What is Third Party/MA Billing? 

Third party billing is also known as Medical Assistance Billing or MA Billing. Federal and state law require all public Minnesota schools to request payment for Individualized Education Program (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 Individualized Family Service Plan (IFSP). 

Why do we need toThird Party Bill? 

It’s the law! - Schools are mandated by law to seek reimbursement and "maximize" attempts to collect MA revenue for IEP Health Related services provided to students receiving specific special education services. (Minn. Stat. 125A.21, 125A74, 125a.744 AND 256b.0625, subd.26)

Why is Third Party Billing important? 

The program provides school districts with additional funds that help support all special education programs. MA funds can only be used exclusively for special education. Minn. Stat. 125A.21.subd.3 

Within the MSED member districts, MA revenue is used to offset non-reimbursable special education costs, which frees up general education revenue for school districts.

There are eight different types of MA billable services:

• Personal Care Assistant (Paraprofessional) Services 

• Special Transportation 

• Mental Health Services 

• Speech/Language Pathology and Audiology 

• Physical Therapy (PT) or Occupational Therapy (OT)

• Assistive Technology Devices

• Nursing Services

• Oral Language & Sign Language Interpreter Services 

In order for these services to be considered billable/reimbursable, the following criteria MUST  be met: 

• Medically necessary and compliant with MA service requirements

• Documented appropriately in the student's IEP/IFS

• Reflected as a need in the student's evaluation report 

• For PCA services, the following must be met: 

○  The IEP Statement MUST describe the 1.) NEED FOR PERSONAL CARE SUPPORT,  2.) DURATION,  3.) SERVICE, and 4.) SUPERVISION

○  PCA Services must be supervised by a qualified professional who is operating within their scope of practice. 

○  These qualified professionals are responsible for ensuring that PCAs are trained on the specific needs of the student, as identified in the   IEP and written in the PCA Plan of Care 

○  Paraprofessionals must pass the DHS Individual PCA Training Course and provide the district with a copy of their certificate of completion in order to qualify as a PCA for the purposes of MA billing

Contact Dawn Peterson with any questions or concerns.

dawnpeterson@midstate.k12.mn.us

320-631-2501

To bill for health-related services in Minnesota under an IEP or IFSP, schools must obtain a signed parental/guardian consent form to share private data and bill Medical Assistance or private insurance. For schools and special education services, this consent is typically obtained in writing using a district consent form.

Federal regulations require school districts to provide specific information to parents before obtaining their consent to share info with DHS & submit bills.   Annually thereafter parents must be given/offered Procedural Safeguards for IEP (Part B) or Written Annual Notice Related to Third Party Billing for IFSP (Part C) students. 

This ensures that families are fully informed that there is no cost to them and that their coverage limits are not affected. 

**Refer to the MA/Third Party Billing Guide below for a sample script you can use to address and discuss the consent form with parents/guardians during your IEP meeting