Medicaid Tips From Management Advisory Group (MAG) of NY

This is often a major holdup for claiming, and it is a very simple and necessary process. The Supervising Therapist (SLP, OTR, PT) signs off with the date that they first observed the child face-to-face. Therapists should continue to observe the students periodically and log those dates as well. When the initial observation is complete, send the observation forms to MAG. No sessions can be billed before the initial observation date. Please schedule your observations as early in the IEP period as possible.

Districts often lose claiming due to a lack of paperwork from outside providers. MAG eligible lists include the location the student receives the services, share this information with these outside providers, and request all documentation for these students. If there are paper service logs coming in from these outside agencies, send them to MAG as soon as possible, and we will manually enter them for claiming.

After an evaluation has been completed, it needs to be entered into IEP Direct under Reports/Assessments. For Cleartrack users, send the evaluation information to MAG for claiming.

All contracted providers and outside agencies (except BOCES) require a signed Statement of Reassignment and Provider Agreement. This ensures that they will comply with Medicaid requirements for billing and that they will not bill Medicaid for the services they provide.

If your District contracts with a transportation company and you claim Special Trans, you will need these forms from the transportation company as well. These forms should be completed at least each contractual period, if not each school year. The Provider Agreement and Statement of Reassignment  forms could be found in the Forms & Guidance section on our website.

These are required to be sent out annually, and the district can decide when to send them, as long as it’s done every school year. It is not required that the parent sign a new consent each year, just that they receive the Annual Notice.

NEW MEDICAID COMPLIANT SCRIPTS ARE NEEDED ANNUALLY AND WHENEVER SERVICE CHANGE OCCURS

In order to claim for Medicaid services (Speech, OT, PT, etc.), order/referral forms (scripts) need to be written annually and whenever the CSE recommends a change in service. The original written order/referral reference is to a specific IEP. If the service type or frequency changes, a new IEP is created and a new written order/referral is required to reference that new IEP.

For example:

The CSE recommends OT services to be provided 2 x 30 min. per week for the 7/1/2015 to 6/30/2016 school year. An order/referral (script) is written and dated 6/30/15 for OT services covering the dates reflected on the IEP.  It states ‘as per IEP’.  If the CSE creates a new IEP on 10/1/2015 which increases the OT services to 4 x 30 min. per week, then a new written order is required.  This new written order/script will have a new set of dates and can still state ‘As per IEP’.

Example of a Problem Script – A script is written for the school year 9/1/13 to 6/30/14.  The script is signed on 12/1/13. The script is good starting 12/1/13. The time period between 9/1/13 to 11/30/13 is not covered. The script is not valid during these times and district will not be able to claim for services between 9/1 and 11/30.

SCRIPTS

• Script effective dates must match the IEP dates; therefore, a new script is needed when the student has a new Annual IEP.
• The script can be signed before the IEP date (just like school year scripts), but only on or after the Meeting date, if the effective date is noted, and matches the IEP dates
• Alert BOCES and Outside Agencies of the policy, so they know they need to write scripts that match the anniversary IEPs
• School Year effective dates (e.g. 22/23 school year or 7/1/22-6/26/23) are NOT acceptable for Anniversary IEPs. Scripts written this way may not cover the entire IEP period and can result in a loss of reimbursements. DO NOT LIST THE SCHOOL YEAR ON THE SCRIPT AT ALL
• Frontline users: Use script form from Frontline for best practice
• Or you can use MAG’s Order/Referral Form: See our Forms and Guidelines section
• All existing Medicaid requirements are still in place for script compliance

Observations

• A NEW Initial Observation is required with each new Annual IEP prior to claiming. It should be completed as soon as possible after effective date of new IEP.
• Ongoing observations are still required
• OT Supervision Plan is required by School Year between the OT and COTA, where applicable
• Reach out to BOCES and outside Agencies to remind them of this
• This shouldn’t be a big issue, many districts have anniversary IEPs, so the outside agencies and BOCES are familiar with them. You will still need to be vigilant.

Meetings

• Try to schedule Annual reviews before the end of the existing IEP
• Leave a time period between IEP meeting date and new IEP date to allow time to get scripts for NEW IEP.
• For Instance- If a student’s Annual review is on 10/26/22, and the new IEP effective date is 10/27/22, you will lose any sessions provided unless you have a script signed on 10/27/22.

Use of Federal Grants

MAG reminds districts that they cannot claim for STAC and Medicaid reimbursement if federal funds are used to pay for staff salaries, benefits, contracted services or equipment. Districts will notice the positive effects on their revenue stream by implementing prudent grant planning strategies.

When constructing the 611 grant, keep in mind that the grant is designed to supplement, and not supplant special education offerings. Usually, small high-cost classes are core educational programs  reimbursable through Excess Cost State Aid (STAC).  The provision of appropriate related services and evaluations are also claimable through Medicaid.  However, school districts need to be cautious because they must not bill for Medicaid for a service and/or evaluation that is paid partially or in full by Federal Funds.

In developing the 611 grant, districts should consider budgeting staff who are assigned to non-high cost education programs into Code 15 (Salaries for Professional Staff), e.g. consultant teachers and resource room teachers.  Additionally, we recommend that general funds be used for related service providers of Medicaid claimable services.

Whenever possible, exclude self-contained teachers teaching small classes, 1:1 or shared aides, 1:1 nurses and related service providers, or any claimable contracted services from the grant budget. These costs should be paid through the general funds budget because they may be reimbursable through the STAC system if students’ costs exceed the threshold levels assigned by the NYS Education Department for your district. This also holds true for purchased services, Code 40 (Purchased Services).

In addition, consider using general funds when purchasing special equipment for  specific students (e.g. personal FM systems, laptops or any other assistive technology devices, could be claimed through Excess Cost State Aid).  If these items are purchased using federal funds, districts cannot be reimbursed through Excess Cost State Aid.

Please note that districts (LEAs) must comply with the Maintenance of Effort (MOE) requirement of 34 CFR 300.203.  In essence funds provided to districts under IDEA Part B must not be used to reduce the level of expenditures for the education of children with disabilities made by the LEA from local funds below the level of expenditures for the preceding year.

UDO and USO Supervision

Medicaid Alert #15-04 was released 7/21/15 to clarify the Timely co-signature requirement for UDO and USO Providers. In a UDO/USO relationship, as per Medicaid Alert #15-04, the attending provider, (practitioner that has overall responsibility for the provided services) besides following UDO/USO responsibilities outlined in Medicaid Handout 3, must co-sign and date each supervised servicing provider’s session note not more than 45 calendar days following the date of service.  When supervision is required, the Attending Providers are PTs, OTs, SLPs, LCSWs, NYS Psychologists and Psychiatrists.  Supervised servicing providers are PTA, OTAs, TSHHs, TSSLDs, and LMSWs).

Under all circumstances, the servicing provider, (any clinician that provides the service) must complete and sign a session note as close to the end of the session as possible (contemporaneously).  Click here: UDO/USO for a detailed explanation of UDO/USO and and click here:  Medicaid Handout 3 for more information on session notes

Because requirements change from time to time, “Licensed professionals are reminded that it is their responsibility to be aware of and adhere to any supervision requirements related to their profession, as outlined on this NYS Education Department Office of the Professions website.”  For example, in 2014, amendments were made to OT regulations.  Among other things it limited the number of OTAs that can be supervised by one professional.  The supervision requirements, in this instance, is as follows: “In no event shall the occupational therapist or licensed physician supervise more than five occupational therapy assistants, or its full time equivalent, provided that the total number of occupational therapy assistants being supervised by a single occupational therapist or licensed physician shall not exceed ten.”   This and other information regarding Occupational Therapy can be found at this link: Part 76, Occupational Therapy.

Due to licensing requirements, services rendered by an OTA or COTA, an OT Supervision Plan needs to be developed.  Click here for a sample: OT Supervision Plan.

International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM)

All scripts/referrals are required to have a diagnosis, and all claims need a billable ICD-10 code to be submitted. Script/Referral writers should use ICD-10 codes for script diagnosis whenever possible. If we have a valid script, but an invalid or missing code, the Attending Provider can “translate” a written diagnosis into a valid ICD-10 code. Many districts lose claiming over this relatively small issue. ICD-10-CM codes can be found by clicking ‘ICD-10-CM codes’.

Parent Notification and Consent For Medicaid