Medicaid in Education Public schools may receive Medicaid funds for some health services provided to students at school. The services must be medically necessary and the student must be enrolled in N.C. Medicaid. In North Carolina, the following services may be reimbursed in schools: Audiology Nursing services Occupational therapy Physical therapy Psychological/counseling services Speech-language pathology services UPDATES/INFORMATION FROM DHB: DHB Medicaid LEA Policy Telehealth Update IDEA Parental Consent Final Regulations (sample notice and consent form to follow) IDEA Parental Consent Final Regulations IDEA Parental Consent Summary (1 page) IDEA Parental Consent Questions and Answers Contact: Lauren Holahan, Coordinator for MedicaidLauren.Holahan@dpi.nc.gov 984.236.2564 Laurie Ray, Medicaid ConsultantLaurie.Ray@dpi.nc.gov 919.636.1827 Bill Hussey, Medicaid Consultant for general education reimbursement/future planning (Tu & Wed only)William.Hussey@dpi.nc.gov 919.632.5378 EPSDT Policy Instructions Update On August 17, 2007, the Division posted the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Policy Instructions Update. These instructions became effective September 01, 2007, and clarify the Division’s initial EPSDT Policy Instructions issued January 28, 2005. Please review the instructions carefully. Providers and case managers should communicate the information contained in the instructions to recipients under 21 years of age and/or their representatives. Children who have previously been denied or terminated from services may be eligible for additional Medicaid services if the services are medically necessary and if a request for services is made in accordance with Medicaid’s policies and procedures. The EPSDT Policy Instructions Update is located on the following website: https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/epsdt-policy-description. Resources Resources Medicaid Policy and Resources Medicaid Policy for LEA based services NC DHHS Division of Health Benefits [Medicaid] Bulletins The LEA Fee Schedule is published on the NC Division of Health Benefits (DHB) Website located here. Sign up for the Medicaid List Serv Medicaid Tools Documentation Checklist Self Assessment Procedures Self Assessment LEA Medicaid Stepwise Procedure The NC Medicaid Plan may be viewed on DHB's website here. FERPA Annual Notice and One-time Consent for FERPA Sample Written Annual Notice 2022 Sample One-time Consent to Release Information 2022 Medicaid and Families: Get the Facts 2019 HIPAA FERPA Joint Guidance 508 Medical Necessity Medical Necessity IDEA and Medicaid (Medicaid Ethics) Documentation Therapy Services Documentation (NOTE::Check on newer form-2011 Memo) Documentation Requirements Webinar - Related Service Provider Documentation Webinar Companion Materials - Related Service Provider Documentation Best Practices in RSP as Webinar- slides only DHB Contacts Policy - John Vitiello, PT, MCP - John.Vitiello@dhhs.nc.gov or 919.527.7653 Post Payment Review Pending NC RAC Provider Info Cost Report Beginning with cost reporting periods ending on or after June 30, 2008, the DHB will begin using a cost-based methodology for all Local Educational Agencies (LEAs). Cost-based methodology will consist of a cost report, time study and reconciliation. If payments exceed Medicaid-allowable costs, the provider will remit the federal share of the overpayment at the time the cost report is submitted; and If the actual, certified costs of an LEA provider exceed the interim payments, the DHB will pay the federal share of the difference to the provider in accordance with the final actual certification agreement and submit claims to the Centers for Medicare and Medicaid Services (CMS) for reimbursement of that payment in the federal fiscal quarter following payment to the provider Cost Report Documents LEA Memo Regarding Fee-for-Service Certification of Non-Federal Match Form (NOTE:: Memo from 2009) Medicaid Cost Report FAQ (NOTE:: From 2008 newer info??) Financial session (NOTE:: From 2007 newer info??) LEA Cost Reports and Instructions Medicaid Administrative Claiming (MAC) and Random Moment Time Study (RMTS) The Centers for Medicare and Medicaid Services (CMS) have approved North Carolina’s School-Based Random Moment Time Study (RMTS) methodology, which was implemented October 1, 2007. Participation in the School-Based Random Moment Time Study is required for LEAs to be reimbursed for both the Medicaid Administrative Claiming and Direct Service/Fee for Service Programs. LEAs are required to reach an 85% return response rate per district per quarter. If an individual district has non-returns greater than 15% and greater than five moments for a quarter, the LEA is in default and will receive a warning letter. If the same LEA is in default (as previously defined) the next quarter, after being warned, the LEA will not be able to participate in the time study for a one-year period of time. Based on approval of the time study, the State agrees to monitor the time study to assure proper use of the time study codes and proper application of the methodology. The State agrees to provide summary reports to the CMS Regional Office detailing the results, issues and concerns identified in the monitoring process on a quarterly basis. The State agrees to provide oversight of outside entity contracted to operate or monitor the time study process. Time StudyMAC document (NOTE:: From 2007) LEA Audit File Checklist MAC (NOTE:: From 2007) Nursing Medicaid & SNServices 2019 Medication Documentation Form Progress Notes Template NCPOC-IHP Template Incorporating Nursing into IEPs Psychological and Counseling Services Psychological and Counseling Services DHB10C Sept 2021 School Psychology Documentation Guidance 2019 EPSDT Program EPSDT Program Medicaid covers a broad array of health and dental services for recipients under age 21. Early Periodic Screening, Diagnostic and Treatment (EPSDT) is known in North Carolina as Health Check and is defined by federal law. EPSDT/Health Check are important because it: Provides early and regular medical and dental screenings for all Medicaid recipients under age 21. Is a part of the federal Medicaid EPSDT requirement that provides recipients with medically necessary health care to correct or ameliorate a defect, physical or mental illness or a condition identified through a screening examination. EPSDT/Health Check includes periodic screening, vision, dental and hearing services. In addition, section 1905(a) of the Social Security Act requires that any medically necessary health care service listed in section 1905(a) be provided to a Medicaid recipient under age 21 even if the service is not available under the State’s Medicaid plan. EPSDT may also cover some services that are not covered for recipients aged 21 and older. Health Check examinations and other Medicaid covered services are free of charge to the recipient. All requests for services must be made in conjunction with the recipient’s physician or other licensed clinician and in accordance with the Division of Medical Assistance’s published procedures. If approval of a request is denied or services are reduced or terminated, the recipient or his/her representative will receive written notification. Additionally, the notice will contain information about how the decision may be appealed. For additional information about Health Check and EPSDT, visit the address below:https://medicaid.ncdhhs.gov/programs-and-services/medical/wellness-visits-and-diagnostic-and-treatment-services.
Medicaid in Education Public schools may receive Medicaid funds for some health services provided to students at school. The services must be medically necessary and the student must be enrolled in N.C. Medicaid. In North Carolina, the following services may be reimbursed in schools: Audiology Nursing services Occupational therapy Physical therapy Psychological/counseling services Speech-language pathology services UPDATES/INFORMATION FROM DHB: DHB Medicaid LEA Policy Telehealth Update IDEA Parental Consent Final Regulations (sample notice and consent form to follow) IDEA Parental Consent Final Regulations IDEA Parental Consent Summary (1 page) IDEA Parental Consent Questions and Answers Contact: Lauren Holahan, Coordinator for MedicaidLauren.Holahan@dpi.nc.gov 984.236.2564 Laurie Ray, Medicaid ConsultantLaurie.Ray@dpi.nc.gov 919.636.1827 Bill Hussey, Medicaid Consultant for general education reimbursement/future planning (Tu & Wed only)William.Hussey@dpi.nc.gov 919.632.5378 EPSDT Policy Instructions Update On August 17, 2007, the Division posted the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Policy Instructions Update. These instructions became effective September 01, 2007, and clarify the Division’s initial EPSDT Policy Instructions issued January 28, 2005. Please review the instructions carefully. Providers and case managers should communicate the information contained in the instructions to recipients under 21 years of age and/or their representatives. Children who have previously been denied or terminated from services may be eligible for additional Medicaid services if the services are medically necessary and if a request for services is made in accordance with Medicaid’s policies and procedures. The EPSDT Policy Instructions Update is located on the following website: https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/epsdt-policy-description. Resources Resources Medicaid Policy and Resources Medicaid Policy for LEA based services NC DHHS Division of Health Benefits [Medicaid] Bulletins The LEA Fee Schedule is published on the NC Division of Health Benefits (DHB) Website located here. Sign up for the Medicaid List Serv Medicaid Tools Documentation Checklist Self Assessment Procedures Self Assessment LEA Medicaid Stepwise Procedure The NC Medicaid Plan may be viewed on DHB's website here. FERPA Annual Notice and One-time Consent for FERPA Sample Written Annual Notice 2022 Sample One-time Consent to Release Information 2022 Medicaid and Families: Get the Facts 2019 HIPAA FERPA Joint Guidance 508 Medical Necessity Medical Necessity IDEA and Medicaid (Medicaid Ethics) Documentation Therapy Services Documentation (NOTE::Check on newer form-2011 Memo) Documentation Requirements Webinar - Related Service Provider Documentation Webinar Companion Materials - Related Service Provider Documentation Best Practices in RSP as Webinar- slides only DHB Contacts Policy - John Vitiello, PT, MCP - John.Vitiello@dhhs.nc.gov or 919.527.7653 Post Payment Review Pending NC RAC Provider Info Cost Report Beginning with cost reporting periods ending on or after June 30, 2008, the DHB will begin using a cost-based methodology for all Local Educational Agencies (LEAs). Cost-based methodology will consist of a cost report, time study and reconciliation. If payments exceed Medicaid-allowable costs, the provider will remit the federal share of the overpayment at the time the cost report is submitted; and If the actual, certified costs of an LEA provider exceed the interim payments, the DHB will pay the federal share of the difference to the provider in accordance with the final actual certification agreement and submit claims to the Centers for Medicare and Medicaid Services (CMS) for reimbursement of that payment in the federal fiscal quarter following payment to the provider Cost Report Documents LEA Memo Regarding Fee-for-Service Certification of Non-Federal Match Form (NOTE:: Memo from 2009) Medicaid Cost Report FAQ (NOTE:: From 2008 newer info??) Financial session (NOTE:: From 2007 newer info??) LEA Cost Reports and Instructions Medicaid Administrative Claiming (MAC) and Random Moment Time Study (RMTS) The Centers for Medicare and Medicaid Services (CMS) have approved North Carolina’s School-Based Random Moment Time Study (RMTS) methodology, which was implemented October 1, 2007. Participation in the School-Based Random Moment Time Study is required for LEAs to be reimbursed for both the Medicaid Administrative Claiming and Direct Service/Fee for Service Programs. LEAs are required to reach an 85% return response rate per district per quarter. If an individual district has non-returns greater than 15% and greater than five moments for a quarter, the LEA is in default and will receive a warning letter. If the same LEA is in default (as previously defined) the next quarter, after being warned, the LEA will not be able to participate in the time study for a one-year period of time. Based on approval of the time study, the State agrees to monitor the time study to assure proper use of the time study codes and proper application of the methodology. The State agrees to provide summary reports to the CMS Regional Office detailing the results, issues and concerns identified in the monitoring process on a quarterly basis. The State agrees to provide oversight of outside entity contracted to operate or monitor the time study process. Time StudyMAC document (NOTE:: From 2007) LEA Audit File Checklist MAC (NOTE:: From 2007) Nursing Medicaid & SNServices 2019 Medication Documentation Form Progress Notes Template NCPOC-IHP Template Incorporating Nursing into IEPs Psychological and Counseling Services Psychological and Counseling Services DHB10C Sept 2021 School Psychology Documentation Guidance 2019 EPSDT Program EPSDT Program Medicaid covers a broad array of health and dental services for recipients under age 21. Early Periodic Screening, Diagnostic and Treatment (EPSDT) is known in North Carolina as Health Check and is defined by federal law. EPSDT/Health Check are important because it: Provides early and regular medical and dental screenings for all Medicaid recipients under age 21. Is a part of the federal Medicaid EPSDT requirement that provides recipients with medically necessary health care to correct or ameliorate a defect, physical or mental illness or a condition identified through a screening examination. EPSDT/Health Check includes periodic screening, vision, dental and hearing services. In addition, section 1905(a) of the Social Security Act requires that any medically necessary health care service listed in section 1905(a) be provided to a Medicaid recipient under age 21 even if the service is not available under the State’s Medicaid plan. EPSDT may also cover some services that are not covered for recipients aged 21 and older. Health Check examinations and other Medicaid covered services are free of charge to the recipient. All requests for services must be made in conjunction with the recipient’s physician or other licensed clinician and in accordance with the Division of Medical Assistance’s published procedures. If approval of a request is denied or services are reduced or terminated, the recipient or his/her representative will receive written notification. Additionally, the notice will contain information about how the decision may be appealed. For additional information about Health Check and EPSDT, visit the address below:https://medicaid.ncdhhs.gov/programs-and-services/medical/wellness-visits-and-diagnostic-and-treatment-services.
