Bill Text: MN SF991 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Special education third-party reimbursement of qualifying services modification
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2011-03-23 - Referred to Education [SF991 Detail]
Download: Minnesota-2011-SF991-Introduced.html
1.2relating to education finance; modifying the process for third-party
1.3reimbursement of qualifying services; amending Minnesota Statutes 2010,
1.4section 125A.21, subdivisions 2, 3, 5, 7.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2010, section 125A.21, subdivision 2, is amended to
1.7read:
1.8 Subd. 2. Third-party reimbursement. (a) Beginning July 1, 2000, districts
1.9shall seek reimbursement from insurers and similar third parties for the cost of services
1.10provided by the district whenever the services provided by the district are otherwise
1.11covered by the child's health coverage. Districts shall request, but may not require, the
1.12child's family to provide information about the child's health coverage when a child with a
1.13disability begins to receive services from the district of a type that may be reimbursable,
1.14and shall request, but may not require, updated information after that as needed.
1.15(b) For children enrolled in medical assistance under chapter 256B or MinnesotaCare
1.16under chapter 256L who have no other health coverage, a district shall provide an initial
1.17written notice to the enrolled child's parent or legal representative of its intent to seek
1.18reimbursement from medical assistance or MinnesotaCare for the individual education
1.19plan health-related services provided by the district. The notice shall include:
1.20(1) the right of the parent or legal representative to request a copy of all records
1.21concerning individualized education program health-related services disclosed by the
1.22district to any third party;
1.23(2) the right of the parent or legal representative to withdraw consent for disclosing a
1.24child's records at any time without consequence, including consent that was initially
2.1given as part of the application process for MinnesotaCare or medical assistance under
2.2section 256B.08, subdivision 1; and
2.3(3) a statement that a decision to revoke consent for schools to share information
2.4from education records does not impact a parent's eligibility for MinnesotaCare or medical
2.5assistance.
2.6(c) The district shall give the parent or legal representative annual written notice of:
2.7(1) the district's intent to seek reimbursement from medical assistance or
2.8MinnesotaCare for individual education plan health-related services provided by the
2.9district;
2.10(2) the right of the parent or legal representative to request a copy of all records
2.11concerning individual education plan health-related services disclosed by the district to
2.12any third party; and
2.13(3) the right of the parent or legal representative to withdraw consent for disclosure
2.14of a child's records at any time without consequence, including consent that was initially
2.15given as part of the application process for MinnesotaCare or medical assistance under
2.16section 256B.08, subdivision 1.
2.17The written notice shall be provided as part of the written notice required by Code of
2.18Federal Regulations, title 34, section 300.504. The Department of Education must ensure
2.19that the notice requirements under this paragraph are included in the notice of procedural
2.20safeguards.
2.21(d) In order to access the private health care coverage of a child who is covered by
2.22private health care coverage in whole or in part, a district must:
2.23(1) obtain annual written informed consent from the parent or legal representative, in
2.24compliance with subdivision 5; and
2.25(2) inform the parent or legal representative that a refusal to permit the district
2.26or state Medicaid agency to access their private health care coverage does not relieve
2.27the district of its responsibility to provide all services necessary to provide free and
2.28appropriate public education at no cost to the parent or legal representative.
2.29(e) If the commissioner of human services obtains federal approval to exempt
2.30covered individual education plan health-related services from the requirement that private
2.31health care coverage refuse payment before medical assistance may be billed, paragraphs
2.32(b), (c), and (d) shall also apply to students with a combination of private health care
2.33coverage and health care coverage through medical assistance or MinnesotaCare.
2.34(f) In the event that Congress or any federal agency or the Minnesota legislature
2.35or any state agency establishes lifetime limits, limits for any health care services,
2.36cost-sharing provisions, or otherwise provides that individual education plan health-related
3.1services impact benefits for persons enrolled in medical assistance or MinnesotaCare, the
3.2amendments to this subdivision adopted in 2002 are repealed on the effective date of any
3.3federal or state law or regulation that imposes the limits. In that event, districts must
3.4obtain informed consent consistent with this subdivision as it existed prior to the 2002
3.5amendments and subdivision 5, before seeking reimbursement for children enrolled in
3.6medical assistance under chapter 256B or MinnesotaCare under chapter 256L who have
3.7no other health care coverage.
3.8EFFECTIVE DATE.This section is effective the day following final enactment.
3.9 Sec. 2. Minnesota Statutes 2010, section 125A.21, subdivision 3, is amended to read:
3.10 Subd. 3. Use of reimbursements. Of the reimbursements received, districts may:
3.11(1) retain an amount sufficient to compensate the district for its administrative costs
3.12of obtaining reimbursements;
3.13(2) regularly obtain from education- and health-related entities training and other
3.14appropriate technical assistance designed to improve the district's ability todetermine
3.15which services are reimbursable and to seek timely reimbursement in a cost-effective
3.16manner access third-party payments for individualized education program health-related
3.17services; or
3.18(3) reallocate reimbursements for the benefit of students withspecial needs
3.19individualized education programs or individual family service plans in the district.
3.20EFFECTIVE DATE.This section is effective the day following final enactment.
3.21 Sec. 3. Minnesota Statutes 2010, section 125A.21, subdivision 5, is amended to read:
3.22 Subd. 5. Informed consent. When obtaining informed consent, consistent with
3.23sections13.05 , subdivision 4a; and,
256B.77, subdivision 2 , paragraph (p), and Code of
3.24Federal Regulations, title 34, parts 99 and 300, to bill health plans for covered services, the
3.25school district must notify the legal representative (1) that the cost of the person's private
3.26health insurance premium may increase due to providing the covered service in the school
3.27setting, (2) that the school district may pay certain enrollee health plan costs, including
3.28but not limited to, co-payments, coinsurance, deductibles, premium increases or other
3.29enrollee cost-sharing amounts for health and related services required by an individual
3.30service plan, or individual family service plan, and (3) that the school's billing for each
3.31type of covered service may affect service limits and prior authorization thresholds. The
3.32informed consent may be revoked in writing at any time by the person authorizing the
3.33billing of the health plan.
4.1EFFECTIVE DATE.This section is effective the day following final enactment.
4.2 Sec. 4. Minnesota Statutes 2010, section 125A.21, subdivision 7, is amended to read:
4.3 Subd. 7. District disclosure of information. A school district may disclose
4.4information contained in a student's individual education plan, consistent with section
4.513.32, subdivision 3
, paragraph (a), and Code of Federal Regulations, title 34, part 99;
4.6including records of the student's diagnosis and treatment, to a health plan company only
4.7with the signed and dated consent of the student's parent, or other legally authorized
4.8individual. The school district shall disclose only that information necessary for the health
4.9plan company to decide matters of coverage and payment. A health plan company may
4.10use the information only for making decisions regarding coverage and payment, and for
4.11any other use permitted by law.
4.12EFFECTIVE DATE.This section is effective the day following final enactment.
4.13 Sec. 5. THIRD-PARTY BILLING.
4.14To allow the cost-effective billing of medical assistance for covered services that
4.15are not reimbursed by other legally liable third parties, the commissioner of human
4.16services must:
4.17(1) summarize and document school district efforts to secure reimbursement from
4.18legally liable third parties; and
4.19(2) request initial and continuing waiver of the requirement to seek payment from a
4.20student's private health plan as allowed in Code of Federal Regulations, title 42, section
4.21433.139, chapter IV, part 433, based on the determination that this requirement is not
4.22cost-effective from the Centers for Medicare and Medicaid Services to allow school
4.23districts to bill Medicaid alone, without first billing private payers, when a child has
4.24both public and private coverage.
4.25EFFECTIVE DATE.This section is effective the day following final enactment.
1.3reimbursement of qualifying services; amending Minnesota Statutes 2010,
1.4section 125A.21, subdivisions 2, 3, 5, 7.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2010, section 125A.21, subdivision 2, is amended to
1.7read:
1.8 Subd. 2. Third-party reimbursement. (a) Beginning July 1, 2000, districts
1.9shall seek reimbursement from insurers and similar third parties for the cost of services
1.10provided by the district whenever the services provided by the district are otherwise
1.11covered by the child's health coverage. Districts shall request, but may not require, the
1.12child's family to provide information about the child's health coverage when a child with a
1.13disability begins to receive services from the district of a type that may be reimbursable,
1.14and shall request, but may not require, updated information after that as needed.
1.15(b) For children enrolled in medical assistance under chapter 256B or MinnesotaCare
1.16under chapter 256L who have no other health coverage, a district shall provide an initial
1.17written notice to the enrolled child's parent or legal representative of its intent to seek
1.18reimbursement from medical assistance or MinnesotaCare for the individual education
1.19plan health-related services provided by the district. The notice shall include:
1.20(1) the right of the parent or legal representative to request a copy of all records
1.21concerning individualized education program health-related services disclosed by the
1.22district to any third party;
1.23(2) the right of the parent or legal representative to withdraw consent for disclosing a
1.24child's records at any time without consequence, including consent that was initially
2.1given as part of the application process for MinnesotaCare or medical assistance under
2.2section 256B.08, subdivision 1; and
2.3(3) a statement that a decision to revoke consent for schools to share information
2.4from education records does not impact a parent's eligibility for MinnesotaCare or medical
2.5assistance.
2.6(c) The district shall give the parent or legal representative annual written notice of:
2.7(1) the district's intent to seek reimbursement from medical assistance or
2.8MinnesotaCare for individual education plan health-related services provided by the
2.9district;
2.10(2) the right of the parent or legal representative to request a copy of all records
2.11concerning individual education plan health-related services disclosed by the district to
2.12any third party; and
2.13(3) the right of the parent or legal representative to withdraw consent for disclosure
2.14of a child's records at any time without consequence, including consent that was initially
2.15given as part of the application process for MinnesotaCare or medical assistance under
2.16section 256B.08, subdivision 1.
2.17The written notice shall be provided as part of the written notice required by Code of
2.18Federal Regulations, title 34, section 300.504. The Department of Education must ensure
2.19that the notice requirements under this paragraph are included in the notice of procedural
2.20safeguards.
2.21(d) In order to access the private health care coverage of a child who is covered by
2.22private health care coverage in whole or in part, a district must:
2.23(1) obtain annual written informed consent from the parent or legal representative, in
2.24compliance with subdivision 5; and
2.25(2) inform the parent or legal representative that a refusal to permit the district
2.26or state Medicaid agency to access their private health care coverage does not relieve
2.27the district of its responsibility to provide all services necessary to provide free and
2.28appropriate public education at no cost to the parent or legal representative.
2.29(e) If the commissioner of human services obtains federal approval to exempt
2.30covered individual education plan health-related services from the requirement that private
2.31health care coverage refuse payment before medical assistance may be billed, paragraphs
2.32(b), (c), and (d) shall also apply to students with a combination of private health care
2.33coverage and health care coverage through medical assistance or MinnesotaCare.
2.34(f) In the event that Congress or any federal agency or the Minnesota legislature
2.35or any state agency establishes lifetime limits, limits for any health care services,
2.36cost-sharing provisions, or otherwise provides that individual education plan health-related
3.1services impact benefits for persons enrolled in medical assistance or MinnesotaCare, the
3.2amendments to this subdivision adopted in 2002 are repealed on the effective date of any
3.3federal or state law or regulation that imposes the limits. In that event, districts must
3.4obtain informed consent consistent with this subdivision as it existed prior to the 2002
3.5amendments and subdivision 5, before seeking reimbursement for children enrolled in
3.6medical assistance under chapter 256B or MinnesotaCare under chapter 256L who have
3.7no other health care coverage.
3.8EFFECTIVE DATE.This section is effective the day following final enactment.
3.9 Sec. 2. Minnesota Statutes 2010, section 125A.21, subdivision 3, is amended to read:
3.10 Subd. 3. Use of reimbursements. Of the reimbursements received, districts may:
3.11(1) retain an amount sufficient to compensate the district for its administrative costs
3.12of obtaining reimbursements;
3.13(2) regularly obtain from education- and health-related entities training and other
3.14appropriate technical assistance designed to improve the district's ability to
3.15
3.16
3.17services; or
3.18(3) reallocate reimbursements for the benefit of students with
3.19individualized education programs or individual family service plans in the district.
3.20EFFECTIVE DATE.This section is effective the day following final enactment.
3.21 Sec. 3. Minnesota Statutes 2010, section 125A.21, subdivision 5, is amended to read:
3.22 Subd. 5. Informed consent. When obtaining informed consent, consistent with
3.23sections
3.24Federal Regulations, title 34, parts 99 and 300, to bill health plans for covered services, the
3.25school district must notify the legal representative (1) that the cost of the person's private
3.26health insurance premium may increase due to providing the covered service in the school
3.27setting, (2) that the school district may pay certain enrollee health plan costs, including
3.28but not limited to, co-payments, coinsurance, deductibles, premium increases or other
3.29enrollee cost-sharing amounts for health and related services required by an individual
3.30service plan, or individual family service plan, and (3) that the school's billing for each
3.31type of covered service may affect service limits and prior authorization thresholds. The
3.32informed consent may be revoked in writing at any time by the person authorizing the
3.33billing of the health plan.
4.1EFFECTIVE DATE.This section is effective the day following final enactment.
4.2 Sec. 4. Minnesota Statutes 2010, section 125A.21, subdivision 7, is amended to read:
4.3 Subd. 7. District disclosure of information. A school district may disclose
4.4information contained in a student's individual education plan, consistent with section
4.6including records of the student's diagnosis and treatment, to a health plan company only
4.7with the signed and dated consent of the student's parent, or other legally authorized
4.8individual. The school district shall disclose only that information necessary for the health
4.9plan company to decide matters of coverage and payment. A health plan company may
4.10use the information only for making decisions regarding coverage and payment, and for
4.11any other use permitted by law.
4.12EFFECTIVE DATE.This section is effective the day following final enactment.
4.13 Sec. 5. THIRD-PARTY BILLING.
4.14To allow the cost-effective billing of medical assistance for covered services that
4.15are not reimbursed by other legally liable third parties, the commissioner of human
4.16services must:
4.17(1) summarize and document school district efforts to secure reimbursement from
4.18legally liable third parties; and
4.19(2) request initial and continuing waiver of the requirement to seek payment from a
4.20student's private health plan as allowed in Code of Federal Regulations, title 42, section
4.21433.139, chapter IV, part 433, based on the determination that this requirement is not
4.22cost-effective from the Centers for Medicare and Medicaid Services to allow school
4.23districts to bill Medicaid alone, without first billing private payers, when a child has
4.24both public and private coverage.
4.25EFFECTIVE DATE.This section is effective the day following final enactment.
