125A.21 THIRD PARTY PAYMENT.
Subdivision 1. Obligation to pay.
Nothing in sections
relieves an insurer or similar third party from an otherwise valid obligation to pay, or changes
the validity of an obligation to pay, for services rendered to a child with a disability, and the
child's family. A school district shall pay the nonfederal share of medical assistance services
provided according to section
256B.0625, subdivision 26
. Eligible expenditures must not be made
from federal funds or funds used to match other federal funds. Any federal disallowances are
the responsibility of the school district. A school district may pay or reimburse co-payments,
coinsurance, deductibles, and other enrollee cost-sharing amounts, on behalf of the student or
family, in connection with health and related services provided under an individual educational
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 consequence.
The written notice shall be provided as part of the written notice required by Code of Federal
Regulations, title 34, section
(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.
Subd. 3. Use of reimbursements.
Of the reimbursements received, districts may:
(1) retain an amount sufficient to compensate the district for its administrative costs of
(2) regularly obtain from education- and health-related entities training and other appropriate
technical assistance designed to improve the district's ability to determine which services are
reimbursable and to seek timely reimbursement in a cost-effective manner; or
(3) reallocate reimbursements for the benefit of students with special needs in the district.
Subd. 4. Parents not obligated to use health coverage.
To the extent required by federal
law, a school district may not require parents of children with disabilities, if they would incur
a financial cost, to use private or public health coverage to pay for the services that must be
provided under an individual education plan.
Subd. 5. Informed consent.
When obtaining informed consent, consistent with sections
13.05, subdivision 4
, paragraph (d); and
256B.77, subdivision 2
, paragraph (p), to bill health
plans for covered services, the school district must notify the legal representative (1) that the cost
of the person's private health insurance premium may increase due to providing the covered
service in the school setting, (2) that the school district may pay certain enrollee health plan costs,
including but not limited to, co-payments, coinsurance, deductibles, premium increases or other
enrollee cost-sharing amounts for health and related services required by an individual service
plan, or individual family service plan, and (3) that the school's billing for each type of covered
service may affect service limits and prior authorization thresholds. The informed consent may be
revoked in writing at any time by the person authorizing the billing of the health plan.
Subd. 6. District obligation to provide service.
To the extent required by federal law, no
school district may deny, withhold, or delay any service that must be provided under an individual
education plan because a family has refused to provide informed consent to bill a health plan
for services or a health plan company has refused to pay any, all, or a portion of the cost of
Subd. 7. District disclosure of information.
A school district may disclose information
contained in a student's individual education plan, consistent with section
, paragraph (a), including records of the student's diagnosis and treatment, to a health plan
company only with the signed and dated consent of the student's parent, or other legally
authorized individual. The school district shall disclose only that information necessary for the
health plan company to decide matters of coverage and payment. A health plan company may
use the information only for making decisions regarding coverage and payment, and for any
other use permitted by law.
History: Ex1959 c 71 art 1 s 17; 1961 c 559 s 2; 1961 c 690 s 1; 1965 c 241 s 1-3; 1967 c
872 s 1; 1969 c 981 s 2-5; 1971 c 689 s 1-3; 1973 c 683 s 1,2; 1975 c 162 s 41; 1975 c 321 s 2;
1975 c 432 s 8-10; 1976 c 211 s 1-6; 1976 c 271 s 13-18; 1977 c 447 art 3 s 1-4; 1977 c 449 s
12; 1978 c 733 s 1; 1978 c 764 s 3-5; 1978 c 793 s 61; 1979 c 334 art 2 s 1,2; art 3 s 2,3; 1980
c 509 s 30; 1981 c 358 art 1 s 1; art 3 s 2-7; 1982 c 424 s 28,29,130; 1982 c 548 art 3 s 1-3;
1983 c 247 s 55; 1983 c 258 s 13; 1983 c 314 art 1 s 22; art 3 s 1; 1984 c 463 art 3 s 1; 1984 c
654 art 5 s 58; 1Sp1985 c 12 art 3 s 2-8; 1986 c 444; 1987 c 384 art 2 s 24; 1987 c 398 art 3 s
2-14; 1988 c 486 s 2-5; 1988 c 629 s 24; 1988 c 718 art 3 s 1; art 6 s 2; 1989 c 209 art 2 s 1;
1989 c 329 art 3 s 1-3; 1991 c 265 art 3 s 1,2,38; art 11 s 1; 1991 c 292 art 6 s 58 subd 2; 1992 c
499 art 3 s 1-7; art 11 s 1; 1993 c 224 art 3 s 1-9; art 14 s 3; 1994 c 483 s 1; 1994 c 647 art 3
s 2-8,34; 1Sp1995 c 3 art 3 s 1-3; art 16 s 13; 1996 c 412 art 2 s 1,2; art 3 s 1-3; 1998 c 397
art 2 s 164; art 11 s 3; 1998 c 398 art 2 s 14; 1999 c 123 s 12; 2000 c 464 art 2 s 1; 2002 c 294
s 2; 2002 c 400 s 3; 1Sp2003 c 9 art 3 s 10