Medicaid $ for School-based Nursing Services and Activities

Transcription

1 Medicaid $ for School-based Nursing Services and Activities Indiana Department of Education School-based Medicaid Claiming contacts: Tracy Brunner, School-based Medicaid Specialist Office of Special Education tbrunner@doe.in.gov, John Hill, Medicaid Liaison Office of Special Education jhill@doe.in.gov, Toll Free:

2 This document, Five Facts About Medicaid in Education, is an overview of Medicaid in Education in our State. Indiana public school corporations, charter and state schools may claim federal funds for Medicaid-covered IEP services. Indiana recently implemented another type of Medicaid claiming, MAC, that allows schools to recover a portion of their costs for administrative activities that help any student gain access to health coverage and health care services. Five Facts About Medicaid in Education is available in the IDOE Medicaid in Schools Community on Learning Connection, in the folder labeled School Medicaid Billing Resources-Indiana under the Files & Bookmarks Tab.

3 IEP R.N. Services Covered In addition to Occupational, Physical and Speech therapies, Audiology and Psych services, Indiana Medicaid now reimburses schools for IEP nursing and specialized transportation services provided on and after July 1, Only IEP services are covered; Medicaid cannot reimburse schools for 504 or other health care plan services. This bulletin is available in the Medicaid Billing Tool Kit for IEP Services on IDOE s Web site and on the Indiana Medicaid agency s Web site at

4 Medicaid-qualified Service Providers To qualify for Medicaid reimbursement, IEP nursing services must be provided by a Licensed Registered Nurse (R.N.) who: 1. is employed by the local education agency (LEA), OR is working under a contract with the LEA, AND 2. meets all other federal and state qualifications, licensure and practice standards described in the School Corporation Medicaid Billing Tool Kit Chapter 8.2 At this time, Indiana Medicaid will reimburse only for IEP nursing services performed by the school s licensed Registered Nurse. Coverage is not available for services that are performed by an LPN or delegated to an aide. More information on Medicaid reimbursement for nursing services is available in the Medicaid Billing Tool Kit, Chapter 8.

5 IEP Nursing Services Medicaid only covers IEP nursing services that are: ordered by a physician (MD/DO) medically necessary provided in a school setting (includes school bus, field trip or other site as required by IEP) provided in accordance with a written plan of care (see Billing Tool Kit Section 8.4.), and furnished by an R.N. (cannot be delegated) Medicaid-reimbursed IEP nursing services require a physician s written order and must be provided in accordance with other Medicaid requirements. Note: Medicaid defines a physician as an MD or DO.

6 Examples of Covered Services Medicaid Billing Tool Kit Appendix F, Page F11 See Appendix F of the Medicaid Billing Tool Kit for examples of Medicaid-covered IEP nursing services.

7 IEP Nursing Services On IEP Nursing Service claims, schools must: bill for the appropriate start and stop times include place of service (Tool Kit Section ) divide total nursing time into 15-minute units use appropriate CPT code/modifier for service Partial units are rounded to nearest whole unit A minimum of eight minutes of service must be provided to bill for one unit For detailed billing requirements please review the Medicaid policy bulletin on IEP Nursing and Transportation Services (#BT201108) and IDOE s Medicaid Billing Tool Kit for IEP Services.

8 Sample Documentation Form Medicaid Billing Tool Kit Appendix F Page F10 Appendix F of the Medicaid Billing Tool Kit includes this sample form for recording Medicaid documentation components. Medicaid-participating districts and charters are encouraged to incorporate these data elements into whatever forms or electronic systems they currently use to document IEP nursing services.

9 Schools Must Keep Multiple Types of Documentation for Auditing Documentation of Direct medical service provision to eligible student e.g., paper or electronic Service Log / Student s Chart Medical Necessity Documentation e.g., physician order, assessments, treatment plan/iep Additional School Corporation Records e.g., financial, attendance (student & staff), staff licensure In addition to the nurse s service log, schools must maintain other types of documentation as well. Chapter 2 of the Medicaid Billing Tool Kit discusses general documentation requirements for all IEP services billed to Medicaid.

10 How do Schools Incorporate Medicaid into the Busy Work Day? Signed Parental Consent to Bill Medicaid Written Order/Referral for Service IEP/Care Plan Describe Service, Frequency, Duration Service Provider License(s) / Credentials Service Logs Describe Service, Date, Place, Progress Indicators, Provider Signature/Initials, etc Signature Cards (Service Provider Signatures/Initials) Evidence of Supervision When Required Attendance Records: Students and Staff Financial Records (e.g., Medicaid Remittance Advice) Districts, individual school buildings and even individual school clinicians already use a variety of forms and procedures to organize their daily workloads. Standard forms and electronic systems are used for everything from explaining policies to parents and developing Individualized Education Programs or Healthcare Plans to logging services provided to a student with disabilities. Compliance with Medicaid requirements is a matter of incorporating specific elements into your daily work flow. Consistency and attention to detail are key factors to success, not only in billing accurately and passing muster in an audit situation, but also in simplifying local business operations for administrators and staff.

11 Integrate Existing Forms, Processes and Systems Participating school districts can simplify their business operations by incorporating Medicaid into staff s daily routines. Rather than creating anything separate just for Medicaid claiming, it usually makes sense to integrate Medicaid requirements into the LEA s existing forms, systems and processes.

12 Medicaid Billing Tool Kit Chapter 10 offers sample documentation checklists and selfauditing ideas specific to each type of Medicaid-covered IEP service.

13 Conducting periodic self audits helps Medicaid-participating LEAs monitor building-, district- and Special Ed Cooperative-level compliance with billing and documentation requirements for all the categories of IEP services they choose to bill.

14 How does reimbursement work? $39.88/Hour for most IEP R.N. Services Billable in15-minute units ($9.97 per unit) Indvl and Group DSMT: $45 per 30 minutes Medicaid check = state + federal funds At present: every Medicaid payment includes approximately 67% federal & 33% state dollars State dollars = advance partial payment of LEA s monthly state tuition support Indiana Medicaid pays participating school corporations $9.97 for each 15 minute unit of IEP Nursing Service. Nearly every IEP nursing service is billed using an all-inclusive procedure code assigned for this purpose. However, IF the school has a doctor s order and the student s IEP specifically requires diabetes self management training, Medicaid will reimburse $45 per 30-minute unit of service for individual or group DSMT provided by an R.N. Please see Medicaid s definition of the Diabetes Self Management and Training service in the Indiana Health Coverage Program (IHCP) Provider Manual or related policy bulletins online at Medicaid payments for IEP services are a mix of state and federal dollars. Currently, about 67% of every Medicaid payment for IEP services is new, unrestricted federal funding to the Local Educational Agency (school corporation, charter or state school). The state dollars (about 33%) are basically a small advance toward the LEA s state tuition support allocation. LEAs typically restore the state share of their IEP services reimbursement to their state tuition support before deciding how to allocate the remaining federal dollars.

15 Schools that bill Medicaid for IEP services receive and retain their entire state tuition support allocation plus the federal Medicaid reimbursement. For school business managers and others interested in the details, IDOE s Office of School Financial Management created a video explaining the Medicaid Adjustment process. Anyone can access the video on IDOE s public Web site, by choosing site map at the bottom of the DOE Home Page and clicking Podcasts / Videos under Other IDOE Services on the Find It Fast menu. After landing on the Podcasts and Videos page, scroll down then click the VIDEO VAULT icon. The Medicaid Adjustment video link [ Medicaid.html] is listed under FINANCE at the bottom left of the screen. State Tuition Support: A Step-by-Step Look at the Medicaid Adjustment walks viewers through this process.

16 Online Resources via IDOE Sites The Medicaid Billing Tool Kit The Medicaid Billing Guidebook Newsletter and Presentation Archives General Info, Reports, Parent Brochure IDOE s Public Web Site: School-based Medicaid Page Resources available on the Indiana Department of Education s new public Web site include manuals, reports, brochures, archived newsletters and presentations (such as this one).

17 The Department s Web site has a new look and format but the address remains the same: To get from the DOE Home Page to this School-based Medicaid page, choose Special Education from the Individualized Learners drop down choices under Support for Students. Then click the School-based Medicaid link [ near the bottom of the Special Ed Office page.

18 Billing Tool Kit and Guidebook Both of these documents can be viewed or downloaded for printing at the School-based Medicaid page: The Guidebook is a general overview of Medicaid claiming for school-based medical services and allowable administrative activities. The Tool Kit outlines basic nuts and bolts of Medicaid medical claiming for IEP services.

19 This full-color 2-sided brochure is another example of the free downloads available on IDOE s School-based Medicaid Web page. IDOE collaborated with About Special Kids to make this parent info sheet available in English and Spanish. It helps school staff explain to families why schools are billing Medicaid for IEP Services. This brochure is also available on the A.S.K. Web site,

20 Quarterly Newsletters IDOE s public Web site also offers an archive of all quarterly Medicaid in Schools newsletters. The archive includes search tips to help readers find specific topics or facts in the archived newsletter editions.

21 IDOE now uses the Learning Connection to share news and collaborative tools with school staff across the state. Anyone with a Learning connection account can become a member of the Medicaid in Schools Community to access announcements, an interactive member s forum, events calendars and many additional resources that are not available on the IDOE public Web site. Check with your local IT Department or district administrator if you need help accessing the Learning Connection.

22 When you click the Medicaid in Schools Community Files and Bookmarks tab you ll find a variety of folders, Web links and files. Clicking a bookmark takes you directly to the described Web site; clicking a file opens a document. Clicking a folder displays a list of bookmarks and files on a specific topic or aimed at a specific audience, such as School Clinicians. You ll find items of specific interest to nurses in this folder. The Presentations folder includes copies of slide shows such as this one with the presenter s notes displayed along with the slides.

23 IndianaMAC: Another Way Schools Claim for Work School Staff including nurses Routinely Perform This IndianaMAC program announcement went out to districts last April. A copy is available in the Superintendent s Mail Community on Learning Connection. This bulletin introduces the new IndianaMAC (Medicaid Administrative Claiming) program, which helps Indiana LEAs recover part of their costs for certain administrative activities that school staff routinely perform, such as: informing parents about and helping them apply for health coverage programs; coordinating health care referrals, in-school health care services or school health fairs; and meeting with school or community partners to address students unmet health care needs. For more information check the IndianaMAC folder at the Medicaid in Schools Community Files & Bookmarks tab, or contact the IDOE staff identified at the end of this slide presentation.

24 Two Different Types of Claiming WHAT does it pay for? MAC: reimburses for ADMINISTRATIVE activities (NOT medical services) that serve all (not solely Special Ed) students Medical claiming: reimburses only for health-related services in an individual Special Education student s IEP Whether it s claiming reimbursement for Medicaid-covered IEP services or for Medicaidrelated administrative activities, Indiana public school corporations, charters and state schools participate in Medicaid claiming on a strictly voluntary basis. Because these two different claiming methods cover entirely different things, using totally separate reimbursement methodologies, schools may choose to participate in either or both. The State s new electronic IEP offers system support for each of these; however, districts do NOT have to use IndianaIEP in order to participate in either type of schoolbased Medicaid claiming.

25 Two Different Types of Claiming HOW are schools claims paid? MAC: based on results of a statewide random moment time study, reimbursements are a % of district-specific staffing costs for allowable administrative activities Medical claiming: Student-specific IEP services are reimbursed based on the established fee schedule for health services Because MAC reimbursable time is captured through a web-based statewide random moment sampling process, IndianaMAC participation requires minimal effort on the part of district staff. District specific costs, student Medicaid eligibility rates and unrestricted indirect cost rates are applied to the results of the statewide time study to determine the amount of federal dollars returned to each MAC-participating district. To claim Medicaid reimbursement for IEP services school districts must enroll as Indiana Medicaid health service providers and ensure their staff who provide Medicaid services meet Medicaid-qualified provider criteria. Medicaid pays schools the same rates as all other community providers of OT, PT, Speech, Psych, Audiology, Nursing and specialized Transportation services.

26 Two Different Types of Claiming WHAT documentation is required? MAC: required documentation includes results of quarterly statewide random moment time studies and related cost data Medical claiming: Student-specific service records and related documentation required Documentation requirements differ for each of these claiming methods. District-specific direct and indirect costs plus statewide time study results are required to support IndianaMAC claims. For IEP service claims, documentation requirements include student-specific IEP service logs, student and staff attendance records and copies of staff licensure/credentials.

27 For More Info on IndianaMAC: Contact PCG Interested LEAs will have the opportunity to sign up for IndianaMAC participation prior to the start of each calendar quarter. Contact Indiana Dept of Ed s contractor, PCG (Public Consulting Group), to learn more. Note: PCG is the designated vendor to provide systems and technical support for all districts that choose to participate in Indiana s statewide school-based Medicaid Administrative Claiming program ( IndianaMAC ). Districts not using the electronic IIEP operated by PCG can participate in IndianaMAC via an alternate web-based portal.

28 National Resources on Schoolbased Medicaid Services LEAnet is a national network of Local Educational Agencies and advocates for continued funding of effective school-based Medicaid programs by educating public policymakers about these programs benefits for schools, students and families. In addition to resources available from our state Education and Medicaid agencies, there are also national-level resources for those interested in Medicaid claiming for school-based services. The National Alliance for Medicaid in Education, NAME Inc., is a non-profit organization of school-based Medicaid staff from State Medicaid, State Education and Local Educational Agencies across the country. NAME focuses on collaboration among all stakeholders not on taking positions or lobbying. As NAME s Governmental Affairs Chair, John Hill from Indiana DOE collaborates with other national associations and federal government agencies. In February 2012, John represented NAME at a special multi-organizational convening on the role of school nursing in our nation s health care and education systems. The meeting focused on strategies to increase school districts funding for health services aimed at disease prevention/management and health promotion. Recommendations from this convening will be included in a report presented to the U.S. Secretary of Education at a public event in May For more details, see the For Nurses Folder under Xtra Links for Clinicians at the Medicaid in Schools Community s Files & Bookmarks Tab on Learning Connection.

29 Thanks for your time! Contact John Hill or Tracy Brunner in IDOE s Office of Special Education any time you have a question, want additional information or need technical assistance related to Medicaid claiming for school-based services and administrative activities.