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Covered and Noncovered IEP Health-Related Services

Revised: 11-16-2017

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Overview

MHCP covers the federal share of the cost of Individualized Education Program (IEP) health-related services such as transportation, developmental, corrective and other supportive services. These are the services required to help a child with a disability benefit from special education and receive a Free Appropriate Public Education (FAPE) at no cost to the child or parent.

Initial Evaluations, Reevaluations and Health Related Assessments

Effective August 1, 2017, Medical Assistance (MA), Minnesota’s Medicaid, will reimburse the federal share of the cost of covered health-related evaluations and assessments under the Individuals with Disabilities Education Act (IDEA) when conducted for the sole purpose of identifying the health-related needs for a child’s IEP or Individualized Family Service Plan (IFSP) or to determine the need for continued coverage. Meaning, if the school is evaluating a child for the sole purpose of identifying the health related needs of that child for the child’s IEP or IFSP, MA will cover the time spent performing that evaluation or assessment even if the service does not get added to the IEP or IFSP or result in an IEP or IFSP.

Eligible Providers

For an IEP health-related assessment to be covered, the assessment must be conducted by one of the following licensed professionals working within their scope of practice:

  • • Physical therapists
  • • Occupational therapists
  • • Speech language pathologists and audiologists
  • • Mental health professionals, clinical trainees and school psychologists
  • • Licensed registered nurses
  • Covered Health-Related Components of an IEP Evaluation or Reevaluation

    MHCP will cover the following:

  • • Face-to-face health-related assessments used to identify rehabilitative services to restore or improve the condition of the child to the child’s best possible functional level
  • • Interpreting health-related assessment results
  • Writing a report of the health-related assessment results
  • Noncovered Components of an IEP Evaluation or Revaluation

    MHCP will not cover time spent evaluating educational needs for the following:

  • • Determining the child’s present academic levels or the academic instructional needs of a child
  • • Screenings or discussions performed by a teacher, specialist or health-related services professional to determine academic instructional strategies for the child’s education setting and curriculum
  • • Evaluations or assessments conducted to determine 504 plans
  • Covered IEP Health-Related Services

    MHCP covers the following services for IEP:

  • • Assistive technology devices
  • • Interpreter services
  • • Mental health
  • • Nursing
  • • Occupational therapy
  • • Physical therapy
  • • Speech-language pathology therapy and audiology
  • • Personal care assistance
  • • Transportation services
  • Review the information in the IEP Health-related Services section for coverage criteria that is specific to the service provided.

    Coverage Criteria for all IEP Health-Related Services

    Services provided to a child under age 21 who is actively enrolled in one of the federally funded MA or MinnesotaCare major programs (MA, RM or NM) must meet the following criteria:

  • • Medically necessary
  • • A health-related service that is necessary for the child to benefit from his or her education
  • • Covered by Medical Assistance
  • • Authorized by the child’s IEP or IFSP team
  • • Documented in the child’s IEP or IFSP (including services provided during extended school year)
  • • Documented in the child’s health record
  • • Provided by qualified service providers within the service provider’s scope of practice or licensure and certification
  • • Provided during the school day (including during extended school year)
  • Note: Review the information provided in the IEP Health-related Services section for coverage criteria that is specific to the service provided.

    Services Not Covered by IEP Funding

    The following is a list of some activities and services that are not covered by MHCP as an IEP health-related service. This list may not be all-inclusive:

  • • Services provided to a child that is not actively enrolled in one of the federally funded MA (MA, RM or NM-CHIP funded eligibility types PC or CB)
  • • Services for a person who has reached the age of 21
  • • Services not medically necessary or not normally covered by MHCP
  • • Services not authorized by the child’s IEP or IFSP team
  • • Services not documented in the child’s IEP or IFSP (including services provided during extended school year)
  • • Classroom instruction, educational services or teaching activities
  • • Services provided by a teacher, teacher’s aide, bus drivers and monitors
  • • Observation or consultation except as specifically included under covered mental health services, nursing services and PCA services
  • • Services provided by service providers who do not meet MHCP qualifications to provide the service
  • • A health-related service that would not be necessary for the child to benefit from his or her education
  • • Services not documented in the child’s health record
  • • Services provided by providers who do not meet MHCP qualifications to provide the service during the school day
  • • Services provided as before or after school programs or activities, for example, sports activities, clubs, class projects, tutoring, music lessons or child care
  • • Activities such as, attending staff meetings; supervising staff; developing instructional and treatment plans or materials; consulting and meeting with parents, teachers and other staff; documenting services; and, billing activities
  • • IEP activities including planning, developing or writing the IEP or IFSP; meetings; consultations; and communications, except communication with a parent as covered under interpreter services when the child and parent are both present
  • • Services that are not face-to-face services provided to the child, except as covered under IEP evaluations, communications by telephone with a parent as covered under interpreter services Interactions with the child’s family as covered under CTSS services
  • • Supervision or direction and services provided without the required supervision or direction
  • • Educational evaluations and assessments and educational components of IEP evaluations
  • • Communications between the service provider and child which are not face-to-face
  • Note: Review the information in the IEP Health-related Services section for coverage criteria that is specific to the service provided.

    Telemedicine Services

    Criteria for Providing Services via Telemedicine

    MHCP allows payment for telemedicine services for some IEP health-related services. Telemedicine is defined as the delivery of health care services or consultations while the child or youth is at an originating site and the licensed health care provider is at a distant site.

    Originating site
    The originating site is the location of the child or youth at the time the provider is providing the service via a telecommunication system. Document home or school as the originating site in the child’s health record.

    Distant site
    The distant site is the location where the licensed health care provider is located while providing the service via telemedicine. Use place of service 02 on the claim to, indicate the service was provided from the distant site.

    Eligible Recipients

    Telemedicine coverage applies to a child or youth who is MA eligible, has an IEP and the service provided is identified in the IEP.

    Eligible Providers

    To be eligible for reimbursement, the school or school district must self-attest that the telemedicine services provided by the professional provider either employed by or contracted by the school meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF).

    Eligible providers include the following:

  • • Charter schools
  • • Education districts
  • • Intermediate districts
  • • Public school districts
  • • Tribal schools (schools that receive funding from the Bureau of Indian Affairs-BIA)
  • • Service cooperatives
  • • Special education cooperatives
  • State academies
  • Telemedicine Coverage

    Coverage limitations
    MHCP allows payment for a total of three telemedicine IEP health related service visits per week per child or youth.

    MHCP telemedicine coverage will not pay the following:

  • • Evaluations or assessments and services that are less effective than if provided in person, face-to-face
  • • Supervision evaluations or visits
  • • Personal care assistants
  • • Nursing services
  • • Transportation services
  • • Electronic connections that are conducted over a website that is not secure and encrypted as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy & Security rules (for example, Skype)
  • • Prescription renewals
  • • Scheduling a test or appointment
  • • Clarification of issues from a previous visit
  • • Reporting test results
  • • Non-clinical communication
  • • Communication via telephone, email or fax
  • Documentation requirements
    As a condition of payment, each occurrence of a telemedicine services must include the following documentation:

  • • The type of service provided
  • • The time the service began and the time the service ended
  • • A description of the provider’s basis for determining that telemedicine is an appropriate and effective means for delivering service to the recipient
  • • The mode of transmission of the telemedicine service
  • • The location of the originating and distant site
  • Billing for Telemedicine

    Use the same HCPC codes and modifiers that describe the IEP services being performed via telemedicine as you would if the service was being provided in person with the child at the same site. Include the following:

  • • Add the modifier GT to indicate the service was provided via an interactive audio and video telecommunications systems
  • • Use the place-of-service code 02 indicating that the service was provided via telemedicine from a distant site
  • When reporting a service with the GT modifier, the school is certifying that the service was provided to a child or youth located at home or school via a secure interactive audio and visual telecommunications system.

    Effective Nov. 1, 2017, identify the distant site as the place of service 02.

    Example: Use HCPCS code T1018 and modifiers U1, TM, and GT to bill for occupational therapy services provided via telemedicine. Use the place of service code 02. If the GT modifier is on the claim without the place of service code 02, the claim will deny.

    Legal References

    Minnesota Statutes 256B.0625, subd. 26 (Covered Services) – Special Education
    Minnesota Statutes 256b.0625 subd. 3B
    (Covered Services) – Telemedicine
    Minnesota Statutes 62A.671
    (Definitions)

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    © 2017 Minnesota Department of Human Services Updated: 11/16/17 10:29 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 11/16/17 10:29 AM