1. Minnesota Health Care Program (MHCP) Billing
“Everything You Need to Know About MHCP Billing
for Covered Special Education Services”
August 2017
Purpose of ppt. is to provide a visual about what we are going to discuss today
Will not be going over every slide - serve as a reference for you later

2. Topics Overview MHCP Billing Process and Required Documentation
Data Entry into SpEd Forms
(to be covered in the afternoon SpEd Forms Training)
Questions & Answers

3. Districts must “maximize” their attempts to collect MHCP revenue.
It’s the Law!!!
Minnesota Statutes 125A.21, subd. 2(a)
Third Party Reimbursement:
“Beginning July 1, 2000, districts shall 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.”
Districts must “maximize” their attempts to collect MHCP revenue.

4. Minnesota Health Care Program Funds Are Available
Schools/districts can get MHCP reimbursement for covered IEP services provided to eligible children.
Services must meet all MHCP requirements and be documented in writing.
Staff who meet MHCP qualifications to provide services can help their schools/districts get MHCP funding.
MHCP revenue is used to offset non-reimbursable special education costs (which frees up general education revenue!).
Note that here in CL we bring in well over $500,000 per school year.

5. Eligible Children Are under age 21, Are enrolled in a MHCP,
Have covered IEP services included in a current IEP/IFSP, and
Receive covered services on service dates billed.

6. Covered IEP Services Physical Therapy Occupational Therapy
Speech/Language Pathology and Audiology
Mental Health Services
Nursing Services
Personal Care Assistant (Paraprofessional) Services
Assistive Technology Devices
Special Transportation
Oral Language Interpreter Services
Sign Language Interpreter Services
* The next series of slides goes into the specific types of service under each of these broad service areas that are covered - won’t read through them all but can be a reference for you to refer back to

7. Additional Information Re: Covered IEP Services
Must be medically necessary
Are authorized by the IEP/IFSP team
Are reflected in the Evaluation Summary Report
Are included on the IEP/IFSP
Must meet all MHCP IEP service requirements
Must be documented in writing
Must be provided by staff who meet MHCP IEP service qualifications
* The next series of slides goes into the specific types of service under each of these broad service areas that are covered - won’t read through them all but can be a reference for you to refer back to

8. Physical Therapy (PT) Occupational Therapy (OT)
Covered services:
Individual and group therapy
Specialized maintenance therapy
IEP evaluations (provided by a physical therapist or occupational therapist)
Covered providers:
Physical Therapist
Occupational Therapist
Physical Therapy Assistant or Certified Occupational Therapy Assistant (CODA) working under the direction of a PT or OT at least every sixth treatment session

9. Speech-Language-Hearing Therapy
Covered services:
Individual and group therapy
Specialized maintenance therapy as provided by a speech and language pathologist
Telemedicine
IEP evaluations
Covered Providers:
Educational speech & language pathologist
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
Master’s and CCC
Audiologist
Clinical fellowship licensee
Master’s degree and completing the supervised clinical fellowship under MN Statutes
* Note: there are specific licensure or certificate requirements for speech pathologists in order to bill MA

10. Mental Health Services
Covered services in SCRED schools:
IEP evaluations as provided by a School Psychologist
Must result in an IEP
Assessments must be included in the Buros’ Mental Health Yearbook

11. Nursing Services
Face-to-face nursing care and simple medication administration
Provided by
Licensed Practical Nurse (LPN)
Registered Nurse (RN)
Public Health Nurse (PHN)
Licensed School Nurse (LSN)
Medication management and IEP evaluations
Provided by a RN, PHN, or LSN
Note: Per MDE, RN’s do not meet criteria to complete evaluations to determine special education eligibility
Not just medication administration - also medication management

12. Physician’s Orders
Orders or prescriptions are required at least annually or upon modifications to the IEP for all nursing services that require a physician’s order/prescription under the nurse’s license (scope of practice).
Orders/prescriptions that are required for IEP services:
must be obtained by the school district from a physician, nurse practitioner or physician assistant,
must include dated signatures,
must be obtained each school year can cover a period of time of up to one year if the time period is stated on the order; otherwise the date of the signature must be used as the begin date for billing,
must be in place at the time service is billed.
Physician’s orders, referrals, or prescriptions are not required for the following services:
•physical therapy •occupational therapy •speech, language and hearing therapy
•mental health services • nursing services that do not otherwise require orders or prescriptions •assistive technology devices •special transportation •oral language interpreter services
The school nurse will facilitate this process after being notified
by the case manager that the student is MCHP eligible.

13. IEP Evaluations Covered Evaluations
Health-related initial evaluations, ongoing assessments to determine progress, re-evaluations
Provided by a PT, OT, Speech/Language Pathologist, Nurse, Audiologist, School Psychologist, Mental Health Professional
Includes administering tests face-to-face; interpreting test results and writing reports
Must result in an IEP/IFSP with covered services and/or determine need for continued IEP services

14. IEP Evaluations
Evaluations Not covered: Meetings with families and staff to discuss results and make recommendations.

15. Personal Care Assistant (Paraprofessional) Services
A child who qualifies for PCA services must
Be dependent in at least one activity of daily living, OR
Have a level one behavior
Level one behavior - self injurious, causes physical injury to others, destroys property
In addition they must receive a covered service:
Activities of daily living
Health-related functions through hands-on assistance
Redirection and intervention for behavior
Supervised by a qualified professional (QP): PT, OT, speech language pathologist, mental health professional,RN, PHN, LSN, physician, developmental disabilities specialist (DCD teacher) or social worker
Supervision is defined pretty informal: How’s it going? Great. Ok. That’s supervision PT, OT, speech language pathologist, mental health professional,RN, PHN, LSN, physician, developmental disabilities specialist (DCD teacher) or social worker

16. Personal Care Assistant (Paraprofessional) Services
Activities of Daily Living
Eating - assisting with hand washing, applying orthotics, transfers, food preparation, and feeding
Toileting - assisting with elimination and diapering, transfers, mobility, positioning, feminine hygiene, use of toileting equipment and supplies, cleansing, skin inspection, adjust clothing assist with re-dressing
Grooming - assisting with personal hygiene, basic hair care, oral care, shaving, applying cosmetics and deodorant, eyeglass and hearing aid care

17. Personal Care Assistant (Paraprofessional) Services
Activities of Daily Living
Dressing - assisting with choosing, applying or changing clothes, applying orthotics and prosthetics or special clothing (TED hose)
Bathing - assist with basic personal hygiene and skin care for bathing or showering; includes transfers, positioning, assist with soap, rinsing, drying, skin inspection, applying lotion or other products
Transferring - assisting with moving from one seat/bed to another; using a lift, pivoting, standing by to assist and two person lifts

18. Personal Care Assistant (Paraprofessional) Services
Activities of Daily Living
Mobility: assisting with ambulation; includes assisting with using a wheelchair, walker, cane
Positioning: assisting with positioning, repositioning or turning for necessary care and comfort; includes relieving pressure areas, positioning with pillows, wedges, or bolsters whether in a chair, bed, sofa or wheelchair

19. Personal Care Assistant (Paraprofessional) Services
Health-Related Tasks
Tasks that do not require the skill of a nurse
Range of motion and passive exercise to maintain muscle function and strength
Assist with self-administered medication (cueing child to take medication; handing child medication that has been set-up; opening medication; assuring child takes medication)
Must be trained by a nurse
Must demonstrate competency to safely assist with self- administered medication
PCAs do not dispense or administer medication

20. Personal Care Assistant (Paraprofessional) Services
Health-Related Tasks
Intervene for seizures including monitoring and observing while the child is having a seizure
Continuous monitoring for seizures is not covered
Tracheostomy suctioning and ventilator care
CLEAN procedures only (PCAs do not provide sterile procedures)
Supervised by a nurse
Delegated and trained by a nurse, respiratory therapist or physician
Specialized training for procedures, tasks and equipment and ventilator care
Individual training on specific needs of child

21. Personal Care Assistant (Paraprofessional) Services
Intervene and Redirect Behavior
Intervention and redirection for behavior that is medically necessary, related to the child’s disability and fits into one of these categories
Increased vulnerability due to cognitive deficits or socially inappropriate behavior
Resisting care and verbal aggression that cause care to take longer than normally expected
Physical aggression towards self or others or destruction of property
Self-injurious behavior; physical injury to others; destruction of property

22. Personal Care Assistant Supervision
Within 14 days or sooner as determined by the QP through direct observation of the PCA’s work
Every 90 days in 1st year; every 120 days after 1st year
Provided by a qualified professional (QP) within the scope of practice
Licensed registered nurse, public health nurse, licensed school nurse; physician
Mental health professional; social worker
Physical therapist; Occupational therapist
Speech-language therapist; Audiologist
Qualified developmental disabilities specialist

23. Personal Care Assistant Training
Persons who provide PCA services
Take the DHS Individual PCA Training before providing PCA services
Take and pass the test
Print the certificate of completion and give a copy to the district
Are trained on the specific needs of each child for whom the PCA provides services
Are trained on tracheostomy suctioning and ventilator care as appropriate

24. Assistive Technology (AT) Devices
Covered Devices:
Purchased or rented; repairs covered
Augmentative communication devices
Hearing amplification devices
Mobility devices
Positioning devices
Hardware/software essential to a covered device
Additional Requirements:
Medically necessary
Cannot be purchased or used by a school or program - device belongs to the child
Need for the device must be in the IEP/IFSP/IIIP
Must be purchased or rented and delivered to the child before billed
* As of 7/1/2013, electronic tablets are covered; before billing check to be sure coverage policy development is complete.

25. Assistive Technology SCRED provides assistance to make AT decisions
Contact the SCRED Services Coordinator that provides support to your service area

26. Special Transportation
Covered Only if All Requirements are Met:
Child has a physical or mental impairment that prevents him/her from safely accessing and using a common carrier (taxi, bus, car, van).
Child requires a special adaptation or a one-on- one aide, nurse, or PCA while being transported (aide cannot also be the driver).
Need for covered IEP special transportation is identified in the IEP/IFSP/IIIP
Child is transported to another MHCP covered IEP service on the same day.
Sign language interpreter services do not count as another MA service for Spec. Trans. To be covered.

27. Special Transportation
Provided by a district in a district owned vehicle or a contracted school transportation agency vehicle
Includes getting a child to and from the vehicle, waiting for the vehicle with the child and transporting the child
Not covered:
Services of bus supervisors and monitors
Services provided in taxis, cars and non-school owned buses and vans
Sign language interpreter services do not count as another MA service for Spec. Trans. To be covered.

28. Oral Language & Sign Language Interpreter Services
Covered When:
Provided to a child with limited English proficiency in conjunction with another covered IEP service.
Provided to a parent in order to obtain and relay information regarding the child during a covered IEP service or evaluation
Provided by:
A person who speaks the language (or signs) and is employed by or has a contract with the school/district to provide language interpreter services.
See requirements for “competent interpreters” in Technical Assistance Guide.
Provided to a parent with limited English proficiency in order to relay and provide information about a covered IEP evaluation or service when both the child and parent are present.

29. Service Not Covered
List in the IEP Services Technical Assistance Guide services section (E)
Not a complete list
Review list carefully
Never assume that a service is covered if not listed as not covered; when in doubt ask DHS
Provided to a parent with limited English proficiency in order to relay and provide information about a covered IEP evaluation or service when both the child and parent are present.

30. The MA Billing Process
It is the responsibility of the special education case manager to determine if the special education student is eligible for MHCP. There is an assigned person in each district to check the MHCP Eligibility website. This is the due process secretary in most districts.
The case manager will determine whether the student receives any of the billable services.
Obtain parental consent to bill MHCP. After initial consent is obtained, the yearly issuance of procedural safeguards is the only ongoing requirement.
Now to the nuts and bolts of MA billing - what does the MA billing process look like in Chisago Lakes?

31. The MA Billing Process (continued)
4. After the meeting, the case manager or other knowledgeable person should discuss with the parent(s) the district’s request to access MHCP to bill for services. See SCRED “Desk Reference MHCP Billing Script” for this purpose.
5. If the student receives nursing services, the case manager will contact the school nurse to obtain a Physician’s Order (for nursing services).
6. Case managers or district-assigned MA billing point person will notify the appropriate service providers (i.e., speech and language, OT, PT, Nursing, etc.) when a student is MHCP eligible.
7. For each student that is MHCP eligible, case managers will complete a “MA Billing/ICD-10-CM code Checklist.” The qualified service provider will assign an ICD-10-CM Code to each eligible service.

32. The MA Billing Process (continued)
For each student that is MHCP eligible, service providers and case managers (or MA Billing Site Contacts in some districts) need to fill out the activity logs and data collection forms (AKA: IEP/IFSP Services Record in SpEd Forms) on a monthly basis and submit to assigned person in their district.
Complete one record per student even if there are multiple paras.
Multiple paras can use the same record.
Make only one entry for the total time served.
Make separate entries when the group size changes.
Note: Data entry should occur for all MHCP eligible students regardless of whether parental consent has been obtained since we can back bill for services if we receive consent at a later date.

33. The MA Billing Process (continued)
For students who receive special transportation, the trip log is completed. The child/student’s need for IEP special transportation must be included in the IEP/IFSP in order to bill MHCP.
Special Transportation is billable per trip from home-to- school and school-to-home each day that the child receives another billable service.
For example if the child receives speech therapy twice a week, we can bill for transportation on those two days, but not on days when child is not receiving billable services. If a student has a paraprofessional every day, then transportation could be billed each day.

34. The MA Billing Process (continued)
For billable special education evaluations, each evaluator must also complete the activity log and data collection form.
In the case of billing for assistive technology (AT), the need for AT must be established in the Evaluation Summary Report (ESR) and the IEP.
Identifying the need for AT must include:
a. The child’s diagnosis or condition.
b. A description of the child’s functional status.
c. The objectives of the device.
d. A description of how the device will be evaluated.

35. Billing Service documentation must be complete and accurate
Cannot submit claims without service documentation and ICD-10-CM Code(s)
Service documentation and attendance records must match
Change: Districts may only bill within the current school year
Districts, not billing agents, are responsible for all MHCP service, billing, rates information, and data requirements

36. Treatment Plans
IEP/IFSP must include frequency, duration and scope of services to be provided and billed to MHCP
Description of the reason for special transportation, assistive technology, and interpreter services must be included on the IEP/IFSP
If IEP/IFSP do not include goals and objectives, treatment plans can be considered additions to the IEP/IFSP for DHS audits

37. Documentation
Written documentation of actual services provided is required
Who got the service; who provided the service; how many children participated; how long did the service take; describe the service; describe results; describe plan for next session
Written documentation of supervision is required
Different services require different supervision documentation
Timely documentation is required
Keep all documentation for 5 years
Remember to complete MHCP billing on at least a monthly basis
Adjust MHCP billing if services change during the year, if the student is exited from special education service, or moves out of the school district

38. Final Reminder Billing MHCP is a legal requirement.
It is not an optional activity!
(and the revenue is a great benefit to your district!)