Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Michigan, Minnesota, Missouri, Ohio, Mississippi, Oklahoma, Texas, Puerto Rico, US Virgin Islands, Wisconsin
Region 2 – State Education Agency Representative
(term ends 2018)
Florida Department of Education
Region 2 – State Medicaid Agency Representative
(term ends 2019)
Steve Ireland (MI)
Department of Health and Human Services
Region 2 – Local Education Agency Representative
(term ends 2018)
Kathleen Cummins Merry (MI)
As part of the Health Students, Promising Futures Collaborative Ohio is working to expand access to health services by bringing needed services to schools. In some areas of Ohio, parents may need to drive an hour and a half to get their children to see a medical specialist or to get medical care for their children, says Lesley Scott-Charlton, a Medicaid health systems administrator at the Ohio Department of Medicaid. “We so often think of food deserts, but we don’t think of medical deserts,” she says. Unfortunately many students across the country, including in Ohio, don’t have easy access to health services. The full article on this project can be found at: https://healthyschoolscampaign.org/health/bringing-healthcare-to-schools-in-ohio/
All NAME Regions have full concern over the possible repeal and replacement of the Affordable Care Act. Many of us have been actively working with the press and our colleagues to tell the story of how School-Based Services supports our local districts along with the physical and mental health needs of our children in schools. Interestingly, two Region 2 states, Texas being number one and Michigan number six, are in the top ten states for receiving Medicaid school funding in the nation.
Now that the U.S. Senate was unable to get the votes to repeal this Act, what’s next? The Senate will continue to try to come up with a compromise that will appeal to both sides of the aisle. As you know, NAME is working to protect Medicaid coverage for the student population, but that isn’t the only component of this repeal. The bill is not dead it’s in a coma, waiting to be revived, if we want to use an unfortunate analogy. Stay tuned...
The Indiana Division of School and Community Nutrition Programs has received permission from USDA to pilot the use of Medicaid Data for the purposes of Direct Certification. While Medicaid has been used for Direct Verification purposes for a decade, this will be the first time that Medicaid eligibility will be used for Direct Certification and the initial eligibility determination for Free and in some cases Reduced-Price Meals. To implement these changes, some small changes need to be made and implemented by Software Vendors who supply services to Indiana School Districts operating the National School Lunch or School Breakfast Programs.
The USDOE press release dated October 7, 2016 stated USDOE’s Office of Safety and Healthy Students has awarded $480,000 to Flint Community Schools in Flint, MI. According to the press release the grant will be “used to restore the learning environment following the water crisis that began in 2014.” Further information on the award other federal efforts to assist Flint can be found at:
Genesee Intermediate School District is also part of another exciting project currently under development. This new project is a combined effort with non-profit Flint Kids Learn, Charles Stewart Mott Foundation, Community Foundation of Greater Flint, University of Michigan-Flint (UM-Flint), Flint Schools and Genesee Intermediate School District. These organizations and foundations have continued to be a part of developing projects to assist Flint children, which has made a tremendous impact in the Flint community.
The project is a new school located in Flint expected to open in the Fall of 2017. The school will be servicing Flint student’s ages 8 weeks to 3 years old. It will also include an adult education learning space, a need identified by community organizations. Genesee Intermediate School District will provide educational programming and services to an expected 200+ children. UM-Flint will collect data and conduct research needed by policy makers.
Genesee Intermediate School District is excited to be a part of such a valuable project which will provide the much needed programs, services and many other supports to the Flint residents. The full article regarding this project can be found at:
The 2016 Florida Legislature appropriated funding to be used for the state match for Medicaid-reimbursable services provided by private and charter schools. The state Medicaid agency is submitting a Medicaid state plan amendment to add the private and charter school providers.
We are pleased so share with you, news from our Region that was submitted by our members. We look forward to hearing from you with your thoughts and feedback.
Region 2 Policies and Procedures Committee Members
Did you know? Two of your fellow Region 2 NAME members— Anne Glass (FL) and Kathy Merry (MI)—serve on the NAME Policies and Procedures Committee (P&P). The P & P Committee is in the process of organizing all of NAME policies and procedures that are relevant to our members. The Committee hopes that knowledge is power, and sharing such information will keep you interested and quench your curiosity about the internal workings of NAME. Once completed, the Committee will post those relevant policies and procedures on the NAME website.
Healthy Schools Campaign: Headquartered in Illinois
The Healthy Schools Campaign is a key member of a coalition of like-minded organizations working to “…ensure that all children have access to healthy schools where they can learn and thrive…”. With headquarters in Chicago, Illinois, the Campaign was one of those organizations that worked to persuade the Centers for Medicare and Medicaid Services to “revise” their “free care policy” (see link below). The Healthy Schools Campaign continues to provide guidance as the new ‘free care’ policy initiative is implemented around the country. To learn more about the Healthy Schools Campaign, visit their website: https://healthyschoolscampaign.org/programs/national/national-collaborative/.
The free care policy fact sheet developed by the Healthy Schools Campaign can be found here:
Indiana is exploring the possibility of adding Medicaid coverage for telehealth services provided in the school setting.
Beginning August 1, 2016, all speech, audiology, occupational therapy, and physical therapy services reimbursed by the Ohio Medicaid in the Schools Program (MSP) will require an order, referral, or prescription to establish medical necessity. Previously, the Individual Education Plan (IEP) served as the prescribing document for services delivered to students and reimbursed to Ohio schools.
The change has come about after discussions between the Centers for Medicare and Medicaid Services (CMS), and the Ohio Medicaid agency on the state’s use of the IEP. The CMS indicated their decision was due in part to requirements of the Affordable Care Act (ACA). While Ohio school therapists meet the federal Medicaid regulations as “licensed practitioners of the healing arts”, current Ohio laws do not authorize therapists the ability to diagnose, which falls short of meeting Medicaid’s requirement for medical necessity.
So beginning in the 2016-17 school year, schools will be required to obtain
an order, referral, or prescription from a medical practitioner whose scope of practice covers diagnosing those previously-mentioned services. This will affect approximately 60,000 children and students in order for Medicaid reimbursement for their therapies to continue.
Both educational and medical stakeholders are working together to design a process for obtaining referrals, prescriptions or orders, that does not disrupt the existent IEP processes for all children and students in special education that also meets the new Medicaid requirements. One approach is to use another state’s practices, so both the Ohio Department of Medicaid and the Department of Education are reviewing other states’ School Based Services policies.
The high lead level water crisis in Flint, Michigan has a direct impact on Flint schools and school aged children and their families. The astronomical amount of local and national coverage of this story makes it impossible for us to summarize it, so we are providing you some links to some news articles and resources that have been developed as a result of this tragedy:
Region 2 Representatives on the NAME Board of Directors,
Anne Glass (FL)
Mark Smith (OH)
at-Large Education Agency
Other article contributors: Tracy Brunner (IN) NAME President, Jennifer Haase (MI) NAME Treasurer, and Jane Reagan (MI) NAME Past President
Did you know NAME has a list of all members on the website? You may also find a listing of many state Medicaid school based services (SBS) program websites. We have begun to update the Region 2 states SBS resource links on the NAME website. You never know when you may want to contact a neighbor to see how they interpret/train/update/communicate with their state's stakeholders. We want to make your networking as easy as possible.
The list of Region 2 contacts can be found by logging into the NAME Members only section > click on Regional News and Information: www.medicaidforeducation.org/members/regional-news-and-information
NAME's webpage of State Medicaid and Education Resources can be found by logging into the NAME Members only section > click on View Links and Online Resources > State Medicaid and Education Resources: www.medicaidforeducation.org/members/publications-and-online-resources
If you find that we've listed any information incorrectly, please let us know and we will correct it. If you have information for a state where no website is listed, please share that information with us. And, as usual, don't hesitate to contact any NAME member when you need a helping hand. We are here to serve and collaborate.
For those of us who have been shivering a lot this cold winter, remember: Spring is coming!
Region 2 Representatives on the NAME Board of Directors,
Jim Donoghue (IA)
by Kathy Merry (MI) Tracy Brunner (IN) and Jim Donoghue (IA)
NAME’s Region 2 consists of these states: Alabama; Arkansas; Florida; Georgia; Illinois; Indiana; Iowa; Louisiana; Michigan; Minnesota; Mississippi; Missouri; Ohio; Oklahoma; Puerto Rico; Texas; US Virgin Islands; and Wisconsin.
One of the most important projects NAME does is conduct the biennial national survey of the states—in which the individuals in each state’s Medicaid and Education agencies who work in the Medicaid school based services program, are asked to complete a survey collecting data about their program. NAME has learned over the years that the turnover in these positions is somewhat frequent, so it is not always easy to find the right individuals to participate in the survey.
Members of the NAME Leadership Team are charged to assist the Survey SubCommittee locate the appropriate people. In Region 2 we are pleased we made contact in early 2014 with many new colleagues from states in the Region, listed below. All of them committed to work on completing the 2013 survey which closes on April 15, 2014 (see other article elsewhere in this issue). For those new to NAME’s survey, we welcome your expertise and insights. For the veteran members, thank you for your continued participation.
In September 2013, Michigan’s Department of Community Health, where the State Medicaid Agency is located, was informed that Michigan had been selected for a federal Office of the Inspector General (OIG) audit of the School Based Services (SBS) Program. This will be the first review of the program since Michigan converted from a true fee-for-service reimbursement methodology to a new cost-based reimbursement plan effective July 2008.
Jim Donoghue (IA)
The program here recognizes a broad range of IEP-ordered services, audiology, behavioral health paraprofessional, medical transportation, nursing, nutrition, occupational and physical therapies, personal health paraprofessional, school psychology, school social work, speech/language services, vision/orientation/mobility services and primary and preventive care services at school-based health centers. During the 2011-12 school year, Iowa began transition to 5010 registration and testing (Iowa LEAs can choose to self-bill through free software or use a vendor), and also increased its monitoring of the DHHS/OIG/DHHS Exclusions Database while weathering the first wave of Exclusions findings (so far, the state has found only two issues where an excluded individual provided billed services). Program Integrity audits by the Single State Medicaid Agency have resulted in reports of very limited instances of unsupported documentation and need for recoupment.
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.
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