In Minnesota, the Department of Human Services (DHS) is the state Medicaid agency. Medicaid funds have been available since 1989 to pay for health related services provided by Minnesota public districts to eligible children through an Individualized Education Program (IEP) or Individualized Family Service Program (IFSP). 

Minnesota Statutes 125A.21, subd. 2(a) requires MN public districts to “seek reimbursement from insurers and similar third parties for the cost of services provided by the districts whenever the services provided by the district are otherwise covered by the child’s health coverage.” 

This Individualized Education Program (IEP) Technical Assistance Guide is designed for districts enrolled as IEP services providers. The purpose of this guide is to provide districts with Medicaid policy, billing and payment information for covered IEP services. The guide and Minnesota Health Care Programs (MHCP) Provider Manual are available online at: www.dhs.state.mn.us/provider/iep. 

“It’s the Law” - We are mandated by law to try to collect MA monies for IEP Health Related services provided to special education students. Minnesota Statutes for Medicaid covered IEP services: Minn. Stat. 125A.21, 125A74, 125a.744 AND 256b.0625, subd.26

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

This is a separate source of MA monies that does not affect any other medical assistance or MinnesotaCare a student/family may be receiving.  Minnesota Statutes for Medicaid covered IEP services: Minn. Stat.125A.21, 125A74, 125a.744 AND 256b.0625, subd.26

An assigned individual in each district periodically checks the MA eligibility website and emails case managers a list of students who are eligible. MA eligibility must be determined for all students, including those who have been referred for an initial special education evaluation. 

This section provides information for PCAs and Supervisors in school districts as they are completing training documentation, mini-time studies, and PCA activity logs.

PCA services must be supervised by a qualified professional who is operating within their scope of practice (see examples in each section). 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 (see the section below on 'Services Documentation' for more information about PCA Plans of Care)—display competency in providing the required services, and understand documentation requirements. In order to qualify as a PCA for the purposes of MA billing, paraprofessionals must pass the DHS Individual PCA Training Course and provide the district with a copy of their certificate of completion. Billable PCA services fall under the three categories: Activities of Daily Living, Health-Related Tasks, and Observation, Redirection, or Intervention of a Behavior.

Covered services include getting a student to and from the vehicle, waiting for the vehicle with the child, and transporting the child. Services are only covered when all of the following requirements are met:

• Services are provided in a district owned vehicle or a contracted school transportation agency vehicle. 

• The student has a physical or mental impairment that prevents him/her from safely accessing and using a common carrier (taxi, bus, car, van).

• The student requires a special adaptation (e.g., wheelchair lift, special harness, safety vest, or special car seat) or a one-on-one aide, nurse, or PCA while being transported. The aide cannot also be the driver.

• The student is transported to another MA covered IEP service on the same day. Note that sign language interpreter services do not count for this requirement.

Covered services include administering tests face-to-face, interpreting test results, and writing reports. Evaluation review meetings are not covered. Assessments must be included in the Buros’ Mental Measurements Yearbook. The evaluation does not need to result in an IEP/IFSP to be covered. 

Covered providers include: School Psychologist when completing the specified IEP evaluation activities. 

Covered providers include: Educational speech & language pathologists (Masters in speech/language pathology, licensed by MN Board of Teaching, and either a Certificate of Clinical Competence (CCC) or has completed the required education and work experience to obtain the CCC), Speech & language pathologist (Masters and CCC), Audiologists, clinical fellowship licensees (Master’s degree and completing the supervised clinical fellowship under MN Statutes 148.511-148-5196). 

Covered services include: Individual and group therapy, specialized maintenance therapy as provided by a speech and language pathologist, telemedicine, and IEP evaluations.

Covered services include: Individual and group therapy, specialized maintenance therapy, and IEP evaluations (provided by a physical therapist or occupational therapist). 

Covered providers include: Physical Therapists, Occupational Therapists, and Physical Therapy Assistants or Certified Occupational Therapy Assistants (CODA) working under the direction of a PT or OT at least every sixth treatment session. 

Covered devices may be purchased or rented, and repairs are also covered. Before billing, the device must be purchased/rented and delivered to the student. It must belong to the student (i.e., it cannot be purchased for ownership and exclusive use by a school program). 

Covered devices include:

• Augmentative and Alternative Communication (AAC) devices

• Hearing amplification devices

• Mobility devices

• Positioning devices

• Hardware/software essential to a covered device

Covered providers include: Licensed School Nurses (LSN), Licensed Practical Nurses (LPN), Registered Nurses (RN), or Public Health Nurses (PHN). 

Covered services include: 

• Face-to-face nursing care or medication administration

• Medication management

• IEP evaluations

Covered providers must speak the language (or sign) and must be employed by or have a contract with the district to provide language interpreter services. 

Covered services include:

• Services provided to a child with limited English proficiency in conjunction with another covered IEP service

• Services provided to a parent in order to obtain and relay information regarding the child during a covered IEP service or evaluation.

After billable services have been identified, case managers (or a district-assigned MA billing point person) send an ICD-10-CM Code Checklist for MA Billing to the appropriate service providers, who then assign codes and return the form to the case manager or MA billing point person. For most MA billable services, the person responsible for assigning the ICD-10 code(s) is the same person who provides the service. For example, a school nurse assigns the ICD-10 code(s) for nursing services, a Physical Therapist assigns the code(s) for PT services, etc.

For PCA and special transportation services, an OT, PT, school nurse, or school psychologist assigns the ICD-10 code(s) — depending on who is qualified to supervise the service. For example, if the student is receiving special transportation for a health-related reason, the school nurse would assign the ICD-10 code. If the student is receiving special transportation due to behavior, a school psychologist would assign the ICD-10 code. For mental health services, school psychologists assign the ICD-10 code(s). 

How to Set-up ICD-10 Codes in Sped Forms Guides

Consent Procedures

PCA Billing and Supervisor Resources

Nursing

Exclusion List

SpEd Forms Resources

ICD 10-CM Codes

Important Links

MDE TPB 101 Videos

IEP Provider Manual