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 122A.09, subdivision 4; 125A.08; 125A.21, 
  1.6             subdivision 1; 125A.74, subdivisions 1 and 2; 
  1.7             125A.744, subdivision 3; 125A.76, subdivision 2; 
  1.8             256B.0625, subdivision 26; and 256B.69, by adding a 
  1.9             subdivision; proposing coding for new law in Minnesota 
  1.10            Statutes, chapters 127A; and 214. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1998, section 122A.09, 
  1.13  subdivision 4, is amended to read: 
  1.14     Subd. 4.  [LICENSE AND RULES.] (a) The board must adopt 
  1.15  rules to license public school teachers and interns subject to 
  1.16  chapter 14. 
  1.17     (b) The board must adopt rules requiring a person to 
  1.18  successfully complete a skills examination in reading, writing, 
  1.19  and mathematics as a requirement for initial teacher licensure.  
  1.20  Such rules must require college and universities offering a 
  1.21  board approved teacher preparation program to provide remedial 
  1.22  assistance to persons who did not achieve a qualifying score on 
  1.23  the skills examination, including those for whom English is a 
  1.24  second language. 
  1.25     (c) The board must adopt rules to approve teacher 
  1.26  preparation programs. 
  1.27     (d) The board must provide the leadership and shall adopt 
  1.28  rules for the redesign of teacher education programs to 
  2.1   implement a research based, results-oriented curriculum that 
  2.2   focuses on the skills teachers need in order to be effective.  
  2.3   The board shall implement new systems of teacher preparation 
  2.4   program evaluation to assure program effectiveness based on 
  2.5   proficiency of graduates in demonstrating attainment of program 
  2.6   outcomes. 
  2.7      (e) The board must adopt rules requiring successful 
  2.8   completion of an examination of general pedagogical knowledge 
  2.9   and examinations of licensure-specific teaching skills.  The 
  2.10  rules shall be effective on the dates determined by the board, 
  2.11  but not later than July 1, 1999. 
  2.12     (f) The board must adopt rules requiring teacher educators 
  2.13  to work directly with elementary or secondary school teachers in 
  2.14  elementary or secondary schools to obtain periodic exposure to 
  2.15  the elementary or secondary teaching environment. 
  2.16     (g) The board must grant licenses to interns and to 
  2.17  candidates for initial licenses. 
  2.18     (h) The board must design and implement an assessment 
  2.19  system which requires a candidate for an initial license and 
  2.20  first continuing license to demonstrate the abilities necessary 
  2.21  to perform selected, representative teaching tasks at 
  2.22  appropriate levels. 
  2.23     (i) The board must receive recommendations from local 
  2.24  committees as established by the board for the renewal of 
  2.25  teaching licenses. 
  2.26     (j) The board must grant life licenses to those who qualify 
  2.27  according to requirements established by the board, and suspend 
  2.28  or revoke licenses pursuant to sections 122A.20 and 214.10.  The 
  2.29  board must not establish any expiration date for application for 
  2.30  life licenses.  
  2.31     (k) In adopting rules to license public school teachers who 
  2.32  provide health-related services for disabled children, the board 
  2.33  shall adopt rules consistent with license or registration 
  2.34  requirements of the commissioner of health and the 
  2.35  health-related boards who license personnel who perform similar 
  2.36  services outside of the school. 
  3.1      Sec. 2.  Minnesota Statutes 1998, section 125A.08, is 
  3.2   amended to read: 
  3.3      125A.08 [SCHOOL DISTRICT OBLIGATIONS.] 
  3.4      (a) As defined in this section, to the extent required by 
  3.5   federal law as of July 1, ~~1999~~ 2000, every district must ensure 
  3.6   the following: 
  3.7      (1) all students with disabilities are provided the special 
  3.8   instruction and services which are appropriate to their needs.  
  3.9   Where the individual education plan team has determined 
  3.10  appropriate goals and objectives based on the student's needs, 
  3.11  including the extent to which the student can be included in the 
  3.12  least restrictive environment, and where there are essentially 
  3.13  equivalent and effective instruction, related services, or 
  3.14  assistive technology devices available to meet the student's 
  3.15  needs, cost to the district may be among the factors considered 
  3.16  by the team in choosing how to provide the appropriate services, 
  3.17  instruction, or devices that are to be made part of the 
  3.18  student's individual education plan.  The individual education 
  3.19  plan team shall consider and may authorize services covered by 
  3.20  medical assistance according to section 256B.0625, subdivision 
  3.21  26.  The student's needs and the special education instruction 
  3.22  and services to be provided must be agreed upon through the 
  3.23  development of an individual education plan.  The plan must 
  3.24  address the student's need to develop skills to live and work as 
  3.25  independently as possible within the community.  By grade 9 or 
  3.26  age 14, the plan must address the student's needs for transition 
  3.27  from secondary services to post-secondary education and 
  3.28  training, employment, community participation, recreation, and 
  3.29  leisure and home living.  In developing the plan, districts must 
  3.30  inform parents of the full range of transitional goals and 
  3.31  related services that should be considered.  The plan must 
  3.32  include a statement of the needed transition services, including 
  3.33  a statement of the interagency responsibilities or linkages or 
  3.34  both before secondary services are concluded; 
  3.35     (2) children with a disability under age five and their 
  3.36  families are provided special instruction and services 
  4.1   appropriate to the child's level of functioning and needs; 
  4.2      (3) children with a disability and their parents or 
  4.3   guardians are guaranteed procedural safeguards and the right to 
  4.4   participate in decisions involving identification, assessment 
  4.5   including assistive technology assessment, and educational 
  4.6   placement of children with a disability; 
  4.7      (4) eligibility and needs of children with a disability are 
  4.8   determined by an initial assessment or reassessment, which may 
  4.9   be completed using existing data under United States Code, title 
  4.10  20, section 33, et seq.; 
  4.11     (5) to the maximum extent appropriate, children with a 
  4.12  disability, including those in public or private institutions or 
  4.13  other care facilities, are educated with children who are not 
  4.14  disabled, and that special classes, separate schooling, or other 
  4.15  removal of children with a disability from the regular 
  4.16  educational environment occurs only when and to the extent that 
  4.17  the nature or severity of the disability is such that education 
  4.18  in regular classes with the use of supplementary services cannot 
  4.19  be achieved satisfactorily; 
  4.20     (6) in accordance with recognized professional standards, 
  4.21  testing and evaluation materials, and procedures used for the 
  4.22  purposes of classification and placement of children with a 
  4.23  disability are selected and administered so as not to be 
  4.24  racially or culturally discriminatory; and 
  4.25     (7) the rights of the child are protected when the parents 
  4.26  or guardians are not known or not available, or the child is a 
  4.27  ward of the state. 
  4.28     (b) For paraprofessionals employed to work in programs for 
  4.29  students with disabilities, the school board in each district 
  4.30  shall ensure that: 
  4.31     (1) before or immediately upon employment, each 
  4.32  paraprofessional develops sufficient knowledge and skills in 
  4.33  emergency procedures, building orientation, roles and 
  4.34  responsibilities, confidentiality, vulnerability, and 
  4.35  reportability, among other things, to begin meeting the needs of 
  4.36  the students with whom the paraprofessional works; 
  5.1      (2) annual training opportunities are available to enable 
  5.2   the paraprofessional to continue to further develop the 
  5.3   knowledge and skills that are specific to the students with whom 
  5.4   the paraprofessional works, including understanding 
  5.5   disabilities, following lesson plans, and implementing follow-up 
  5.6   instructional procedures and activities; and 
  5.7      (3) a districtwide process obligates each paraprofessional 
  5.8   to work under the ongoing direction of a licensed teacher and, 
  5.9   where appropriate and possible, the supervision of a school 
  5.10  nurse. 
  5.11     Sec. 3.  Minnesota Statutes 1998, section 125A.21, 
  5.12  subdivision 1, is amended to read: 
  5.13     Subdivision 1.  [OBLIGATION TO PAY.] Nothing in sections 
  5.14  125A.03 to 125A.24 and 125A.65 relieves an insurer or similar 
  5.15  third party from an otherwise valid obligation to pay, or 
  5.16  changes the validity of an obligation to pay, for services 
  5.17  rendered to a child with a disability, and the child's family.  
  5.18  A school district shall pay the nonfederal share of medical 
  5.19  assistance services provided according to section 256B.0625, 
  5.20  subdivision 26.  Eligible expenditures must not be made from 
  5.21  federal funds or funds used to match other federal funds.  Any 
  5.22  federal disallowances are the responsibility of the school 
  5.23  district.  A school district may pay or reimburse copayments, 
  5.24  coinsurance, deductibles, and other enrollee cost-sharing 
  5.25  amounts, on behalf of the student or family, in connection with 
  5.26  health and related services provided under an individual 
  5.27  educational plan.  
  5.28     Sec. 4.  Minnesota Statutes 1998, section 125A.74, 
  5.29  subdivision 1, is amended to read: 
  5.30     Subdivision 1.  [ELIGIBILITY.] A district may enroll as a 
  5.31  provider in the medical assistance program and receive medical 
  5.32  assistance payments for covered special education services 
  5.33  provided to persons eligible for medical assistance under 
  5.34  chapter 256B.  To receive medical assistance payments, the 
  5.35  district must pay the nonfederal share of medical assistance 
  5.36  services provided according to section 256B.0625, subdivision 
  6.1   26, and comply with relevant provisions of state and federal 
  6.2   statutes and regulations governing the medical assistance 
  6.3   program. 
  6.4      Sec. 5.  Minnesota Statutes 1998, section 125A.74, 
  6.5   subdivision 2, is amended to read: 
  6.6      Subd. 2.  [FUNDING.] A district that provides a covered 
  6.7   service to an eligible person and complies with relevant 
  6.8   requirements of the medical assistance program is entitled to 
  6.9   receive payment for the ~~service provided, including that~~ portion 
  6.10  of the ~~payment~~ services that will subsequently be reimbursed by 
  6.11  the federal government, in the same manner as other medical 
  6.12  assistance providers.  ~~The school district is not required to~~ 
  6.13  ~~provide matching funds or pay part of the costs of the service,~~ 
  6.14  ~~as long as the rate charged for the service does not exceed~~ 
  6.15  ~~medical assistance limits that apply to all medical assistance~~ 
  6.16  ~~providers.~~ 
  6.17     Sec. 6.  Minnesota Statutes 1998, section 125A.744, 
  6.18  subdivision 3, is amended to read: 
  6.19     Subd. 3.  [IMPLEMENTATION.] Consistent with section 
  6.20  256B.0625, subdivision 26, school districts may enroll as 
  6.21  medical assistance providers or subcontractors and bill the 
  6.22  department of human services under the medical assistance fee 
  6.23  for service claims processing system for special education 
  6.24  services which are covered services under chapter 256B, which 
  6.25  are provided in the school setting for a medical assistance 
  6.26  recipient, and for whom the district has secured informed 
  6.27  consent consistent with section 13.05, subdivision 4, paragraph 
  6.28  (d), and section 256B.77, subdivision 2, paragraph (p), to bill 
  6.29  for each type of covered service.  School districts shall be 
  6.30  reimbursed by the commissioner for the federal share of 
  6.31  individual education plan health-related services that qualify 
  6.32  for reimbursement by medical assistance, minus five percent 
  6.33  retained by the commissioner for administrative costs.  A school 
  6.34  district is not eligible to enroll as a home care provider or a 
  6.35  personal care provider organization for purposes of billing home 
  6.36  care services under section 256B.0627 until the commissioner of 
  7.1   human services issues a bulletin instructing county public 
  7.2   health nurses on how to assess for the needs of eligible 
  7.3   recipients during school hours.  To use private duty nursing 
  7.4   services or personal care services at school, the recipient or 
  7.5   responsible party must provide written authorization in the care 
  7.6   plan identifying the chosen provider and the daily amount of 
  7.7   services to be used at school.  ~~Medical assistance services for~~ 
  7.8   ~~those enrolled in a prepaid health plan shall remain the~~ 
  7.9   ~~responsibility of the contracted health plan subject to their~~ 
  7.10  ~~network, credentialing, prior authorization, and determination~~ 
  7.11  ~~of medical necessity criteria.  The commissioner of human~~ 
  7.12  ~~services shall adjust payments to health plans to reflect~~ 
  7.13  ~~increased costs incurred by health plans due to increased~~ 
  7.14  ~~payments made to school districts or new payment or delivery~~ 
  7.15  ~~arrangements developed by health plans in cooperation with~~ 
  7.16  ~~school districts.~~ 
  7.17     Sec. 7.  Minnesota Statutes 1998, section 125A.76, 
  7.18  subdivision 2, is amended to read: 
  7.19     Subd. 2.  [SPECIAL EDUCATION BASE REVENUE.] (a) The special 
  7.20  education base revenue equals the sum of the following amounts 
  7.21  computed using base year data: 
  7.22     (1) 68 percent of the salary of each essential person 
  7.23  employed in the district's program for children with a 
  7.24  disability during the fiscal year, not including the share of 
  7.25  salaries for personnel providing health-related services counted 
  7.26  in clause (8), whether the person is employed by one or more 
  7.27  districts or a Minnesota correctional facility operating on a 
  7.28  fee-for-service basis; 
  7.29     (2) for the Minnesota state academy for the deaf or the 
  7.30  Minnesota state academy for the blind, 68 percent of the salary 
  7.31  of each instructional aide assigned to a child attending the 
  7.32  academy, if that aide is required by the child's individual 
  7.33  education plan; 
  7.34     (3) for special instruction and services provided to any 
  7.35  pupil by contracting with public, private, or voluntary agencies 
  7.36  other than school districts, in place of special instruction and 
  8.1   services provided by the district, 52 percent of the difference 
  8.2   between the amount of the contract and the basic revenue of the 
  8.3   district for that pupil for the fraction of the school day the 
  8.4   pupil receives services under the contract; 
  8.5      (4) for special instruction and services provided to any 
  8.6   pupil by contracting for services with public, private, or 
  8.7   voluntary agencies other than school districts, that are 
  8.8   supplementary to a full educational program provided by the 
  8.9   school district, 52 percent of the amount of the contract for 
  8.10  that pupil; 
  8.11     (5) for supplies and equipment purchased or rented for use 
  8.12  in the instruction of children with a disability, not including 
  8.13  the portion of the expenses for supplies and equipment used to 
  8.14  provide health-related services counted in clause (8), an amount 
  8.15  equal to 47 percent of the sum actually expended by the 
  8.16  district, or a Minnesota correctional facility operating on a 
  8.17  fee-for-service basis, but not to exceed an average of $47 in 
  8.18  any one school year for each child with a disability receiving 
  8.19  instruction; 
  8.20     (6) for fiscal years 1997 and later, special education base 
  8.21  revenue shall include amounts under clauses (1) to (5) for 
  8.22  special education summer programs provided during the base year 
  8.23  for that fiscal year; ~~and~~ 
  8.24     (7) for fiscal years 1999 and later, the cost of providing 
  8.25  transportation services for children with disabilities under 
  8.26  section 123B.92, subdivision 1, paragraph (b), clause (4); and 
  8.27     (8) for fiscal years 2001 and later the cost of salaries, 
  8.28  supplies and equipment, and other related costs actually 
  8.29  expended by the district for the nonfederal share of medical 
  8.30  assistance services according to section 256B.0625, subdivision 
  8.31  26. 
  8.32     (b) If requested by a school district operating a special 
  8.33  education program during the base year for less than the full 
  8.34  fiscal year, or a school district in which is located a 
  8.35  Minnesota correctional facility operating on a fee-for-service 
  8.36  basis for less than the full fiscal year, the commissioner may 
  9.1   adjust the base revenue to reflect the expenditures that would 
  9.2   have occurred during the base year had the program been operated 
  9.3   for the full fiscal year. 
  9.4      (c) Notwithstanding paragraphs (a) and (b), the portion of 
  9.5   a school district's base revenue attributable to a Minnesota 
  9.6   correctional facility operating on a fee-for-service basis 
  9.7   during the facility's first year of operating on a 
  9.8   fee-for-service basis shall be computed using current year data. 
  9.9      Sec. 8.  [127A.11] [MONITOR MEDICAL ASSISTANCE SERVICES FOR 
  9.10  DISABLED STUDENTS.] 
  9.11     The commissioner of children, families, and learning, in 
  9.12  cooperation with the commissioner of human services, shall 
  9.13  monitor the costs of health-related, special education services 
  9.14  provided by public schools. 
  9.15     Sec. 9.  [214.045] [COORDINATION WITH BOARD OF TEACHING.] 
  9.16     The commissioner of health and the health-related licensing 
  9.17  boards must coordinate with the board of teaching when modifying 
  9.18  licensure requirements for regulated persons in order to have 
  9.19  consistent regulatory requirements for personnel who perform 
  9.20  services in schools. 
  9.21     Sec. 10.  Minnesota Statutes 1998, section 256B.0625, 
  9.22  subdivision 26, is amended to read: 
  9.23     Subd. 26.  [SPECIAL EDUCATION SERVICES.] (a) Medical 
  9.24  assistance covers medical services identified in a recipient's 
  9.25  individualized education plan and covered under the medical 
  9.26  assistance state plan.  Covered services include occupational 
  9.27  therapy, physical therapy, speech-language therapy, clinical 
  9.28  psychological services, nursing services, school psychological 
  9.29  services, school social work services, personal care assistants 
  9.30  serving as management aides, assistive technology devices, 
  9.31  transportation services, and other services covered under the 
  9.32  medical assistance state plan.  The services may be provided by 
  9.33  a Minnesota school district that is enrolled as a medical 
  9.34  assistance provider or its subcontractor, and only if the 
  9.35  services meet all the requirements otherwise applicable if the 
  9.36  service had been provided by a provider other than a school 
 10.1   district, in the following areas:  medical necessity, 
 10.2   physician's orders, documentation, personnel qualifications, and 
 10.3   prior authorization requirements.  The nonfederal share of costs 
 10.4   for services provided under this subdivision is the 
 10.5   responsibility of the local school district as provided in 
 10.6   section 125A.74.  Services listed in a child's individual 
 10.7   education plan are eligible for medical assistance reimbursement 
 10.8   only if those services meet criteria for federal financial 
 10.9   participation under the Medicaid program.  
 10.10     (b) Approval of health-related services for inclusion in 
 10.11  the individual education plan does not require prior 
 10.12  authorization for purposes of reimbursement under this chapter.  
 10.13  The commissioner may require physician review and approval of 
 10.14  the plan not more than once annually or upon any modification of 
 10.15  the individual education plan that reflects a change in 
 10.16  health-related services. 
 10.17     (c) Services of a speech-language pathologist provided 
 10.18  under this section are covered notwithstanding Minnesota Rules, 
 10.19  part 9505.0390, subpart 1, item L, if the person: 
 10.20     (1) holds a masters degree in speech-language pathology; 
 10.21     (2) is licensed by the Minnesota board of teaching as an 
 10.22  educational speech-language pathologist; and 
 10.23     (3) either has a certificate of clinical competence from 
 10.24  the American Speech and Hearing Association, has completed the 
 10.25  equivalent educational requirements and work experience 
 10.26  necessary for the certificate or has completed the academic 
 10.27  program and is acquiring supervised work experience to qualify 
 10.28  for the certificate. 
 10.29     (d) Medical assistance coverage for medically necessary 
 10.30  services provided under other subdivisions in this section may 
 10.31  not be denied solely on the basis that the same or similar 
 10.32  services are covered under this subdivision. 
 10.33     (e) The commissioner shall develop and implement package 
 10.34  rates, bundled rates, or per diem rates for special education 
 10.35  services under which separately covered services are grouped 
 10.36  together and billed as a unit in order to reduce administrative 
 11.1   complexity.  
 11.2      (f) The commissioner shall develop a cost-based payment 
 11.3   structure for payment of these services.  
 11.4      (g) Effective July 1, 2000, medical assistance services 
 11.5   provided under an individual education plan or an individual 
 11.6   family service plan by local school districts shall not count 
 11.7   against medical assistance authorization thresholds for that 
 11.8   child. 
 11.9      Sec. 11.  Minnesota Statutes 1998, section 256B.69, is 
 11.10  amended by adding a subdivision to read: 
 11.11     Subd. 4b.  [INDIVIDUAL EDUCATION PLAN AND INDIVIDUALIZED 
 11.12  FAMILY SERVICE PLAN SERVICES.] The commissioner shall amend the 
 11.13  federal waiver allowing the state to separate out individual 
 11.14  education plan and individualized family service plan services 
 11.15  for children enrolled in the prepaid medical assistance program 
 11.16  and the MinnesotaCare program.  Effective July 1, 1999, or upon 
 11.17  federal approval, medical assistance coverage of eligible 
 11.18  individual education plan and individualized family service plan 
 11.19  services shall not be included in the capitated services for 
 11.20  children enrolled in health plans through the prepaid medical 
 11.21  assistance program and the MinnesotaCare program.  Upon federal 
 11.22  approval, local school districts shall bill the commissioner for 
 11.23  these services, and claims shall be paid on a fee-for-service 
 11.24  basis. 
 11.25     Sec. 12.  [EXPANSION OF SPECIAL EDUCATION SERVICES.] 
 11.26     The commissioner shall examine opportunities to expand the 
 11.27  scope of providers eligible for reimbursement for medical 
 11.28  assistance services listed in a child's individual education 
 11.29  plan, based on state and federal requirements for provider 
 11.30  qualifications.  The commissioner shall complete these 
 11.31  activities, in consultation with the commissioner of children, 
 11.32  families, and learning, by December 1999 and seek necessary 
 11.33  federal approval. 
 11.34     Sec. 13.  [EFFECTIVE DATE.] 
 11.35     Sections 2 to 7 and 10, are effective July 1, 2000.