Third Party Billing
Third-Party Billing for Special Education Services
Minnesota law (M.S.125A.21) requires school districts to seek reimbursement from private and public health insurers for the cost of health-related services provided to students receiving special education services.
If your child receives health-related services as part of their Individual Education Program (IEP), Individual Family Service Program (IFSP), or IIIP, a member of your child’s team may ask for your permission to share information with your insurer and/or physician to bill for these services.
What are Health-Related Services?
Health-related services are developmental, corrective, and supportive services required for a student to benefit from their specialized instruction program. These include supports such as:
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Assessments: Diagnosis, evaluation, and assessment
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Therapies: Speech, physical, and occupational therapies
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Specialized Care: Audiology and mental health services
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Support Staff: Paraprofessional and Personal Care Assistant (PCA) services
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Health & Nursing: Direct nursing and health services
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Logistics: Specialized transportation
Our Billing Policy: Public Insurance Only
While state law requires districts to look into both private and public options, Kasson-Mantorville (KM) Public Schools will only bill public insurance—specifically Medical Assistance (MA) and MinnesotaCare (MC).
Important Note on Private Insurance: KM Public Schools will not bill private insurance, as doing so could increase your rates or negatively impact your family's coverage.
If your child is covered by both private insurance and MA/MC: The district will ask for your permission to contact your private insurer to seek a formal denial of coverage (since private insurers typically do not pay for school-provided services). Once we receive that denial, we can safely bill your public insurance.
Parent and Student Protections
Minnesota law offers strict protections for families when schools bill MA or MC. Rest assured that billing public insurance has no impact on your child’s or family’s medical coverage.
Specifically, services paid for by MA or MC through the school district:
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Do not count toward limits: They do not count toward any monthly, annual, or lifetime limits for the same or similar services. (Example: School-based occupational therapy won't limit the therapy your child can receive from an outside rehab agency).
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Do not affect home care or waivers: They do not count toward home care or waiver caps. (Example: School assistance with eating or toileting won't reduce your child's home PCA hours).
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Do not impact other providers: They do not affect services your child receives from outside providers or those covered by a Prepaid Medical Assistance Plan (PMAP).
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Cost you nothing: There are no parental fees or co-pays for district services paid by MA.
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Do not count toward a spend-down.
How are the Reimbursed Funds Used?
Minnesota law is very strict about how districts can spend money received from third-party billing. Funds 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 administrative costs of processing third-party billing.
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For training and resources to help increase the district's third-party billing efficiency.