almost everything you wanted to know about “t hird p arty ”
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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 - PowerPoint PPT PresentationTRANSCRIPT
Almost Everything You Wanted to Know About
“ThirdParty”
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
Realize the potential benefits to districts from third party billing
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)]
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]
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]
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
How Does TP Fit?
Referral Child study or evaluation team Evaluation completed and report written Individualized Education Program written
How Does TP Fit?
The IEP opens the door to the potential for billing a third party like Minnesota Health Care Programs (MA/MinnesotaCare)
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
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
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
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
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
State of the State
State of the StateAmounts Received by MN School Districts by School Year
$541,966
$4,003,234
$6,076,586
$11,248,554
$16,745,087
$19,725,800
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006
School Year
Am
ou
nt
Series1
State of the State
Approximate Payments to Districts by MHCP by Category of Service
$-
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
PhysicalTherapy
OccupationalTherapy
Speech-Audiology
Mental Health Nursing Personal Care AT Spec Trans
Service
Am
ou
nt
2000-2001
2001-2002
2002-2003
2003-2004
*2004-2005*
State of the StateAverage Received Per District
$7,039
$20,321$23,017
$39,607
$58,755
$65,973
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
SFY 01 SFY 02 SFY 03 SFY 04 SFY 05 SFY 06
School Fiscal Year
Am
ou
nt
Series1
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