Medicaid and Department of Education Training

1. 1 Medicaid and Department of Education Training October 2, 2007 Charlottesville, Virginia

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3. 3 State Plan Amendments Adds additional coverage for several services provided in the schools Effective only for Medicaid and Medicaid expansion enrolled children FAMIS state plan amendment has not yet been approved

4. 4 Prior to the State Plan Amendment approval… Physical Therapy Occupational Therapy Speech Therapy Psychiatric and Psychological evaluations and therapy Skilled Nursing

5. 5 Medicaid Services in the School Setting Now… Physical Therapy Occupational Therapy Speech Therapy Psychiatric and Psychological evaluations and therapy Skilled Nursing Audiology Personal Care Assistance Services Medical Evaluations Transportation

6. 6 Effective July 1, 2003 Audiology Personal Care Assistant Services Medical Evaluations Social Workers providing psychological services (as defined by special education regulations) CMS has been reinterpreting in the last few years what it will allow for school coverage. They are now more strictly approving school coverage. CMS is doing this in part because of federal audits of school services in other states. The proposed SPA by DMAS prompted CMS to review all DMAS school coverage going back to what was originally approved in the early 1990s. CMS has been reinterpreting in the last few years what it will allow for school coverage. They are now more strictly approving school coverage. CMS is doing this in part because of federal audits of school services in other states. The proposed SPA by DMAS prompted CMS to review all DMAS school coverage going back to what was originally approved in the early 1990s.

7. 7 Effective July 1, 2003 cont. MD orders for PT, OT and ST are no longer a requirement Practitioner of the healing arts may order evaluations and write POC within discipline

8. 8 Effective July 1, 2006 Transportation Services Cost Based Reimbursement

9. 9 Effective July 1, 2006 cont. School Services moved to 42 Code of Federal Regulation Part 440.40 (EPSDT) Identification of defects, illnesses or conditions and services necessary to correct or ameliorate them Habilitation services - services to assist an individual in obtaining a skill Maintenance therapy

10. 10 How do I get claims for retroactive services paid? Only for new services Needed for claims over one year old Paper claims only Submit claims with Waive of Timely Filing attachment Use Modifier “22” in box 24d Write “Attachment” in box 10d Deadline to submit: June 30, 2008

11. 11 FAMIS Children and New Services Submit claims for the new services for all children. Children enrolled in FAMIS will deny for the new services until CMS approves the FAMIS SPA. At time of approval, DMAS will recycle the denied FAMIS claims for schools to receive interim payment Final reimbursement will be at time of cost settlement

12. 12 Explanation of Parental Consent 9/1/07: Updated explanation of parental consent by DMAS Director Now available in Spanish Parental consent is needed to bill for all Medicaid services rendered by employees of school divisions that are enrolled with DMAS for: Children qualifying to receive special education services Children eligible for EPSDT screening services

13. 13 Parental Consent Every child who is currently active has at one time had a signed application with the parental consent language. Use the Parent Consent Letter for those children where parental consent is unknown.

14. 14 False Claim ActEducational Requirements Effective 1/1/07 Mandated by Deficit Reduction Act Will impact providers receiving Medicaid payments of $5 million or more per federal fiscal year Requires providers to adopt written policies and inform employees about certain fraud and abuse laws. Review 12/22/06 Medicaid Memo for more information.

15. 15 Claims System Issues Age Limit System in process of being updated to allow claims for 22 year old students Until system is fixed, attach to the claim of 22 year old, a document on school letterhead stating student is currently enrolled.

16. 16 Provider Qualifications Provide DOE copy of provider qualifications if: Provider is new to the school division, or Provider has new/change in qualifications Notify DOE when a provider has left the school division. DOE will perform random audits on provider qualifications.

17. 17 Provider Qualifications cont. Submit provider qualifications to DOE for these new services: Audiology Social Work Medical Evaluations Do not submit paperwork for: Personal Care Assistant Transportation provider

18. 18 Quality Management Review Team Amy Burkett / Barbara Seymour PT/OT/ST Anne Young Skilled Nursing Services Ashley Barton Psych Audiology Personal Care Transportation Medical Evaluations

19. 19 Tammy Whitlock, Manager Maternal and Child Health Services 804-225-4714 Tamara.Whitlock@dmas.virginia.gov Ashley Barton, Coordinator Maternal and Child Health Services 804-371-7824 Ashley.Barton@dmas.virginia.gov