School-Based Medicaid Programs Update

1. 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

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

3. SHARS Medicaid Billing Policy Highlights General Eligibility Requirements Medical Services (Occupation Therapy, Physical Therapy, Personal Care Services, etc.) must be listed in a students IEP and document the medical necessity for services • Child must be under 21 years of age • Child must be enrolled in a public school special education program • Child must have a disability • Child must be Medicaid eligible * All of the eligibility requirements are necessary to bill under the SHARS Medicaid program

4. SHARS Medicaid Billing Policy Highlights Provider Documentation Requirements • Session Notes* • Date of Service • Related IEP Objective • Activity Performed during Session • Provider Initial’s per entry with signature at bottom of session note • Billable start time, billable stop time and billable total minutes • Student Observation • Have informed parental consent to bill Medicaid for the specific services and the frequency as outlined in the child’s current IEP. *Psychological Services-Assessment services, Nursing Services, Evaluations, Personal Care Services, Transportation do not require session notes, but use other forms or logs to document services. Medicaid numbers are required to be on student record.

5. Some SHARS Billing Policies ChangesImpacting School Districts • Specialized Transportation Services The presence of a bus monitor is no longer be considered a special adaptation. More than likely, the bus monitor services would be billable as “Personal Care Services on the Bus” assuming the appropriate documentation is maintained and the service is in the student’s IEP. • Personal Care Services Indication of placement in a self-contained setting [i.e., Life Skills classroom, Preschool Programs for Children with Disabilities (PPCD), etc.] is not sufficient IEP documentation to support Medicaid reimbursement for PCS. • Eligibility Requirements Have informed parental consent to bill Medicaid for the specific services and the frequency as outlined in the child’s current IEP

6. What Districts can do to Address the Changes…Adapting to the Changes Specialized Transportation Services The presence of a bus monitor is no longer be considered a special adaptation. • More than likely, the bus monitor services would be billable as “Personal Care Services on the Bus” assuming the appropriate documentation is maintained and the service is in the student’s IEP. This is especially important if Specialized Transportation is eliminated in August

7. What Districts can do to Address the Changes….Know your Facts and Share Personal Care Services The definition has changed and indication of placement in a self-contained setting [i.e., Life Skills classroom, Preschool Programs for Children with Disabilities (PPCD), etc.] is not sufficient IEP documentation to support Medicaid reimbursement for PCS. • The new SHARS “Q and A” outlines a new definition. Special education department’s need this information so they can determine the best way to include the information in their IEPs. Please share this information with your Special Education Director. They can find the definition on our Website.

8. What Districts can do to Address the Changes…Working Smarter Informed Parental Consent Section 300.154(d) of the reauthorized IDEA 2004 requires districts to obtain informed parental consent. • Train appropriate staff members • Be prepared to explain the policy…know your facts • Adopt a working model and replicate best practices • Discuss winning practices with staff, other district personnel, SHARS vendors.

9. What Districts can do to Address the Changes…Some Facts to Know Section 300.154(d) of the reauthorized IDEA 2004 requires districts to obtain informed parental consent. • It may be reassuring to let parents know that: billing Medicaid is not a new process • SHARS is reimbursement money to the schools • The child’s ability to receive services outside of the school setting will not be impacted • SHARS is a program under EPSDT and is not subject to any type of limit or “cap” on services • They can withdraw permission at any time

10. Resources for School Districts • Office of Interagency Coordination • Interagency Website • School-based Medicaid List Serve • Check with your Third-Party Billing Agent* *(some districts use a vendor, usually though the Special Education Office)

11. Resources: The Office of Interagency Coordination Responsible for improving the effectiveness of coordination between public education and the health and human service agencies by serving as a liaison to other state agencies and external organizations. The Office of Interagency Coordination, with the support of numerous divisions and departments within the Agency, other state agencies, private organizations, and advocacy groups, assists in: • reducing the negative impact of health and social problems upon children's school performance, • reducing school districts responsibilities for the provision of non-educational services, • increasing children's access to needed services, • improving school attendance, • reducing school dropouts, and • increasing funds available to school districts to directly provide and expand services needed by children and youth.

12. Resources: Navigating the Interagency Coordination Website 1. Go to www.tea.state.tx.us 2. Click on “Index A - Z” 3. Click on the letter “I” for Interagency Coordination 4. Under the letter “I” scroll down and click 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 scroll down and click on: “Updated 12/5/07 Billing Guidelines” or “Updated 12/5/07 Frequently Asked Questions”

13. Resources: School-Based Medicaid Services List Serve Instructions for “Joining” the School-based Medicaid Services List Serve • Click on the following link: http://miller.tea.state.tx.us/list/ • Click on “Select a List” • Scroll down to “School-based Medicaid Programs”.Click to select this list. (formerly listed under School Health and Related Services) • Click on “join” button • Type in your Email Address and Name and click on Join SHARS (do not change subscription type or any other information listed) • Exit this link. • You will be sent a confirmation to your email address. Please be sure to click the link to accept the confirmation. (It may take several minutes or several hours to receive this confirmation email) • If you have any problems, call Interagency Coordination at 512-463-9283.

14. Resources: School-Based Medicaid Services List Serve Instructions for “Leaving” the School-based Medicaid Services List Serve • Click on the following link: http://miller.tea.state.tx.us/list/ • Click on “Select a List” • Scroll down to “School-based Medicaid Programs”.Click to select this list. (formerly listed under School Health and Related Services) • Click on “leave” button • Type in your Email Address and Name and click on Leave SHARS (do not change subscription type or any other information listed) • Exit this link. • You will be sent a confirmation to your email address. Please be sure to click the link to accept the confirmation. (It may take several minutes or several hours to receive this confirmation email) • If you have any problems, call Interagency Coordination at 512-463-9283.

15. Resources: Third Party Vendors • Many districts contract with SHARS billing service companies to assistant them with their Medicaid billing. Many of those companies offer an array of services that might assist you in dealing with the changes. • Check with your Special Education office to see if your district works with a vendor and what services they provide.

16. Legislative Updates In response to a TASBO request on the status of legislative activities on the national level, the Office of Interagency Coordination has gathered the following information: • The final rule promulgated 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 published in the Federal Register on December 28, 2007 (72 Fed. Reg. 73,635).

17. Legislative Updates What does this mean to school districts when and if the rule goes into effect? The final rule eliminates Medicaid reimbursement of school-based administrative expenses and costs related to transportation of school-age children.  The rule has an effective date of August 28, 2008.  The effect of the rule will: • fully eliminate any Medicaid reimbursement to school districts for any Medicaid administrative claiming (MAC) activities and • fully eliminate Medicaid reimbursement for specialized transportation services under the School Health and Related Services (SHARS) program.

18. IMPORTANT – Last Scheduled Training Monday March 10, 2008 TETN Regional Educational Service Center (or at District if available) Time: 8:30 a.m. to 3:30 p.m. • From HHSC website: • Attendance at the SHARS cost report training is strongly recommended for all individuals who prepare the cost reports or who sign the Cost Report Certification and/or Certification of Funds pages.

19. Importance of Cost Reporting Information • The cost report will be used for the cost reconciliation and settlement processes and may also be used to calculate future district-specific interim rates. • Due date – April 1, 2008 • Future years – March 1 • What if you don’t file? • Failure to file a completed cost report by the cost report due date in accordance with instructions and rules may result in vendor hold until an acceptable cost report is received by HHSC.

20. Recordkeeping • Maintain records that are accurate and sufficiently detailed to substantiate the legal, financial, and statistical information reported on the cost report. Include, but are not limited to; • accounting ledgers, journals, invoices, purchase orders, vouchers, canceled checks, timecards, payrolls, mileage logs, flight logs, loan documents, insurance policies, asset records, inventory records, organizational charts, time studies, functional job descriptions, work papers used in the preparation of the cost report, trial balances, and cost allocation spreadsheets. • HHSC requires that the provider maintain cost report work papers for a minimum period of five years or until audited whichever is longer following the end of each cost-reporting period. • Adequate documentation for seminars/conferences includes, at a minimum, a program brochure describing the seminar or a conference program with a description of the workshop attended.

21. Cost Reporting Information • 9/1/06 – 8/31/07 • http://www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Shars/Shars.html

22. Legislative Updates…Promising Activities

23. Texas Health and Human Services Contacts District-Specific Interim Rates and Cost Report Questions • PRIMARY CONTACT: Cathy Rutherford, Rate Analyst, HHSC (512) 491-1361: E-mail: cathy.rutherford@hhsc.state.tx.us • SECONDARY CONTACT: Nancy Kimble, Senior Rate Analyst, HHSC (512) 491-1363; E-mail: nancy.kimble@hhsc.state.tx.us SHARS Program/Policy/Payment Questions • Clarice Cefai, Senior Policy Analyst, HHSC (512) 249-3736; E-mail: clarice.cefai@hhsc.state.tx.us

24. Texas Health and Human Services Contacts RMTS and MAC Questions • Vicki Echols, MAC/Time Study (RMTS) Team Lead, HHSC (512) 491-5556; E-mail: vicki.echols@hhsc.state.tx.us IEP and Other IDEA/Educational Questions • Robert Vitela, Assistant Director of Interagency Coordination, TEA (512) 463-9283; E-mail: robert.vitela@tea.state.tx.us • Tammy Wooten, Program Specialist, TEA (512) 463-9283; E-mail: tammy.wooten@tea.state.tx.us Cost Report System and Website Questions • Fairbanks Hotline (888) 321-1225; E-mail: info@fairbanksllc.com

25. Cost Reporting Information • HHSC cost report information (including training) and district-specific interim rates can be found on the HHSC Rate Analysis SHARS website: http://www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Shars/Shars.html • Information about RMTS and cost report data entry can be found on the Fairbanks website: www.fairbanksllc.com/

26. Issues…………..