School-Based Medicaid Programs Update

Presentation Transcript

School-Based Medicaid Programs Update TASBO Conference March 2008 Presented by: Texas Education Agency Office of Interagency Coordination Robert Vitela, Director Texas Association of School Business Officials Becky Bunte, Project Specialist

Program Overview School Health and Related Service (SHARS) Medicaid Billing Policies Preparing for the Changes Resources for School Districts Legislative Updates Cost Reporting

SHARS Medicaid Billing Policy Highlights General Eligibility Requirements Medical Services (Occupation Therapy, Physical Therapy, Personal Care Services, and so on.) must be recorded in an understudies IEP and archive the therapeutic need for administrations Child must be under 21 years old Child must be enlisted in a state funded school custom curriculum program Child must have an incapacity Child must be Medicaid qualified * All of the qualification prerequisites are important to charge under the SHARS Medicaid program

SHARS Medicaid Billing Policy Highlights Provider Documentation Requirements Session Notes* Date of Service Related IEP Objective Activity Performed amid Session Provider Initial's per section with mark at base of session note Billable begin time, billable stop time and billable aggregate minutes Student Observation Have educated parental agree to bill Medicaid for the particular administrations and the recurrence as sketched out in the tyke's present IEP. *Psychological Services-Assessment administrations, Nursing Services, Evaluations, Personal Care Services, Transportation don't require session notes, however utilize different structures or logs to archive administrations. Medicaid numbers are required to be on understudy record.

Some SHARS Billing Policies Changes Impacting School Districts Specialized Transportation Services The nearness of a transport screen is never again be viewed as an extraordinary adjustment. More than likely, the transport screen administrations would be billable as "Individual Care Services on the Bus" expecting the proper documentation is kept up and the administration is in the understudy's IEP. Individual Care Services Indication of situation in an independent setting [i.e., Life Skills classroom, Preschool Programs for Children with Disabilities (PPCD), etc.] is not adequate IEP documentation to bolster Medicaid repayment for PCS. Qualification Requirements Have educated parental agree to bill Medicaid for the particular administrations and the recurrence as delineated in the kid's present IEP

What Districts can do to Address the Changes… Adapting to the Changes Specialized Transportation Services The nearness of a transport screen is never again be viewed as a unique adjustment. More than likely, the transport screen administrations would be billable as "Individual Care Services on the Bus" expecting the fitting documentation is kept up and the administration is in the understudy's IEP. This is particularly critical if Specialized Transportation is killed in August

What Districts can do to Address the Changes… .Know your Facts and Share Personal Care Services The definition has changed and sign of position in an independent setting [i.e., Life Skills classroom, Preschool Programs for Children with Disabilities (PPCD), etc.] is not adequate IEP documentation to bolster Medicaid repayment for PCS. The new SHARS "question and answer" diagrams another definition. Specialized curriculum office's need this data so they can decide the most ideal approach to incorporate the data in their IEPs. It would be ideal if you impart this data to your Special Education Director. They can discover the definition on our Website.

What Districts can do to Address the Changes… Working Smarter Informed Parental Consent Section 300.154(d) of the reauthorized IDEA 2004 obliges locale to get educated parental assent. Prepare proper staff individuals Be set up to clarify the arrangement… know your certainties Adopt a working model and recreate best practices Discuss winning practices with staff, other region faculty, SHARS sellers.

What Districts can do to Address the Changes… Some Facts to Know Section 300.154(d) of the reauthorized IDEA 2004 obliges areas to get educated parental assent. It might console to tell guardians that: billing Medicaid is not another procedure SHARS is repayment cash to the schools The kid's capacity to get benefits outside of the school setting won't be affected SHARS is a program under EPSDT and is not subject as far as possible or "top" on administrations They can pull back consent whenever

Resources for School Districts Office of Interagency Coordination Interagency Website School-based Medicaid List Serve Check with your Third-Party Billing Agent* *(some locale utilize a merchant, for the most part however the Special Education Office)

Resources: The Office of Interagency Coordination Responsible for enhancing the adequacy of coordination between government funded instruction and the wellbeing and human administration offices by serving as a contact to other state offices and outer associations. The Office of Interagency Coordination, with the support of various divisions and offices inside the Agency, other state offices, private associations, and backing bunches, helps with: decreasing the negative effect of wellbeing and social issues upon youngsters' school execution, diminishing school regions duties regarding the arrangement of non-instructive administrations, expanding kids' entrance to required administrations, enhancing school participation, lessening school dropouts, and expanding stores accessible to class areas to straightforwardly give and grow administrations required by kids and youth.

Resources: Navigating the Interagency Coordination Website 1. Go to www.tea.state.tx.us 2. Click on "List A - Z" 3. Click on the letter "I" for Interagency Coordination 4. Under the letter "I" look down and tap on "Interagency Coordination" 5. Division of Interagency Coordination page will open 6. Click on "School Health and Related Services" *located inside green box 7. SHARS page will open and look down and tap on: "Updated 12/5/07 Billing Guidelines" or "Updated 12/5/07 Frequently Asked Questions"

Resources: School-Based Medicaid Services List Serve Instructions for "Joining" the School-based Medicaid Services List Serve Click on the accompanying connection: http://miller.tea.state.tx.us/list/Click on " Select a List" Scroll down to "Class based Medicaid Programs ". Snap to choose this rundown. ( some time ago recorded under School Health and Related Services) Click on "join" catch Type in your Email Address and Name and tap on Join SHARS (don't change membership sort or some other data recorded) Exit this connection. You will be sent an affirmation to your email address. If it's not too much trouble make sure to tap the connection to acknowledge the affirmation. (It might take a few minutes or a few hours to get this affirmation email) If you have any issues, call Interagency Coordination at 512-463-9283.

Resources: School-Based Medicaid Services List Serve Instructions for "Leaving" the School-based Medicaid Services List Serve Click on the accompanying connection: http://miller.tea.state.tx.us/list/Click on " Select a List" Scroll down to "Class based Medicaid Programs ". Snap to choose this rundown. ( once in the past recorded under School Health and Related Services) Click on "leave" catch Type in your Email Address and Name and tap on Leave SHARS (don't change membership sort or some other data recorded) Exit this connection. You will be sent an affirmation to your email address. Kindly make sure to tap the connection to acknowledge the affirmation. (It might take a few minutes or a few hours to get this affirmation email) If you have any issues, call Interagency Coordination at 512-463-9283.

Resources: Third Party Vendors Many regions contract with SHARS charging administration organizations to collaborator them with their Medicaid charging. A large number of those organizations offer a variety of administrations that may help you in managing the progressions. Check with your Special Education office to check whether your area works with a merchant and what administrations they give.

Legislative Updates in light of a TASBO ask for on the status of authoritative exercises on the national level, the Office of Interagency Coordination has assembled the accompanying data: The last run proclaimed by the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), entitled "Medicaid Program; Elimination of Reimbursement Under Medicaid for School Administration Expenditures and Costs Related to Transportation of School-Age Children Between Home and School" (RIN: 0938-AP13) was distributed in the Federal Register on December 28, 2007 (72 Fed. Reg. 73,635).

Legislative Updates What does this intend to class locale when and if the run becomes effective? The last run disposes of Medicaid repayment of school-based regulatory costs and costs identified with transportation of school-age children.  The administer has a viable date of August 28, 2008.  The impact of the manage will: completely take out any Medicaid repayment to class locale for any Medicaid managerial asserting (MAC) exercises and completely wipe out Medicaid repayment for specific transportation benefits under the School Health and Related Services (SHARS) program.

IMPORTANT – Last Scheduled Training Monday March 10, 2008 TETN Regional Educational Service Center (or at District if accessible) Time: 8:30 a.m. to 3:30 p.m. From HHSC site: Attendance at the SHARS cost report preparing is emphatically suggested for all people who set up the cost reports or who sign the Cost Report Certification as well as Certification of Funds pages.

Import