Transcript Medicaid and Schools Annual Training

Virginia Department of Medical Assistance Services (DMAS)
and
Virginia Department of Education (DOE)
Medicaid and Schools
The Arc of Virginia Annual
Convention
August 11, 2011
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Medicare Catastrophic Coverage
Act of 1988
Medicaid funds could be used to pay for
health-related services provided under
Individuals with Disabilities Education
Act (IDEA).
 Provided by a participating Medicaid provider
 Medically necessary
 Included in the state's Medicaid plan
 Provided to an individual eligible for Medicaid
 Screened for any other third party payment
that may be available for reimbursement.
Virginia: Medicaid and Schools
 1991 – DMAS began covering some
health related services in schools due to
requirement from the Governor’s Child
Health Task Force
 The 2002 Virginia General Assembly
directed DMAS to maximize federal
reimbursement for services, by working
with numerous organizations including
Local Education Agencies (LEAs).
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Virginia: Medicaid and Schools
2011 - Health related services have
expanded over the years for which schools
may receive reimbursement for children
enrolled in Medicaid, FAMIS or FAMIS Plus.
 These services must be provided by school
division employees, contracted employees, or
contracted agencies.
Virginia: Medicaid and Schools
Services include:
 Physical Therapy
 Nursing
 Occupational Therapy
 Personal Care
 Speech-Language
Therapy
 Medical Evaluations
 Audiology
 Specialized
Transportation
 Psychiatric,
Psychology and Mental
Health
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Virginia: Medicaid and Schools
The following services/administrative
duties are for both general education and
special education students
 Early Periodic Screening, Diagnosis and
Treatment (EPSDT)
 Administrative Claiming
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Federal and State Match Rates
Public schools may receive federal
Medicaid and CHIP reimbursement that
must be matched by state and/or local
dollars.
Federal Match rate for Administrative
Claiming is 50% - Virginia DMAS keeps
half of federal share
Federal Match Rate for Medicaid is 50%
Federal Match Rate for Medicaid Expansion
and FAMIS is 65%
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Provider Requirements
Services must be specified in the child’s
IEP
Current license on file with DOE for each
service practitioner
Signed Provider Agreement with DMAS
Signed Business Associates Agreement
with DMAS
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Business Associates Agreement
 To ensure privacy and security of
protected health information (PHI)
 Individually identifiable information, including
demographics, which relates to a person's
health, health care, or payment for health
care as specified in
45 CFR § 160.103 of the Final HIPAA Privacy
Rule.
 Virginia public schools shall not use PHI
otherwise than as expressly permitted by
the Agreement, or as required by law.
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Provider Requirements
Special Education and FERPA
 Obtain parental permission for billing public
insurance
DMAS Agency Director’s Letter to Parents
 Assures that by giving school permission to bill
public insurance does not impact services their
child receives by non-school providers nor
does it impact the service limits their child is
eligible for.
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DMAS website:
dmasva.dmas.virginia.gov
Medicaid
and
Schools
Find Provider Manuals and Memos at this link to the Medicaid Web Portal.
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DOE website:
www.doe.virginia.gov
Medicaid
and
Schools
Contact Information
DOE
 Amy Edwards, 804-692-0150
amy.edwards@doe.virginia.gov
DMAS
 Ashley Barton, 804-371-7824
ashley.barton@dmas.virginia.gov
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