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1. 1 Medicaid and Department of Education Training October 2, 2007
Charlottesville, Virginia
2. 2
3. 3 State Plan Amendments Adds additional coverage for several services provided in the schools
Effective only for Medicaid and Medicaid expansion enrolled children
FAMIS state plan amendment has not yet been approved
4. 4 Prior to the State Plan Amendment approval… Physical Therapy
Occupational Therapy
Speech Therapy
Psychiatric and Psychological evaluations and therapy
Skilled Nursing
5. 5 Medicaid Services in the School Setting Now… Physical Therapy
Occupational Therapy
Speech Therapy
Psychiatric and Psychological evaluations and therapy
Skilled Nursing
Audiology
Personal Care Assistance Services
Medical Evaluations
Transportation
6. 6 Effective July 1, 2003 Audiology
Personal Care Assistant Services
Medical Evaluations
Social Workers providing psychological services (as defined by special education regulations) CMS has been reinterpreting in the last few years what it will allow for school coverage. They are now more strictly approving school coverage. CMS is doing this in part because of federal audits of school services in other states. The proposed SPA by DMAS prompted CMS to review all DMAS school coverage going back to what was originally approved in the early 1990s.
CMS has been reinterpreting in the last few years what it will allow for school coverage. They are now more strictly approving school coverage. CMS is doing this in part because of federal audits of school services in other states. The proposed SPA by DMAS prompted CMS to review all DMAS school coverage going back to what was originally approved in the early 1990s.
7. 7 Effective July 1, 2003 cont. MD orders for PT, OT and ST are no longer a requirement
Practitioner of the healing arts may order evaluations and write POC within discipline
8. 8 Effective July 1, 2006 Transportation Services
Cost Based Reimbursement
9. 9 Effective July 1, 2006 cont. School Services moved to 42 Code of Federal Regulation Part 440.40 (EPSDT)
Identification of defects, illnesses or conditions and services necessary to correct or ameliorate them
Habilitation services - services to assist an individual in obtaining a skill
Maintenance therapy
10. 10 How do I get claims for retroactive services paid? Only for new services
Needed for claims over one year old
Paper claims only
Submit claims with Waive of Timely Filing attachment
Use Modifier “22” in box 24d
Write “Attachment” in box 10d
Deadline to submit: June 30, 2008
11. 11 FAMIS Children and New Services Submit claims for the new services for all children.
Children enrolled in FAMIS will deny for the new services until CMS approves the FAMIS SPA.
At time of approval, DMAS will recycle the denied FAMIS claims for schools to receive interim payment
Final reimbursement will be at time of cost settlement
12. 12 Explanation of Parental Consent 9/1/07: Updated explanation of parental consent by DMAS Director
Now available in Spanish
Parental consent is needed to bill for all Medicaid services rendered by employees of school divisions that are enrolled with DMAS for:
Children qualifying to receive special education services
Children eligible for EPSDT screening services
13. 13 Parental Consent Every child who is currently active has at one time had a signed application with the parental consent language.
Use the Parent Consent Letter for those children where parental consent is unknown.
14. 14 False Claim ActEducational Requirements Effective 1/1/07
Mandated by Deficit Reduction Act
Will impact providers receiving Medicaid payments of $5 million or more per federal fiscal year
Requires providers to adopt written policies and inform employees about certain fraud and abuse laws.
Review 12/22/06 Medicaid Memo for more information.
15. 15 Claims System Issues Age Limit
System in process of being updated to allow claims for 22 year old students
Until system is fixed, attach to the claim of 22 year old, a document on school letterhead stating student is currently enrolled.
16. 16 Provider Qualifications Provide DOE copy of provider qualifications if:
Provider is new to the school division, or
Provider has new/change in qualifications
Notify DOE when a provider has left the school division.
DOE will perform random audits on provider qualifications.
17. 17 Provider Qualifications cont. Submit provider qualifications to DOE for these new services:
Audiology
Social Work
Medical Evaluations
Do not submit paperwork for:
Personal Care Assistant
Transportation provider
18. 18 Quality Management Review Team Amy Burkett / Barbara Seymour
PT/OT/ST
Anne Young
Skilled Nursing Services
Ashley Barton
Psych
Audiology
Personal Care
Transportation
Medical Evaluations
19. 19
Tammy Whitlock, Manager
Maternal and Child Health Services
804-225-4714
Tamara.Whitlock@dmas.virginia.gov
Ashley Barton, Coordinator
Maternal and Child Health Services
804-371-7824
Ashley.Barton@dmas.virginia.gov