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Almost Everything You Wanted to Know About “T hird P arty ”

Almost Everything You Wanted to Know About “T hird P arty ”. Minnesota Infinite Campus Interchange March 20, 2007 Arden Hills, MN. Goals for Today. You will: Know why districts bill third parties Understand how third party billing fits into due process

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Almost Everything You Wanted to Know About “T hird P arty ”

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  1. Almost Everything You Wanted to Know About “ThirdParty” Minnesota Infinite Campus Interchange March 20, 2007 Arden Hills, MN

  2. Goals for Today You will: • Know why districts bill third parties • Understand how third party billing fits into due process • Realize the potential benefits to districts from third party billing

  3. Why? • Federal Intent • Schools are obligated to provide specialized instruction and related services at no cost to families, but not prohibited from charging others [P.L. 94-142 / 1975] • May use whatever state, local, federal and private sources are available [34 CFR §300.103(a)] • Financial responsibility of State Medicaid Agency precedes that of local education agency [34 CFR §300.154(a)(1)]

  4. Why? • Minnesota Mandate • Beginning July 1, 2000, districts shall seek reimbursement from third parties [Minn. Stat. §125A.21, subd.2] • Payments to districts do not count toward monthly, annual, or lifetime limits for other MA or waivered services [Minn. Stat. §256B.0625, subd. 26] • Payments to districts by MA do not increase MA parental fees or have any copays attached [Minn.. Stat. §256B.0625, subd.26]

  5. Why? • Brings additional revenue into district • No reduction in state aide [Minn. Stat.§124.90, subd. 5] • Must be used to: • Cover the cost of doing third party billing • Obtain training and technical assistance to increase third party billing • Benefit students with special needs in the district [Minn. Stat. §125A.21, subd. 3]

  6. Why? • Quality improvements happen • Assures appropriate credentials • Increased accountability • Increased communication and team work • Fits the IIIP and local collaborative models • Think of it as a fund raiser that’s: • Less fattening than a bake sale • Less work than a carnival • Drier than a car wash

  7. How Does TP Fit? • Referral • Child study or evaluation team • Evaluation completed and report written • Individualized Education Program written

  8. How Does TP Fit? • The IEP opens the door to the potential for billing a third party like Minnesota Health Care Programs (MA/MinnesotaCare)

  9. How Does TP Fit? • When writing the IEP, track any related services that are covered by MHCP • If the IEP includes covered services, make sure the: • Evaluation Report Summary supports the medical necessity of the service • IEP adequately describes and authorizes the service • After the IEP is finalized and approved discuss the need to explore funding options and obtain the appropriate release/consent from parent or legal representative

  10. How Does TP Fit? • MA or MinnesotaCare only or MA/MnCare and Private but billing only Personal Care and/or Special Transportation • Provide initial notice via Notice of Procedural Safeguards • Obtain one time release of information to share private data with MN Department of Human Services (DHS) • If billing for nursing and/or personal care, obtain annual release to secure medical orders • Provide annual notice via Notice of Procedural Safeguards • Keep signed release in education record according to district retention policy or at least five years after last claim submitted

  11. How Does TP Fit? • Private or MA/MnCare and Private • Give parent or legal representative enough information to make an informed decision • Obtain an annual release of information and consent to ask/bill form • If billing for nursing and/or personal care, obtain annual release to secure medical orders • Repeat process each year • Keep signed release in education record according to district retention policy or at least five years after last claim submitted

  12. Things to Remember…. • Due process is not affected in any way by billing a third party • Quality of service does not change • Amount or type of service does not change • Service is provided in the least restrictive environment • Services are not terminated, reduced or denied due to third party refusal to pay • Families do not incur any direct costs

  13. Things to Remember…. • If problems arise, we will work through them together • If there is a payment dispute, district still provides the service • It takes time and effort to be successful at accessing third party revenue • Realistic and supportive leadership is essential to be successful with third party billing • Not every related service we provide is billable

  14. State of the State

  15. State of the State

  16. State of the State

  17. State of the State

  18. No Maytag Repairman Cathy Griffin Third Party Reimbursement Policy Specialist MN Department of Education 1500 Highway 36 West Roseville, MN 55113 Phone: 651-582-8263 Fax: 651-582-8729 cathy.griffin@state.mn.us

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