Minnesota law (M.S.125A.21) requires
that school districts seek reimbursement from private and public health
insurers for the cost of health-related services provided to students
who receive special education services. If your child receives
health-related services as part of their IEP, IFSP or IIIP, a member of
your child’s team may ask your permission to share information with your
insurer and/or physician in order to bill for these services.
Health-related
services are developmental, corrective and supportive services that are
required in order for a student to benefit from their program of
specialized instruction. Health-related services include supports such
as:
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Diagnosis, evaluation and assessment;
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Speech, physical and occupational therapies;
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Audiology;
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Paraprofessional/personal care assistant (PCA) services;
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Mental health services;
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Transportation;
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Health services such as nursing.
While
districts are required to seek payment from both private and public
insurers, Pine Island Public Schools will seek to bill only public
insurance – Medical Assistance (MA) and MinnesotaCare (MC). Billing
public insurance has no impact on your child’s nor family’s medical
coverage. Pine Island Public Schools will not seek to bill private
insurance, as doing so could cause your insurance rates to increase
and/or have other negative effects on your child’s and family’s
insurance coverage.
If
your child is covered both by private insurance and MA/MC, the district
will ask your permission to contact your private insurer to seek a
denial of coverage (private insurers typically will not pay for services
provided by schools). Once we have received a letter of denial, we will
then bill your public insurance.
One
of the most important things to know is that Minnesota laws offer
protections to parents and students when schools bill MA or MC. These
protections include:
-
Services
provided by the district and paid by MA or MC do not count toward any
monthly, annual or lifetime limits for the same or similar services. For
example, if your child’s IEP includes occupational therapy services, it
does not affect therapy service limits your child might need or receive
from a rehab agency.
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Services
provided by the district and paid by MA or MC do not count toward any
home care or waiver caps. For example, if your child’s IEP includes
staff to assist with eating and toileting, it does not affect the amount
of personal care assistant services your child can receive at home.
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Services
provided by the district and paid by MA or MC do not affect services
you child gets from other providers, or those covered by a PMAP.
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There are no parental fees nor co-pays for services provided by the district and paid by MA.
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Services provided by the district and paid by MA does not count toward a spenddown.
Minnesota law requires that any money received from third party billing can only be used for three things:
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For the benefit of students with special needs within the district,
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To pay for the cost of doing third party billing, and
- For training and help to increase the amount of third party billing.
Contact: Jill Petersen, Director of Special Education