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Individualized Education Program (IEP) health-related services provided by the schools are eligible for Minnesota Health Care Program (MHCP) reimbursement when the services meet criteria for federal financial participation and the child or youth meets the MHCP eligibility requirements.
When a youth reaches 21 years old, MHCP will no longer pay for IEP health-related services, but the youth may receive special education services until he or she turns 22 years old.
Note: All other Minnesota Health Care Programs have specific medically necessary criteria or are not federally funded. MHCP will not pay for IEP health-related services provided under those programs.
Districts can check eligibility for one child or multiple children using MN–ITS Interactive. Refer to the MN–ITS User Guide Verify Eligibility for MHCP Recipients for step-by-step instructions.
To avoid denied claims, it is the provider’s (school districts) responsibility to verify eligibility before submitting claims to MHCP. It is important to verify a child’s eligibility at least monthly. In most cases, MHCP coverage is determined on a month-to-month basis.
Schools will be responsible for 100 percent of the cost of IEP health-related services provided to children who do not meet the MHCP eligibility requirements.
On the eligibility response:
Note: Ignore references to special transportation, pharmacy and waiver services. Although they may be reported on the eligibility response, they are not IEP related.
Children eligible for MHCP may have their health care covered by a managed care organization (MCO) – a prepaid Medical Assistance plan. IEP services are “carved out” (not covered) by the MCO. Bill IEP services directly to MHCP.
Note how IEP services coordinate with other MHCPs:
Families may apply for MHCP online at www.MNsure.org or by completing a paper version of the application. A link to print the application is available at How to apply for Minnesota Health Care Programs. Refer to the MNsure and MHCP Member Help Desk contact information for hours and phone numbers, as well as county and tribal offices contacts.
DHS refers questions about parental consent to the Minnesota Department of Education (MDE), the state education authority on education law. Issues deal with the Family Educational Rights and Privacy Act (FERPA) and the Individuals with Disabilities Education Act (IDEA). Review MDE’s Third-party Billing webpage for more information.
Both the initial MHCP application and the renewal application that the parent completes contain the language that is required under FERPA and IDEA about permission for school districts to access the child’s health information and to bill for services. Check the signature page of the most current version of the application to see the parent agreements and rights. Refer to the appendix for the Notice of Privacy Practices. The section on release and sharing of medical information contains information about how records may be released to several parties including schools.
Note: A parent must sign the MHCP application consent statement for Medical Assistance to cover heath care costs. However, a parent has the right under FERPA to deny consent to school districts to access information and to bill MHCP. A parent may stop consent for sharing records with school districts at any time. These two rights are covered in the MDE Notice of Procedural Safeguards.
Notification, consent and release forms are available only from MDE. Contact MDE with questions about notification, consent and release documents related to billing for IEP services and other consents required by education laws.
MHCP maintains an MHCP Provider Directory for families to locate enrolled IEP providers in their area. From Select drop down, choose Individual Education Plan/School District. Type district ISD #0000 in the name field or select the county from drop down in MN county field. Check the list periodically to assure district information is accurate.
Minnesota Health Care Programs (MHCP) Individualized Education Program (IEP) Services – Information for Families brochures are available in eleven languages: www.dhs.state.mn.us/provider/iep, under Quick Links for IEP Providers.
34CFR 300.154 (Title 34: Education Part 300 - Assistance to States for the Education of Children with Disabilities - Methods of ensuring services
Minnesota Statues 256B.0625, subd. 26 (Covered Services – Special Education)