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Medicaid and Schools

Medicaid and Schools. Tara Larson, Assistant Director DMA October 4, 2006. The Current Medicaid Environment. NC serves 1.5 million Medicaid recipients during FY 05-06. 18% of NC population is eligible for Medicaid 19% birth to 4 and 37% ages 5-20 8 Billion Dollars

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Medicaid and Schools

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  1. Medicaid and Schools Tara Larson, Assistant Director DMA October 4, 2006

  2. The Current Medicaid Environment • NC serves 1.5 million Medicaid recipients during FY 05-06. 18% of NC population is eligible for Medicaid • 19% birth to 4 and 37% ages 5-20 • 8 Billion Dollars • 55,000 different providers, including LEAs

  3. DMA and LEAs • Starts and Stops • Moving Forward • Formation of an advisory group • Membership • Representation of LEAs • DPI • DMA • Mutual agreement of outcomes and priorities • Avenue for communication, hot issues, CMS news

  4. Provide Medicaid reimbursable services in schools to the extent possible. • Recognize schools and staff as providers of service. • Establish practices and procedures that utilize existing school documentation and practices to the extent possible while maintaining compliance with CMS and NC Medicaid requirements. • Identify and train any new requirements that must be met and establish reasonable rates to meet the requirements. • Utilize a team approach to address issues and utilize team when communicating with CMS • Identify other partners who need to be informed of or be a part of the planning and development of Medicaid services in schools.

  5. Priorities • Nursing Services • OT and PT Services • Audiology Services • Psychological Services • Identification of other services that schools may provide or bill • Issues regarding services provided by others in schools

  6. Nursing Services • July 18 and September 21 meetings • Flexibility in options of service provider • Scope of services, documentation • Comparison of other nursing services by other providers • Next steps • LEA as direct provider • Other agencies as provider, place of service-schools • CCNC Networks • Financial • Legislative

  7. Reminders • Documentation • Medically necessity • Compliance to policy requirements • FFS CPE Form • Form is required to be submitted for any quarter payment is received. • Revised FFS CPE form is on web.

  8. ValueOptions and MH/DD/SA • 6.6% ages 6-11with MH issues • 7.8% ages 12-17 with SA issues • Delays • MH/SA/DD services in schools • 693 day treatment, 23 pending • Joint DMA/DMH memos • Transition of MH/DD/SA in schools • Video on DMH web

  9. Other Medicaid Initiatives • Pediatric Day Health • Stakeholder Group • CAP-C Modifications • EPSDT • CAP-MR/DD • Deficit Reduction Act (DRA) • Case Management

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