Third Party Reimbursement

What is Third Party Reimbursement?

Third party reimbursement allows schools to seek reimbursement for Individualized Education Program (IEP) health-related services from public and private health insurers.

Federal and state law require all public Minnesota schools to request payment for Individualized Education Program (IEP) health-related services from public and private health insurers. Minnesota Health Care Programs (MHCP) pays the federal share of covered health-related services described on a child’s IEP or Individualized Family Service Plan (IFSP).

Schools are reimbursed when a child has a disability and an IEP or IFSP, requires health-related services in order to benefit from special education and is eligible for MHCP (which includes Medical Assistance (MA), MinnesotaCare and other public, government health programs). Reimbursable IEP health-related services include assessments and services for:
  • Physical therapy.
  • Occupational therapy.
  • Speech-language-hearing.
  • Children’s Therapeutic Services and Systems (Mental Health).
  • Nursing.
  • Personal care assistance services.
  • Assistive technology devices (medical equipment).
Parents of children with disabilities must be fully informed before consenting to schools sharing information with the Department of Human Services (DHS) and to bill. See the consent policy and form below.

See the related links on this page for legal requirements, school finance instructions and guidance from DHS, the Medicaid authority in Minnesota.

The third party reimbursement (TPR) SharePoint site provides access to the latest materials for coordinators and staff setting up the TPR system and billing. For access to the TPR SharePoint site, contact Julie Neururer.

What is School-Based Community Services?

School-Based Community Services allows schools to bill and receive payment for school-based community services for students not on, or provided services not part of, an IEP or IFSP.

A student needs to be eligible for MHCP (which includes MA, MinnesotaCare and other public, government health programs). Minnesota public schools can elect to provide and bill for the following school-based community services:
  • Occupational therapy services.
  • Physical therapy services.
  • Speech language pathology and audiology services.
  • Outpatient mental health services.
  • Public health nursing clinic services.
  • Interpreter services when needed during a medical service.
MHCP considers School-Based Community Services to have the same requirements as MHCP services provided outside the school. DHS requires schools to meet all requirements and coverage criteria as for services delivered by other MHCP service providers in communities. See below for additional guidance.

 

  • Medical Assistance Billing Information and Consent Policy Revision - 4/6/21
    Questions and answers about revisions to medical assistance billing and consent policies effective July 1, 2013.
  •  - 10/30/18
    Minnesota Departments of Education and Human Services contacts for questions and issues related to third-party reimbursement.
  •  - 9/14/18  pdf iconPDF 
    Agreement regarding third party reimbursement between Department of Human Services and Department of Education
  • Consent form for Third Party Billing Health-Related Services - 5/31/17  pdf iconPDF 
    Consent form for Part C and Part B third party billing -- federally approved. Includes Microsoft Word version for local use.
  • Special Education Third Party Reimbursement - ICD-10-CM Coding Progress memo - 8/16/16
    January 22, 2016 memo about progress with and resources for coding for third party reimbursement.
  • Parent Consent to Share Data and Seek Payment for Individualized Education Program (IEP) Health Related Services - 11/9/15
    Parental consent form for Part B only
  • Part C Annual Notice for Third Party Billing - 10/6/15
    System of Payments Policy for Part C Third Party Billing -- federally approved.
  • Third Party Reimbursement: Private Insurance Coverage - 5/1/15
    MDE obtains responses from private health insurance plans on behalf of school districts statewide to reduce duplication of effort and expedite billing. Find the steps school districts must take.

School-based Community Services

  • 4/21/21
    Changes to procedures to allow schools to bill and receive payment for school-based community services for students not on, or provided services not part of, an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Translated Documents