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Third Party Reimbursement for IEP Health Related Services

In order to access an increase in federal funding to Minnesota schools for IEP health related services, the Minnesota legislators mandated (MS 125A.21, Subd. 2, retrieved August 14, 2007, (link below) that schools must seek third party reimbursement for Individualized Education Program (IEP) health related services as of July 1, 2000.

"Related services" means transportation and such developmental, corrective, and other supportive services as are required to assist a student with a disability to benefit from special education (34CFR 300.34, retrieved August 14, 2007) (link below)

Covered IEP related health related services through Medical Assistance include (MS256B.0625, Subd. 26, retrieved August 14, 2007) (link below) speech/language/hearing services, occupational therapy, physical therapy, nursing services, mental health services (social work services, and school psychologist services), personal care assistant (PCA)/paraprofessional services, interpreter services, assistive technology devices and special transportation.

IEP Health Related Services eligible for Medical Assistance payment must meet the following criteria (DHS, 2007, IEP Technical Assistance Guide, Retrieved on August 14, 2007 (link below)

  • Medically necessary
  • Provided to an eligible MA or MinnesotaCare enrollee under the age of 21
  • Included in the child/student's IEP, IFSP, IIIP
  • Health related services necessary for the child/student to benefit from his/her education
  • Provided by qualified service providers within the service provider's scope of practice and/or licensure/certification
  • Documented on a service log (EASYIEP electronic documentation is used to document services provided)
  • Authorized by the child/student's IEP/IFSP/IIIP team; and
  • Provided by the school during the school day
     

 Legislation for Third Party Billing   MS 125A.21, Subd. 2, retrieved August 14, 2007
 Definition of IEP Health Related Services   (34CFR 300.34, retrieved August 14, 2007
 Covered IEP Health Related Services through Medical Assistance   MS256B.0625, Subd. 26, retrieved August 14, 2007
 IEP Technical Assistance Guide   DHS, September 2008, IEP Technical Assistance Guide, Retrieved on March 19, 2009