Embedded Files
Explanation
Third party Medicaid billing helps to access funds to support Minnesota schools in building capacity to provide better health and behavioral health services to students.
Federal and state law require all public Minnesota schools to request payment for IEP health-related services from public and private health insurers. Minnesota Health Care Programs (MHCP) pays the federal share of covered health-related services described on a child’s IEP or IFSP.
Schools are reimbursed when a child has a disability and an IEP or IFSP, requires health-related services to benefit from special education, and is eligible for MHCP (which includes Medical Assistance (MA), MinnesotaCare and other public, government health programs). Reimbursable IEP or IFSP health-related services include assessments and services for:
Physical therapy.
Occupational therapy.
Speech-language-hearing.
Children’s Therapeutic Services and Supports (Mental Health).
Nursing.
Personal care assistance services.
Assistive technology devices (medical equipment).
Interpreter services when needed during a medical service.
Parents / guardians of children with disabilities must be fully informed before consenting to schools sharing information with the Minnesota Department of Human Services (DHS) and to bill. The case manager provides the parent/guardian a hard copy of the MA Consent form to review and sign, then uploads the document into History. This form is given to all students initially qualifying for services and for all students new to BCCS.
Important Resources
This is the MA Billing Guide from SpEd Forms. It has multiple sections that can be navigated to by category.
This is the Department of Human Services IEP Services online manual.
This 2021 video covers how to complete MA Activity logs in SpEd Forms.
This 2021 video covers Electronic signatures on MA logs in SpEd Forms.
MA Eligibility
Staff do not need to determine if a student is MA eligible. An eligibility report is frequently run through SpEd Forms to DHS to determine which students are eligible and receiving MA.
As a service provider, if you are only billing for MA eligible students, use this doc: How to find your MA eligible students
Billable Services
Personal Care Assistance (PCA) (ie: Paraprofessional/SEA) Services
Personal Care Assistance (PCA) (ie: Paraprofessional/SEA) Services
PCA services are determined through team collaboration and in conjunction with a Qualified Professional in the areas of Activities of Daily Living (ADLs) or Level 1 behaviors. PCA services are detailed in a student's Care Plan and referenced in the IEP.
Special Transportation
Special Transportation
Special transportation is a billable service when there has been a modification made to the vehicle transporting the student to their medically necessary school-based services. Special transportation must be indicated on the student's IEP.
Mental Health Services
Mental Health Services
There are specific portions of an evaluation that can be billed for - this is typically done by the School Psychologist.
Some students may have mental health services on their IEP that are provided by a mental health professional (or practitioner with a supervision plan in place).
Speech Language Pathology & Audiology
Speech Language Pathology & Audiology
Physical Therapy (PT) & Occupational Therapy (OT)
Physical Therapy (PT) & Occupational Therapy (OT)
Assistive Technology Devices
Assistive Technology Devices
Nursing Services
Nursing Services
Oral Language & Sign Language Interpreter Services
Oral Language & Sign Language Interpreter Services
ICD-10 Codes
ICD-10 codes are determined by the provider or the Qualified Professional (ADLs or Level 1 behavior).
Service Documentation
Parent Consent to Bill
Parents / guardians of children with disabilities must be fully informed before consenting to schools sharing information with the Minnesota Department of Human Services (DHS) and to bill. Once the consent form has been signed, services may be billed. The annual Procedural Safeguards includes the written annual notice to parent/guardians for billing. If a consent form has not been signed, the district must wait a year. After the student has been enrolled and receiving billable services for a year, informed consent is in effect (Part B only). For Part C students, an initial signed consent form is required for billing, there is no informed consent timeframe.
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