IEP Nursing Services

Revised: September 20, 2023

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Overview

Minnesota Health Care Programs (MHCP) covers face-to-face nursing and non faced-to-face nursing when appropriate and included in a child’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP). Eligible nursing services must meet coverage criteria and the nurse must be working within their scope of practice.

Authorization and Orders

The IEP team authorizes health-related services included in an IEP or IFSP.

Medical orders are necessary for some nursing services, such as medication administration, and some medically necessary treatments and procedures.

Medical orders are required each school year or when a child’s plan is modified.

Orders must:

· Include an ICD medical diagnosis code and description to verify medical necessity.

· Describe the actual service needed.

· Be signed and dated by a physician, advanced practice registered nurse, nurse practitioner or physician assistant.

· Have a date span of no more than one year. If there is no date span or the date span extends one year, the orders are effective for one year from the date of the signature.

· Be in place before services are billed.

Qualified Service Providers

Professional nurses

· Registered Nurse (RN) – Has a current Minnesota Board of Nursing professional nursing license (Minnesota Statutes, 148.171, subdivisions 15 and 22)

· Licensed School Nurse (LSN) – Has a license from the Minnesota Professional Educator Licensing and Standards Board (PELSB) as a school nurse (Minnesota Rules, 8710.6100) which requires current Minnesota Board of Nursing, both professional nursing license (RN) and certification as a Public Health Nurse (PHN).

· Public Health Nurse (PHN) – Has both a current Minnesota Board of Professional Nursing license (RN) and certification as a Public Health Nurse (Minnesota Statutes, 148.171, subdivision 18; Minnesota Rules, 6316.0100)

Practical nurses

Licensed Practical Nurse (LPN) – Has a current Minnesota Board of Nursing practical nursing license (Minnesota Statutes, 148.171, subdivisions 8 and 14)

Covered Services

Covered nursing services include individual face-to-face and non-face-to-face nursing services when identified and included in the child’s IEP/IFSP in order for a child to attend school and receive a free appropriate public education (FAPE) during the school day.

· Providing eligible nursing services that are ordered or prescribed by a licensed health care provider including medication administration, treatments and procedures including, but not limited to, catheterization, tube feeding, suctioning and ventilator care.

· Medication management includes, but is not limited to, the review of the child’s current medications, adherence to medications as ordered, effectiveness, potential adverse reactions, and the collaboration with health care professionals and the parent or guardian regarding questions, changes, or concerns.

· Educating and counseling the child about medication or their chronic health conditions could include, but is not limited to, educating the child about possible side effects, reactions, and the need for adherence of treatments and procedures.

· Independent nursing interventions based on the observation and monitoring of the child’s health status and nursing services provided.

· Chronic disease management related to the medical condition identified in the IEP may include, but is not limited to, observation and monitoring, collaborating, and when appropriate, coordinating with health care providers and parent or guardian regarding questions, changes or concerns on the child’s condition.

Activities of daily living services provided by a nurse are only covered when the IEP indicates a one-on-one nurse is required all day at school.

Refer to Initial Evaluations, Reevaluations and Health-Related Assessments in the Covered and Noncovered IEP Health-Related Services section for information on the nursing assessment of the student health status for the IEP evaluation.

Noncovered services

· Services not authorized or documented in the child’s IEP/IFSP or health record (including services provided during extended school year).

· Services that are not face-to-face (for example, consultation) provided to the child, except as covered under IEP evaluations, or when appropriate, while providing medication management or chronic disease management.

· Medical care and administering medications and treatment for acute and episodic illnesses and injury.

· Classroom health education such as first aid classes and substance prevention classes.

· Services delegated to or provided by someone who is not a nurse or personal care assistant (PCA). For example, services provided by a classroom teacher, secretary, health aide or principal.

· Training and supervision of nursing cares, including health assistants and PCA.

· Supplies for the health office, including, but not limited to, bandages, gauze, gloves, cotton balls, cotton swabs and masks.

· Time spent writing the PCA plan of care, individualized health plan (IHP) or emergency care plan (ECP).

Note: The RN may delegate medication that is self-administered and other treatments and procedures. These delegated functions may be billable under PCA services.

Refer to the Covered and Noncovered Services section for an overview of covered and noncovered services criteria for all IEP services.

Health Records and Documentation

Review the Record Keeping and Documentation section for an overview of the basic IEP record keeping, documentation of service time and encounter reporting requirements.

Billing

Submit claims using the 837P Professional claim type. Refer to the Billing for IEP Services section of the MN–ITS User Manual for step-by-step instructions for direct data entry claims. Batch billers submitting X12 837P claims may review the MHCP 5010/D.0 compliance webpage and the AUC Minnesota Uniform Companion Guides for transaction guidelines.

Review the IEP Billing and Authorization Requirements section for general billing requirements.

Legal Reference

Minnesota Statues, 256B.0625, subdivision 26 (Covered Services – Special education services)
Minnesota Rules, 9505.0175, subpart 25 (Medically necessary or medical necessity)
Minnesota Statutes, 148.171, subdivisions 14, 15, 18 and 22 (Minnesota Nurse Practice Act)
Minnesota Rules, 8710.6100 (Board of Teaching Rule: School Nurse)