, in the same manner as other medical 
  4.30  assistance providers.  ~~The school district is not required to~~ 
  4.31  ~~provide matching funds or pay part of the costs of the service,~~ 
  4.32  ~~as long as the rate charged for the service does not exceed~~ 
  4.33  ~~medical assistance limits that apply to all medical assistance~~ 
  4.34  ~~providers.~~ 
  4.35     Sec. 5.  [214.045] [COORDINATION WITH BOARD OF TEACHING.] 
  4.36     The commissioner of health and the health-related licensing 
  5.1   boards must coordinate with the board of teaching when modifying 
  5.2   licensure requirements for regulated persons in order to have 
  5.3   consistent regulatory requirements for personnel who perform 
  5.4   services in schools. 
  5.5      Sec. 6.  Minnesota Statutes 1998, section 256B.0625, 
  5.6   subdivision 26, is amended to read: 
  5.7      Subd. 26.  [SPECIAL EDUCATION SERVICES.] (a) Medical 
  5.8   assistance covers medical services identified in a recipient's 
  5.9   individualized education plan and covered under the medical 
  5.10  assistance state plan.  Covered services include occupational 
  5.11  therapy, physical therapy, speech-language therapy, clinical 
  5.12  psychological services, nursing services, school psychological 
  5.13  services, school social work services, personal care assistants 
  5.14  serving as management aides, assistive technology devices, 
  5.15  transportation services, and other services covered under the 
  5.16  medical assistance state plan.  Mental health services eligible 
  5.17  for medical assistance reimbursement must be provided through a 
  5.18  children's mental health collaborative where a collaborative 
  5.19  exists.  The services may be provided by a Minnesota school 
  5.20  district that is enrolled as a medical assistance provider or 
  5.21  its subcontractor, and only if the services meet all the 
  5.22  requirements otherwise applicable if the service had been 
  5.23  provided by a provider other than a school district, in the 
  5.24  following areas:  medical necessity, physician's orders, 
  5.25  documentation, personnel qualifications, and prior authorization 
  5.26  requirements.  The nonfederal share of costs for services 
  5.27  provided under this subdivision is the responsibility of the 
  5.28  local school district as provided in section 125A.74.  Services 
  5.29  listed in a child's individual education plan are eligible for 
  5.30  medical assistance reimbursement only if those services meet 
  5.31  criteria for federal financial participation under the Medicaid 
  5.32  program.  
  5.33     (b) Approval of health-related services for inclusion in 
  5.34  the individual education plan does not require prior 
  5.35  authorization for purposes of reimbursement under this chapter.  
  5.36  The commissioner may require physician review and approval of 
  6.1   the plan not more than once annually or upon any modification of 
  6.2   the individual education plan that reflects a change in 
  6.3   health-related services. 
  6.4      (c) Services of a speech-language pathologist provided 
  6.5   under this section are covered notwithstanding Minnesota Rules, 
  6.6   part 9505.0390, subpart 1, item L, if the person: 
  6.7      (1) holds a masters degree in speech-language pathology; 
  6.8      (2) is licensed by the Minnesota board of teaching as an 
  6.9   educational speech-language pathologist; and 
  6.10     (3) either has a certificate of clinical competence from 
  6.11  the American Speech and Hearing Association, has completed the 
  6.12  equivalent educational requirements and work experience 
  6.13  necessary for the certificate or has completed the academic 
  6.14  program and is acquiring supervised work experience to qualify 
  6.15  for the certificate. 
  6.16     (d) Medical assistance coverage for medically necessary 
  6.17  services provided under other subdivisions in this section may 
  6.18  not be denied solely on the basis that the same or similar 
  6.19  services are covered under this subdivision. 
  6.20     (e) The commissioner shall develop and implement package 
  6.21  rates, bundled rates, or per diem rates for special education 
  6.22  services under which separately covered services are grouped 
  6.23  together and billed as a unit in order to reduce administrative 
  6.24  complexity.  
  6.25     (f) The commissioner shall develop a cost-based payment 
  6.26  structure for payment of these services.  
  6.27     (g) Effective July 1, 2000, medical assistance services 
  6.28  provided under an individual education plan or an individual 
  6.29  family service plan by local school districts shall not count 
  6.30  against medical assistance authorization thresholds for that 
  6.31  child. 
  6.32     Sec. 7.  Minnesota Statutes 1998, section 256B.69, is 
  6.33  amended by adding a subdivision to read: 
  6.34     Subd. 4b.  [INDIVIDUAL EDUCATION PLAN AND INDIVIDUALIZED 
  6.35  FAMILY SERVICE PLAN SERVICES.] The commissioner shall amend the 
  6.36  federal waiver allowing the state to separate out individual 
  7.1   education plan and individualized family service plan services 
  7.2   for children enrolled in the prepaid medical assistance program 
  7.3   and the MinnesotaCare program.  Effective July 1, 1999, or upon 
  7.4   federal approval, medical assistance coverage of eligible 
  7.5   individual education plan and individualized family service plan 
  7.6   services shall not be included in the capitated services for 
  7.7   children enrolled in health plans through the prepaid medical 
  7.8   assistance program and the MinnesotaCare program.  Upon federal 
  7.9   approval, local school districts shall bill the commissioner for 
  7.10  these services, and claims shall be paid on a fee-for-service 
  7.11  basis. 
  7.12     Sec. 8.  [EXPANSION OF SPECIAL EDUCATION SERVICES.] 
  7.13     The commissioner shall examine opportunities to expand the 
  7.14  scope of providers eligible for reimbursement for medical 
  7.15  assistance services listed in a child's individual education 
  7.16  plan, based on state and federal requirements for provider 
  7.17  qualifications.  The commissioner shall complete these 
  7.18  activities, in consultation with the commissioner of children, 
  7.19  families, and learning, by December 1999 and seek necessary 
  7.20  federal approval. 
  7.21     Sec. 9.  [EFFECTIVE DATE.] 
  7.22     Sections 1 to 4 and 6 are effective July 1, 2000.