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Medicaid Claiming

This training provides a comprehensive review of Medicaid claiming procedures, updates on new requirements, and training on claim forms and record keeping. It also covers the role of social workers and psychologists in claiming and introduces the newly required parent/guardian consent form.

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Medicaid Claiming

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  1. Medicaid Claiming Updates and Training for Grant Wood AEA Staff 2007-08

  2. PURPOSE • Comprehensive review of essential information and references • Response to Department of Education accreditation visit and statewide audits • Introduce newly required parent/ guardian consent form and processes

  3. BRIEF HISTORICAL CONTEXT • 1965 Social Security Act (Medicaid, Title XIX) provides medical assistance for eligible individuals and families with low incomes and limited resources. • 1989 AEA Medicaid Reimbursement Act provides federal reimbursement for AEA services. • 2001 Iowa Medicaid included Early ACCESS services. • Iowa State Legislature mandates AEA participation.

  4. BRIEF HISTORICAL CONTEXT AEA related covered services are speech-language, physical therapy, occupational therapy, psychology, social work, audiology, and vision. The Early ACCESS Infant and Toddler Program includes above services plus service coordination, family training, and developmental services.

  5. BRIEF HISTORICAL CONTEXT • Beginning 2001, districts also participate in Medicaid reimbursement for nursing care, health and behavioral paraprofessional services, transportation, and counseling. • AEA social workers and psychologists involved in district behavioral health claiming. • Both the AEA and districts file claims for reimbursement at state-established rates.

  6. CURRENT SITUATION • GWAEA has been reimbursed $ . • Money put into special education general funds that support staff positions.

  7. CURRENT SITUATION Basic requirements remain constant: • Service providers must be licensed and meet special education provider requirements. • Services must be specific to a Medicaid-eligible student who has an IEP or IFSP. • IEP or IFSP is the document authorizing services.

  8. TRAINING:IEP AND IFSP IEP/IFSP is “treatment plan” and must: • Be based on professional assessment that demonstrates medical need(s) • Have measurable goals • Specify the types of services to be provided • Specify the time/frequency of services provided • Include a health or behavior plan if this need is indicated • Include a system for performance monitoring (measurability)

  9. TRAINING:CLAIM FORMS AND OTHER RECORDS Two types of AEA forms exist in hard copy and electronic versions: • Part B for school-based services • Part C for Early ACCESS services for infants and toddlers

  10. TRAINING:CLAIM FORMS AND OTHER RECORDS • Forms include pre-populated demographic information at top. • Form body includes date of service (one date per line), discipline-specific procedure codes, unit size, place of service for IFSP, time in/out, goal codes, and student’s response and progress.

  11. TRAINING:CLAIM FORMS AND OTHER RECORDS • Form bottom is a validation of services that includes printed provider name, signature, discipline, and date.

  12. TRAINING:CLAIM FORMS AND OTHER RECORDS • Review samples. • Discuss strategies for simplifying documentation.

  13. TRAINING:CLAIM FORMS AND OTHER RECORDS Record keeping requirements • Medicaid requires that claim forms and IEP/IFSP be kept for five years. AEA does this. • Other provider records not kept by AEA.

  14. TRAINING:FREQUENTLY ASKED QUESTIONS • Refer to this reference that is updated annually. • Review with an elbow partner. Is there any new information? Is anything still unclear?

  15. TRAINING:SOCIAL WORKER AND PSYCHOLOGIST ROLE IN LEA CLAIMING • Serve as Medicaid required “mental health professional.” • Supervise the FBA, BIP, and/or interventions for a behavioral IEP goal. • Sign monthly progress report documentation to substantiate that services provided were appropriate. • Signature does not imply knowledge that services were actually delivered on a daily basis.

  16. PARENT/GUARDIAN AUTHORIZATION FORM • Introduced in Fall 2006, mandated use beginning Fall 2007 • Required by FERPA • Functions as a consent for records release to Medicaid • Same form for LEA and AEA (share) • Parent signature required annually • New consent required if Medicaid-claimable services change during year

  17. PARENT/GUARDIAN AUTHORIZATION FORM GWAEA Processes for 2007-08 • IMS tracks consent response (yes, no, or blank) • IMS generates claim forms only for students whose parent/guardian has consented • GWAEA staff to get consents at annual IEP/IFSP meeting

  18. PARENT/GUARDIAN AUTHORIZATION FORM • Review Information for Parents with FAQ • Practice asking permission with a partner • Questions?

  19. AEA Expectations The AEA expectation is that staff complete claims for all eligible students and have appropriate IEP/IFSP, parent consent, and claim form documentation in a timely fashion.

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