Bill Text: MN SF2837 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Autism spectrum disorder (ASD) early intensive intervention benefit under medical assistance (MA) and health insurance coverage modifications and clarifications
Spectrum: Moderate Partisan Bill (Democrat 4-1)
Status: (Introduced - Dead) 2014-03-21 - Author added Dziedzic [SF2837 Detail]
Download: Minnesota-2013-SF2837-Introduced.html
1.2relating to human services; insurance; modifying autism early intensive
1.3intervention benefit under medical assistance; modifying insurance coverage for
1.4autism spectrum disorder;amending Minnesota Statutes 2012, section 252.27, by
1.5adding a subdivision; Minnesota Statutes 2013 Supplement, sections 62A.3094,
1.6subdivisions 1, 2; 252.27, subdivision 2a; 256B.0949, subdivisions 2, 3, 4, 7, 9;
1.7Laws 2013, chapter 9, section 15; Laws 2013, chapter 108, article 12, section 2.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2013 Supplement, section 62A.3094, subdivision 1,
1.10is amended to read:
1.11 Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
1.12paragraphs (b) to (d) have the meanings given.
1.13(b) "Autism spectrumdisorders disorder" means the conditions a condition as
1.14determined by criteria set forth in the most recent edition of the Diagnostic and Statistical
1.15Manual of Mental Disorders of the American Psychiatric Association.
1.16(c) "Medically necessary care" means health care services appropriate, in terms of
1.17type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
1.18testing and preventative services. Medically necessary care must be consistent with
1.19generally accepted practice parameters as determined by physicians and licensed
1.20psychologists who typically manage patients who have autism spectrumdisorders disorder
1.21and must meet the requirements in section 62Q.53.
1.22(d) "Mental health professional" means a mental health professional as defined in
1.23section245.4871, subdivision 27 , clause (1), (2), (3), (4), or (6), who has training and
1.24expertise in autism spectrumdisorder and child development disorders.
2.1 Sec. 2. Minnesota Statutes 2013 Supplement, section 62A.3094, subdivision 2, is
2.2amended to read:
2.3 Subd. 2. Coverage required. (a) A health planissued to a large employer, as
2.4defined in section62Q.18 62Q.01, subdivision 1 3
2.5diagnosis, evaluation, multidisciplinary assessment, and medically necessary care of
2.6children a child under age 18 with an autism spectrum disorders disorder, including but
2.7not limited to the following:
2.8(1) early intensive behavioral and developmental therapy based in behavioral and
2.9developmental science, including, but not limited to, all types of applied behavior analysis,
2.10intensive early intervention behavior therapy, and intensive behavior intervention;
2.11(2) neurodevelopmental and behavioral health treatments and management;
2.12(3) speech therapy;
2.13(4) occupational therapy;
2.14(5) physical therapy; and
2.15(6) medications.
2.16(b) The diagnosis, evaluation, and assessment must include an assessment of the
2.17child's developmental skills, functional behavior, needs, and capacities.
2.18(c) The coverage required under this subdivision must include treatment that is in
2.19accordance with an individualized treatment plan prescribed by the enrollee's treating
2.20physician or mental health professional.
2.21(d) A health carrier may not refuse to renew or reissue, or otherwise terminate or
2.22restrict, coverage of an individual solely because the individual is diagnosed with an
2.23autism spectrum disorder.
2.24(e) A health carrier may request an updated treatment plan only once every six
2.25months, unless the health carrier and the treating physician or mental health professional
2.26agree that a more frequent review is necessary due to emerging circumstances.
2.27(f) An independent progress evaluation conducted by a mental health professional
2.28with expertise and training in autism spectrum disorder and child development must be
2.29completed to determine if progress towardfunction functional and generalizable gains, as
2.30determined in the treatment plan, is being made.
2.31 Sec. 3. Minnesota Statutes 2013 Supplement, section 252.27, subdivision 2a, is
2.32amended to read:
2.33 Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor
2.34child, including a child determined eligible for medical assistance without consideration of
2.35parental income, must contribute to the cost of services used by making monthly payments
3.1on a sliding scale based on income, unless the child is married or has been married, parental
3.2rights have been terminated, or the child's adoption is subsidized according to chapter
3.3259A or through title IV-E of the Social Security Act. The parental contribution is a partial
3.4or full payment for medical services provided for diagnostic, therapeutic, curing, treating,
3.5mitigating, rehabilitation, maintenance, and personal care services as defined in United
3.6States Code, title 26, section 213, needed by the child with a chronic illness or disability.
3.7 (b) For households with adjusted gross income equal to or greater than 275 percent
3.8of federal poverty guidelines, the parental contribution shall be computed by applying the
3.9following schedule of rates to the adjusted gross income of the natural or adoptive parents:
3.10 (1) if the adjusted gross income is equal to or greater than 275 percent of federal
3.11poverty guidelines and less than or equal to 545 percent of federal poverty guidelines,
3.12the parental contribution shall be determined using a sliding fee scale established by the
3.13commissioner of human services which begins at2.76
3.14income at 275 percent of federal poverty guidelines and increases to7.5 two percent of
3.15adjusted gross income for those with adjusted gross income up to 545 percent of federal
3.16poverty guidelines;
3.17 (2) if the adjusted gross income is greater than 545 percent of federal poverty
3.18guidelines and less than 675 percent of federal poverty guidelines, the parental
3.19contribution shall be7.5 determined using a sliding fee scale which begins at two percent
3.20of adjusted gross income at 545 percent of the federal poverty guidelines and increases to
3.21three percent of adjusted gross income for those with adjusted gross income up to 675
3.22percent of the federal poverty guidelines;
3.23 (3) if the adjusted gross income is equal to or greater than 675 percent of federal
3.24poverty guidelines and less than 975 percent of federal poverty guidelines, the parental
3.25contribution shall be determined using a sliding fee scale established by the commissioner
3.26of human services which begins at7.5 four percent of adjusted gross income at 675 percent
3.27of federal poverty guidelines and increases toten five percent of adjusted gross income for
3.28those with adjusted gross income up to 975 percent of federal poverty guidelines; and
3.29 (4) if the adjusted gross income is equal to or greater than 975 percent of federal
3.30poverty guidelines, the parental contribution shall be12.5 six percent of adjusted gross
3.31income.
3.32 If the child lives with the parent, the annual adjusted gross income is reduced by
3.33$2,400 prior to calculating the parental contribution. If the child resides in an institution
3.34specified in section256B.35 , the parent is responsible for the personal needs allowance
3.35specified under that section in addition to the parental contribution determined under this
4.1section. The parental contribution is reduced by any amount required to be paid directly to
4.2the child pursuant to a court order, but only if actually paid.
4.3 (c) The household size to be used in determining the amount of contribution under
4.4paragraph (b) includes natural and adoptive parents and their dependents, including the
4.5child receiving services. Adjustments in the contribution amount due to annual changes
4.6in the federal poverty guidelines shall be implemented on the first day of July following
4.7publication of the changes.
4.8 (d) For purposes of paragraph (b), "income" means the adjusted gross income of the
4.9natural or adoptive parents determined according to the previous year's federal tax form,
4.10except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
4.11have been used to purchase a home shall not be counted as income.
4.12 (e) The contribution shall be explained in writing to the parents at the time eligibility
4.13for services is being determined. The contribution shall be made on a monthly basis
4.14effective with the first month in which the child receives services. Annually upon
4.15redetermination or at termination of eligibility, if the contribution exceeded the cost of
4.16services provided, the local agency or the state shall reimburse that excess amount to
4.17the parents, either by direct reimbursement if the parent is no longer required to pay a
4.18contribution, or by a reduction in or waiver of parental fees until the excess amount is
4.19exhausted. All reimbursements must include a notice that the amount reimbursed may be
4.20taxable income if the parent paid for the parent's fees through an employer's health care
4.21flexible spending account under the Internal Revenue Code, section 125, and that the
4.22parent is responsible for paying the taxes owed on the amount reimbursed.
4.23 (f) The monthly contribution amount must be reviewedat least every 12 months;
4.24 annually, when there is a change in household size;, and when there is a loss of or gain
4.25in income from one month to another in excess of ten percent when a parent requests a
4.26review due to a substantial decrease in income or an extreme hardship. The local agency
4.27shall mail a written notice 30 days in advance of the effective date of a change in the
4.28contribution amount. A decrease in the contribution amount is effective in the month that
4.29the parent verifies a reduction in income or change in household size.
4.30 (g) Parents of a minor child who do not live with each other shall each pay the
4.31contribution required under paragraph (a). An amount equal to the annual court-ordered
4.32child support payment actually paid on behalf of the child receiving services shall be
4.33deducted from the adjusted gross income of the parent making the payment prior to
4.34calculating the parental contribution under paragraph (b).
4.35 (h) The contribution under paragraph (b) shall be increased by an additional five
4.36percent if the local agency determines that insurance coverage is available but not obtained
5.1for the child. For purposes of this section, "available" means the insurance is a benefit of
5.2employment for a family member at an annual cost of no more than five percent of the
5.3family's parent's annual income. For purposes of this section, "insurance" means health
5.4and accident insurance coverage, enrollment in a nonprofit health service plan, health
5.5maintenance organization, self-insured plan, or preferred provider organization.
5.6 Parents who have more than one child receiving services shall not be required
5.7to pay more than the amount for the child with the highest expenditures. There shall
5.8be no resource contribution from the parents. The parent shall not be required to pay
5.9a contribution in excess of the cost of the services provided to the child, not counting
5.10payments made to school districts for education-related services. Notice of an increase in
5.11fee payment must be given at least 30 days before the increased fee is due.
5.12 (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
5.13in the 12 months prior to July 1:
5.14 (1) the parent applied for insurance for the child;
5.15 (2) the insurer denied insurance;
5.16 (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
5.17a complaint or appeal, in writing, to the commissioner of health or the commissioner of
5.18commerce, or litigated the complaint or appeal; and
5.19 (4) as a result of the dispute, the insurer reversed its decision and granted insurance.
5.20 For purposes of this section, "insurance" has the meaning given in paragraph (h).
5.21 A parent who has requested a reduction in the contribution amount under this
5.22paragraph shall submit proof in the form and manner prescribed by the commissioner or
5.23county agency, including, but not limited to, the insurer's denial of insurance, the written
5.24letter or complaint of the parents, court documents, and the written response of the insurer
5.25approving insurance. The determinations of the commissioner or county agency under this
5.26paragraph are not rules subject to chapter 14.
5.27 Sec. 4. Minnesota Statutes 2012, section 252.27, is amended by adding a subdivision
5.28to read:
5.29 Subd. 2d. Fees limited. Notwithstanding subdivision 2a, the fee a parent is required
5.30to contribute to the cost of services under medical assistance for an individual child shall
5.31not exceed the maximum insurance premium charged in Minnesota under the federal
5.32Patient Protection and Affordable Care Act, Public Law 111-148, as amended, for a
5.33child-only policy for a child with the same amount of income.
6.1 Sec. 5. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 2,
6.2is amended to read:
6.3 Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
6.4this subdivision have the meanings given.
6.5 (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
6.6current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
6.7 (c) "Child" means a person under the age of 18.
6.8 (d) "Commissioner" means the commissioner of human services, unless otherwise
6.9specified.
6.10 (e) "Early intensive intervention benefit" means autism treatment options based in
6.11behavioral and developmental science, which may include modalities such as applied
6.12behavior analysis, developmental treatment approaches, and naturalistic and parent
6.13training models.
6.14 (f) "Generalizable goals" means results or gains that are observed during a variety
6.15of activities with different people, such as providers, family members, other adults, and
6.16children, and in different environments including, but not limited to, clinics, homes,
6.17schools, and the community.
6.18 (g) "Mental health professional"has the meaning given means a mental health
6.19professional as defined in section245.4871 , subdivision 27, clauses (1) to (6) who has
6.20training and expertise in autism spectrum disorders.
6.21 Sec. 6. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 3,
6.22is amended to read:
6.23 Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
6.24assistance who:
6.25(1) has an autism spectrum disorder diagnosis; for services that meet the criteria for
6.26medically necessary care under Minnesota Rules, part 9505.0175, subpart 25.
6.27(2) has had a diagnostic assessment described in subdivision 5, which recommends
6.28early intensive intervention services; and
6.29(3) meets the criteria for medically necessary autism early intensive intervention
6.30services.
6.31 Sec. 7. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 4,
6.32is amended to read:
6.33 Subd. 4. Diagnosis. (a) A diagnosis must:
7.1 (1) be based upon current DSM criteria including direct observations of the child
7.2and reports from parents or primary caregivers; and
7.3 (2) be completed byboth either (i) a licensed physician or advanced practice
7.4registered nurseand or (ii) a mental health professional.
7.5 (b) Additional diagnostic assessment information may be considered including from
7.6special education evaluations and licensed school personnel, and from professionals
7.7licensed in the fields of medicine, speech and language, psychology, occupational therapy,
7.8and physical therapy.
7.9(c) If the commissioner determines there are access problems or delays in diagnosis
7.10for a geographic area due to the lack of qualified professionals, the commissioner shall
7.11waive the requirement in paragraph (a), clause (2), for two professionals and allow a
7.12diagnosis to be made by one professional for that geographic area. This exception must be
7.13limited to a specific period of time until, with stakeholder input as described in subdivision
7.148, there is a determination of an adequate number of professionals available to require two
7.15professionals for each diagnosis.
7.16 Sec. 8. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 7,
7.17is amended to read:
7.18 Subd. 7. Ongoing eligibility. (a)An independent A progress evaluation conducted
7.19by a licensed mental health professional with expertise and training in autism spectrum
7.20disorder and child development must be completed aftereach the first six months of
7.21treatment and not more than once every 12 months thereafter,or more frequently as
7.22determined by the commissioner unless the treating licensed mental health professional
7.23determines more frequent evaluations are necessary, to determine if progress is being
7.24made toward achieving generalizable goals and meeting functional goals contained in
7.25the treatment plan.
7.26 (b) The progress evaluation must include:
7.27 (1) the treating provider's report;
7.28 (2) parental or caregiver input;
7.29 (3) anindependent observation of the child which can be performed by the child's
7.30licensed special education staff;
7.31 (4) any treatment plan modifications; and
7.32 (5) recommendations for continued treatment services.
7.33 (c) Progress evaluations must be submitted to the commissioner in a manner
7.34determined by the commissioner for this purpose.
8.1 (d) A child who continues to achieve generalizable goals and treatment goals as
8.2specified in the treatment plan and who is recommended for continued treatment services
8.3by the treating mental health professional under paragraph (b), clause (5), is eligible to
8.4continue receiving this benefit.
8.5 (e) The commissioner may consider an alternative eligibility recommendation to the
8.6recommendation of the treating mental health professional under paragraph (b), clause (5),
8.7if there is a detailed report provided by a licensed mental health professional with expertise
8.8treating children with autism spectrum disorder using the relevant treatment modality
8.9showing that progress is not being made in a particular case. In this case, treatment shall
8.10not be interrupted and shall continue to be reimbursed until a final determination is made.
8.11 (f) A child's treatment shall continue to be reimbursed during the progress evaluation
8.12using the process determined under subdivision 8, clause (8) until a final determination is
8.13made. Treatment may continue during an appeal pursuant to section256.045 .
8.14 Sec. 9. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 9,
8.15is amended to read:
8.16 Subd. 9. Revision of treatment options. (a) The commissioner mayrevise add
8.17 covered treatment options as needed based on outcome data and other evidence.
8.18 (b) Before the changes become effective, the commissioner must provide public
8.19notice of the changes, the reasons for the change, and a 30-day public comment period
8.20to those who request notice through an electronic list accessible to the public on the
8.21department's Web site.
8.22 Sec. 10. Laws 2013, chapter 9, section 15, is amended to read:
8.23 Sec. 15. MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION
8.24TERMINATION.
8.25(a) The commissioner of commerce, in consultation with the board of directors of the
8.26Minnesota Comprehensive Health Association, has the authority to develop and implement
8.27the phase-out and eventual appropriate termination of coverage provided by the Minnesota
8.28Comprehensive Health Association under Minnesota Statutes, chapter 62E. The phase-out
8.29of coverage shall begin no sooner than January 1, 2014, or upon the effective date of the
8.30operation of the Minnesota Insurance Marketplace and the ability to purchase qualified
8.31health plans through the Minnesota Insurance Marketplace, whichever is later, and shall,
8.32to the extent practicable, ensure the least amount of disruption to the enrollees' health care
8.33coverage. The member assessments established under Minnesota Statutes, section62E.11 ,
8.34shall take into consideration any phase-out of coverage implemented under this section.
9.1(b)(1) Notwithstanding paragraph (a), the Minnesota Comprehensive Health
9.2Association shall continue beyond any phaseout or termination specified in paragraph (a)
9.3for the purpose of providing coverage for autism spectrum disorder as defined in Minnesota
9.4Statutes, section 62A.3094, subdivision 1, paragraph (b), for children under the age 18.
9.5(2) The coverage provided under clause (1) must comply with Minnesota Statutes,
9.6section 62A.3094, subdivision 2.
9.7(3) The Minnesota Comprehensive Health Association may charge a premium for
9.8the coverage required under this section, not to exceed the average cost of a child-only
9.9insurance premium in Minnesota under the federal Patient Protection and Affordable Care
9.10Act, Public Law 111-148, as amended. The association may continue to use its current
9.11procedures for assessing the association's members for costs the association incurs, or
9.12expects to incur, in excess of premiums it receives under this clause.
9.13(4) This paragraph expires if and when coverage of autism spectrum disorder is
9.14included in the essential health benefit set required under the federal Patient Protection
9.15and Affordable Care Act.
9.16EFFECTIVE DATE.This section is effective if legislation is not enacted by August
9.171, 2014, to expand the private insurance mandate to cover children under age 18 with an
9.18autism spectrum disorder under Minnesota Statutes, section 62A.3094, subdivision 2, and
9.19to limit medical assistance fees under Minnesota Statutes, section 252.27, subdivision 2d.
9.20The commissioner of human services shall notify the revisor of statutes if this section
9.21becomes effective and place a notice in the State Register.
9.22 Sec. 11. Laws 2013, chapter 108, article 12, section 2, the effective date, is amended to
9.23read:
9.24EFFECTIVE DATE.This section is effectiveJanuary July 1, 2016 2014, or the
9.25date a collective bargaining agreement or compensation plan that includes changes to this
9.26section is approved under Minnesota Statutes, section3.855 , whichever is earlier.
1.3intervention benefit under medical assistance; modifying insurance coverage for
1.4autism spectrum disorder;amending Minnesota Statutes 2012, section 252.27, by
1.5adding a subdivision; Minnesota Statutes 2013 Supplement, sections 62A.3094,
1.6subdivisions 1, 2; 252.27, subdivision 2a; 256B.0949, subdivisions 2, 3, 4, 7, 9;
1.7Laws 2013, chapter 9, section 15; Laws 2013, chapter 108, article 12, section 2.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2013 Supplement, section 62A.3094, subdivision 1,
1.10is amended to read:
1.11 Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
1.12paragraphs (b) to (d) have the meanings given.
1.13(b) "Autism spectrum
1.14determined by criteria set forth in the most recent edition of the Diagnostic and Statistical
1.15Manual of Mental Disorders of the American Psychiatric Association.
1.16(c) "Medically necessary care" means health care services appropriate, in terms of
1.17type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
1.18testing and preventative services. Medically necessary care must be consistent with
1.19generally accepted practice parameters as determined by physicians and licensed
1.20psychologists who typically manage patients who have autism spectrum
1.21and must meet the requirements in section 62Q.53.
1.22(d) "Mental health professional" means a mental health professional as defined in
1.23section
1.24expertise in autism spectrum
2.1 Sec. 2. Minnesota Statutes 2013 Supplement, section 62A.3094, subdivision 2, is
2.2amended to read:
2.3 Subd. 2. Coverage required. (a) A health plan
2.4defined in section
2.5diagnosis, evaluation, multidisciplinary assessment, and medically necessary care of
2.6
2.7not limited to the following:
2.8(1) early intensive behavioral and developmental therapy based in behavioral and
2.9developmental science, including, but not limited to, all types of applied behavior analysis,
2.10intensive early intervention behavior therapy, and intensive behavior intervention;
2.11(2) neurodevelopmental and behavioral health treatments and management;
2.12(3) speech therapy;
2.13(4) occupational therapy;
2.14(5) physical therapy; and
2.15(6) medications.
2.16(b) The diagnosis, evaluation, and assessment must include an assessment of the
2.17child's developmental skills, functional behavior, needs, and capacities.
2.18(c) The coverage required under this subdivision must include treatment that is in
2.19accordance with an individualized treatment plan prescribed by the enrollee's treating
2.20physician or mental health professional.
2.21(d) A health carrier may not refuse to renew or reissue, or otherwise terminate or
2.22restrict, coverage of an individual solely because the individual is diagnosed with an
2.23autism spectrum disorder.
2.24(e) A health carrier may request an updated treatment plan only once every six
2.25months, unless the health carrier and the treating physician or mental health professional
2.26agree that a more frequent review is necessary due to emerging circumstances.
2.27(f) An independent progress evaluation conducted by a mental health professional
2.28with expertise and training in autism spectrum disorder and child development must be
2.29completed to determine if progress toward
2.30determined in the treatment plan, is being made.
2.31 Sec. 3. Minnesota Statutes 2013 Supplement, section 252.27, subdivision 2a, is
2.32amended to read:
2.33 Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor
2.34child, including a child determined eligible for medical assistance without consideration of
2.35parental income, must contribute to the cost of services used by making monthly payments
3.1on a sliding scale based on income, unless the child is married or has been married, parental
3.2rights have been terminated, or the child's adoption is subsidized according to chapter
3.3259A or through title IV-E of the Social Security Act. The parental contribution is a partial
3.4or full payment for medical services provided for diagnostic, therapeutic, curing, treating,
3.5mitigating, rehabilitation, maintenance, and personal care services as defined in United
3.6States Code, title 26, section 213, needed by the child with a chronic illness or disability.
3.7 (b) For households with adjusted gross income equal to or greater than 275 percent
3.8of federal poverty guidelines, the parental contribution shall be computed by applying the
3.9following schedule of rates to the adjusted gross income of the natural or adoptive parents:
3.10 (1) if the adjusted gross income is equal to or greater than 275 percent of federal
3.11poverty guidelines and less than or equal to 545 percent of federal poverty guidelines,
3.12the parental contribution shall be determined using a sliding fee scale established by the
3.13commissioner of human services which begins at
3.14income at 275 percent of federal poverty guidelines and increases to
3.15adjusted gross income for those with adjusted gross income up to 545 percent of federal
3.16poverty guidelines;
3.17 (2) if the adjusted gross income is greater than 545 percent of federal poverty
3.18guidelines and less than 675 percent of federal poverty guidelines, the parental
3.19contribution shall be
3.20of adjusted gross income at 545 percent of the federal poverty guidelines and increases to
3.21three percent of adjusted gross income for those with adjusted gross income up to 675
3.22percent of the federal poverty guidelines;
3.23 (3) if the adjusted gross income is equal to or greater than 675 percent of federal
3.24poverty guidelines and less than 975 percent of federal poverty guidelines, the parental
3.25contribution shall be determined using a sliding fee scale established by the commissioner
3.26of human services which begins at
3.27of federal poverty guidelines and increases to
3.28those with adjusted gross income up to 975 percent of federal poverty guidelines; and
3.29 (4) if the adjusted gross income is equal to or greater than 975 percent of federal
3.30poverty guidelines, the parental contribution shall be
3.31income.
3.32 If the child lives with the parent, the annual adjusted gross income is reduced by
3.33$2,400 prior to calculating the parental contribution. If the child resides in an institution
3.34specified in section
3.35specified under that section in addition to the parental contribution determined under this
4.1section. The parental contribution is reduced by any amount required to be paid directly to
4.2the child pursuant to a court order, but only if actually paid.
4.3 (c) The household size to be used in determining the amount of contribution under
4.4paragraph (b) includes natural and adoptive parents and their dependents, including the
4.5child receiving services. Adjustments in the contribution amount due to annual changes
4.6in the federal poverty guidelines shall be implemented on the first day of July following
4.7publication of the changes.
4.8 (d) For purposes of paragraph (b), "income" means the adjusted gross income of the
4.9natural or adoptive parents determined according to the previous year's federal tax form,
4.10except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
4.11have been used to purchase a home shall not be counted as income.
4.12 (e) The contribution shall be explained in writing to the parents at the time eligibility
4.13for services is being determined. The contribution shall be made on a monthly basis
4.14effective with the first month in which the child receives services. Annually upon
4.15redetermination or at termination of eligibility, if the contribution exceeded the cost of
4.16services provided, the local agency or the state shall reimburse that excess amount to
4.17the parents, either by direct reimbursement if the parent is no longer required to pay a
4.18contribution, or by a reduction in or waiver of parental fees until the excess amount is
4.19exhausted. All reimbursements must include a notice that the amount reimbursed may be
4.20taxable income if the parent paid for the parent's fees through an employer's health care
4.21flexible spending account under the Internal Revenue Code, section 125, and that the
4.22parent is responsible for paying the taxes owed on the amount reimbursed.
4.23 (f) The monthly contribution amount must be reviewed
4.24 annually, when there is a change in household size
4.25
4.26review due to a substantial decrease in income or an extreme hardship. The local agency
4.27shall mail a written notice 30 days in advance of the effective date of a change in the
4.28contribution amount. A decrease in the contribution amount is effective in the month that
4.29the parent verifies a reduction in income or change in household size.
4.30 (g) Parents of a minor child who do not live with each other shall each pay the
4.31contribution required under paragraph (a). An amount equal to the annual court-ordered
4.32child support payment actually paid on behalf of the child receiving services shall be
4.33deducted from the adjusted gross income of the parent making the payment prior to
4.34calculating the parental contribution under paragraph (b).
4.35 (h) The contribution under paragraph (b) shall be increased by an additional five
4.36percent if the local agency determines that insurance coverage is available but not obtained
5.1for the child. For purposes of this section, "available" means the insurance is a benefit of
5.2employment for a family member at an annual cost of no more than five percent of the
5.3
5.4and accident insurance coverage, enrollment in a nonprofit health service plan, health
5.5maintenance organization, self-insured plan, or preferred provider organization.
5.6 Parents who have more than one child receiving services shall not be required
5.7to pay more than the amount for the child with the highest expenditures. There shall
5.8be no resource contribution from the parents. The parent shall not be required to pay
5.9a contribution in excess of the cost of the services provided to the child, not counting
5.10payments made to school districts for education-related services. Notice of an increase in
5.11fee payment must be given at least 30 days before the increased fee is due.
5.12 (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
5.13in the 12 months prior to July 1:
5.14 (1) the parent applied for insurance for the child;
5.15 (2) the insurer denied insurance;
5.16 (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
5.17a complaint or appeal, in writing, to the commissioner of health or the commissioner of
5.18commerce, or litigated the complaint or appeal; and
5.19 (4) as a result of the dispute, the insurer reversed its decision and granted insurance.
5.20 For purposes of this section, "insurance" has the meaning given in paragraph (h).
5.21 A parent who has requested a reduction in the contribution amount under this
5.22paragraph shall submit proof in the form and manner prescribed by the commissioner or
5.23county agency, including, but not limited to, the insurer's denial of insurance, the written
5.24letter or complaint of the parents, court documents, and the written response of the insurer
5.25approving insurance. The determinations of the commissioner or county agency under this
5.26paragraph are not rules subject to chapter 14.
5.27 Sec. 4. Minnesota Statutes 2012, section 252.27, is amended by adding a subdivision
5.28to read:
5.29 Subd. 2d. Fees limited. Notwithstanding subdivision 2a, the fee a parent is required
5.30to contribute to the cost of services under medical assistance for an individual child shall
5.31not exceed the maximum insurance premium charged in Minnesota under the federal
5.32Patient Protection and Affordable Care Act, Public Law 111-148, as amended, for a
5.33child-only policy for a child with the same amount of income.
6.1 Sec. 5. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 2,
6.2is amended to read:
6.3 Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
6.4this subdivision have the meanings given.
6.5 (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
6.6current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
6.7 (c) "Child" means a person under the age of 18.
6.8 (d) "Commissioner" means the commissioner of human services, unless otherwise
6.9specified.
6.10 (e) "Early intensive intervention benefit" means autism treatment options based in
6.11behavioral and developmental science, which may include modalities such as applied
6.12behavior analysis, developmental treatment approaches, and naturalistic and parent
6.13training models.
6.14 (f) "Generalizable goals" means results or gains that are observed during a variety
6.15of activities with different people, such as providers, family members, other adults, and
6.16children, and in different environments including, but not limited to, clinics, homes,
6.17schools, and the community.
6.18 (g) "Mental health professional"
6.19professional as defined in section
6.20training and expertise in autism spectrum disorders.
6.21 Sec. 6. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 3,
6.22is amended to read:
6.23 Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
6.24assistance who
6.25
6.26medically necessary care under Minnesota Rules, part 9505.0175, subpart 25.
6.27
6.28
6.29
6.30
6.31 Sec. 7. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 4,
6.32is amended to read:
6.33 Subd. 4. Diagnosis. (a) A diagnosis must:
7.1 (1) be based upon current DSM criteria including direct observations of the child
7.2and reports from parents or primary caregivers; and
7.3 (2) be completed by
7.4registered nurse
7.5 (b) Additional diagnostic assessment information may be considered including from
7.6special education evaluations and licensed school personnel, and from professionals
7.7licensed in the fields of medicine, speech and language, psychology, occupational therapy,
7.8and physical therapy.
7.9
7.10
7.11
7.12
7.13
7.14
7.15
7.16 Sec. 8. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 7,
7.17is amended to read:
7.18 Subd. 7. Ongoing eligibility. (a)
7.19by a licensed mental health professional with expertise and training in autism spectrum
7.20disorder and child development must be completed after
7.21treatment and not more than once every 12 months thereafter,
7.22
7.23determines more frequent evaluations are necessary, to determine if progress is being
7.24made toward achieving generalizable goals and meeting functional goals contained in
7.25the treatment plan.
7.26 (b) The progress evaluation must include:
7.27 (1) the treating provider's report;
7.28 (2) parental or caregiver input;
7.29 (3) an
7.30licensed special education staff;
7.31 (4) any treatment plan modifications; and
7.32 (5) recommendations for continued treatment services.
7.33 (c) Progress evaluations must be submitted to the commissioner in a manner
7.34determined by the commissioner for this purpose.
8.1 (d) A child who continues to achieve generalizable goals and treatment goals as
8.2specified in the treatment plan and who is recommended for continued treatment services
8.3by the treating mental health professional under paragraph (b), clause (5), is eligible to
8.4continue receiving this benefit.
8.5 (e) The commissioner may consider an alternative eligibility recommendation to the
8.6recommendation of the treating mental health professional under paragraph (b), clause (5),
8.7if there is a detailed report provided by a licensed mental health professional with expertise
8.8treating children with autism spectrum disorder using the relevant treatment modality
8.9showing that progress is not being made in a particular case. In this case, treatment shall
8.10not be interrupted and shall continue to be reimbursed until a final determination is made.
8.11 (f) A child's treatment shall continue to be reimbursed during the progress evaluation
8.12
8.13made. Treatment may continue during an appeal pursuant to section
8.14 Sec. 9. Minnesota Statutes 2013 Supplement, section 256B.0949, subdivision 9,
8.15is amended to read:
8.16 Subd. 9. Revision of treatment options. (a) The commissioner may
8.17 covered treatment options as needed based on outcome data and other evidence.
8.18 (b) Before the changes become effective, the commissioner must provide public
8.19notice of the changes, the reasons for the change, and a 30-day public comment period
8.20to those who request notice through an electronic list accessible to the public on the
8.21department's Web site.
8.22 Sec. 10. Laws 2013, chapter 9, section 15, is amended to read:
8.23 Sec. 15. MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION
8.24TERMINATION.
8.25(a) The commissioner of commerce, in consultation with the board of directors of the
8.26Minnesota Comprehensive Health Association, has the authority to develop and implement
8.27the phase-out and eventual appropriate termination of coverage provided by the Minnesota
8.28Comprehensive Health Association under Minnesota Statutes, chapter 62E. The phase-out
8.29of coverage shall begin no sooner than January 1, 2014, or upon the effective date of the
8.30operation of the Minnesota Insurance Marketplace and the ability to purchase qualified
8.31health plans through the Minnesota Insurance Marketplace, whichever is later, and shall,
8.32to the extent practicable, ensure the least amount of disruption to the enrollees' health care
8.33coverage. The member assessments established under Minnesota Statutes, section
8.34shall take into consideration any phase-out of coverage implemented under this section.
9.1(b)(1) Notwithstanding paragraph (a), the Minnesota Comprehensive Health
9.2Association shall continue beyond any phaseout or termination specified in paragraph (a)
9.3for the purpose of providing coverage for autism spectrum disorder as defined in Minnesota
9.4Statutes, section 62A.3094, subdivision 1, paragraph (b), for children under the age 18.
9.5(2) The coverage provided under clause (1) must comply with Minnesota Statutes,
9.6section 62A.3094, subdivision 2.
9.7(3) The Minnesota Comprehensive Health Association may charge a premium for
9.8the coverage required under this section, not to exceed the average cost of a child-only
9.9insurance premium in Minnesota under the federal Patient Protection and Affordable Care
9.10Act, Public Law 111-148, as amended. The association may continue to use its current
9.11procedures for assessing the association's members for costs the association incurs, or
9.12expects to incur, in excess of premiums it receives under this clause.
9.13(4) This paragraph expires if and when coverage of autism spectrum disorder is
9.14included in the essential health benefit set required under the federal Patient Protection
9.15and Affordable Care Act.
9.16EFFECTIVE DATE.This section is effective if legislation is not enacted by August
9.171, 2014, to expand the private insurance mandate to cover children under age 18 with an
9.18autism spectrum disorder under Minnesota Statutes, section 62A.3094, subdivision 2, and
9.19to limit medical assistance fees under Minnesota Statutes, section 252.27, subdivision 2d.
9.20The commissioner of human services shall notify the revisor of statutes if this section
9.21becomes effective and place a notice in the State Register.
9.22 Sec. 11. Laws 2013, chapter 108, article 12, section 2, the effective date, is amended to
9.23read:
9.24EFFECTIVE DATE.This section is effective
9.25date a collective bargaining agreement or compensation plan that includes changes to this
9.26section is approved under Minnesota Statutes, section
