In
order for school districts, §4201 schools or counties to claim Medicaid
reimbursement for services, they must have all private agencies or service
providers with whom they contract, sign a Provider Agreement Form and a Statement
of Reassignment (see Appendix C1 and C2).
Specifically, if a school district, §4201 school or county contracts
directly for a service such as transportation or speech therapy with an agency
or person who is not an employee of the county or BOCES, that provider must
have signed the Provider Agreement Form and the Statement of Reassignment. An independent agency may be an individual
person or a corporation. A provider
agreement and statement of reassignment is needed from each agency, but not
from each individual service provider within the agency. We recommend school districts/§4201 schools/counties review
these forms at the time of contract renewal.
The federal Family
Educational Rights and Privacy Act (FERPA, also known as the Buckley Amendment)
and Medicaid regulations require that the identity of a student with a
disability and any identification of services provided be kept confidential and
not released without the expressed consent of the parent. To assist the agency responsible for
administering the School Age/Preschool program in getting this parental
consent, the Medicaid application and recertification forms were modified to
secure the parental consent for Medicaid billing, thereby satisfying Education
Law.
Since Medicaid eligibility is automatic for all Supplemental Security Income (SSI) recipients, parents/guardians of students who receive SSI do not apply for Medicaid. However, if a parent/student has completed a Medicaid application in the State of New York, the consent for release of information has already been given. If a Medicaid application has not been filled out, or if there is a break in services, the school district/§4201school/county will have to obtain parental consent to bill Medicaid for the SSI student in order to comply with Federal Education confidentiality requirements.
The SSI indicator is designated on the eligibility listings by three asterisks (***) next to the student’s name. If the eligibility reports show a break in Medicaid eligibility prior to current SSI eligibility, the parental release on the Medicaid application signed at the local district is not in effect. The school district, §4201 school or county would have to get a separate parental release. Although the presence of a release will not be a Department of Health audit issue, it is an issue for school districts, §4201 schools and counties for complying with Federal confidentiality requirements. A copy of a sample “Release Form” is in Appendix C-5.
It is recommended that all school districts/§4201 schools/counties request a release from all parents/ guardians of students at the time of enrollment or at least at the time of referral to the CSE/CPSE. This procedure would guarantee compliance with the Buckley Amendment for all students.
The Preschool
Supportive Health Service Program (PSHSP) provider (counties) and the School
Supportive Health Service Program (SSHSP) provider (public school districts) no
longer have to determine if a child has access to other third party health
insurance before Medicaid can be billed for these services. This only applies
to PSHSP and SSHSP providers for Medicaid eligible services that appear on a
student's IEP after May 21, 1999.
If a private
provider under contract with a school district or county is billing Medicaid
directly for services listed on a student's IEP their governing regulations
would apply. In these instances Medicaid would be the payer of last resort and
any Third Party Health Insurance carriers would have to be billed first with
full parental consent.
The Centers for
Medicare and Medicaid (CMS, formerly HCFA) in its draft Medicaid School-Based
Administrative Claiming Guide indicated that Section 1903 (c) of the Social
Security Act makes Medicaid the payer of first resort for Medicaid eligible
services that appear on a student's Individualized Education Program. This
clarified what appeared in a HCFA Medicaid Director's letter dated May 21 1999
indicating that Medicaid was the payer of first resort for IDEA related
services.
Medicaid reimbursement is
not available for students receiving services in accordance with Section
504 Accommodation Plans.