Medicaid

Billing/Claiming Guidance:

School Supportive Health Services Program
Preschool Supportive Health Services Program
Billing/Claiming Guidance – June 21, 2010

The Medicaid-in-Education Claiming/Billing Handbook Update #7 is currently under development. In the interim, the Department of Health (DOH), in coordination with the State Education Department (SED), has compiled Billing/Claiming Guidance materials to be used as both instructions and as reference tools for the Preschool/School Supportive Health Services Program (SSHSP).

These instructions/reference tools will be incorporated into the Medicaid-in-Education Claiming/Billing Handbook Update #7. Until completion of the Medicaid-in-Education Claiming/Billing Handbook Update #7, the materials listed below should be used as billing/claiming and policy guidelines for SSHSP.

Materials currently available are:

PowerPoint presentation (updated September 2010) titled “SSHSP/Medicaid in Education Training on Compliance Agreement, Written Compliance Policies and Program Update”

Handouts:
1. Provider Qualifications and Documentation Requirements (153 KB)
(updated April 2012)
2.   Under the Direction of”/”Under the Supervision of” (15.4 KB)
3.   Session Notes and Progress Notes (60.31 KB)
4.   Initial entry into SSHSP (101.00 KB)
(explains when evaluations are Medicaid reimbursable)
5.   Current Procedural Terminology (CPT) codes (77.08 KB)
6.   Special Transportation Rates (36.51 KB)
7.   SSHSP Billing/Claiming Guidance (82.53 KB)

Explanations:

PowerPoint presentation – This training presentation reviews the Compliance Agreement, the OMIG Compliance Program and the State Plan Amendment (SPA) 09-61. Changes resulting from SPA 09-61 primarily surround provider qualifications and the billing methodology for SSHSP.
Provider Qualifications and Documentation Requirements – This detailed chart identifies the initial requirements and approved Medicaid service providers for each evaluation and service under SSHSP, and clarifies required Medicaid documentation.
“Under the Direction of”/”Under the Supervision of” – This document provides definitions of “Under the Direction of” (UDO) and “Under the Supervision of” (USO), and includes a chart outlining which providers must receive UDO/USO and who may provide UDO/USO.
Initial entry into SSHSP – This flow chart explains when evaluations are Medicaid reimbursable.
List of Current Procedural Terminology (CPT) codes – This document is organized by service type. It contains approximately 100 CPT codes to be used for all dates of service 9/1/2009 and forward. For each CPT code there is a description, special notes if applicable, session time/units, and the 2010 payment rate.
Special Transportation Rates - Effective 9/1/2009, Special Transportation will be billed on a one-way basis. For example, if the student is picked up and brought home, two one-way rates are billed as long as all other Medicaid requirements are met. There are separate rates for school-aged and preschool students.
Session Notes and Progress Notes – This document provides definitions of session notes (a Medicaid requirement) and progress notes (a requirement under the Individuals with Disabilities Education Act). The required elements of a session note are listed.
SSHSP BILLING/CLAIMING GUIDANCE – This document includes a chart which explains in date-order the documentation requirements for billing Medicaid. It also explains which billing process is to be used (rate code/monthly billing or CPT code/encounter-based billing).