HBS Topics of the Week

NAME is the National Alliance for Medicaid in Education, and was formed in 2003 to “Advocate Program Integrity for School Based Medicaid Reimbursement”. Members consist of National School Districts, State Medicaid and Education Agencies, Consulting Firms, and School Associations. HBS has been a member of NAME since 2004.

Mark Smith, our ODE Medicaid School Program lead, was last year’s NAME president, so Ohio has the pleasure of hosting the NAME 2015 Conference. This year’s conference is being held in Baltimore, Maryland on Sunday, October 4th – Wednesday, October 7th. We intentionally scheduled the conference in the DC area in hopes of getting more participation from our Federal Partners, which has worked out well, as we have the majority of our conference presentations being given by Federal Agencies and National Therapy Associations. We dodged a government shutdown, which would have affected the majority of our planned sessions, and now we are crossing our fingers that the hurricane tracks away from Baltimore.
We have a very exciting array of speakers and topics in this year’s conference, and I will update everyone upon my return. Here is a brief overview of the scheduled presenters and topics.

Free Care/504 Plans, Time Study Compliance, Third Party Insurance Liability, ICD-10
Centers for Medicare and Medicaid Services
US Department of Education

The “Free Care” issue could allow for Medicaid reimbursement for 504 Plans. Time Study Compliance is important as CMS has started questioning some state’s practices. The Third Party Liability issue could allow for Medicaid reimbursement for students that also have third party insurance coverage. The ICD-10 requirement just took effect 10/01/2015.

Practitioner Panel Discussion
National Association of State School Nurse Consultants
American Speech-Language Hearing Association
Center for School Mental Health
American PT Association
American OT Association
National Association of School Nurses

It is always good to hear the concerns from the therapy associations. Having their support is critical for a successful Medicaid program.

Medicaid Audits
US Department of Health and Human Services, Office of the Inspector General

Ohio needs to get ready for more audits. Our program is starting its sixth year, and with planned expansion, more extensive audits will be coming soon.

EPSDT
Centers for Medicare and Medicaid Services

Early Periodic Screening Diagnostic Treatment provides comprehensive and preventative health services that are effective and are more cost effective.

Strategic Partner Fireside Chat
Council for Administrators of Special Education
National Association of Medicaid Directors
American Association of School Administrators
School Based Health Alliance
Healthy Schools Campaign

This will be an interesting discussion on school Medicaid services from a national perspective.

Medicaid Documentation and Cost Allocation
Centers for Medicare and Medicaid Services

This discussion will be related to Medicaid Cost Reporting and Audits. I am excited to hear directly from CMS on their expectations regarding documentation and cost allocation.

The Ohio Collaboration
Ohio Department of Education
Ohio Department of Medicaid
Healthcare Billing Services, Inc.
Healthcare Process Consulting
Rea and Associates CPA Firm
University of Massachusetts
Cleveland Metropolitan School District

I am proud to be part of this panel that will discuss the Ohio Medicaid School Program and our collaboration with the various program stakeholders.

Connecting Kids to Coverage
Centers for Medicare and Medicaid Services

We are hopeful that CMS will have some good ideas on how to make certain that all eligible children have Medicaid coverage and are receiving their needed services.

It’s a full agenda and for those of us who eat, breathe, and sleep Medicaid, it’s like a “Medicaid Geek’s Dream Vacation”. I look forward to updating everyone next week on a great conference.

The majority of Ohio Medicaid Reimbursement is generated through Speech, OT, PT, and Psychology services. Nursing costs are reimbursable, but only for those nurses serving students with IEP’s and physician prescriptions. Most districts do not offer clinical Counseling or Social Work services, and very few IEP students qualify for Targeted Case Management services. Transportation services became Medicaid billable starting with the 2015/16 school year.

Three new services may be added to the program in the near future, but will require specific rules to be developed by the Ohio Department of Medicaid (ODM), approval by The Centers for Medicaid and Medicare Services (CMS), and implementation by the Ohio Department of Education (ODE). All this will take time, and the soonest we should expect any MSP expansion would be next school year (2016/17), or more realistically the 2017/18 school year.

Current Reimbursable Services

Speech-Language Pathology Services

• Licensed Speech-Language Pathologist
• Licensed Speech-Language Pathology Aide
• Conditional Licensed Speech-Language Pathologist

Audiology Services

• Licensed Audiologist
• Licensed Audiology Aide

Occupational Therapy Services

• Licensed Occupational Therapist
• Licensed Occupational Therapy Assistant

Physical Therapy Services

• Licensed Physical Therapist
• Licensed Physical Therapy Assistant

Nursing Services

• Licensed Registered Nurse
• Licensed Practical Nurse

Mental Health Services

• Licensed Psychologist
• Licensed School Psychologist
• Licensed Clinical Counselor
• Licensed Counselor
• Licensed Independent Social Worker
• Licensed Social Worker

Targeted Case Management
Individuals eligible for Medicaid coverage in Ohio for TCM services must be determined to have Mental Retardation or a Developmental Disability. Ohio is unique, in that the majority of students that qualify for TCM are being served in a DD Board, and the County DD Board bills the TCM directly to Medicaid themselves, and therefore does not bill school districts for the service. There are very few, if any, Ohio school districts that provide Medicaid reimbursable Targeted Case Management services. With so few eligible providers, the RMTS hits would overwhelm the therapists, and generate very little in Medicaid reimbursement. We do not recommend that school districts seek Medicaid Reimbursement for Targeted Case Management services in the current Ohio Medicaid School Program.

Specialized Transportation
Specialized Transportation became MSP billable beginning with the 2015/16 school year, and is Medicaid reimbursable for students that have a medical disability that prevents them from riding on the regular bus route. Specialized Transportation is only reimbursable on the days the student is transported and they also received another billable MSP service.

Future Reimbursable Services

Delegated Nursing and Personal Care Services
There is an “MSP Stakeholder Committee” consisting of the Ohio Department of Education, Ohio Department of Medicaid, MSP Billing Vendors, MSP CPA Audit Firms, School Associations, and School District Representatives that meet monthly. We have made great progress on a number of issues. MSP expansion into Delegated Nursing and Personal Care Services is currently our main agenda item. There is still a pending House Bill that attempts to force the Department of Medicaid into expanding the Ohio Medicaid School Program to include these two services. We do not support this legislation and we continue to urge all parties to work together as a team to expand the program in a responsible manner that benefits all Ohio school districts.

Intensive Behavioral Services
This service will soon be added to the entire Ohio Medicaid Program including the Ohio Medicaid School Program. With the growing number of students with Autism Spectrum Disorders, this service will help offset the enormous cost of providing service to autistic students. I am hopeful that this new service will be available by the beginning of next school year.

Make certain that your district is seeking MSP reimbursement on all eligible service providers, and that you are not billing for services provided by non-eligible providers. Also, be careful budgeting for services that are not currently included in the Medicaid School Program.

The Ohio Medicaid School Program (MSP) requires that therapists assign an ICD-9 Code to each student that they document medical services for under MSP. ICD stands for “International Classification of Diseases”, and is an alphanumeric code that corresponds to the symptom or diagnosis related to the medical service being provided. These classifications are used worldwide and are developed by the “World Health Organization”, and in the U.S. are overseen by the National Center for Health Statistics, which is part of CMS (Centers for Medicare and Medicaid Services). All medical services worldwide uses this coding system.

An example of an ICD-9 Code is: Expressive Language Disorder – ICD-9 = 315.31

Beginning with services dated October 1, 2015, the ICD-9 coding system will change to ICD-10 Codes. There are currently approximately 18,000 different ICD-9 Codes and they have been in use since 1979. There will now be over 140,000 ICD-10 codes which are more clinically accurate and include more recent medical terminology.
Many of the ICD-9 Codes have a one-on-one cross match with an ICD-10 Code, but some ICD-9 Codes will now be broken down into several ICD-10 Codes. In our MSP documentation system, the ICD-9 Codes with a one-on-one match will automatically update to the new code. For those that do not have a one-on-one match, the user will be given the corresponding ICD-10 Codes to choose from, which will then be automatically saved in the student file. Since we have 365 days from the date of service to process MSP claims, we will be using both codes until 10/01/2016. The system will automatically choose the ICD-9 or ICD-10 Code based on the service date.

This ICD-10 conversion is taking place nationwide and all medical services provided after October 1, 2015 will require the new coding. We have tried to make this transition as transparent as possible, as we realize that therapists do not have a lot of time to change codes manually. The Ohio Department of Medicaid has spent a lot of time and effort to get their payment system (MITS) ready for this changeover. We are confident that we will have a smooth transition on October 1st.