Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming
Region 3 – State Education Agency Representative
(term ends 2020)
Ely Sanders (OR)
Oregon Department of Education
Region 3 – State Medicaid Agency Representative
(term ends 2018)
Christie Guinn (NM)
New Mexico Human Services Department
Region 3 – Local Education Agency Representative
(term ends 2020)
Margie Bobe (CA)
Los Angeles Unified School District
Welcome Ely Sanders!
The NAME Board of Directors is pleased to welcome Ely Sanders as the Region 3 State Education Agency Representative. Ely is the School Medicaid Program Specialist for the Oregon Department of Education. He has over 20 years of experience in the areas of education, school health, and sexual health. For the last 3 years, Mr. Sanders has overseen school health services and comprehensive sexuality education for the Oregon Department of Education. His current position focuses on the implementation of SB 111 (2017), which established a Medicaid billing pilot project to leverage Federal Medicaid dollars to increase funding for school health services in Oregon’s schools. Mr. Sanders is a graduate of Portland State University’s Hatfield School of Government’s Executive Master of Public Administration program. Ely grew up in Portland where he lives with his wife and children and enjoys wood working, sailing, and everything outdoors. We are glad to have you join the NAME Leadership Team, Ely!
California’s Ongoing Work on State Plan Amendment
The state of California is continuing to work toward approval and implementation of a State Plan Amendment (SPA) for new services, providers and to lift the limitation cap of 20 reimbursable non-IEP services. Pending approval, the planned implementation date is July 1, 2019. To prepare for the SPA approval, the CA Department of Health Care Services (DHCS) is proactively working with Local Education Agency (LEA) stakeholders across the state on the implementation of the Random Moment Time Study (RMTS) plan and training guides.
On April 26, 2017 the Region 3 Representatives hosted the NAME National Conference Call “How to Meet Compliance from One State’s Perspective”. The representatives chose the topic of program compliance as a result of the feedback that was given in the Region 3 Town Hall Meetings held during the 2016 Conference in Bozeman, MT.
The goal was for participants to learn first-hand about one state’s experience in working to meet compliance billing for school-based Medicaid services. Christie Guinn, NM School Health Manager and Region 3 State Medicaid Agency Representative, discussed the process that has been used in New Mexico for several years, including tools and strategies that other states and LEAs can utilize in their own programs to ensure compliant Medicaid billing.
The presentation and handouts are posted in the “Members Only” section of the website under the NAME National Conference Calls section: www.medicaidforeducation.org/members/name-national-conference-calls. We hope to have an audio recording of the call posted soon as well.
By Region 3 Representatives and contributing authors: Shanna Muirhead (WA), Program Manager, School-Based Health Care Services, Washington State Health Care Authority and Cathy Bennett, Medi-Cal Program Specialist, Sacramento City Unified School District
The School Based Health Care Services Program in Washington State recently started allowing school based providers to electronically sign daily treatment notes and service logs for direct health care services provided to children with IEPs and IFSPs. Since authenticating treatment notes with a handwritten signature can be very time consuming, the use of electronic records and electronic signatures can significantly reduce costs as well as simplify and speed up work processes. It is expected that acceptance of electronic signatures will relieve some of the administrative burden that can come with Medicaid billing. The State law authorizing Washington State agencies to utilize electronic signatures is codified in Chapter 19.360 RCW.
The New Mexico Human Services Department’s Medical Assistance Division is in the final stages of negotiating a State Plan Amendment (SPA) with the Centers for Medicare and Medicaid Services (CMS). This SPA will transition the Medicaid School-Based Services (MSBS) direct service payments from the standard fee-for-service model to one that involves cost reporting and settlement for services. This change will start with services provided on or after July 1, 2015. The department’s School Health Office, which administers the MSBS, has been working with Fairbanks, LLC to implement the cost report. The state and Fairbanks have been co-administering the state’s current random moment time study (RMTS) and administrative claiming programs since 2011. In 2013, as the state prepared to re-procure the contract for the RMTS and administrative claiming, it was decided to add direct services cost reporting and settlement. According to School Health Manager Christie Guinn, “The agency felt comfortable with the current RMTS process and decided that making the transition to cost settlement was something we were ready to do. We anticipate this being a very positive change for our schools and are anxious to get final approval from CMS and begin the final stages of implementation.”
On September 30, 2015 California’s Department of Health Care Services (DHCS) submitted to the Centers for Medicare and Medicaid Services (CMS) and State Plan Amendment (SPA). This SPA will include new assessment and treatment services, new practitioner types, and a Random Moment Time Survey (RMTS) methodology to the LEA Medi-Cal Billing Option Program. In addition, DHCS is implementing the guidelines in accordance with the letter to the State Medicaid Director (SMD-14-006) dated December 15, 2014.
More information regarding the CA SPA and copies of CMS and DHCS communications to Request Additional Information (RAI) can be found by clicking here.
In April 2015 the NAME Region 3 Representatives to the Board of Directors had the opportunity to host a NAME Member National Conference Call. We started planning for this event by summarizing the topics that generated the most interest at the Region 3 Town Hall meetings at the NAME Annual Conference in Niagara Falls in September 2014. We then narrowed it down to three possible topics for the focus of the National Call and asked the Region 3 members to vote for the topic they wanted covered.
Based on member feedback, we conducted a National Conference Call on “Cost Based Rate Methodologies and Random Moment Time Study (RMTS)” on April 23, 2015. In spite of some minor technical difficulties, the feedback on the content of the presentation was overwhelmingly positive.
We want to thank all of the members of Region 3 who provided questions in advance, which helped to focus the content of the presentation. And thank you to all NAME members who participated on the Call and posed more questions to our presenters.
If you were unable to participate in the call, the PowerPoint presentation and the audio recording of the webinar are posted on the NAME website, in the “Members Only” section > NAME National Conference Calls.
If there are questions or future topic ideas you want to hear about, please email us anytime.
Stacie Martin (KS)
Region 3 - State Education Agency Representative
Melinda Hollinshead (AZ)
Region 3 - State Medicaid Agency Representative
Jeremy Ford (CA)
Region 3 - Local Education Agency Representative
Shannon Huska (CO)
At- Large - State Medicaid Agency Representative
Melinda Hollinshead (AZ), Cathy Bennett (CA), Stacie Martin (KS)
Please do not hesitate to contact us if there are issues you would like to discuss or inform others—just let us know!
We are also following up on a recent commitment made by all NAME Board of Directors Representatives, to work harder to recruit new members to join NAME. We encourage you to help us in this effort. If you have a colleague who is not yet a member and works in our field, when you have the opportunity, explain the benefits of membership and encourage them to join NAME which is a great value for only $50 annual dues.
Washington State’s School-Based Health Care Services (SBHS) program could soon be experiencing a positive expansion. The Individuals with Disabilities Education Act (IDEA) Part C services, known as early intervention (birth to age three), is soon to be added to the SBHS program in Washington State. SBHS currently reimburses participating school districts for health-care-related service, but only for children and students ages 3 to 21 under IDEA Part B. The Department of Early Learning (DEL) and Washington’s Health Care Authority (HCA-Medicaid agency) have determined approximately 300 children statewide currently receive Part C services in the school setting but the school districts are not being reimbursed for these services.
Reimbursement for Part C services under the SBHS program would allow schools to draw down additional state and federal monies. Once a Medicaid state plan amendment (SPA) has been submitted and approved by the federal Centers for Medicare and Medicaid Services (CMS), participating school districts will be allowed to retroactively submit claims, effective April 1, 2014. The current plan is that the Washington state Medicaid agency will submit a SPA to CMS by the end of June 2014.
Medicaid reimbursement to schools for Part C services not only requires a Medicaid state plan amendment (SPA), but also revisions to the Washington Administrative Code (WAC), updates to the SBHS Medicaid Provider Guide, and ongoing training for school districts will need to occur. The Washington state Medicaid agency anticipates this preparation process will take approximately one year with no budget impact.
Washington State Charter Schools to Receive Medicaid SBHS Reimbursement
The positive growth at HCA does not stop there with both SBHS and Medicaid Administrative Claiming (MAC) programs. In June 2014, the State’s first charter school (First Place Scholars) prepares to open their doors to any student living in Washington State. First Place Scholars, a social-services agency in Seattle’s Central Area, provides a variety of supports for children who are homeless and those with disabilities. First Place Scholars will become a publicly funded K-5 charter school starting in the Fall 2014, and intends to participate in the Medicaid MAC and SBHS programs.
Charter schools across Washington State that elect to become enrolled as a Medicaid provider and comply with the licensure and billing requirements of a local education agency, will be allowed to contract with HCA for reimbursement of direct health-care-related services for Medicaid eligible children in Special Education and MAC. In Washington State, charter schools are free, privately operated schools that are not bound by many of the rules and regulations that govern traditional public school districts. Under Initiative 1240 approved by the voters in November 2012, they are considered public schools because they receive taxpayer dollars on a per-student basis, like other public school districts in Washington State. Washington State will be the 42nd state to allow public charter schools.
Cathy Bennett (CA)
The result from a recent CMS audit has determined that California’s School-Based Medi-Cal Administrative Activities (SMAA) claims do not comply with the claiming plan for school-based services approved by CMS in 2003. CMS is deferring California’s SMAA claims until adequate documentation can be provided. To read the deferral notice click here. CMS is requesting additional documentation including LEA’s to provide certification of activities performed to support submitted invoices. In addition, The California Department of Health Care Services (DHCS) must submit a revised time study methodology and statewide claiming plan for use beginning July 1, 2012. DHCS is working with CMS and stakeholders to resolve these issues as quickly as possible. (Exceptions to this deferral include LAUSD which utilizes the recently approved RMTS, and Santa Barbara County Education Office-Special Education)
As a result of Washington’s budgetary constraints, the School-Based Healthcare Services (SBS) program was eliminated effective December 31, 2010. During the 2011 legislative session and budget making process, funds were allocated to reinstate the program effective July 1, 2011. Prior to program elimination, the SBS program was funded by state matching dollars put up by the Health Care Authority (HCA), the state Medicaid agency, and federal financial participation (FFP). Upon reinstatement, our state legislature changed the funding mechanism to require 60% of the match dollars to come from school districts while 40% would come from the HCA to pull down the FFP. The funding mechanism required that, for the first time, we contract with each school district individually. The reinstatement of the program also required our agency to submit a state plan amendment to the Centers for Medicare and Medicaid Services (CMS), which was completed on September 28, 2011, and approved on December 16, 2011.
Representative Jim Donoghue (IA)
Greetings from Region VII! Of our four states, Iowa is in the news! We are happy to report that LEA reimbursement increased each of the last two years in Iowa. Regional audits conducted from 2010 to 2011 by the Iowa Medicaid Program Integrity Unit are in process and results are pending. The Iowa Department of Education in cooperation with the Iowa Department of Public Health is rolling out a 2010-2011 training initiative for school nurses to become Qualified Entities able to determine Medicaid Presumptive Eligibility. This collaboration was recently highlighted in the U.S. Department of Health and Human Services (DHHS) 2010 Children's Health Insurance Program Reauthorized (CHIPRA) Annual Report: Connecting Kids to Coverage.