Medicaid and Education

April 13, 2011

C e n te rs fo r M ed ic a r e & M ed ic a id S e rv ic es

M e d i ca r e M e d i ca i d S C H IP H IP A A P u b lica t io ns L o ca l In fo rm atio n S ta ts & D a ta R e se a rc h & D em o s L a w s & R eg s P u b lic A ffa irs A bo u t C M S

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M edicaid M edicaid is a jointly-funded, F edera l-S tate health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally as sisted income maintenance payments.

E mergency P ayment For Services

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State Plan

Each state determines its State

Plan within the general guidelines of the federal CMS.

Medicaid and Education Timeline

U.S. Congress

IDEA

WV Code 18-2-5b

Medicaid State Plan Amended

1989 20001990

…for children with IEPs Only Therapies Added

IEPs, Care Coor, Sp. Trans.

Personal Aides

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…

IDEAA 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.

IDEAA 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)]

IDEAIf 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.

IDEAReduction 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)

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

1990 2000

RESA LEA

WVDHHR - Molina Processing Agency;Bureau ofMedical Services BMS

Remittance AdviceDenial/pending

Electronic claim

Billing Form or WVEIS Entry

Supporting Documentation: IEP Progress Notes Attendance Records Care Coordination form

Payment – Direct Deposit

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.

State of West Virginia – Form DOE-105 Version 8/09/01 Physician Authorization/Certification Form Student Name (L, F, M): __________________________________________________ Diagnosis: __________________________________________________ Medicaid Number: __________________________________________________ The following services have been included on the above-named student’s Individualized Education Plan.

Service

X = Included on IEP

Service Amount (times per wk/mo and/or minutes per wk/mo)

Speech Therapy PT; OT

I certify the above-identified services as medically necessary. ____________________________________ ______________ Name (Print) Date ____________________________________ Signature

Freedom of Choice

Freedom to choose services from providers outside the school system

Medicaid cannot cover duplicate services

Establish in writing that the School System is not to seek reimbursement 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.

Service Record – Care Coordination

Medicaid Number Last Name First Name

WVEIS Number Diagnosis Code School

County Beginning Date Ending Date Procedure Code Units

T2022 1

Care Coordination. T2022 = 1 unit per month. List dates of any and all activities completed this calendar month. Care Coordination Activities Date(s) A. Met with Special Ed. or Reg. Ed. teacher regarding child’s service needs/progress

B. Met with Therapist regarding service needs/progress C. Met with Psychologist regarding service needs/progress D. Met with Social Worker E. Met with Counselor regarding service needs/progress F. Met with Personal Care Aide regarding needs/progress G. Met with other health care provider regarding child’s service needs/progress H. Issued letter/memorandum regarding child’s service needs/progress I. Contacted provider(s) to schedule testing/consultation J. Met with parent(s)/guardian(s) regarding child’s treatment needs/progress K. Met with parent(s)/guardian(s) on testing results L. Issued letter/memorandum to parent(s)/guardian(s) M. Contacted parent(s)/guardian(s) to schedule consultation N. Met with child to discuss progress O. Met with child to discuss service needs P. Met with child to discuss social/behavioral issues Q. Reviewed provider assessment/testing results R. Reviewed provider notes/memoranda regarding child’s service needs/progress S. Prepared progress notes T. Prepared summary of provider consultation U. Prepared summary of parent/guardian consultation V. Prepared summary of child consultation W. Prepared other documentation of service treatment/progress X. Other:

Outcome: (Circle one) A. Progress Satisfactory - Continue IEP until completion date. or B. Reconvene IEP Team to address change ________________________________ __________________ Signature Date

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https://wveis.k12.wv.us/surveys/mmis.cfm

IDEADiscussion: 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).

IDEAInformation 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.

CONSENT TO RELEASE INFORMATION FROM EDUCATIONAL RECORDS FOR MEDICAID BILLING

Student’s Full Name The county school district wishes to periodically apply for reimbursement for certain services provided to eligible children during the year by accessing Medicaid or other publicly funded benefits. This access will not result in any decrease in available lifetime coverage or any other insured benefit; will not result in any cost to the child or the child’s family; will not increase any premium or lead to the discontinuation of the child’s benefits or insurance; and will not create any risk of loss of the child’s eligibility for West Virginia’s Title XIX MR/DD Waiver Program based on aggregate health-related expenditures. The county school system is providing the following Medicaid covered services to your child:

TYPE OF SERVICE FREQUENCY (per week/month/year)

Is the service also provided outside the

school system? Audiology Services Occupational Therapy Services Physical Therapy Services Psychological Services Speech Therapy Services Nursing (RN) Specialized Procedures Personal Care Aide (direct 1:1) Specialized Transportation (vehicle) Specialized Transportation (aide) IEP-Development (Initial or Annual/Triennial Update)

Care Coordination One per month If your child is receiving audiological, occupational therapy, physical therapy, psychological and/or speech services from a provider(s) outside the school system, please list the name of the provider(s) in the box(es) provided so that the school system does not duplicate the outside provider’s Medicaid billing. Medicaid reimbursement to districts is authorized by West Virginia Code 18-2-5b, effective March 15, 1990. These funds provide additional financial resources for the county’s educational services. Regardless of the status of the consent, the school district will continue to provide your child’s IEP services with available federal, state and/or local school district dollars. I give my consent to release information from my child’s educational records for the purpose of Medicaid billing for the duration of services. Parent Signature: _______________________________________ Child’s Medicaid Number: ________________________________ Family Physician (optional): _______________________________________

http://wvde.state.wv.us/osp/medicaid.html