Medicaid Document Compliance Requirements

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AGENDA

• Timeline• Process Overview• Persons Responsible• Parent Medicaid Consent Forms• Creating Letter of Medical Necessity Forms• Q/A• RECAP

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Timeline

• Documents generated and signed should follow to the BOE within 24 hours of creation.

• This timeline is required to maintain the accuracy of claiming and compliance.

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Parent Medicaid ConsentThe Starting Point…

Parent Medicaid Consent form given to parent, explained

Yes

No

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The Process Parent Medicaid Consent Form = Yes

Initial Meeting or New to DistrictOT, PT, Speech

Parent Medicaid Consent form- give

form to parent, explain.

YesLetter of Medical

Necessity for a New File

Consent obtained once per child, not annually.

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The Process Parent Medicaid Consent Form = Yes

Annual ReviewOT, PT, Speech

Parent Medicaid Consent form

previously givenYes

Letter of Medical Necessity for an Annual Review

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The Process Parent Medicaid Consent Form = Yes

AddendumOT, PT, Speech

Parent Medicaid Consent form

previously givenYes

Letter of Medical Necessity for an

Addendum

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The Process - No

Parent Medicaid Consent form No

Send original to Robbi Moody at

the BOE

Keep copy in file material

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Persons Responsible

• Speech Pathologists will originate and obtain the Parent Medicaid Consent (PMC) and originate the Letter of Medical Necessity (LMN) for all students with Speech Therapy. – Speech Only– Speech with OT– Speech with PT– Speech with OT and PT

• OT and PT only files will be obtained/originated by the OT if both OT and PT exist- and by the PT if only PT exists.

-OT and PT will be obtained/originated by OT-PT only will be obtained/originated by PT

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PARENT MEDICAID CONSENT

(PMC)

Creating and obtaining the Parent Medicaid Consent form

• Go to Infinite Campus• Go to student file in IC• Go to the “Index>Student Information>Special Education>General-

documents tab • Create “new” document > new simple form > Parent Medicaid Consent – fill

out IEP date, save, print• Explain form to parent• When the parent/guardian signs and returns the form, check for signatures,

dates, completed doctor information. If incomplete, contact parent to get updated information

• Scan and attach completed form to the student file in IC• Return original signature form immediately (24 hours) to Robbi Moody at

the BOE via interoffice mail• See Parent FAQ’s

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More info…Parent Consent

• Obtain parent consent using the form within IC ***Do not use old printed forms

• The Parent Medicaid Consent (PMC) must be created within IC, docs tab, student file…

• Make a copy for your own file • Scanning, copying, sending are all a part of the compliance

process• A PMC is only required on: 1) new files, 2)students new to the

district or 3)as directed by District Office personnel• Correct explanation of the purpose of the PMC to the parent is

required, seek out information if you are unaware of specifics (see Robbi Moody for training)

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Explaining The

Parent Medicaid Consent Form

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Purpose

1) Obtain consent from parent / guardian to exchange data about their child to the Department of Community Health (DCH/Medicaid), if requested

2) Request reimbursement for services already delivered to child for OT, PT, Speech

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The purpose statement in the form…

The School System is providing health-related services to your child in accordance with his/her Individual Education Program (IEP) at no cost to you, the parent/guardian. Medicaid is required to help the School System cover the cost of some services provided to your child. The School System is required to share information in your child’s IEP with the Department of Community Health (DCH) and your child’s primary care physician or another physician who has had a face to face visit with your child prior to billing Medicaid for its share of the costs of the services.

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Parent Choices

• The choices are ‘yes’ or ‘no’. • Neither choice will impact service delivery as

reimbursements are claimed on services already rendered

• No future impact on service delivery if ‘no’• Signature and date are required and signify

the choices made

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The choice statement in the form….

I understand that denial of my consent will not affect delivery of services under my child’s IEP. I further understand that the school district may receive partial reimbursement from Federal Medicaid funds for these services and that this reimbursement will not affect my child’s Medicaid insurance benefits.

YES I give my consent for the Paulding County School District to bill Medicaid/Peach Care and for the School System to share information in my child’s IEP with DCH with my child’s primary care physician or another physician who has seen my child face to face.

NO I do not give my consent for the Paulding County School District to bill Medicaid/Peach Care and for the School System to share information in my child’s IEP with DCH with my child’s primary care physician or another physician who has seen my child face to face.

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Signature statements in the form…

• Parent/Guardian Name (PLEASE PRINT)

• Parent/Guardian Signature: Date

• It is my responsibility as a parent/guardian to notify the Special Education Department in writing if I ever decide to withdraw my permission. I understand that if I do not give permission or if I withdraw by permission, the School System will continue to provide IEP related services to my child at no cost to me.

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Primary Care PractitionerDoctor Information

• Primary Care Practitioner (PCP) information is required

• Some persons do not yet have a doctor, this information can be updated later through phone, email or direct contact

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If you give permission, please provide the information below.

DR. NAME student’s physician):

DR. PHONE NUMBER:

DR. ADDRESS: CITY/ZIP:

If you have any questions, please call: 770-443-8030

Primary Care PractitionerDoctor Information in the form….

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When parent has chosen ‘yes’ in the Parent Medicaid Consent form, go forward with processing of a Letter of Medical Necessity. If the parent marked ‘no’, then no Letter of Medical Necessity is required.

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Letter of Medical Necessity

(LMN)

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Letter of Medical NecessityAnnual Review

• Speech Pathologists will create the Letter of Medical Necessity for any/all OT, PT, Speech services following the annual review IEP meeting or immediately following an addendum in which services for OT, PT or Speech changed.

• Go to student file within IC>Index>Special Ed>General-Documents tab>Create new form>Create New Simple Form>Letter of Medical Necessity. Create, save, print.

• Check the services that apply, sign and send the form to Robbi Moody at the BOE via interoffice mail.

Notes:• 24 hour turnaround time from creation to sending…• Supervising OT will sign all COTA served treatment plans before

the document will be complete with signatures.

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Letter of Medical Necessity Amendment

• At every annual review a Letter of Medical Necessity is required

• For amendments, a Letter of Medical Necessity (LMN) is only needed if services changed or services were added in the amendment (service related to OT, PT, Speech)

• Create in IC, save to IC, print/sign and send form to Robbi Moody

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Paulding County School District 3236 Atlanta Highway Dallas, GA 30132 770 443 8030‐ ‐ District Phone 770 443 7027‐ ‐ District Fax

Student’s Name: Date of Birth: School: Med #

Parents/Legal Guardian Name:

Dear Physician:

The Paulding County School District (PCSD) participates in the Children’s Intervention School Services program, which allows the district to seek and obtain Medicaid reimbursement for covered services provided to Medicaid‐eligible students. The above named student is currently eligible under the Individual with Disabilities Educational Act and State of Georgia Regulations to receive specialized instruction and related services as determined by the students Individual Education Program (IEP) team which includes the parent.

As the child’s primary care practitioner (or other prescribing practitioner at the request of the PCP) please sign this form as documentation of medical necessity for all services listed below.

IEP Service: Treating Provider’s Signature Date

Occupational Therapy Services

Physical Therapy Services

Speech/Language Services

**The above noted services may be provided in a group setting

Physician’s Name (Please type or print):

Address: Street Number & Name City State

Zip Code

Physician’s Signature: Date: Phone #:

Physician NPI#

The Georgia Department of Community Health (DCH) requires claims submitted to Medicaid for school‐based health services include the National Provider Identifier (NPI) of the ordering, prescribing, or referring physician. In order to comply with DCH’s requirement, the district intends to obtain your NPI from the NPI Registry and include it in Medicaid claims for services that you ordered, prescribed, or to which you referred a student. If you prefer, you may directly provide your NPI to the district on the form below. The district’s own NPI will continue to be on all claims as the Medicaid provider. If you have any questions about the requirement for your NPI to be on PCSD’s Medicaid claims as the ordering, prescribing, or referring physician, please contact Department of Community Health.

Thank you for your time in completing this form.

Upon completion please fax it to: ATTN: Robbi Moody, 770 443 7027‐ ‐ (Fax)

Save

Internal use:

PCSD Fax date:

PCSD Received date:

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PMC & LMN Recap-New ONLY for student files who have an IEP / eligibility AND the following services: OT, PT, Speech

The Provider responsibilities for new files/new eligibilities/new OT, PT, Speech services are:

1) Provide Parent Medicaid Consent to Parent/Guardian, only needed once at initial IEP or new file created upon entrance to the district (or at any other ‘directed’ time). 2) Explain the Parent Medicaid Consent to the Parent/Guardian. 3) Obtain signatures and doctor (Primary Care Practitioner) information on the Parent Medicaid Consent form.4) Return the Parent Medicaid Consent form to Robbi Moody at the BOE via interoffice mail within 24 hours of obtaining document signature. 5) Maintain copies of document in the electronic student file (scan and attach to IC), and in the provider file. 6) If the parent marked ‘yes’ then continue to next steps.7) Create the Letter of Medical Necessity, choose the applicable services (OT, PT, Speech), sign the service line in which you serve the student. In the case of COTA served, the supervising OT must also sign along with COTA. (scan and attach to IC) 8) Return documents within 24 hours to Robbi Moody at the BOE via interoffice mail.

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LMN Recap-Annual Review

For files in which you are having an annual review that contain OT, PT, Speech and the Parent Medicaid Consent form is ‘yes’: 1) Upon the annual review meeting completion, print,

create and sign the Letter of Medical Necessity. 2) Return the Letter of Medical Necessity to Robbi

Moody at the BOE via interoffice mail within 24 hours of the meeting. (Scan and attach to the file in IC)

3) Monitor all files routinely for completed paperwork (LMN)

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LMN Recap-Addendum

For files in which you are having an addendum that changes service types, times and delivery methods for OT, PT, Speech and the Parent Medicaid Consent is ‘yes’. 1) Upon the addendum meeting completion, print,

create and sign the Letter of Medical Necessity. 2) Return the Letter of Medical Necessity to Robbi

Moody at the BOE via interoffice mail within 24 hours of the meeting.

3) Monitor all files routinely for completed paperwork (LMN).

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Q/A• What are the responsibilities?

For FY15, Speech Pathologists are required to manage the Medicaid document process if the student receives any combination of services that include speech.

Examples:• SLD student receiving Speech and OT. • Speech only student.• Speech student with PT services.• SLD student with Speech, OT and PT services.

Files with OT and or OT/PT will be the responsibility of the OT/COTA for management of the Medicaid document process.

Files with PT only will be the responsibility of the PT for management of the Medicaid document process.

Once the Medicaid Parent Consent and Letter of Medical Necessity packet is received by the District, the District office will take up responsibility for getting the document to the doctor and back.

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Q/A

• I’m not responsible for anything that happened with a prior case manager nor in a prior year, correct?

As an employee of the district, it is our responsibility to make sure that procedures are followed whether we were the case manager, therapist/provider or not. <Caseload reviews>

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Q/A

• What happens if the letter of medical necessity gets lost from case manager to the BOE?

Routinely we will ask for another letter of medical necessity to be signed if it is missing. An e-mail or phone call will be placed if that happens.

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Q/A

• The parent waived the Parent Medicaid Authorization form explanation….what do I do?

The parent can waive their right to the explanation if they so choose.

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Q/A

• The parent said they are not on Medicaid. I don’t need to do anything else, correct?

Please note it is not necessary to be on public Medicaid, Peach Care, etc. in order to see if a student qualifies for school based service reimbursement. The CISS eligibility can be an ever changing process. Therefore, there is no question of whether they are currently ‘on Medicaid’ or not. It is a question of whether or not they will allow the district to: A) see if the student qualifies/is eligible and B) request reimbursements if they agreed to ‘A’.

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Q/A

• I do not feel comfortable explaining Medicaid forms to the parent. I should leave it to the Principal, Lead, District office to explain it.

No, as a Case Manager, Service Provider, Therapist and Administrative Outreach person, you should familiarize yourself with all training and materials available such that you can explain the Parent Medicaid Consent to the parent. You are the person that the parent should rely upon for information. Seek out information to help you do that such as training materials, asking questions, etc.

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Parent FAQ’s PARENTS FREQUENTLY ASKED QUESTIONS RELATED TO BILLING FOR THE MEDICAID CHILDREN’S INTERVENTION SCHOOL SERVICES PROGRAM. What is the Children’s Intervention School Services Program? The State of Georgia participates in a Federal Medicaid program called Children’s Intervention School- Services. The Georgia Children’s Intervention School Services program is under the direction of the Georgia Department of Community Health, Division of Medicaid. The school services program assists school districts by providing partial reimbursement for medically-related services that are listed on a student’s Individualized Educational Program (IEP). Although this partial reimbursement is available only for students who are Medicaid eligible, services are provided to all students with disabilities regardless of their Medicaid eligibility status. Is there a cost to me? NO –school-based health related services are provided to students with disabilities at NO cost to the parent/guardian. Your child is entitled to a free and appropriate public education under the Individuals with Disabilities Education Act (IDEA). Will it impact my family’s Medicaid benefits? No. The Children’s Intervention School Services program DOES NOT impact a family’s Medicaid services, funds, or limits. Georgia operates the Children’s Intervention School Services program differently than the Family Medicaid program. How are services outside the school affected? Your child will not be denied services, if the services are medically necessary. Your child can receive medical services in the school and privately without impacting service limitations. What type of services for children does the Children’s Intervention School Services program cover?

• Audiology Services • Counseling Services • Nursing Services • Nutrition Services • Occupational Therapy • Physical Therapy • Speech Therapy

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Parent FAQ’sWhich of my child’s services will be billed to Medicaid? Only those services that are Medicaid reimbursable and identified on the IEP will be billed to Medicaid. The school needs your consent to bill Medicaid for services. Are there limitations to the services my child can receive? No. The frequency of services is determined by the IEP team. What if my child loses Medicaid? The school system will only bill for services if a child is identified as Medicaid eligible. Losing Medicaid will not affect the services your child receives. Who decides what services are medically necessary? Your child’s Primary Care Practitioner (PCP) signs and dates the IEP, Letter of Medical Necessity or Plan of Care which serves as the prescription for the school based health related-services recommended by the IEP Team at your child’s IEP meeting. What if I have private insurance, too? Your private insurance will not be affected by Children’s Intervention School Services billing. What if I give consent and change my mind? Parent consent is voluntary and can be revoked if you change your mind. Parents are asked to give written documentation withdrawing permission to bill Medicaid for the services on the child’s IEP. What if my child is not Medicaid eligible? It is recommended to provide consent even though the family is not Medicaid eligible in case the eligibility status may change. A school district cannot bill for services if the child is not Medicaid eligible. How can I help assure my school district receives benefits from the Children’s Intervention School Services program?

Provide written consent granting your permission to provide services and bill Medicaid. Schedule an annual “wellcheck” with your child’s Primary Care Practitioner (PCP). Provide the correct contact information for your child’s Primary Care Practitioner and

authorization for release of information to your PCP.

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Practitioner FAQ’s PRACTITIONER’S FREQUENTLY ASKED QUESTIONS RELATED TO BILLING FOR THE MEDICAID CHILDREN’S INTERVENTION SCHOOL SERVICES PROGRAM. What is the Medicaid Children’s Intervention School Services (CISS) Program? The CISS Program provides school systems reimbursement for medically necessary services that are received in schools and provided by or arranged by a school system for Medicaid-eligible students with an Individualized Education Program (IEP). The CISS program is administered by the Georgia Department of Community Health, Division of Medicaid. Policies and procedures are developed within Federal and State guidelines. ----------------------------------------------------------------------------------------------------------------- Why is the school system requesting documentation of medical necessity? The child’s primary care practitioner must sign and date the IEP, Letter of Medical Necessity or Plan of Care to determine medical necessity of school health related-services recommended by the child’s IEP Team. A Prescribing Practitioner is defined as a licensed primary care practitioner (PCP)/or other prescribing practitioner at the request of the PCP who has had a face-to-face visit with the child. ----------------------------------------------------------------------------------------------------------------- How does the prescribing practitioner document medical necessity? The practitioner must review, sign and date the IEP, Letter of Medical Necessity or Plan of Care as documentation of medical necessity for the recommended services in the child’s IEP (speech, occupational or physical therapy). -------------------------------------------------------------------------------------------------------------------- What is the definition of medical necessity in the CISS Manual? Medically necessary, medical necessity or medically necessary and appropriate means medical services or equipment based upon generally accepted medical practices in light of conditions at the time of treatment which are: appropriate and consistent with the diagnosis of the treating physician. Section 605.1 -------------------------------------------------------------------------------------------------------------------- Is the CISS Program separate from the Children’s Intervention Services Program (CIS)? Eligible students may receive medically necessary services through the CISS program and the Children’s Intervention Services (CIS) program simultaneously when the services have been deemed medically necessary and not duplicative