1.1 	A bill for an act
1.2 	relating to education finance; making the K-12 special education third-party 
1.3 	billing process more cost effective;amending Minnesota Statutes 2008, 
1.4 	section 125A.21, subdivision 2; Minnesota Statutes 2009 Supplement, section 
1.5 	256B.0625, subdivision 26; Laws 2009, chapter 79, article 5, section 60.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2008, section 125A.21, subdivision 2, is amended to 
1.8 	read:
1.9 		Subd. 2.Third party reimbursement. (a) Beginning July 1, 2000, districts shall 
1.10 	seek reimbursement from insurers and similar third parties for the cost of services 
1.11 	provided by the district whenever the services provided by the district are otherwise 
1.12 	covered by the child's health coverage. Districts shall request, but may not require, the 
1.13 	child's family to provide information about the child's health coverage when a child with a 
1.14 	disability begins to receive services from the district of a type that may be reimbursable, 
1.15 	and shall request, but may not require, updated information after that as needed.
1.16 	(b) For children enrolled in medical assistance under chapter 256B or MinnesotaCare 
1.17 	under chapter 256L who have no other health coverage, a district shall provide an initial 
1.18 	written notice to the enrolled child's parent or legal representative of its intent to seek 
1.19 	reimbursement from medical assistance or MinnesotaCare for the individual education 
1.20 	plan health-related services provided by the district.
1.21 	(c) The district shall give the parent or legal representative annual written notice of:
1.22 	(1) the district's intent to seek reimbursement from medical assistance or 
1.23 	MinnesotaCare for individual education plan health-related services provided by the 
1.24 	district;
2.1 	(2) the right of the parent or legal representative to request a copy of all records 
2.2 	concerning individual education plan health-related services disclosed by the district to 
2.3 	any third party; and
2.4 	(3) the right of the parent or legal representative to withdraw consent for disclosure 
2.5 	of a child's records at any time without consequence, including consent that was initially 
2.6 	given as a part of the application process for MinnesotaCare or medical assistance under 
2.7 	section 256B.0625, subdivision 26.
2.8 	The written notice shall be provided as part of the written notice required by Code of 
2.9 	Federal Regulations, title 34, section 300.504.  
2.10 	(d) In order to access the private health care coverage of a child who is covered by 
2.11 	private health care coverage in whole or in part, a district must:
2.12 	(1) obtain annual written informed consent from the parent or legal representative, in 
2.13 	compliance with subdivision 5; and
2.14 	(2) inform the parent or legal representative that a refusal to permit the district 
2.15 	or state Medicaid agency to access their private health care coverage does not relieve 
2.16 	the district of its responsibility to provide all services necessary to provide free and 
2.17 	appropriate public education at no cost to the parent or legal representative.
2.18 	(e) If the commissioner of human services obtains federal approval to exempt 
2.19 	covered individual education plan health-related services from the requirement that private 
2.20 	health care coverage refuse payment before medical assistance may be billed, paragraphs 
2.21 	(b), (c), and (d) shall also apply to students with a combination of private health care 
2.22 	coverage and health care coverage through medical assistance or MinnesotaCare.
2.23 	(f) In the event that Congress or any federal agency or the Minnesota legislature 
2.24 	or any state agency establishes lifetime limits, limits for any health care services, 
2.25 	cost-sharing provisions, or otherwise provides that individual education plan health-related 
2.26 	services impact benefits for persons enrolled in medical assistance or MinnesotaCare, the 
2.27 	amendments to this subdivision adopted in 2002 are repealed on the effective date of any 
2.28 	federal or state law or regulation that imposes the limits. In that event, districts must 
2.29 	obtain informed consent consistent with this subdivision as it existed prior to the 2002 
2.30 	amendments and subdivision 5, before seeking reimbursement for children enrolled in 
2.31 	medical assistance under chapter 256B or MinnesotaCare under chapter 256L who have 
2.32 	no other health care coverage.

2.33 	EFFECTIVE DATE. This section is effective the day following final enactment.

3.1 	Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 26, 
3.2 	is amended to read:
3.3 		Subd. 26.Special education services. (a) Medical assistance covers medical 
3.4 	services identified in a recipient's individualized education plan and covered under the 
3.5 	medical assistance state plan. Covered services include occupational therapy, physical 
3.6 	therapy, speech-language therapy, clinical psychological services, nursing services, 
3.7 	school psychological services, school social work services, personal care assistants 
3.8 	serving as management aides, assistive technology devices, transportation services, 
3.9 	health assessments, and other services covered under the medical assistance state plan. 
3.10 	Mental health services eligible for medical assistance reimbursement must be provided or 
3.11 	coordinated through a children's mental health collaborative where a collaborative exists if 
3.12 	the child is included in the collaborative operational target population. The provision or 
3.13 	coordination of services does not require that the individual education plan be developed 
3.14 	by the collaborative.
3.15 	The services may be provided by a Minnesota school district that is enrolled as a 
3.16 	medical assistance provider or its subcontractor, and only if the services meet all the 
3.17 	requirements otherwise applicable if the service had been provided by a provider other 
3.18 	than a school district, in the following areas: medical necessity, physician's orders, 
3.19 	documentation, personnel qualifications, and prior authorization requirements. The 
3.20 	nonfederal share of costs for services provided under this subdivision is the responsibility 
3.21 	of the local school district as provided in section 125A.74. Services listed in a child's 
3.22 	individual education plan are eligible for medical assistance reimbursement only if those 
3.23 	services meet criteria for federal financial participation under the Medicaid program.
3.24 	(b) Approval of health-related services for inclusion in the individual education plan 
3.25 	does not require prior authorization for purposes of reimbursement under this chapter. 
3.26 	The commissioner may require physician review and approval of the plan not more than 
3.27 	once annually or upon any modification of the individual education plan that reflects a 
3.28 	change in health-related services.
3.29 	(c) Services of a speech-language pathologist provided under this section are covered 
3.30 	notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
3.31 	(1) holds a masters degree in speech-language pathology;
3.32 	(2) is licensed by the Minnesota Board of Teaching as an educational 
3.33 	speech-language pathologist; and
3.34 	(3) either has a certificate of clinical competence from the American Speech and 
3.35 	Hearing Association, has completed the equivalent educational requirements and work 
4.1 	experience necessary for the certificate or has completed the academic program and is 
4.2 	acquiring supervised work experience to qualify for the certificate.
4.3 	(d) Medical assistance coverage for medically necessary services provided under 
4.4 	other subdivisions in this section may not be denied solely on the basis that the same or 
4.5 	similar services are covered under this subdivision.
4.6 	(e) The commissioner shall develop and implement package rates, bundled rates, or 
4.7 	per diem rates for special education services under which separately covered services are 
4.8 	grouped together and billed as a unit in order to reduce administrative complexity.
4.9 	(f) The commissioner shall develop a cost-based payment structure for payment 
4.10 	of these services. The commissioner shall reimburse claims submitted based on an 
4.11 	interim rate, and shall settle at a final rate once the department has determined it. The 
4.12 	commissioner shall notify the school district of the final rate. The school district has 60 
4.13 	days to appeal ~~the~~ a final rate that has been established prior to April 1. If the final rate 
4.14 	is set after April 1, the school district has 120 days to appeal the final rate. To appeal 
4.15 	the final rate, the school district shall file a written appeal request to the commissioner 
4.16 	within 60 days of the date the final rate determination was mailed. The appeal request 
4.17 	shall specify (1) the disputed items and (2) the name and address of the person to contact 
4.18 	regarding the appeal.
4.19 	(g) Effective July 1, 2000, medical assistance services provided under an individual 
4.20 	education plan or an individual family service plan by local school districts shall not count 
4.21 	against medical assistance authorization thresholds for that child.
4.22 	(h) Nursing services as defined in section 148.171, subdivision 15, and provided 
4.23 	as an individual education plan health-related service, are eligible for medical assistance 
4.24 	payment if they are otherwise a covered service under the medical assistance program. 
4.25 	Medical assistance covers the administration of prescription medications by a licensed 
4.26 	nurse who is employed by or under contract with a school district when the administration 
4.27 	of medications is identified in the child's individualized education plan. The simple 
4.28 	administration of medications alone is not covered under medical assistance when 
4.29 	administered by a provider other than a school district or when it is not identified in the 
4.30 	child's individualized education plan.

4.31 	EFFECTIVE DATE. This section is effective for rates set after April 1, 2010.

4.32 	Sec. 3. Laws 2009, chapter 79, article 5, section 60, is amended to read:
4.33 	Sec. 60. Minnesota Statutes 2008, section 256L.05, is amended by adding a 
4.34 	subdivision to read:
5.1 		Subd. 1c.Open enrollment and streamlined application and enrollment 
5.2 	process. (a) The commissioner and local agencies working in partnership must develop a 
5.3 	streamlined and efficient application and enrollment process for medical assistance and 
5.4 	MinnesotaCare enrollees that meets the criteria specified in this subdivision.
5.5 	(b) The commissioners of human services and education shall provide 
5.6 	recommendations to the legislature by January 15, 2010, on the creation of an open 
5.7 	enrollment process for medical assistance and MinnesotaCare that is coordinated with 
5.8 	the public education system. The recommendations must:
5.9 	(1) be developed in consultation with medical assistance and MinnesotaCare 
5.10 	enrollees and representatives from organizations that advocate on behalf of children and 
5.11 	families, low-income persons and minority populations, counties, school administrators 
5.12 	and nurses, health plans, and health care providers;
5.13 	(2) be based on enrollment and renewal procedures best practices, including express 
5.14 	lane eligibility as required under subdivision 1d;
5.15 	(3) simplify the enrollment and renewal processes wherever possible; ~~and~~
5.16 	(4) establish a process:
5.17 	(i) to disseminate information on medical assistance and MinnesotaCare to all 
5.18 	children in the public education system, including prekindergarten programs; and
5.19 	(ii) for the commissioner of human services to enroll children and other household 
5.20 	members who are eligible; and
5.21 	(5) require the enrollment forms to contain authorization for the consent for coverage 
5.22 	and payment required under section 125A.21.
5.23 	The commissioner of human services in coordination with the commissioner of 
5.24 	education shall implement an open enrollment process by August 1, 2010, to be effective 
5.25 	beginning with the 2010-2011 school year.
5.26 	(c) The commissioner and local agencies shall develop an online application process 
5.27 	for medical assistance and MinnesotaCare.
5.28 	(d) The commissioner shall develop an application that is easily understandable 
5.29 	and does not exceed four pages in length.
5.30 	(e) The commissioner of human services shall present to the legislature, by January 
5.31 	15, 2010, an implementation plan for the open enrollment period and online application 
5.32 	process.

5.33 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
5.34 	approval, which must be requested by the commissioner, whichever is later.

5.35 	Sec. 4. INITIAL AND CONTINUING WAIVER; THIRD-PARTY BILLING.
 6.1 	The commissioner of human services must summarize and document the prior 
6.2 	efforts of school districts to secure reimbursement from legally liable third parties and 
6.3 	request an initial and continuing waiver from the Centers for Medicare and Medicaid 
6.4 	Services to allow the cost-effective billing of medical assistance for covered services that 
6.5 	are not reimbursed by other legally liable third parties.

6.6 	EFFECTIVE DATE. This section is effective the day following final enactment.