Now is time to ask your questions. NAME will collect questions until February 20, 2015 and deliver them to CMS. The NAME Governmental Affairs and Public Relations Committee Chair, Amy Edwards (VA), and the NAME Executive Director, John Hill, will be meeting with CMS in early April 2015 to continue the ‘free care’ discussion, so please submit your questions by February 20, 2015 using this link:
Here are the questions that NAME already submitted to CMS in mid-January 2015: 1. Is there an effective date for implementation of the clarifications provided in the Dear State Medicaid Director (SMD) letter or can states establish their own timeline/effective date? 2. According to the CMS 1997 Technical Assistance Guide, there are two barriers that prevent schools from billing Medicaid for Section 504 services:
a. These services are provided for free, and therefore conflict with the free care policy (which the recent SMD letter resolves), and b. Education is the primary payor (i.e. legally liable third party-TPL) for these services.
3. Does the clarification on third party liability (TPL) in the SMD letter, which states that “CMS does not view public agencies… such as schools… as legally liable third parties at the federal level for purposes of Medicaid reimbursement…” resolve this second barrier, thereby allowing schools to bill Medicaid for 504 services when all other billing requirements are met? 4. The SMD letter states "we also note that, even if a state determines that schools or providers of IDEA services generally are legally liable third parties…”. Can states determine whether to designate the school as the legally liable third party for special education (IEP/IFSP) services? 5. Is it correct, based on the SMD letter that medically related services provided by schools do not need to be documented in an IEP in order to obtain Medicaid reimbursement as long as all of the Medicaid requirements are met?
Thank you, NAME members and friends, for taking the time to review the letter from CMS and sharing your questions with NAME. We appreciate your interest while continuing our ongoing dialogue with CMS regarding this very important issue for schools involved in Medicaid reimbursement.
In a December 15, 2014 letter to State Medicaid Directors, the Centers for Medicare and Medicaid Services (CMS) issued guidance regarding “free care”. This topic appears in a number of previous CMS guidance documents, including: “1997 Medicaid and School Health: A Technical Assistance Guide,” and “2003 Medicaid School-Based Administrative Claiming Guide.” The 12/15/14 letter provides clarification on “free care” in light of 2004 Departmental Appeals Board (DAB) Decision Number 1924.
NAME hopes to continue providing you information on this topic, as we reach out to our federal partners at CMS.
The American Public Health Association and its Center for School, Health and Education website highlights the role of school-based health services in helping to prevent school dropout and improve graduation rates. In another publication demonstrating the inextricable link between health and academic success, the Center for Society and Health at Virginia Commonwealth University argues the cost effectiveness of public investments to reduce debilitating chronic conditions, save tax dollars and boost economic productivity. And, in recognition that school dropout poses a major threat to public health, the Healthy People 2020 goals include an indicator related to educational achievement for the first time.
On November 12, 2014, the U.S. Department of Education’s Office for Civil Rights and Office of Special Education and Rehabilitative Services, together with the U.S. Department of Justice’s Civil Rights Division, issued joint guidance that explain that public elementary and secondary students with hearing, vision, or speech disabilities have civil rights to receive effective communication. The guidance is in the form of a letter to educators (available in Spanish) with an attached Frequently Asked Questions document, and is intended to help schools understand and comply with federal legal requirements on meeting the communication needs of students with disabilities. They also released a fact sheet on the guidance for parents (available in Spanish). Please share this information widely with your colleagues, affiliates, and networks.