1. Third Party Reimbursement – Covered Services
Jenny Roth - DHS IEP Coordinator
Health Care – Purchasing and Delivery Services (PDS)
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

2. Minnesota Department of Human Services | mn.gov/dhs
Eligible Providers
To bill Medical Assistance (MA) for the federal share of IEP health related services, districts and tribal schools must enroll with Minnesota Health Care Programs (MHCP) as a health care provider.
It is the responsibility of the districts to ensure the individuals performing IEP health related services are qualified, properly trained, licensed, certified and are working within their scope of practice.
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

3. Minnesota Department of Human Services | mn.gov/dhs
Eligible Children
A child must meet the MHCP eligibility requirements in order for schools to be reimbursed by MA. Eligibility requirements include:
The child or youth is under the age of 21
Is actively enrolled in one of the following MHCP major programs:
MA - Medical Assistance
NM - Non-citizen program that include CHIP eligibly types CB or PC
RM - Refugee Medical Assistance for first 8 months after arriving in the United States
Has a current IEP or IFSP that identifies the special education needs, supports, accommodations and the specific health related services the child will need throughout the school day because of the child’s disability
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

4. Minnesota Department of Human Services | mn.gov/dhs
Identify the Service
Assistive technology devices
Interpreter services
Mental health
Nursing Services
Occupational Therapy (OT)
Physical Therapy (PT)
Speech Language Pathology and audiology service
Personal Care Assistance
Transportation
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

5. Minnesota Department of Human Services | mn.gov/dhs
Documenting
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

6. Errors from past audits
PERM or CMS audits have found the following errors:
Non-covered services provided to students
Documentation that does not demonstrate the need for the health related service
Lack of, or inadequate documentation in progress reports
Missing or Inadequate clinical notes
The start and end times for services rendered were not documented
Records indicate the service was provided, but the attendance records show the child was not is school that particular day
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

7. Minnesota Department of Human Services | mn.gov/dhs
Documentation
Record Keeping and Documentation
Health Care Service Records
Additional documentation information
Service Time and Encounters
Record Retention
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

8. Coding and Billing Requirements
Billing and Authorization Requirements
ICD Codes
Seek Reimbursement from other payers
Timely Billing
Reporting Coordination of Benefits
IEP Procedure Codes, Modifiers and Units
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

9. Minnesota Department of Human Services | mn.gov/dhs
Online Resources
The IEP provider Home page will provide links to forms, checklists, logs, reports, documents and other IEP related resources, and also CTSS resources for school certification, recertification and tracking document. ( The IEP Services Manual should be used as one of your primary information resources for MHCP polices, covered services, rates and billing requirement for reimbursement. (
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

10. Online Resources – MHCP IEP Provider Home Page
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

11. Online Resources – MHCP IEP Services Manual
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs

12. Can you tell me…
Questions ?
What If…

13. Minnesota Department of Human Services | mn.gov/dhs
Thank you!
Jenny Roth,
1/13/2019
Minnesota Department of Human Services | mn.gov/dhs