1.1.................... moves to amend H.F. No. 1233, the delete everything amendment
1.2(A13-0408), as follows:
1.3Page 171, after line 30, insert:
1.4 "Sec. .... Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
1.5to read:
1.6 Subd. 35. Commissioner must annually report certain prepaid medical
1.7assistance plan data. (a) The commissioner of human services and the commissioner
1.8of education may share private or nonpublic data to allow the commissioners to analyze
1.9the screening, diagnosis, and treatment of children with autism spectrum disorder and
1.10other developmental conditions. The commissioners may share the individual-level data
1.11necessary to:
1.12 (1) measure the prevalence of autism spectrum disorder and other developmental
1.13conditions;
1.14 (2) analyze the effectiveness of existing policies and procedures in the early
1.15identification of children with autism spectrum disorder and other developmental
1.16conditions;
1.17 (3) assess the effectiveness of screening, diagnosis, and treatment to allow children
1.18with autism spectrum disorder and other developmental conditions to meet developmental
1.19and social-emotional milestones;
1.20 (4) identify and address disparities in screening, diagnosis, and treatment related
1.21to the native language or race and ethnicity of the child;
1.22 (5) measure the effectiveness of public health care programs in addressing the medical
1.23needs of children with autism spectrum disorder and other developmental conditions; and
1.24 (6) determine the capacity of educational systems and health care systems to meet
1.25the needs of children with autism spectrum disorder and other developmental conditions.
1.26 (b) The commissioner of human services shall use the data shared with the
1.27commissioner of education under this subdivision to improve public health care program
2.1performance in early screening, diagnosis, and treatment for children once data are
2.2available and shall report on the results and any summary data, as defined in section 13.02,
2.3subdivision 19, on the department's public Web site by each September 30."
2.4Page 176, delete section 8, and insert:
2.5 "Sec. ....
[256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
2.6 Subdivision 1. Purpose. This section creates a new benefit available under the
2.7medical assistance state plan when federal approval consistent with the provisions in
2.8subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable Care Act, section
2.92402(c), amending United States Code, title 42, section 1396n(i)(1), or other option to
2.10provide early intensive intervention to a child with an autism spectrum disorder diagnosis.
2.11This benefit must provide coverage for diagnosis, multidisciplinary assessment, ongoing
2.12progress evaluation, and medically necessary treatment of autism spectrum disorder.
2.13 Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
2.14this subdivision have the meanings given.
2.15 (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
2.16current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
2.17 (c) "Child" means a person under the age of 7, or for two years at any age under
2.18age 18 if the person was not diagnosed with autism spectrum disorder before age 5, or a
2.19person under age 18 pursuant to subdivision 12.
2.20 (d) "Commissioner" means the commissioner of human services, unless otherwise
2.21specified.
2.22 (e) "Early intensive intervention benefit" means autism treatment options based in
2.23behavioral and developmental science, which may include modalities such as applied
2.24behavior analysis, developmental treatment approaches, and naturalistic and parent
2.25training models.
2.26 (f) "Generalizable goals" means results or gains that are observed during a variety
2.27of activities with different people, such as providers, family members, other adults, and
2.28children and in different environments including, but not limited to, clinics, homes,
2.29schools, and the community.
2.30 Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
2.31assistance who:
2.32 (1) has an autism spectrum disorder diagnosis;
2.33 (2) has had a diagnostic assessment described in subdivision 5, which recommends
2.34early intensive intervention services;
2.35 (3) meets the criteria for medically necessary autism early intensive intervention
2.36services; and
3.1 (4) declines to enroll in the state services described in section 252.27.
3.2 Subd. 4. Diagnosis. (a) A diagnosis must:
3.3 (1) be based upon current DSM criteria including direct observations of the child
3.4and reports from parents, or primary caregivers;
3.5 (2) be completed by a professional who has expertise and training in autism spectrum
3.6disorder and child development and who is a licensed physician, nurse practitioner, or
3.7a licensed mental health professional until the commissioner's assessment required in
3.8subdivision 8, clause (7), shows there are adequate professionals to avoid access problems
3.9or delays in diagnosis for young children if two professionals are required for a diagnosis
3.10pursuant to clause (3); and
3.11 (3) be completed by both a medical and mental health professional who have expertise
3.12and training in autism spectrum disorder and child development when the assessment in
3.13subdivision 8, clause (7), demonstrates that there are sufficient professionals available.
3.14 (b) Additional diagnostic assessment information including from special education
3.15evaluations and licensed school personnel, and from professionals licensed in the fields of
3.16medicine, speech and language, psychology, occupational therapy, and physical therapy
3.17may be considered.
3.18 Subd. 5. Diagnostic assessment. The following information and assessments must
3.19be performed, reviewed, and relied upon for the eligibility determination, treatment and
3.20services recommendations, and treatment plan development for the child:
3.21 (1) an assessment of the child's developmental skills, functional behavior, needs,
3.22and capacities based on direct observation of the child which must be administered by
3.23a licensed mental health professional and may also include observations from family
3.24members, licensed school personnel, childcare providers, or other caregivers, as well as
3.25any medical or assessment information from other licensed professionals such as the
3.26child's physician, rehabilitation therapists, or mental health professionals; and
3.27 (2) an assessment of parental or caregiver capacity to participate in therapy including
3.28the type and level of parental or caregiver involvement and training recommended.
3.29 Subd. 6. Treatment plan. (a) Each child's treatment plan must be:
3.30 (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
3.31 (2) coordinated with medically necessary occupational, physical, and speech and
3.32language therapies, special education and other services the child and family are receiving;
3.33 (3) family centered;
3.34 (4) culturally sensitive; and
3.35 (5) individualized based on the child's developmental status and the child's and
3.36family's identified needs.
4.1 (b) The treatment plan must specify the:
4.2 (1) child's goals which are developmentally appropriate, functional, generalizable;
4.3 (2) treatment modality;
4.4 (3) treatment intensity;
4.5 (4) setting; and
4.6 (5) level and type of parental or caregiver involvement.
4.7 (c) The treatment must be supervised by a professional with expertise and training in
4.8autism and child development who is a licensed physician, nurse practitioner, or mental
4.9health professional.
4.10 (d) The treatment plan must be submitted to the commissioner for approval in a
4.11manner determined by the commissioner for this purpose.
4.12 (e) Services authorized must be consistent with the child's approved treatment plan.
4.13 Subd. 7. Ongoing eligibility. (a) An independent progress evaluation conducted
4.14by a licensed mental health professional with expertise and training in autism spectrum
4.15disorder and child development must be completed after each six months of treatment,
4.16or more frequently as determined by the commissioner, to determine if progress is being
4.17made toward achieving generalizable gains and meeting functional goals contained in
4.18the treatment plan.
4.19 (b) The progress evaluation must include:
4.20 (1) the treating provider's report;
4.21 (2) parental or caregiver input;
4.22 (3) an independent observation of the child which can be performed by the child's
4.23licensed special education staff;
4.24 (4) any treatment plan modifications; and
4.25 (5) recommendations for continued treatment services.
4.26 (c) Progress evaluations must be submitted to the commissioner in a manner
4.27determined by the commissioner for this purpose.
4.28 (d) A child who continues to achieve generalizable gains and treatment goals as
4.29specified in the treatment plan is eligible to continue receiving this benefit.
4.30 (e) A child's treatment shall continue during the progress evaluation and during an
4.31appeal if continuation of services pending appeal have been requested pursuant to section
4.32256.045 subdivision 10.
4.33 Subd. 8. Refining the benefit with stakeholders. The commissioner must develop
4.34the implementation details of the benefit in consultation with stakeholders and consider
4.35recommendations from the Health Services Advisory Council, the Department of Human
4.36Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
5.1Disorder Task Force, and the Interagency Task Force of the Departments of Health,
5.2Education, and Human Services. The commissioner must release these details for a 30-day
5.3public comment period prior to submission to the federal government for approval. The
5.4implementation details include, but are not limited to, the following components:
5.5 (1) a definition of the qualifications, standards, and roles of the treatment team,
5.6including recommendations after stakeholder consultation on whether board certified
5.7behavior analysts and other types of professionals trained in autism spectrum disorder and
5.8child development should be added as a mental health or other professional for treatment
5.9supervision or other function under medical assistance;
5.10 (2) development of initial, uniform parameters for comprehensive multidisciplinary
5.11diagnostic assessment information and progress evaluation standards;
5.12 (3) the design of an effective and consistent process for assessing parent and
5.13caregiver capacity to participate in the child's early intervention treatment and methods of
5.14involving the parents in the treatment of the child;
5.15 (4) formulation of a collaborative process in which professionals have opportunities
5.16to collectively inform the comprehensive, multidisciplinary diagnostic assessment, and
5.17progress evaluation processes and standards and to support quality improvement of early
5.18intensive intervention services;
5.19 (5) coordination of this benefit and its interaction with other services provided by the
5.20Departments of Human Services, Health and Education;
5.21 (6) evaluation, on an ongoing basis, of research regarding the program and treatment
5.22modalities provided to children under this benefit; and
5.23 (7) determination of the availability of licensed medical and mental health
5.24professionals with expertise and training in autism spectrum disorder throughout the state
5.25in order to assess whether there are sufficient professionals to require involvement of
5.26both a medical and mental health professional to provide access and prevent delay in the
5.27diagnosis and treatment of young children so as to implement subdivision 4, paragraph
5.28(a), and to ensure treatment is effective, timely, and accessible.
5.29 Subd. 9. Revision of treatment options. (a) The commissioner may revise covered
5.30treatment options as needed based on outcome data and other evidence.
5.31 (b) Before the changes become effective, the commissioner must provide public
5.32notice of the changes, the reasons for the change, and a 30-day public comment period
5.33to those who request notice through an electronic list accessible to the public on the
5.34department's Web site.
5.35 Subd. 10. Coordination between agencies. The commissioners of human services
5.36and education must develop the capacity to coordinate services and information including
6.1diagnostic, functional, developmental, medical, and educational assessments, service
6.2delivery, and progress evaluations across health and education sectors.
6.3 Subd. 11. Federal approval of the autism benefit. The provisions of subdivision 9
6.4shall apply to state plan services under Title XIX of the Social Security Act when federal
6.5approval is granted under 1915(i) or other authority which allows children eligible for
6.6medical assistance through the TEFRA option under section 256B.055, subdivision 12, to
6.7qualify and includes children eligible for medical assistance in families over 150 percent
6.8of the federal poverty guidelines.
6.9 Subd. 12. Local school districts option to continue treatment. (a) A local school
6.10district may contract with the commissioner of human services to pay the state share of
6.11the benefits described under this section to continue this treatment as part of the special
6.12education services offered to all students in the district diagnosed with an autism spectrum
6.13disorder.
6.14 (b) A local school district may utilize third party billing to seek reimbursement
6.15for the district for any services paid by the district under this section for which private
6.16insurance coverage was available to the child.
6.17EFFECTIVE DATE.The autism benefit under subdivisions 1 to 7, 9, and 12, is
6.18effective upon federal approval for the benefit under 1915(i) or other federal authority
6.19needed to meet the requirements of subdivision 11, but no earlier than March 1, 2014.
6.20Subdivisions 8, 10 and 11 are effective July 1, 2013."
6.21Page 190, after line 24, insert:
6.22 "Sec. .... Minnesota Statutes 2012, section 256B.69, is amended by adding a
6.23subdivision to read:
6.24 Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
6.25children with autism spectrum disorder and other developmental conditions. (a) The
6.26commissioner shall require managed care plans and county-based purchasing plans, as
6.27a condition of contract, to implement strategies that facilitate access for young children
6.28between the ages of one and three years to periodic developmental and social-emotional
6.29screenings, as recommended by the Minnesota Interagency Developmental Screening
6.30Task Force, and that those children who do not meet milestones are provided access to
6.31appropriate evaluation and assessment, including treatment recommendations, expected to
6.32improve the child's functioning, with the goal of meeting milestones by age five.
6.33 (b) The managed care plans must report the following data annually:
6.34 (1) the number of children who received a diagnostic assessment;
6.35 (2) the total number of children ages one to six with a diagnosis of autism spectrum
6.36disorder who received treatments;
7.1 (3) the number of children identified under clause (2) reported by each 12-month
7.2age group beginning with age one and ending with age six;
7.3 (4) the types of treatments provided to children identified under clause (2) listed by
7.4billing code, including the number of units billed for each child;
7.5 (5) barriers to providing screening, diagnosis, and treatment of young children
7.6between the ages of one and three years and any strategies implemented to address
7.7those barriers; and
7.8 (6) recommendations on how to measure and report on the effectiveness of the
7.9strategies implemented to facilitate access for young children to provide developmental
7.10and social-emotional screenings, diagnoses, and treatment."
7.11Page 197, after line 15, insert:
7.12 "Sec. 24.
TRAINING OF AUTISM SERVICE PROVIDERS.
7.13 The commissioners of health and human services shall ensure that the departments'
7.14autism-related service providers receive training in culturally appropriate approaches to
7.15serving the Somali, Latino, Hmong, and Indigenous American Indian communities, and
7.16other cultural groups experiencing a disproportionate incidence of autism.
7.17 Sec. 25.
DIRECTION TO COMMISSIONER.
7.18 By January 1, 2014, the commissioner of human services shall apply to the federal
7.19Centers for Medicare and Medicaid Services for a waiver or other authority to provide
7.20applied behavioral analysis services to children with autism spectrum disorder and related
7.21conditions under the medical assistance program.
7.22EFFECTIVE DATE.This section is effective the day following final enactment."
7.23Page 381, after line 9, insert:
7.24 "Sec. ...
[62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
7.25 Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
7.26paragraphs (b) to (e) have the meanings given.
7.27 (b) "Autism spectrum disorders" means the conditions as determined by criteria
7.28set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental
7.29Disorders of the American Psychiatric Association.
7.30 (c) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
7.31 (d) "Medically necessary care" means health care services appropriate, in terms of
7.32type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
7.33testing and preventative services. Medically necessary care must be consistent with
8.1generally accepted practice parameters as determined by physicians and licensed
8.2psychologists who typically manage patients who have autism spectrum disorders.
8.3 (e) "Mental health professional" has the meaning given in section 245.4871,
8.4subdivision 27.
8.5 Subd. 2. Optional coverage required. (a) A health plan must provide:
8.6 (1) all health benefits related to the treatment of autism spectrum disorders required
8.7by the essential health benefits required under section 1302 of the Affordable Care Act;
8.8 (2) all health benefits required by this or any other section of state law as of
8.9December 31, 2012; and
8.10 (3) an offer of one or more options for the purchase of supplemental autism coverage
8.11for young children for children under age 18 for the diagnosis, evaluation, assessment,
8.12and medically necessary care of autism spectrum disorders, including but not limited to
8.13the following:
8.14 (i) early intensive behavioral and developmental therapy based in behavioral and
8.15developmental science, including but not limited to applied behavior analysis, intensive
8.16early intervention behavior therapy, intensive behavior intervention, and Lovaas therapy
8.17and developmental approaches;
8.18 (ii) neuro-developmental and behavioral health treatments and management;
8.19 (iii) speech therapy;
8.20 (iv) occupational therapy;
8.21 (v) physical therapy; and
8.22 (vi) medications.
8.23 (b) The diagnosis, evaluation, and assessment must include an assessment of the
8.24child's developmental skills, functional behavior, needs, and capacities.
8.25 (c) The coverage option required under this section shall include treatment that is
8.26in accordance with an individualized treatment plan prescribed by the insured's treating
8.27physician or mental health professional.
8.28 (d) A health plan may not refuse to renew or reissue, or otherwise terminate or
8.29restrict, coverage of an individual solely because the individual is diagnosed with an
8.30autism spectrum disorder.
8.31 (e) A health plan may request an updated treatment plan only once every six months,
8.32unless the health plan and the treating physician or mental health professional agree that a
8.33more frequent review is necessary due to emerging circumstances.
8.34 (f) An independent progress evaluation conducted by a mental health professional
8.35with expertise and training in autism spectrum disorder and child development must be
9.1completed to determine progress toward functional and generalizable gains, as determined
9.2in the treatment plan, are being made.
9.3 (g) A health plan may cap the dollar value of the supplemental coverage offered
9.4under this subdivision, but may not cap the value at less than $50,000 per calendar year
9.5per individual receiving a diagnosis of autism spectrum disorder.
9.6 Subd. 3. No effect on other law. Nothing in this section limits in any way the
9.7coverage required under section 62Q.47.
9.8 Subd. 4. State health care programs. This section does not affect benefits available
9.9under the medical assistance and MinnesotaCare programs and does not limit, restrict, or
9.10otherwise reduce coverage under these programs.
9.11EFFECTIVE DATE.This section is effective January 1, 2014, and sunsets effective
9.12December 31, 2015, and applies to coverage offered; issued; sold; renewed; or continued
9.13as defined in Minnesota Statutes, section 60A.02, subdivision 2a; on or after that date."
9.14Page 443, after line 31, insert:
9.15 "Sec. ....
ASSESSMENT OF QUALITY METRICS FOR MEASURING THE
9.16SCREENING, DIAGNOSIS, AND TREATMENT OF YOUNG CHILDREN WITH
9.17AUTISM SPECTRUM DISORDER.
9.18 As part of the annual review and on-going development of quality measures under
9.19Minnesota Statutes, section 62U.02, the commissioner of health shall assess the medical
9.20evidence and feasibility of adding a set of quality metrics for measuring the screening,
9.21diagnosis, and treatment of young children with autism spectrum disorder."
9.22Page 459, after line 27, insert:
9.23"
Premium subsidy. $3,000,000 is
9.24appropriated from the general fund in both
9.25fiscal year 2014 and fiscal year 2015 to the
9.26commissioner of human services for the
9.27purpose of providing a premium subsidy to
9.28families purchasing supplemental autism
9.29coverage for young children on the private
9.30market if a family has an income below
9.31400 percent of the federal poverty level.
9.32The commissioner may utilize the existing
9.33eligibility and enrollment system described
9.34in section 252.27 to determine a family's
9.35eligibility for subsidies under this section.
10.1This appropriation is available until expended
10.2and does not become part of the base."
10.3Renumber the sections in sequence and correct the internal references
10.4Amend the title accordingly