1 Virginia Department of Medical Assistance Services (DMAS) and Virginia Department of Education (DOE) Medicaid and Schools The Arc of Virginia Annual Convention August 11, 2011

Medicare Catastrophic Coverage Act of 1988  Medicaid funds could be used to pay for health-related services provided under Individuals with Disabilities Education Act (IDEA). Provided by a participating Medicaid provider Medically necessary Included in the state's Medicaid plan Provided to an individual eligible for Medicaid Screened for any other third party payment that may be available for reimbursement.

3 Virginia: Medicaid and Schools  1991 – DMAS began covering some health related services in schools due to requirement from the Governor’s Child Health Task Force  The 2002 Virginia General Assembly directed DMAS to maximize federal reimbursement for services, by working with numerous organizations including Local Education Agencies (LEAs).

Virginia: Medicaid and Schools  Health related services have expanded over the years for which schools may receive reimbursement for children enrolled in Medicaid, FAMIS or FAMIS Plus. These services must be provided by school division employees, contracted employees, or contracted agencies.

5 Virginia: Medicaid and Schools  Physical Therapy  Occupational Therapy  Speech-Language Therapy  Audiology  Psychiatric, Psychology and Mental Health  Nursing  Personal Care  Medical Evaluations  Specialized Transportation Services include:

6 Virginia: Medicaid and Schools  The following services/administrative duties are for both general education and special education students Early Periodic Screening, Diagnosis and Treatment (EPSDT) Administrative Claiming

7 Federal and State Match Rates  Public schools may receive federal Medicaid and CHIP reimbursement that must be matched by state and/or local dollars.  Federal Match rate for Administrative Claiming is 50% - Virginia DMAS keeps half of federal share  Federal Match Rate for Medicaid is 50%  Federal Match Rate for Medicaid Expansion and FAMIS is 65%

8 Provider Requirements  Services must be specified in the child’s IEP  Current license on file with DOE for each service practitioner  Signed Provider Agreement with DMAS  Signed Business Associates Agreement with DMAS

9 Business Associates Agreement  To ensure privacy and security of protected health information (PHI) Individually identifiable information, including demographics, which relates to a person's health, health care, or payment for health care as specified in 45 CFR § of the Final HIPAA Privacy Rule.  Virginia public schools shall not use PHI otherwise than as expressly permitted by the Agreement, or as required by law.

10 Provider Requirements  Special Education and FERPA Obtain parental permission for billing public insurance  DMAS Agency Director’s Letter to Parents Assures that by giving school permission to bill public insurance does not impact services their child receives by non-school providers nor does it impact the service limits their child is eligible for.

DMAS website: dmasva.dmas.virginia.gov Medicaid and Schools Find Provider Manuals and Memos at this link to the Medicaid Web Portal. 14

DOE website: Medicaid and Schools

16 Contact Information  DOE Amy Edwards,  DMAS Ashley Barton,