Medical, Dental & Pharmacy
- Medical
- Ambulatory Surgical Services
- Children's Services
- Chiropractic
- Clinic Services
- Community First Services and Supports (CFSS)
- Early Intensive Development and Behavioral Intervention (EIDBI)
- Equipment and Supplies
- HCBS
- Hearing Services
- Home Care Services
- Hospice Services
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Laboratory/Pathology, Radiology, and Diagnostic Services
- Language Interpreter Services
- Long-Term Care
- Medication Reconciliation
- Mental Health Services
- Optical Services
- Personal Care Assistance (PCA) Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitation Services
- Renal Dialysis
- Restricted Recipient Program
- School-Based Community Services
- Substance Use Disorder
- Telehealth Services
- Transportation
- Tribal and Federal Indian Health Services
- Dental
- Pharmacy
School-Based Community Services
Overview
School-Based Community Services (SBCS) are certain medically necessary services PrimeWest Health will reimburse when provided to children in the school by a qualified health care provider employed or contracted by the school. Effective July 1, 2021, Minnesota public schools will be able to bill for these services.
SBCS are optional. They are not new or expanded services, but are part of the Medical Assistance (Medicaid) benefit package. Schools have the option of providing these services to help students that are not receiving health-related services through an Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP) or when the services are not identified in the IEP.
Eligible Providers
Eligible providers include those who are eligible to provide the specific professional services needed for SBCS.
Enrollment
School districts or schools must enroll with PrimeWest Health to provide SBCS, and schools or school districts must be enrolled with Minnesota Health Care Programs (MHCP) before they can enroll with PrimeWest Health. Please see the MHCP Provider Enrollment web page to complete the MHCP enrollment.
Note: Schools that are interested in providing Public Health Nursing Clinic (PHNC) services will need to enroll as a PHNC. Schools enrolling with PrimeWest Health as a PHNC use the PHNC NPI for billing. Please refer to Public Health Clinic for more information on the PHNC covered services and billing information.
Rendering Providers
Schools must verify the rendering provider’s credentials, licensure, and certifications to ensure they are current and meet the requirements for the services they will provide.
Before the school can bill for SBCS, the school must notify the qualified professionals that they must obtain an NPI and enroll with MHCP and PrimeWest Health. The individual rendering provider must follow the enrollment criteria according to the covered service they are qualified to provide.
Eligible Members
Members eligible for SBCS must be under the age of 21 and actively enrolled in one of the major Medical Assistance (Medicaid) or MinnesotaCare programs and be enrolled with PrimeWest Health.
Covered Services
PrimeWest Health covers the following SBCS:
- Rehabilitation Services
- Occupational Therapy
- Physical Therapy
- Speech-Language Pathology
- Audiology
- Mental Health Services
- Outpatient Mental Health Services
- Children’s Therapeutic Services and Supports
- Diagnostic Assessments
- Explanation of Findings
- Family Psychoeducation
- Health and Behavioral Health Assessments
- Psychological Testing
- Psychotherapy
- Psychotherapy for Crisis
PrimeWest Health will reimburse for interpreter services as a related service when it is necessary to communicate with the child or parent(s) during a covered SBCS or evaluation.
Noncovered Services
The following services are not covered services for SBCS:
1. Personal Care Assistance
2. Assistive Technology
3. Special Transportation
Refer to the noncovered services information provided under each specific service type for complete listings of noncovered services.
Billing
When billing for SBCS, list the qualified professional as the treating or rendering provider on the claim for which you are providing services and list the school as the pay-to provider. List the place of service as 03 (school) when appropriate.
Use the correct procedure codes and modifiers for each service.
Refer to the Billing Policy Overview section of the PrimeWest Health Provider Manual for general billing requirements.
Tribal providers should refer to Tribal and Federal Indian Health Services in the PrimeWest Health Provider Manual for more information regarding provider eligibility.
Legal References
Minnesota Statutes, 256B.0625 (Covered Services)
