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1 School/Preschool Supportive Health Services Medicaid-in-Education Overview Medicaid 101 To insert your company logo on this slide From the Insert Menu.

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Presentation on theme: "1 School/Preschool Supportive Health Services Medicaid-in-Education Overview Medicaid 101 To insert your company logo on this slide From the Insert Menu."— Presentation transcript:

1 1 School/Preschool Supportive Health Services Medicaid-in-Education Overview Medicaid 101 To insert your company logo on this slide From the Insert Menu Select “Picture” Locate your logo file Click OK To resize the logo Click anywhere inside the logo. The boxes that appear outside the logo are known as “resize handles.” Use these to resize the object. If you hold down the shift key before using the resize handles, you will maintain the proportions of the object you wish to resize.

2 2 MEDICAID-101 TRAINING TOPICS Billing Requirements Student Demographics Documentation Requirements Claiming Process Reports

3 3 Billing Requirements

4 4 What are the requirements for billing? District/County/§4201 school must have a Medicaid provider number and a Federal NPI Number Student must be eligible for Medicaid (have an eligible CIN) District/County/§4201 schools must obtain parental consent (in accordance with IDEA) prior to billing Medicaid District/County/§4201 schools must incur a cost for the service and/or evaluation Evaluations: student must have been officially referred to CSE/CPSE Student must be referred and/or classified as a student with a disability Delivery of services must be documented Services/evaluations delivered by appropriately credentialed provider

5 5 What services and evaluations are reimbursable? SERVICES: –Speech Therapy –Physical Therapy –Occupational Therapy –Psychological Counseling (pended) –Nursing EVALUATIONS: –Psychological -basic (pended) –Comprehensive Psychological with social history (pended) –Medical –Specialist Medical –Audiological SPECIAL TRANSPORTATION: - Special transportation provided to eligible students as listed on the IEP TARGETED CASE MANAGEMENT (schoolage only) - IEP Reviews - Ongoing Service Coordination

6 6 Student Demographics

7 7 How is the demographic information processed? When student is referred to CSE/CPSE District/County/§4201 schools must obtain parental consent (in accordance with IDEA) Enter demographics onto your local computer software –Name (First and Last) –Date of Birth –Gender

8 8 Create Electronic Demographic File The SD/County/§4201 Schools will create and submit a Medicaid Demographic (MD) file, using Medicaid software, to CNYRIC via the internet/e-mail/FTP or MEDweb site.

9 9 CNYRIC processes your demographic information and matches for Medicaid eligibility. The eligibility information is posted on the CNYRIC Website in your monthly Medicaid Eligibility (ME) file (ELIGDATA). Each month the SD/County/§4201 schools would need to update their students’ Medicaid eligibility information by downloading the ELIGDATA file to their local computer. Matching Process

10 10 Matching Process Eligibility Reports and Files These reports and files are now available on the CNY-Web Report site and your RIC will provide training on access and interpretation. Medicaid Eligibility Report (ELIGREPT) lists your students with a CIN Medicaid Eligibility (ME) File (ELIGDATA) must be downloaded onto your local computer Non-Matching Reports (MATCH): –Near-Match - possible matches –Multiple Match – must select correct CIN and reenter –Match Not Found – no CIN match identified

11 11 Matching Process Eligibility Reports and Files (con’t) These reports and files are now available on the CNY-Web Report site and your RIC will provide training on access and interpretation. Biographical Reports: –Delete Unmatched Students (BIODLTE) - students w/o a CIN –Inactivated Students (BIOINCT) - students w/CIN but not claimed Transaction (BIOUPDT): –Error Report - lists problems with the biographic data you submitted –Update Report – lists accepted adjustments (ADD/CHG/DEL)

12 12 Documentation Requirements see handout

13 13 What EVALUATION documentation is required? Referral to the CSE/CPSE Signed/Dated copy of Evaluation Medical Referral (for a formal Speech, Specialist Medical, Audiological Evaluation) Professional Licenses & Certifications When necessary, a Provider Agreement & Statement of Reassignment are required

14 14 Who can complete a medical referral for an evaluation? Speech Physician, Physician Assistant, Nurse Practitioner, NYS Licensed and Registered Speech Language Pathologist Specialist Medical Physician, Physician Assistant, Nurse Practitioner Audiological Physician, Physician Assistant, Nurse Practitioner

15 15 When must a medical referral be completed? Every time a ‘Formal’ Evaluation is needed. The medical referral must be signed/dated and can be in a list format (can contain more than one student). Note - A ‘formal’ evaluation for Speech, Specialist Medical and Audiological requires parental permission.

16 16 What SERVICE documentation is required? An IEP* (that covers the service period) Medical recommendation (order) for Services - (for Speech, OT, PT, & Nursing before beginning services) Provider Service Sheets* (date specific, signed/dated) Progress Notes* (that cover the billed period) must be signed and dated by service provider *electronic or paper format is acceptable

17 17 What SERVICE documentation is required (con’t)? Professional Licenses and Certifications Speech-”Under the Direction Of” (UDO) proof The Nature of Special Transportation on IEP When necessary, a Provider Agreement & Statement of Reassignment is requiredProvider Agreement Statement of Reassignment TCM-Ongoing Service Coordination contact sheets

18 18 Who can complete a medical recommendation (order) for services? Speech Physician, Physician Assistant, Nurse Practitioner, NYS Licensed and Registered Speech Language Pathologist Physical Therapy Physician, Physician Assistant, Nurse Practitioner Occupational Therapy Physician, Physician Assistant, Nurse Practitioner Skilled Nursing Service Physician, Physician Assistant, Nurse Practitioner

19 19 A Medical Recommendation (Order) for Services Must be signed/dated by an appropriate professional. Must be child specific Must either include frequency and duration or include the phrase “as indicated on IEP” Is good for the life of the referenced IEP

20 20 Why is “Under the Direction of” for Speech Services necessary? SED requires that speech services must be provided by teacher of speech and hearing handicapped (TSHH) or teacher of students with speech and language disabilities (TSSLD) Medicaid regulations require that speech services must be provided by NYS Licensed and Registered Speech Language Pathologist

21 21 What is the responsibility of the speech pathologist? Assures services scheduled as indicated on IEP Assures services are medically appropriate see handout-365Asee handout-365A Accessible to TSHH and TSSLD Reviews progress notes (see handout-May 23, 2003 SED ltr)

22 22 What documentation is needed for “Under the Direction of”? Certification for “UDO” and accessibility - A list of TSHHs and TSSLDs - How accessibility will be provided - Dated signature of Speech Language Pathologist (SLP), w/title Note – This sheet must be updated when there is a change in personnel (see handout)(see handout)

23 23 Documentation Needed for “Under the Direction Of” (con’t) Documentation must exist that would support the IEP, Student Service schedule, and Progress Notes have been reviewed by the SLP February 6, 2007 Theresa Savo Letter (see handout)(see handout) Face to face contact (SLP and student) - at the beginning of treatment and periodically thereafter (If TSHH/TSSLD is also an SLP, see handout-6/03 SED ltr)see handout-6/03 SED ltr)

24 24 Documentation Needed for “Under the Direction Of” (con’t) SLP must be familiar with student’s treatment plan SLP assumes responsibility for services SLP must provide adequate supervisory direction to teacher Regularly scheduled meetings and phone contacts must be documented Accessibility must be documented per occurrence All documentation must be signed/initialed and dated

25 25 Who must have a copy of the certification for “Under the Direction of” and accessibility? School District TSHH/TSSLD NYS Licensed and Registered Speech Pathologist

26 26 Psychological Counseling Service Billing for Psychological Counseling Services is pended until further notice. Documentation required for psychological counseling services: 1.Must be on the IEP. 2.Quarterly Progress Notes, signed and dated. 3.Monthly Service Report, signed and dated. 4.Service must be provided by licensed professional (certification alone is not sufficient) - Professional titles will be determined at a later date

27 27 PHYSICAL THERAPY & OCCUPATIONAL THERAPY Documentation required: –Must be on the IEP with Frequency & Duration. –Appropriate Credential of the Licensed and Registered Therapist. –Medical Recommendation (Order) for service, Signed and Dated. –Quarterly Progress Notes – Signed and Dated. –Monthly Service Report indicating Attendance, Signed and Dated by the Therapist. –All of the above required when supervising a PTA or OTA.

28 28 Additional Supervision Requirements for Physical Therapy Assistant Documentation required for Supervision: 1.Licensed PT sets all Goals and establishes a plan of care & determines whether the student is appropriate to receive care from a PTA. 2.Initial joint visit between the student, the Lic. PT and the PTA. 3.Periodic Treatment of the Student by the Lic. PT as indicated in the Plan of Care. Must occur every sixth visit or every 30 days, whichever occurs first. 4.The performance appraisals and evaluations of the PTAs. 5.All documents must be signed and dated by the Lic. PT. see Article 136

29 29 Additional Supervision Requirements for Occupational Therapist Assistants The Licensed Occupational Therapist must sign and Date: 1.The Treatment Plan 2.The evaluations and assessment documents that are used to determine the method of treatment. 3.The weekly service notes after reviewing 4.The performance appraisals and evaluations of the OTAs, see Article 156

30 30 Nursing Services Documentation Requirements: 1.Must be on the IEP 2.Medical Recommendation for the Service. 3.Monthly service report in 15 minute segments. 4.Health Care Plan if appropriate. 5.Health Care Protocols if appropriate. 6.All services must be provided in accordance with the Nurse Practice Act. 7.Only acceptable credential is Registered Nurse“RN” or a Licensed Practical Nurse “LPN” under the supervision of an “RN”.

31 31 As defined in the SED March, 2005 Rebecca Cort memo (see handout)(see handout) –Must be included in the IEP –The Nature of Spec. Trans. must be documented on the IEP –Can only be claimed for a round trip on a day of Medicaid reimbursable service - School bus rosters (schedules) - Bus logs (attendance) - Service delivery documents Special Transportation

32 32 What Targeted Case Management (TCM) documentation is required? Referral to the CSE The IEP and/or CSE meeting notes (with the meeting type clearly labeled) –Initial Review –Annual Review –Triennial Review (Reevaluation) –Amended/Requested Review Ongoing Service Coordination (OSC) - contact notes Note: TCM is not billable for preschool students

33 33 Ongoing Service Coordination Must be discussed at CSE meeting. The service coordinator or case manager must document at least two contacts per month relating to service coordination or case management in order to bill Medicaid The contact notes* (see handout) will serve as documentation for billing Medicaid.(see handout) District must be preapproved to bill for OSC *Must identify who was contacted, when and include issue, action, summary of the contact then the sheet must be signed/dated by the coordinator.

34 34 Retention of Documentation Per January, 2002 Richard Cate letter (see handout):(see handout): All documentation must be retained until further notice! The School District/County/§4201 School officials are responsible for and should have formal written policy regarding compliance of all documentation requirements.

35 35 Claiming Process (see handout)

36 36 Claiming Services and Evaluations SD/County/§4201 Schools collect: –Monthly/Annual Service Provider Sheets –School-age documentation for Targeted Case Management SD/County/§4201 Schools enter service dates/evaluation completion dates and completed Targeted Case Management review dates (SD/§4201 Schools only) onto their Medicaid billing software

37 37 Processing of Claim Data SD/County/§4201 Schools submit claiming files to CNYRIC

38 38 To determine when claims should be submitted to CNYRIC and when checks should arrive Your Business Office should be notified as to when a claim has been submitted, the amount of the claim and when to expect the (SED & DOH) checks 2010 Claiming Calendar (see handout)(see handout)

39 39 Review Service Reports/Files Service Update Report (SRVUPDT) –Accepted claims –Rejected claims –Held Claims Billing Summary Report –Claims forwarded to CSC for processing (BILLSUM) –Non-Billed Report-lists rejected billing (NONBILL) Remittance Report (REMIT) –Paid –Denied –Pended Remittance File (MR File) (RMITDATA)

40 40 Management Reports CNYRIC SERVNOS Report (SRVNDIST) –Generated quarterly by CNYRIC (March, June, September, December) –A two year listing of claims submitted for each individual student, by month/service –DOH - Summary of Paid Claims –For all SD within a designated RIC –Individual, for each SD/County/§4201 School

41 41 Medicaid in Education CNYRIC-Web Report Internet Access You will now be able to access your SD/County/§4201 School reports at anytime via the internet on the CNYRIC Website at http://www.cnyric.org under ‘Web Applications’, in the ‘Web Reports’http://www.cnyric.org Please contact your RIC for password authorization procedures and Web access training.

42 42 Websites Medicaid-in-Education homepage: http://www.oms.nysed.gov/medicaid/http://www.oms.nysed.gov/medicaid/ Office of Professions homepage: http://www.op.nysed.gov National Alliance for Medicaid in Education http://medicaidforeducation.org/ LEAnet http://www.theleanet.com/

43 43 SED Contact Listing SED: Harold Matotthmatott@mail.nysed.gov 518-486-1979hmatott@mail.nysed.gov Steven Wrightswright2@mail.nysed.gov 518-486-4887swright2@mail.nysed.gov Kelly Gicobbikgicobbi@mail.nysed.gov 518-486-7828kgicobbi@mail.nysed.gov http://www.oms.nysed.gov/medicaid/conta cts/State_Medicaid_Contacts.htm


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