Bill Text: MN SF969 | 2013-2014 | 88th Legislature | Introduced
Bill Title: School social work and psychological services in individualized education program medical assistance (MA) reimbursement coverage authorization
Sponsorship: Bipartisan Bill
Status: (Introduced - Dead) 2013-03-04 - Referred to Health, Human Services and Housing [SF969 Detail]
Download: Minnesota-2013-SF969-Introduced.html
1.2relating to education; authorizing medical assistance reimbursement for school
1.3social work and school psychological services included in a child's individualized
1.4education program;amending Minnesota Statutes 2012, section 256B.0625,
1.5subdivision 26.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 256B.0625, subdivision 26, is amended to
1.8read:
1.9 Subd. 26. Special education services. (a) Medical assistance covers medical
1.10services identified in a recipient's individualized education program and covered under the
1.11medical assistance state plan. Covered services include occupational therapy, physical
1.12therapy, speech-language therapy, clinical psychological services, nursing services,
1.13school psychological services, school social work services, personal care assistants
1.14serving as management aides, assistive technology devices, transportation services,
1.15health assessments, and other services covered under the medical assistance state plan.
1.16Mental health services eligible for medical assistance reimbursement must be provided or
1.17coordinated through a children's mental health collaborative where a collaborative exists if
1.18the child is included in the collaborative operational target population. The provision or
1.19coordination of services does not require that the individualized education program be
1.20developed by the collaborative.
1.21The services may be provided by a Minnesota school district that is enrolled as a
1.22medical assistance provider or its subcontractor, and only if the services meet all the
1.23requirements otherwise applicable if the service had been provided by a provider other
1.24than a school district, in the following areas: medical necessity, physician's orders,
1.25documentation, personnel qualifications, and prior authorization requirements. In order
2.1to receive reimbursement for the individual education program health-related mental
2.2health services, school districts may use the evaluation or assessment used for emotional
2.3or behavioral disorder, as defined in Minnesota Rules, part 3525.1329, in lieu of the
2.4diagnostic assessment required as part of the children's therapeutic services and supports.
2.5School districts may use the individualized education program, behavior intervention plan,
2.6and student progress reviews in lieu of the individual treatment plan, crisis plan, and
2.790-day review required by children's therapeutic services and supports. The nonfederal
2.8share of costs for services provided under this subdivision is the responsibility of the local
2.9school district as provided in section125A.74 . Services listed in a child's individualized
2.10education program are eligible for medical assistance reimbursement only if those services
2.11meet criteria for federal financial participation under the Medicaid program.
2.12(b) Approval of health-related services for inclusion in the individualized education
2.13program does not require prior authorization for purposes of reimbursement under this
2.14chapter. The commissioner may require physician review and approval of the plan not
2.15more than once annually or upon any modification of the individualized education
2.16program that reflects a change in health-related services.
2.17(c) Services of a speech-language pathologist provided under this section are covered
2.18notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
2.19(1) holds a masters degree in speech-language pathology;
2.20(2) is licensed by the Minnesota Board of Teaching as an educational
2.21speech-language pathologist; and
2.22(3) either has a certificate of clinical competence from the American Speech and
2.23Hearing Association, has completed the equivalent educational requirements and work
2.24experience necessary for the certificate or has completed the academic program and is
2.25acquiring supervised work experience to qualify for the certificate.
2.26(d) Medical assistance coverage for medically necessary services provided under
2.27other subdivisions in this section may not be denied solely on the basis that the same or
2.28similar services are covered under this subdivision.
2.29(e) The commissioner shall develop and implement package rates, bundled rates, or
2.30per diem rates for special education services under which separately covered services are
2.31grouped together and billed as a unit in order to reduce administrative complexity.
2.32(f) The commissioner shall develop a cost-based payment structure for payment of
2.33these services. Only costs reported through the designated Minnesota Department of
2.34Education data systems in distinct service categories qualify for inclusion in the cost-based
2.35payment structure. The commissioner shall reimburse claims submitted based on an
2.36interim rate, and shall settle at a final rate once the department has determined it. The
3.1commissioner shall notify the school district of the final rate. The school district has 60
3.2days to appeal the final rate. To appeal the final rate, the school district shall file a written
3.3appeal request to the commissioner within 60 days of the date the final rate determination
3.4was mailed. The appeal request shall specify (1) the disputed items and (2) the name and
3.5address of the person to contact regarding the appeal.
3.6(g) Effective July 1, 2000, medical assistance services provided under an
3.7individualized education program or an individual family service plan by local school
3.8districts shall not count against medical assistance authorization thresholds for that child.
3.9(h) Nursing services as defined in section148.171, subdivision 15 , and provided
3.10as an individualized education program health-related service, are eligible for medical
3.11assistance payment if they are otherwise a covered service under the medical assistance
3.12program. Medical assistance covers the administration of prescription medications by a
3.13licensed nurse who is employed by or under contract with a school district when the
3.14administration of medications is identified in the child's individualized education program.
3.15The simple administration of medications alone is not covered under medical assistance
3.16when administered by a provider other than a school district or when it is not identified in
3.17the child's individualized education program.
3.18(i) School social work services, as defined in the practice of social work in
3.19section 148E.010, subdivision 15, and provided as an individualized education program
3.20health-related service, are eligible for medical assistance payment. School social work
3.21services include those services provided to assist the student or family members in
3.22understanding the nature of the disability, the special needs of the student, and the student's
3.23development. The services, as identified and described in the individualized education
3.24program include, but are not limited to: evaluations; social work services provided to
3.25children and youth with social, psychological, or behavioral problems; and unscheduled
3.26activities for the purpose of resolving an immediate crisis situation. School social work
3.27services are provided to youth and children with conditions that may impair or limit
3.28behavioral, cognitive, emotional, mental, or social functioning. School social work
3.29service, as an individualized education program health-related service, shall be billed as a
3.30separate service and not require children's therapeutic services and supports certification.
3.31School social work services shall be provided by a social worker that possesses both a
3.32social work license from the Board of Social Work and a school social work license
3.33from the Board of Teaching.
3.34(j) School psychological services, as defined in Minnesota Rules, part 8710.6200,
3.35and provided as an individualized education program health-related service, are eligible
3.36for medical assistance payment. School psychological services include those services
4.1provided to assist the student or family members in understanding the nature of the
4.2disability, the special needs of the student, and the student's development. The services,
4.3as identified and described in the individualized education program include, but are
4.4not limited to: evaluations; psychological services provided to children and youth
4.5with social, psychological, or behavioral problems; and unscheduled activities for the
4.6purpose of resolving an immediate crisis situation. School psychological services are
4.7provided to youth and children with conditions that may impair or limit behavioral,
4.8cognitive, emotional, mental, or social functioning. School psychological service, as an
4.9individualized education program health-related service, shall be billed as a separate
4.10service and not require children's therapeutic services and supports certification. School
4.11psychological services shall be provided by a school psychologist that possesses a school
4.12psychological license from the Board of Teaching.
1.3social work and school psychological services included in a child's individualized
1.4education program;amending Minnesota Statutes 2012, section 256B.0625,
1.5subdivision 26.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 256B.0625, subdivision 26, is amended to
1.8read:
1.9 Subd. 26. Special education services. (a) Medical assistance covers medical
1.10services identified in a recipient's individualized education program and covered under the
1.11medical assistance state plan. Covered services include occupational therapy, physical
1.12therapy, speech-language therapy, clinical psychological services, nursing services,
1.13school psychological services, school social work services, personal care assistants
1.14serving as management aides, assistive technology devices, transportation services,
1.15health assessments, and other services covered under the medical assistance state plan.
1.16Mental health services eligible for medical assistance reimbursement must be provided or
1.17coordinated through a children's mental health collaborative where a collaborative exists if
1.18the child is included in the collaborative operational target population. The provision or
1.19coordination of services does not require that the individualized education program be
1.20developed by the collaborative.
1.21The services may be provided by a Minnesota school district that is enrolled as a
1.22medical assistance provider or its subcontractor, and only if the services meet all the
1.23requirements otherwise applicable if the service had been provided by a provider other
1.24than a school district, in the following areas: medical necessity, physician's orders,
1.25documentation, personnel qualifications, and prior authorization requirements. In order
2.1to receive reimbursement for the individual education program health-related mental
2.2health services, school districts may use the evaluation or assessment used for emotional
2.3or behavioral disorder, as defined in Minnesota Rules, part 3525.1329, in lieu of the
2.4diagnostic assessment required as part of the children's therapeutic services and supports.
2.5School districts may use the individualized education program, behavior intervention plan,
2.6and student progress reviews in lieu of the individual treatment plan, crisis plan, and
2.790-day review required by children's therapeutic services and supports. The nonfederal
2.8share of costs for services provided under this subdivision is the responsibility of the local
2.9school district as provided in section
2.10education program are eligible for medical assistance reimbursement only if those services
2.11meet criteria for federal financial participation under the Medicaid program.
2.12(b) Approval of health-related services for inclusion in the individualized education
2.13program does not require prior authorization for purposes of reimbursement under this
2.14chapter. The commissioner may require physician review and approval of the plan not
2.15more than once annually or upon any modification of the individualized education
2.16program that reflects a change in health-related services.
2.17(c) Services of a speech-language pathologist provided under this section are covered
2.18notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
2.19(1) holds a masters degree in speech-language pathology;
2.20(2) is licensed by the Minnesota Board of Teaching as an educational
2.21speech-language pathologist; and
2.22(3) either has a certificate of clinical competence from the American Speech and
2.23Hearing Association, has completed the equivalent educational requirements and work
2.24experience necessary for the certificate or has completed the academic program and is
2.25acquiring supervised work experience to qualify for the certificate.
2.26(d) Medical assistance coverage for medically necessary services provided under
2.27other subdivisions in this section may not be denied solely on the basis that the same or
2.28similar services are covered under this subdivision.
2.29(e) The commissioner shall develop and implement package rates, bundled rates, or
2.30per diem rates for special education services under which separately covered services are
2.31grouped together and billed as a unit in order to reduce administrative complexity.
2.32(f) The commissioner shall develop a cost-based payment structure for payment of
2.33these services. Only costs reported through the designated Minnesota Department of
2.34Education data systems in distinct service categories qualify for inclusion in the cost-based
2.35payment structure. The commissioner shall reimburse claims submitted based on an
2.36interim rate, and shall settle at a final rate once the department has determined it. The
3.1commissioner shall notify the school district of the final rate. The school district has 60
3.2days to appeal the final rate. To appeal the final rate, the school district shall file a written
3.3appeal request to the commissioner within 60 days of the date the final rate determination
3.4was mailed. The appeal request shall specify (1) the disputed items and (2) the name and
3.5address of the person to contact regarding the appeal.
3.6(g) Effective July 1, 2000, medical assistance services provided under an
3.7individualized education program or an individual family service plan by local school
3.8districts shall not count against medical assistance authorization thresholds for that child.
3.9(h) Nursing services as defined in section
3.10as an individualized education program health-related service, are eligible for medical
3.11assistance payment if they are otherwise a covered service under the medical assistance
3.12program. Medical assistance covers the administration of prescription medications by a
3.13licensed nurse who is employed by or under contract with a school district when the
3.14administration of medications is identified in the child's individualized education program.
3.15The simple administration of medications alone is not covered under medical assistance
3.16when administered by a provider other than a school district or when it is not identified in
3.17the child's individualized education program.
3.18(i) School social work services, as defined in the practice of social work in
3.19section 148E.010, subdivision 15, and provided as an individualized education program
3.20health-related service, are eligible for medical assistance payment. School social work
3.21services include those services provided to assist the student or family members in
3.22understanding the nature of the disability, the special needs of the student, and the student's
3.23development. The services, as identified and described in the individualized education
3.24program include, but are not limited to: evaluations; social work services provided to
3.25children and youth with social, psychological, or behavioral problems; and unscheduled
3.26activities for the purpose of resolving an immediate crisis situation. School social work
3.27services are provided to youth and children with conditions that may impair or limit
3.28behavioral, cognitive, emotional, mental, or social functioning. School social work
3.29service, as an individualized education program health-related service, shall be billed as a
3.30separate service and not require children's therapeutic services and supports certification.
3.31School social work services shall be provided by a social worker that possesses both a
3.32social work license from the Board of Social Work and a school social work license
3.33from the Board of Teaching.
3.34(j) School psychological services, as defined in Minnesota Rules, part 8710.6200,
3.35and provided as an individualized education program health-related service, are eligible
3.36for medical assistance payment. School psychological services include those services
4.1provided to assist the student or family members in understanding the nature of the
4.2disability, the special needs of the student, and the student's development. The services,
4.3as identified and described in the individualized education program include, but are
4.4not limited to: evaluations; psychological services provided to children and youth
4.5with social, psychological, or behavioral problems; and unscheduled activities for the
4.6purpose of resolving an immediate crisis situation. School psychological services are
4.7provided to youth and children with conditions that may impair or limit behavioral,
4.8cognitive, emotional, mental, or social functioning. School psychological service, as an
4.9individualized education program health-related service, shall be billed as a separate
4.10service and not require children's therapeutic services and supports certification. School
4.11psychological services shall be provided by a school psychologist that possesses a school
4.12psychological license from the Board of Teaching.
