1 virginia department of medical assistance services (dmas) and virginia department of education...
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Virginia Department of Medical Assistance Services (DMAS) Virginia Department of Medical Assistance Services (DMAS) and and
Virginia Department of Education (DOE)Virginia Department of Education (DOE)
Medicaid and SchoolsThe Arc of Virginia Annual
ConventionAugust 11, 2011
Medicare Catastrophic Coverage Act of 1988Medicaid funds could be used to pay for
health-related services provided under Individuals with Disabilities Education Act (IDEA). Provided by a participating Medicaid provider
Medically necessary
Included in the state's Medicaid plan
Provided to an individual eligible for Medicaid
Screened for any other third party payment that may be available for reimbursement.
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Virginia: Medicaid and Schools 1991 – DMAS began covering some
health related services in schools due to requirement from the Governor’s Child Health Task Force
The 2002 Virginia General Assembly directed DMAS to maximize federal reimbursement for services, by working with numerous organizations including Local Education Agencies (LEAs).
Virginia: Medicaid and Schools2011 - Health related services have
expanded over the years for which schools may receive reimbursement for children enrolled in Medicaid, FAMIS or FAMIS Plus. These services must be provided by school
division employees, contracted employees, or contracted agencies.
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Virginia: Medicaid and Schools
Physical Therapy
Occupational Therapy
Speech-Language Therapy
Audiology
Psychiatric, Psychology and Mental Health
Nursing
Personal Care
Medical Evaluations
Specialized Transportation
Services include:
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Virginia: Medicaid and SchoolsThe following services/administrative
duties are for both general education and special education students Early Periodic Screening, Diagnosis and
Treatment (EPSDT)
Administrative Claiming
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Federal and State Match RatesPublic schools may receive federal Medicaid
and CHIP reimbursement that must be matched by state and/or local dollars.
Federal Match rate for Administrative Claiming is 50% - Virginia DMAS keeps half of federal share
Federal Match Rate for Medicaid is 50%
Federal Match Rate for Medicaid Expansion and FAMIS is 65%
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Provider RequirementsServices must be specified in the child’s
IEP
Current license on file with DOE for each service practitioner
Signed Provider Agreement with DMAS
Signed Business Associates Agreement with DMAS
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Business Associates Agreement To ensure privacy and security of
protected health information (PHI) Individually identifiable information, including
demographics, which relates to a person's health, health care, or payment for health care as specified in45 CFR § 160.103 of the Final HIPAA Privacy Rule.
Virginia public schools shall not use PHI otherwise than as expressly permitted by the Agreement, or as required by law.
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Provider RequirementsSpecial Education and FERPA
Obtain parental permission for billing public insurance
DMAS Agency Director’s Letter to Parents Assures that by giving school permission to bill
public insurance does not impact services their child receives by non-school providers nor does it impact the service limits their child is eligible for.
DMAS website:DMAS website:dmasva.dmas.virginia.govdmasva.dmas.virginia.gov
Medicaid and
Schools
Find Provider Manuals and Memos at this link to the Medicaid Web Portal. 14
DOE website:DOE website:www.doe.virginia.govwww.doe.virginia.gov
Medicaid and
Schools
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Contact InformationDOE
Amy Edwards, 804-692-0150
DMAS Ashley Barton, 804-371-7824