School Based Medicaid & Medi-Cal Consultants
Seven-year-old Winnie Hoyt sits nestled in her mother’s lap in a therapy room at Oregon Health and Science University in Portland. She’s dressed in a lavender romper that sets off her soft brown eyes, and smacks her lips occasionally while her mom and her speech-language pathologist fiddle with settings on an iPad-like device hovering in her line of sight. Read more
Office of Special Education and Rehabilitative Services, Department of Education. Secretary proposes to remove the requirement for public agencies to obtain parental consent prior to accessing for the first time a child’s public benefits or insurance ( e.g., Medicaid, Children’s Health Insurance Program (CHIP)) to provide or pay for required IDEA Part B services.
We encourage your LEA to submit a comment in support of this proposed rule to remove parent consent requirements.
The Center for Medicaid/Medicare Services has released an updated Comprehensive Guide for School-based billing programs. It has been over 20 years since the last update and there is new flexibility for states in improving school-based services and reimbursement.
Apr 18, 2023
Today, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved a state plan amendment (SPA) that will provide Illinois more Medicaid funding for eligible children receiving Medicaid-covered health care services in schools. This approval advances the expansion of school-based health services, a key priority for the Biden-Harris Administration to improve health care access, especially for youth mental health services. Today’s action is also part of ongoing efforts by HHS in support of President Biden’s call to address the nation’s mental health crisis, including its impact on children.
“Today we celebrate the historic action taken by Illinois to expand access to critical health care services in schools for eligible children,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration is committed to meeting children where they are to provide care that addresses the challenges our nation’s youth are facing, including mental health challenges. I am hopeful additional states will follow Illinois’ lead.”
“We’re thrilled to partner with states like Illinois to seize opportunities in Medicaid to expand access to health care in schools,” said CMS Administrator Chiquita Brooks-LaSure. “CMS encourages all states to consider adopting this flexibility. It just makes sense to deliver health care services and supports to children where they spend the majority of their time: in school.”
Illinois’ newly approved SPA allows schools to receive more Medicaid funding for covered services for all children with Medicaid, rather than only those children with an Individualized Education Program (IEP), which is a plan or program tailored for children with disabilities.
This SPA approval represents one of several steps CMS and HHS are taking to promote access to school-based health services and the availability of Medicaid-covered services, including mental health treatment in schools. Last year, Secretary Becerra and U.S. Department of Education Secretary Miguel Cardona issued two letters (available here and here) to states, encouraging them to leverage federal resources, especially Medicaid, to expand school-based health services for children. In August, the Centers for Medicaid and the Children’s Health Insurance Program (CHIP) Services released additional guidance outlining best practices for the delivery of health services to kids in schools.
Additionally, as part of its implementation of the Bipartisan Safer Communities Act, CMS expects to release a Comprehensive Guide to Medicaid Services and Administrative Claiming, launch a new school-based services Technical Assistance Center in partnership with the Department of Education, and release a notice of funding opportunity for $50 million in grants to states to strengthen school-based health services.
The school setting provides a unique opportunity to deliver health care services to children and adolescents, especially those enrolled in Medicaid. Together, Medicaid and the Children’s Health Insurance Program (CHIP) cover over 41 million children, or more than 50% of all children in the country. School-based health services — which can include preventive care, behavioral health services, physical and occupational therapy, and disease management, among other Medicaid-covered services — are important resources for Medicaid-enrolled children and their families and have been shown to improve health and academic outcomes.
Illinois joins 11 other states that have already expanded Medicaid payment for school-based health care services under their state plans. These include: Arizona, California, Colorado, Connecticut, Georgia, Kentucky, Louisiana, Massachusetts, Michigan, Nevada, and North Carolina. CMS celebrates and supports all states in expanding school-based health care services to more children with Medicaid.
For more information on Illinois’ SPA, please visit Medicaid.gov. For more information on state opportunities to expand access to school-based services in Medicaid, see CMS’ August 2022 informational bulletin.
Beginning January 1st, 2023, LEA’s are able to bill for individual and group counseling provided by Credentialed School Counselors. California Education Code 49600 has been updated to include provisions for direct services, allowing the role of school counselors in mental and behavioral health. Specifically, it clarifies that school counselors are mental health professionals,
A recent California Association of School Counselors article by Loretta Whitson, Ed.D. discusses the changes and potential billing opportunities for LEA’s. Practi-Cal has also informed our clients of this new policy change and are working with our clients to identify potential service and billing opportunities. You can read the article here.
The forthcoming CDE implementation requirements provide an opportunity to improve Medi-Cal reimbursement for California LEA’s. The new CDE policy, requires LEA’s to document the minutes providing promised services to students in special education. While promised services may be delivered, they are not necessarily being documented. Practi-Cal tracks promised service delivery using algorithms that analyze special education data and models of delivery for each student. Practi-Cal also reports out service compliance data that allows LEA leaders, department leads, and service providers to drill down to identify missing services.
To improve Medi-Cal billing, Practi-Cal uses the same data and reports out services that have not been documented for Medi-Cal eligible students. While some students may not qualify for a variety of other reasons, until a service record is documented, your LEA will be in the dark on potential reimbursement. Practi-Cal also reports out the missing potential reimbursement amounts for services that have yet to be documented. LEA’s are finding that in some cases, they could double the size of their reimbursement program just on the amount of undocumented services.
How do program leaders monitor and track missing services and potential reimbursement? Program leaders should actively review their Program Health Dashboard in SpEdCare. This dashboard provides valuable tools to drill-down and identify actionable tasks to improve program results.
One of these tools is the Projected Reimbursement for Promised Services widget. This widget pulls in promised services (IEP and Non-IEP) in a variety of practices, where services have been promised to Medi-Cal eligible students, but not yet documented. Clicking on any bar in the graph will open a screen to allow leaders to drill-down and see exactly what Medi-Cal covered services are missing for each student.
Once services are recorded, a few may still be held for a variety of reasons, such as parent consent or a valid prescription or order. These held claims can be viewed on the Potential Reimbursement widget. Leaders can again drill-down, by clicking any portion of the chart and take action to fix or follow-up on compliance factors that are holding the claims. Once these compliance items are fixed, the claims will be released for adjudication and reimbursement.
