Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Michigan, Minnesota, Missouri, Ohio, Mississippi, Oklahoma, Texas, Puerto Rico, US Virgin Islands, Wisconsin
The 2020 Florida Legislature passed House Bill 81, Health Care for Children, and Governor DeSantis signed the bill on June 23, 2020. This legislation amends section 409.9071, Florida Statutes, revising provisions for the reimbursement of school-based services by the Agency for Health Care Administration (AHCA). This bill has an effective date of July 1, 2020 and can be viewed at http://laws.flrules.org/2020/79. The bill deletes the requirement specifying the use of certified state and local funds for Medicaid reimbursable school-based services. Currently, these funds may only be used as certified match for services provided through an individual educational plan (IEP) or individual family support plan (IFSP). By removing this requirement, the amended statute will allow for AHCA to reimburse school districts for certain Medicaid-reimbursable school-based services, defined by AHCA, provided to all students who are Medicaid eligible, not just services provided through an IEP or IFSP. The scope of reimbursable services is under AHCA’s purview and will be defined in AHCA rule.
Region 2 – State Education Agency Representative
(term ends 2021)
Nanci English (FL)
Florida Department of Education
Phone: (850) 245-7838
Region 2 – State Medicaid Agency Representative
(term ends 2022)
Steve Ireland (MI)
Department of Health and Human Services
Region 2 – Local Education Agency Representative
(term ends 2021)
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.
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)
Representative Mark Smith (OH)
Indiana: During May, Department of Education officials John Hill and Tracy Brunner conducted three daylong trainings throughout various regions of Indiana on Medicaid in education programs. John and Tracy worked in cooperation with representatives from the state's Medicaid agency claims contractor and the Education agency's IEP and MAC coordination areas. Additionally, CMS Region V's Lead Funding Specialist provided an overview of federal auditing at each session.
Wisconsin: Carlynn Higbie, a Wisconsin-based school therapy consultant with MJ Care, is collaborating with Medicaid in education officials both within and beyond the Region V area to begin discussing the topic of medical progress reporting and goal writing. While states vary in how they interpret these requirements, she hopes the discussion will help add perspective and clarify the benefits for both IDEA requirements as well as Medicaid's requirements for medical necessity of services delivered in schools.
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.
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.
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.