Resources

Medicaid Policy and Resources

• Medicaid Policy for LEA based services Scroll down to Specialized Therapies, then click 10C, Local Education Agencies (LEAs)
• NC DHHS Division of Health Benefits [Medicaid] Bulletins
• LEA Fee Schedule 
• Sign up for the Medicaid List Serv 
• Medicaid Tools
  • Documentation Checklist
  • Self Assessment Procedures
  • Self Assessment
  • LEA Medicaid Stepwise Procedure

FERPA

•  Annual Notice and One-time Consent for FERPA
  • Sample Written Annual Notice 2022
  • Sample Written Annual Notice (Spanish)
  • Sample One-time Consent to Release Information 2022
  • Sample One-time Consent to Release Information (Spanish)
• 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
• Documentation Requirements
• Webinar - Related Service Provider Documentation
• Webinar Companion Materials - Related Service Provider Documentation
• Best Practices in RSP as Webinar- slides only

DHB Contacts 

• Roseann Sparano, LEA Policy 10-C
• Jim Flowers, Annual Cost Report
• John Mathewson, Random Moment Time Study

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
• Medicaid Cost Report FAQ
• Financial session
• 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
• LEA Audit File Checklist MAC

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 October 2023
• School Psychology Documentation Guidance 2019