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Medicaid and Education. April 13, 2011. www.cms.gov. State Plan. Each state determines its State Plan within the general guidelines of the federal CMS. Medicaid and Education Timeline. 1989. 1990. 2000. Medicaid State Plan Amended. IDEA. U.S. Congress. WV Code 18-2-5b.
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Medicaid and Education April 13, 2011
State Plan Each state determines its State Plan within the general guidelines of the federal CMS.
Medicaid and Education Timeline 1989 1990 2000 Medicaid State Plan Amended IDEA U.S. Congress WV Code 18-2-5b …for children with IEPs Added IEPs, Care Coor, Sp. Trans. Personal Aides Only Therapies
WV Code 18-2-5b (a) The state board shall become a Medicaid provider and seek out Medicaid eligible students for the purpose of providing Medicaid and related services to students eligible under the Medicaid program and to maximize federal reimbursement for all services available under the Omnibus Budget Reconciliation Act of one thousand nine hundred eighty-nine, as it relates to Medicaid expansion…
IDEA A noneducational public agency described in paragraph (b)(1)(i) of this section may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context… Reinforced that Medicaid would reimburse covered services provided by the school.
IDEA A public agency may use the Medicaid or other public benefits or insurance programs in which a child participates to provide or pay for services required under this part, as permitted under the public benefits or insurance program…[300.154(b)]
IDEA If a public agency spends reimbursements from Federal funds (e.g., Medicaid) for services under this part, those funds will not be considered "State or local" funds for purposes of the maintenance of effort provisions in Sec. Sec. 300.163 and 300.203.
IDEA Reduction of Other Benefits.--Nothing in this part shall be construed to permit the State to reduce medical or other assistance available or to alter eligibility under titles V and XIX of the Social Security Act…(300.186)
1990 2000 Each School District – 1st # Therapy Provider # 0 00XXXXXXXX Audiology # OT # PT # SLP # RN # Psychology # Each School District – 2nd # Cost-Based Provider # 15XXXXXXXX - New Initial/Triennial IEP Annual IEP Personal Care (full) Personal Care (part) Sp. Trans. Vehicle Sp. Trans. Aide Care Coordination
Billing Form or WVEIS Entry WVDHHR - Molina Processing Agency; Bureau of Medical Services BMS Electronic claim LEA RESA Remittance Advice Denial/pending Payment – Direct Deposit Supporting Documentation: IEP Progress Notes Attendance Records Care Coordination form
Documentation • Student Related Documentation Included in IEP services – the IEP form Therapy notes/log: Notes/outcome re: student progress and prognosis The Care Coordination form Personal Care form Specialized Transportation form – number of special education students riding specialized transportation • Billing Documentation - WVEIS Maintain documentation in the student’s individual cumulative file in a centralized location.
Freedom of Choice Freedom to choose services from providers outside the school system Medicaidcannotcoverduplicateservices EstablishinwritingthattheSchoolSystem isnottoseekreimbursement for services that are provided by an outside agency. (Consent form)
Frequently Asked Questions Personal care : Services must be provided on a full-time basis. The aide must not be responsible for any other student. Not specific to the aide Full-time / Full Day = $150.94/day ($3,018.80/month – 20 days) Full-time/ Partial Day = $75.47/day ($1509.40/month – 20 days)
Frequently Asked Questions Care Coordination : Coordinate delivery of services related to IEP. Check all activities completed during that month, but may bill even if only one activity was checked. 1 billing per month/per student = $77.09/mo.
IDEA Discussion: In order for a public agency to use the Medicaid or other public benefits or insurance program in which a child participates to provide or pay for services required under the Act, the public agency must provide the benefits or insurance program with information from the child's education records (e.g., services provided, length of the services).
IDEA Information from a child's education records is protected under the Family Educational Rights and Privacy Act of 1974, (FERPA)… Under FERPA and section 617(c) of the Act, a child's education records cannot be released to a State Medicaid agency without parental consent, except for a few specified exceptions that do not include the release of education records for insurance billing purposes.
