Individualized Education Program (IEP) Enrollment Criteria and Forms

Revised: October 2, 2025

Minnesota public schools must enroll with Minnesota Health Care Programs (MHCP) to bill and receive federal reimbursement for covered health-related services provided to children that have an IEP or an Individualized Family Service Plan (IFSP).

Enrollment Criteria

To bill Medical Assistance for the covered IEP services, a school district must enroll as an MHCP IEP services provider.

Before enrolling with MHCP, schools and school districts must obtain a National Provider Identifier (NPI) that will be used in submitting and processing health-related service claims and other transactions. Refer to Enrollment with Minnesota Health Care Programs (MHCP) under Provider Basics in the MHCP Provider Manual for complete enrollment process information.

Effective Oct. 1, 2025, schools or school districts currently delivering or seeking to deliver school-based community services (SBCS) must obtain a separate NPI and enroll an IEP SBCS record.

Eligible Schools

The following Minnesota districts and tribal schools can enroll as IEP services providers or school-based community services providers (out-of-state schools and districts cannot enroll as Minnesota IEP or SBCS providers):

· 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

Note: Private schools are not directly reimbursed for IEP services. IEP services provided to children who attend private schools are billed by, and payments are made to, the public school district that provides the IEP service.

How to enroll

A school district can enroll as an IEP service provider or enroll as a SBCS provider with MHCP in one of the following ways:

· Use the online Minnesota Provider Screening and Enrollment (MPSE) portal.

· Register to access the MPSE portal by using the instructions in the Registration and Access section of the MPSE user manual.

· Complete and upload the following documents in the MPSE portal:

· Completed, signed, and initialed Fee-for-Service (FFS) Only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Schools or school districts providing SBCS services must also complete and submit the School-Based Community Services (Intent to Bill) (DHS-8084) (PDF). Only submit this form if you are enrolling to provide SBCS services.

or

Complete the following documents and fax your materials to 651-431-7462. Type or neatly print the following forms as completely as possible. Do not skip required fields. An incomplete form will delay processing this application.

· Organization Provider Enrollment Application (DHS-4016A) (PDF) [select Individual Education Plan (IEP) 09] Organization- Provider Enrollment Application (DHS-4016A) (PDF) (select Individual Education Plan (IEP) 09 to enroll as an IEP service provider or to enroll as a SBCS provider)

· Completed, signed, and initialed Fee-for-Service (FFS) Only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF) must be completed for “managers” that work with the special education program and fit the definition on Page 5 of the form. Social Security numbers must be provided for these individuals.

· Complete the “Managing Employee” section for general managers, business managers, administrators, directors or others who exercise operational or managerial control over or who directly or indirectly conduct the day-to-day operations. Enter residential addresses and Social Security numbers for individuals listed.

· Enter main business location for business address, not a U.S. Post Office box or private company mailbox (such as, Mail Boxes) address.

· Schools or school districts providing SBCS services must also complete and submit the School-Based Community Services (Intent to Bill) (DHS-8084) (PDF). Only submit this form if you are enrolling to provide SBCS services.

Review the MHCP Data Privacy Notice (DHS-6287) (PDF).

Tribal schools that receive funding from the BIA must also complete and sign the Model QHP Addendum for Indian Health Care Providers (PDF) and return it with their application. Tribal schools may use BIA funds as matching funds for federal Medicaid funds. (U.S. Code, title 25, Chapter 22, Section 2010 [h])

MHCP will notify the school district of their active status after they successfully complete the enrollment process.

Revalidation

According to federal law, the Minnesota Department of Human Services (DHS) must conduct screening activities and revalidation of provider-controlled locations where direct service are provided. The MHCP Provider Eligibility and Compliance unit will contact you with more details when it is time for your organization to complete revalidation.

Refer to Revalidation in the Provider Screening Requirements under Provider Basics in the MHCP Provider Manual for more information about how to complete revalidation.

Reporting Changes

It is the responsibility of the provider to keep all addresses and contact information updated. Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in the Enroll with MHCP under Provider Basics in the MHCP Provider Manual for details.

· Report district closings and changes to district name, number and contact information to Provider Eligibility and Compliance immediately.

· Report closed districts and acting fiscal agents to the DHS IEP Services Coordinator immediately.

Legal References

Minnesota Statutes, 125A.08 (Individualized Education Programs)Minnesota Statutes, 125A.21 (Third Party Payment)Minnesota Statutes, 125A.74 (Medical Assistance Payment to School Districts)Minnesota Statutes, 125A.744 (Statewide Data Management System to Maximize Medical Assistance Reimbursement)Code of Federal Regulations, title 34, section 300.154: Education Part 300 (Assistance to States for the Education of Children with Disabilities - Methods of ensuring services)Code of Federal Regulations, title 42, section 1001.1901(b) (Effect of exclusion on excluded individuals and entities)Code of Federal Regulations, title 42, section 1003.102(a)(2) (Basis for civil money penalties and assessments)