• The District must obtain consent from the parent, or legal guardian, to release records used for billing.  This consent shall be ongoing as long as the student continues to be eligible for special education. 
• The District must provide an initial and annual written notice to the parent, or legal guardian, of the intent of the District to bill Medical Assistance, or MinnesotaCare.  The initial notice is given to the parent on the HSRM-52 form below.  The annual written notice is done through the Third Party Billing Office.
• The parent, or legal guardian, has a right to request a copy of all records concerning individual education plan health related services that are being disclosed for billing purposes.
• The parent, or legal guardian, has a right to withdraw consent at any time without any consequences.
• If the parent signs the consent there will be NO cost to the child’s family and this will NOT affect their Medical Assistance, or MinnesotaCare, in any way.
• When the parent, or legal guardian, signs the consent form the District is allowed to bill for IEP Health Related Services and access federal funding for special education.
• When the parent, or legal guardian, does not sign the consent form the District is not allowed to bill for the IEP Health Related Services and cannot access the federal funding for special education.

Use the HSRM-52 form below to obtain a signature from the parent/legal guardian.

• Place the white copy in the special education IEP folder.
• Send the yellow copy to the Third Party Billing Office at 360 Billing Office.
• Give the pink copy to the parent, or legal guardian.  Give the families the Notice of Procedural Safeguards brochure. You may download the latest version from this site.(See below).