Changes in the Medicaid Rules Could Impact Funding for School-Based Health Centers in New York City Schools
School-based health centers (SBHCs) are an emerging concept in schools today. In a SBHC, the student can go to the health suite to seek medical care from the school nurse, a nurse practitioner or a physician. The intent of the centers is to keep kids healthy and in school at the same time. For parents, convenience is a large factor, as they do not need to leave work or struggle to obtain transportation to take their child to the doctor.
A change in New York’s Medicaid rules could adversely affect access to SBHCs in New York City.
Connecticut, Delaware, District of Columbia, Kentucky, Maryland, Massachusetts, Maine, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont,, Virginia, West Virginia
Here are some interesting developments and news from Region 1 that we thought would be of interest to NAME members.
UVA Offers First Special Education Master’s Program in Northern Virginia – Due to a national shortage of special education teachers, the University of Virginia (UVA) will begin offering a Special Education Master’s Program in Northern Virginia at its Curry School of Education. This program is the first of its kind in the Northern Virginia area. According to the U.S. Department of Education, 47 U.S. states declared a shortage of special education teachers during the 2013-2014 school year. By opening the program in Northern Virginia, the Curry School can increase the number of schools it can partner with for practicum experiences, as well as hopefully slow the shortage of special education teachers. See more at this link: <Click Here>
Potential Medicaid Privatization in North Carolina In the state of North Carolina, the legislature voted to approve the privatization of Medicaid. The house bill passed the North Carolina Senate with a 33-15 vote and also passed the North Carolina House of Representatives with a 65-40 vote. The concept of privatization of Medicaid has been a topic of discussion for months in the state. The passing of this legislation will put some controls in the Medicaid system according to Senator Ralph Hise. There are additional steps that need to occur for the bills to accomplish their intent. See more at this link: <Click Here>
Massachusetts expanding school-based Medicaid to include a specific Autism program: ABA In Massachusetts, school-based claiming issued a notice in August that effective October 1, 2015, school districts will be able to seek reimbursement for Applied Behavior Analysis (ABA) services, both direct services and administrative claiming, that are being provided to treat individuals with autism spectrum disorder. The service must be provided by a board certified behavioral analyst or a board certified assistant behavioral analyst. For more information: http://www.mass.gov/eohhs/docs/masshealth/bull-2015/sbm-29.pdf
If you have questions, concerns or issues to share, or if your state has any news to share with NAME members, please send it along to us. We would love to hear from you.
Thank you to the 86 Region 1 members (75% of the Region 1 members) who attended the 2014 NAME Conference in Niagara Falls. We were pleasantly surprised to see and interact with members from 16 of the 18 states in the region represented at the Conference. The Town Hall meetings led to some very robust and candid conversations regarding Medicaid and our role in education. We appreciate the opportunity serve you, and to learn from your vast experiences as we all grow together.
In our Town Hall meetings, there was a great deal of discussion about the recent audit reports from the federal Office of the Inspector General (OIG), and the evolving landscape of Medicaid State Plan amendments. We discovered that because of the OIG review, New York State had been subjected to the interruption of billing; was required to revise their Medicaid State Plan and retrain school district staff . While these are huge tasks for one state to undertake, the ability to continue to receive Medicaid reimbursement that sustains the many programs needed by children and students is a desirable outcome and reward.
Since the 2014 Conference adjourned, the political landscape of the nation changed as a result of the November elections. Our Region remains concerned about what the changes in Congress will mean for Medicaid billing by school districts, covered services, and the sustainability of the Affordable Care Act. We hope to be able to shed some light on these issues soon and determine what the next steps may be for many in the Region. We are currently making plans to host a regional conference call on these topics. The tentative date to host this discussion is Tuesday, February 10th. We will send details by direct email to all members of NAME. Mark your calendars!!
As we move into 2015, we hope to see many of you at the NAME Conference in Baltimore (Region 1!), Maryland on October 4-7, 2015. Since the Conference is being held a short distance from the Centers for Medicare and Medicaid Services (CMS) headquarters, we hope to see and hear in person from some of our partners at CMS. This is a golden opportunity for NAME to move forward in collaboration with CMS. We hope you will be able to attend.
May you and your family have a spectacular and safe holiday season!
with any questions, ideas, or just to say “hi!”
Region 1 Representatives on the NAME Board of Directors,
First, the two vacant seats on the NAME Board of Directors for our Region, due to resignations, have been filled. At their May 22, 2014 meeting, the NAME Board of Directors appointed two new Representatives to fill the vacancies left by Mary Hall (LEA Rep from Hanover Schools, Virginia) who is now the NAME Treasurer and Ashley Harrell (Medicaid Rep from Virginia Medicaid agency) who was promoted and no longer works in the school based services field.
Charles Tyler, Jr., MBA, was appointed to serve as the LEA Representative for Region 1, for a term that ends in the Fall of 2015. Here’s a little more about Charles:
“I am employed by the Baltimore County Public Schools in Maryland as the Fiscal Manager in the Office of Third Party Billing, and hold a Bachelor’s degree in Management Science and a Master’s Degree in Business Administration. I have over 20 years of experience in the billing arena and currently manage the billing to Medicaid for children ages 3-21, Infants & Toddlers, school-based health centers, and the Autism Waiver programs. I have been a member of NAME since 2006 and have presented at the NAME Conference in 2008 (Return on Investment), 2011 (Knock Knock…Who’s There? The OIG), and in 2013 (The Balancing Act…Maximizing Revenue and Avoiding Fraud).”
Tabitha L. Taylor, MPA, was appointed to fill the unexpired term of Ashley Harrell as the Medicaid Representative for Region 1. In fact, Tabitha now holds the same position at Virginia Medicaid that Ashley held! Meet Tabitha Taylor:
“I am a Managed Care Program Analyst in the Maternal and Child Health Division at the Department of Medical Assistance Services (DMAS). I have a Master’s Degree in Public Administration and have worked at DMAS for 14 years. The past 7 years have been in the MCH Division. I am responsible for the daily operations of the School Health Services Program at DMAS. My responsibilities include participating in educational and other cooperative efforts internally and externally in conjunction with other agencies regarding the school services program. I represent DMAS at conferences, interagency meetings, educational activities and other functions pertaining to school services. I collaborate with the Virginia Department of Education to ensure the school program is accomplishing appropriate tasks. I perform Quality Management Reviews (QMRs) to ensure school providers are in compliance with federal and state guidelines when billing and providing Medicaid services in the schools, travel statewide to perform provider trainings, and I produce reports and perform data analysis for the School Health Services Program.
In addition to my duties for the School Health Services Program, I manage the Plan First program (Medicaid’s limited benefit family planning program), participate in work groups and task forces including the Virginia Home Visiting Consortium, the Healthy Families Advisory Council, the Tobacco Cessation Committee, the Text4Baby Workgroup, the Infant Mortality Workgroup, and the LARC Workgroup (Virginia’s Long-Acting Reversible Contraception Program).”
We want you to know that, the NAME 2014 Conference registration is now OPEN! Visit the NAME website and use the Preliminary Program on the website when you request permission to travel and attend. Make sure you spread the word that the Conference is being held in a Region 1 state this year – New York!—from September 16-19, 2014. Many more details can be found on the website under the Annual Conference page.
In April, the entire NAME Leadership Team (officers, Directors from the Regions and Committee Chairs) were in Niagara Falls for three days of their triennial Strategic Planning Meetings. Not only did the group develop a plan for the next three years for the NAME organization, but we purposely scheduled in the same city as the Conference. We all gained knowledge about the Niagara Falls area and committed to promoting the Conference, which will be informative but also enjoyable for nearly 300 attendees.
Be sure to register early to take advantage of the social events we have scheduled as space is limited. Use the link below to begin your registration and lock in the early bird rate!
As we approach the conference date, your Region1 representatives will be sending out a request for topics for our Town Hall meeting(s) that are held at each NAME Conference. I hope all of you are able to attend the conference and take advantage of the opportunity to network with your fellow Region 1 NAME members!
with any questions, ideas, or just to say “hi!”
We wish you all an enjoyable summer!
Your Representatives on the NAME Board of Directors,
Sheila Costa (NY) Tabitha L. Taylor (VA) Charles Tyler, Jr. (MD) Education Medicaid Local Education Agency
Sheila Costa (NY), Region 1 Education Representative
This is the first opportunity I’ve had since the conference to thank Region 1 members for attending the 2013 NAME Conference and for participating in our Town Hall meetings. Members shared information on topics of interest and provided conference feedback and suggestions for future conferences. If you weren’t able to attend the conference and/or the Town Hall meetings, we’d love for you to join us in Niagara Falls, New York in September 2014! Keep watching the Annual Conference Home Page for more Conference information
so we can share with other states.
Virginia Regional Medicaid Coordinators’ Meetings - Mary Hall and Ashley Harrell (VA)
Last year the Medicaid Specialist for the State of Virginia started hosting quarterly Medicaid Coordinators’ meetings in collaboration with the state Medicaid agency. The meetings are held at a location that is central for the state. Presenters have covered a large array of topics ranging from the new state Web portal for online billing, cost settlement-lessons learned, provider qualifications review, and random moment time study updates.
There is always time for question and answer sessions. The format allows for an open forum among the coordinators to share ideas and lessons learned. Several significant changes to our program have resulted from these meetings including clarification of our record retention policies and documentation for personal care services. It has proven to be an excellent venue for the exchange of ideas and information in an informal setting.
Speech/Language Therapy Via Telepractice is Now Reimbursable in Virginia - Ashley Harrell (VA)
Virginia Department of Medical Assistance Services (DMAS) staff announced at the first Mid-Atlantic Telehealth Resource Center Summit in March 2012 that school based speech/language (S/L) therapy services administered via telepractice are now reimbursable through Medicaid for school district Medicaid providers. “Telepractice” as used here is the delivery by a DMAS approved speech language pathologist (SLP) of S/L therapy services through the use of videoconferencing to a child at a remotelocation. Telepractice was added in Virginia effective September 1, 2011, to help school districts lacking DMAS approved SLPs increase children’s access to services. DMAS reimburses school based services directly to the districts and considers telepractice as another means for delivering S/L therapy services.
In 2003, DMAS began covering statewide telemedicine for select services delivered by physicians, nurse practitioners, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers, and licensed professional counselors.
From Region IV (AL, FL, GA, KY, MS, NC, SC, TN) Representative Nora Poisella (NC)
Georgia: Terri Portis, Department of Community Health - Georgia's Administrative Claiming for Education Program was authorized by CMS on April 1, 2011, and the State is currently seeking approval for Cost Settlement with the fee-for-service program.
Tennessee: Holly Christopher, Stellar Therapy Services, -- This past school year was the first year our company assisted in obtaining TennCare-Medicaid reimbursements for Special Ed services. We are working hard to build relationships with the Managed Care Organizations and are still awaiting payment from one. We have met with the State Special Education Deputy Commissioner and believe that office is now "on board". Since the Medicaid reimbursement process is not defined statewide, implementation is difficult for schools.