With respect to the End of Year Cost Report that is coming due on December 31, 2015 for FY 2015, MSB recently sought clarification regarding the Medicaid eligibility statistics described in the November 2013 MassHealth School-Based Medicaid Program Instruction Guide for Massachusetts School-Based Program Annual Cost Report (effective July 2013, the “Guide”). Specifically, we sought additional clarification as to Section 3 – Statistics, Step 4, found on page 13 of the Guide which reads as follows:
“The medical records of all Medicaid or CHIP students included in this section are subject to audit. School-Based Medicaid Providers must therefore exclude from this section any Medicaid or CHIP recipients for whom they are not able to seek reimbursement and for whom they do not have proper documentation as of the date the cost report is submitted.”
MSB is currently collecting statistical information from you in order to assist with the submission of your FY 15 end of year cost report. This particular requirement is to report the number of IEP students in your district as of January 5, 2015 who have at least one Medicaid-covered medical service in their IEP which could include nursing, occupational therapy, physical therapy, speech therapy, and emotional/behavioral/psychological counseling.
The clarification we sought was with respect to whether or not the district had to submit an actual interim claim during the period for the student in order to include them in the number of students described above. The answer we received was “no”, but that the district would have to retain documentation for the service(s) delivered to the student in order to include them in the statistics. The Guide also indicates that in order to report a student in this number, the district must have parental consent in order to either claim services for Medicaid reimbursement and/or to include the student in the Medicaid eligibility statistics.
To summarize, the following are required in order to report a student in the Medicaid eligibility statistics for the number of students who have Medicaid covered, medical services in their IEPs:
- Student must have at least one Medicaid-covered medical service in his/her IEP as of January 5th of the reporting year (i.e. 2015);
- District must have parental consent in order to claim Medicaid reimbursement (if applicable) and/or include the student in the statistics;
- District must retain documentation of the delivery of the IEP-ordered, Medicaid covered medical service(s) whether or not the services were claimed for Medicaid reimbursement; and
- Student should be included in this number/statistic regardless of whether or not they qualify or are covered by MassHealth/Medicaid