Vermont Medicaid Training Copyright MSB 2013 Revision Date 9/4/13

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1 Vermont Medicaid Training Copyright MSB 2013 Revision Date 9/4/13

2 SCHOOL-BASED Health Services Program The Medicaid School-Based Health Services Program is used by the State to generate Medicaid reimbursement for medically related services provided to eligible students. Each school district can only submit claims for the students for which the district serves as the local education agency under the federal special education law (IDEIA) and is fiscally responsible. This includes students that are tuitioned by the school district to another school district whether in or out of the state of Vermont. STUDENT ELIGIBLITY Student must be receiving special education services as outlined in an IEP. Student must be enrolled in Vermont Medicaid. Student is between the age of 3-21 years old. RELEASE OF INFORMATION On February 14, CFR was revised. The revision changed the consent requirements for the School-Based Health Services Program. The new consent requirements are as follows and pertain to services billed for any IEP written or amended 5/1/13 or later. 1. For any IEP written or amended 5/1/13 or later, a Release of Information form (with a footer revision date of May 2013) must be obtained before billing for dates of service covered by the IEP/Revision. 2. A letter must be provided to the parent/guardian explaining the ROI form year olds must sign their own ROI form upon turning 18, unless there is a court appointed legal guardian, in which case the court appointed legal guardian would sign the ROI form. 4. If the student is in joint custody of two legal guardians, the signatures and approval of both guardians is required on the ROI form. 5. Consent Statement on the IEP The consent statement on the IEP will be revised to comply with the new federal requirements when the IEP forms are revised for next school year. This statement will serve as an annual written notification and there will not be a need to obtain an I give permission indication on the IEP.

3 The Release of Information Form is a one-time consent.

4 A letter must be provided to the parent / guardian explaining the Release of Information form.

5 What are Medicaid Billable Services? Case Management Developmental and Assistive Therapy Mental Health Counseling Rehabilitative Nursing Services Speech, Language and Hearing Services Occupational Therapy Physical Therapy Personal Care

6 Four types of Documentation Logs 1. Case Management Assurance Log 2. Developmental and Assistive Therapy Log (DAT) 3. Personal Care Documentation Log - now includes a Personal Care Verification Form 4. Related Services Documentation Log

8 Any handwritten changes including cross outs MUST be initialed by the provider! No White Out! No Pencil! Be sure you are using the current version July 2013

9 Be sure you are using the current version July 2013

10 The Personal Care Verification Form is mandatory for all students whose services are being billed as Personal Care. STUDENT S SCHOOL DAY Enter the exact number of hours/minutes that the student is in school each day. Do not round, do not average, list the actual time for each day. Total the hours at the bottom of the column. If the personal care aide is with the student from the time school begins to the time school ends, this is the amount of time to be listed on the form. If the personal care aide is with the student from the time they arrive at school to the time they depart school (or go to an extracurricular activity), this is the amount of time to be listed on the form. BUS HOURS If the student receives personal care on the bus as stated in the IEP, the total hours per week must be listed in this section. Only the time the aide is with the student on the bus can be billed. Do not list the time the aide is on the bus without the child present. Bus hours can include other types of transportation (i.e. taxi). IEP SERVICES THAT COMBINE TO BE PERSONAL CARE Enter the service description and total weekly hours from the IEP for each 1:1 service that combine to be personal care. Total the hours at the bottom of the column. These services are documented together on the Personal Care log. OTHER 1:1 IEP SERVICES WHEN THE PERSONAL CARE AIDE IS NOT PRESENT Enter the service description and total weekly hours from the IEP for each 1:1 service where the aide is not present. Total the hours at the bottom of the column. Services in this section are documented on corresponding documentation log(s), not the Personal Care log. Example: if the aide does not attend 2hrs of speech services each week, list the speech service in this section. If billing for the speech service, document on a Related Services log. Service Description must be written exactly as it appears on the IEP service page. Be sure you are using the current version July 2013

11 Be sure you are using the current version July 2013

12 Progress Notes Progress notes are required for all RELATED services billed to the SBHS RELATED SERVICES are professional services including PT, OT, Speech, Language & Hearing, Vision, Nutrition, Mental Health Counseling, Rehabilitative Nursing Services Need to be completed Quarterly or to coincide with school marking period There is no need to print out progress notes and send to MSB if using Adori

13 Be sure you are using either the January 2013 or the July 2013 version

14 Be sure you are using either the January 2013 or the July 2013 version

17 Medicaid requires providers whose services are billed at the professional level sign a Provider Certification Agreement relinquishing their right to bill Medicaid directly for services in accordance with an IEP. The form is signed only once unless the provider has a name change. Providers must also submit a copy of their current license. Only a new provider that has not previously signed a form would need to sign the new version.

18 When a student attends an out-ofdistrict program, the sending school needs to obtain a signed copy of the Out-of-District Provider Certification Agreement before level of care claims can be submitted to Medicaid. The Out-of-District Provider Certification Agreement must be signed once a year. Be sure you are using the July 2013 version

19 Frequently Asked Questions??????

20 What is an IEP Correction & IEP Amendment? IEP correction can be made when information was omitted or typed incorrectly on the IEP form. A correction is effective the date services were initiated. The case manager must contact the parent prior to making a correction on an IEP. If the parent has the same understanding as the case manager then the IEP can be corrected and redistributed. If the parent does not agree the amendment process would need to be followed. (A note should be placed in the Special Education file outlining the change). No hand changes to IEPs are allowed. Pages must be updated and reprinted with the correct information. IEP amendment is defined as a change to an IEP based on the child s need. Amendments must clearly indicate the changes and when the changes are effective. Specific paperwork needs to be placed in the Medicaid file to support an IEP amendment. When a revision/amendment to the IEP is completed with a meeting, the following documents need to be added to the Medicaid file: A completed form 5c or 7a A revised cover page (which includes the revision date) A revised service page When a revision/amendment to the IEP is completed without a meeting, the following documents need to be added to the Medicaid file: A completed 5b (must include how the parent was notified of the change & must be signed and dated by the case manager) A revised cover page A revised service page

21 State Form 5b Agreement to Revise the IEP Between Annual Review Meetings, was revised back on 1/1/2012 to drop the requirement that a parent/guardian sign the form regarding a change without holding a formal meeting. Vermont State Form 7a can be used in lieu of State Form 5c but cannot be used in place of Form 5b. Be sure you are using the January 1, 2013 version.

22 State Form 5c Use Form 5c when a revision is made through the use of a formal meeting of the IEP team between Annual Reviews. Vermont State Form 7a can be used in lieu of State Form 5c. Be sure you are using the January 1, 2013 version.

23 Vermont State Form 7a can be used in lieu of State Form 5c but cannot be used in place of Form 5b. Be sure you are using the January 1, 2013 version.

24 Contact Information Kelly Bilodeau Claims Analyst Steve Courter Director of Client and Business Services MSB 97 High Street Somersworth NH,

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