School-Based Community Services (SBCS)
Overview
School-based community services (SBCS) are certain medically necessary services Minnesota Health Care Programs (MHCP) will reimburse when provided to children in the school by a qualified health care provider employed or contracted by the school. Effective July 1, 2021, Minnesota public schools will be able to bill for these services.
SBCS are optional. They are not new or expanded services but are part of the Medical Assistance (MA) benefit package. Schools have the option in providing these services to help students that are not receiving health-related services through an Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP) or when the services are not identified in the IEP.
SBCS can be billed to fee-for-service or managed care organizations and receive 100 percent reimbursement. Fee-for-service is for MA members who are not enrolled in a health plan.
Eligible Providers
Eligible providers include those who are eligible to provide the specific professional services needed for SBCS. Refer to Covered Services for a complete list of MHCP eligible providers for each service area.
Note: Providers may be eligible to deliver additional services under Minnesota’s Child and Teen Checkups (C&TC) program, as part of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. Refer to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Services: Child and Teen Checkups (C&TC) in the MHCP Provider Manual for information on provider eligibility, screening schedules, covered services, billing guidance, and related resources.
Enrollment
Effective Oct. 1, 2025, schools or school districts currently delivering or seeking to deliver school-based community services (SBCS) must obtain a separate national provider identifier (NPI) and enroll a separate IEP SBCS record. Refer to IEP Enrollment Criteria and Forms under Enrollment with MHCP in the MHCP Provider Manual for information on how to enroll.
Note: Schools that are interested in providing public health nursing clinic services will need to enroll as a public health nursing clinic (PHNC) with MHCP. Refer to Public Health Nursing Clinic (PHNC) Enrollment Criteria and Forms section under Enrollment with MHCP in the MHCP Provider Manual for more information on enrollment. Refer to School-Based PHNC under Clinic Services in the MHCP Provider Manual for more information on PHNC covered services and billing.
Rendering Providers
Schools must verify the rendering provider’s credentials, licensure and certifications to ensure they are current and meet the requirements for the services they will provide.
Before the school can bill for SBCS, the school must notify the qualified professionals that they are required to obtain a National Provider Identifier and enroll with MHCP. The individual rendering provider must follow the enrollment criteria according to the covered service they are qualified to provide.
Eligible Members
Eligible members for SBCS must be under the age of 21 and actively enrolled in one of the major Medical Assistance or MinnesotaCare programs.
Refer to MHCP Member Eligibility for more information about the major program codes.
Refer to MHCP Benefits-at-a-glance for major program codes for MHCP covered services.
Covered Services
MHCP covers the following school-based community services:
MHCP reimburses language interpreter services when it is necessary to communicate with the child or parent(s) during a covered SBCS medically necessary health care service or evaluation. Refer to Language Interpreter Services in the Access Services section under Provider Basics in the MHCP Provider Manual for more information.
Noncovered Services
The following services are not covered services for SBCS.
Refer to the noncovered services information provided under each specific service type for complete listings of noncovered services.
Billing
When billing for SBCS, list the qualified professional as the treating or rendering provider on the claim for which services you are providing, and list the school as the pay-to provider. List the place of service as 03 (school) when appropriate.
Refer to the Billing Policy Overview section of the MHCP Provider Manual for general MHCP billing requirements.
Refer to the MHCP MN–ITS User Manual for instructions on how to submit electronic claims. Use the MHCP MN–ITS User Manual as a guide for information and instructions about all MN–ITS features and functions available.
DHS will reimburse schools at the MHCP Fee Schedule rate.
Use the appropriate procedure codes and modifiers for each service.
Tribal providers should refer to Tribal and Federal Indian Health Services in the MHCP Provider Manual for more information regarding provider eligibility.
Legal References
Minnesota Statutes, 256B.0625 (Covered Services)
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