Table of Contents
Introduction.................. i
History of
SSHSP/PSHSP........... i
Basic
Requirements for Billing.................. i
Services and Evaluations Covered
by SSHSP/PSHSP.................. i
Eligibility and Confidentiality.................. ii
Billing Process.................. ii
Use of Public Insurance Funds for
Students with Disabilities.................. iii
Medicaid Claiming Process.................. 1
School District and County
Responsibilities.................. 1
Flowchart: Medicaid Claiming
Process.................. 3
Processing of a Students
Medicaid Biographical Data as Reported in the Medicaid Biographical:.................. 4
Non-Match Report, and CIN
Transactions Processing......... 4
Adjust/Void Process......... 5
Delete Transaction......... 6
Health Insurance Portability and
Accountability Act......... 7
Family Policy Compliance Office
Fact Sheet......... 8
Procedures for the Transmission of Student Specific Information......... 9
FAX TRANSMISSIONS 9
E-MAIL TRANSMISSIONS 9
TELEPHONE 9
MAILING OF DISKETTES 9
Hand Delivered Files, Logs, Documentation and Personally Identifiable
Information 9
Encryption Information 9
File Transfer Protocol 10
Provider Agreement and Statement
of Reassignment......... 10
Consent for Release of
Information......... 10
Third Party Health Insurance......... 11
Section 504......... 11
Documentation Requirements
Summary......... 12
Services.................. 13
Speech Therapy......... 13
Under the Direction of
13
Documentation Requirements for
Under the Direction of......... 14
Medical Referral for Speech
Evaluation......... 15
Practice Guidelines for Providing
Direction to TSHH......... 16
Physical Therapy......... 17
Occupational Therapy......... 18
Psychological Counseling......... 19
Skilled Nursing Services......... 20
Evaluations.................. 21
Basic Psychological Evaluation......... 21
Comprehensive Psychological
Evaluation (with Social History)......... 22
Medical Evaluation......... 23
Medical Specialist Evaluation......... 24
Audiological Evaluation......... 25
Special Transportation.................. 26
Requirements for Claiming
Medicaid Reimbursement for Special Transportation......... 26
Targeted Case Management.................. 27
Reviews......... 27
Initial Review 28
Review a.k.a. Amended/Requested Review 28
Review a.k.a. Annual Review 28
Re-Evaluation a.k.a. Triennial Review 28
Students Transitioning from
Preschool to School Age Special Education Programs 29
Ongoing Service Coordination......... 30
Who May Provide Service Coordination 31
Summary of Targeted Case Management Documentation Requirements.................. 31
Sample of
Ongoing Service Coordination Case Notes......... 32
Charts.................. 33
SSHSP & PSHSP Monthly
Claiming Billing Calendar......... 33
School Supportive Health Services
Program (SSHSP) Claiming Fees......... 34
Preschool Supportive Health
Services Program (PSHSP) Claiming Fees......... 35
School Supportive Health Services
Program (SSHSP) Claiming Frequency......... 36
Preschool Supportive Health
Services Program (PSHSP) Claiming Frequency......... 37
Summary of Program Documentation
Requirements by Type of Service......... 38
Appendix A: General Definitions.................. A-1
IEP (Individualized Education Program)......... A-1
IHCP (Individualized Health Care Plan) (Appendix C, Pg.C-19).................. A-1
Referral for Medicaid purposes.................. A-1
Recommendation.................. A-1
Order.................. A-2
Monthly Service Delivery Documentation.................. A-2
Progress Notes.................. A-2
Center Based vs. Individual
Based.................. A-3
Medicaid Billable Monthly
Related Services.................. A-3
§ 365-a
Character and adequacy of assistance....................... A-3-4
Special Transportation:.................. A-5
Deputy Commissioner Rebecca H. Corts 2005
Memorandum-Special Transportation.................. A-5-6
2002 Memorandum from Robert J. Scalise Coordinator Medicaid
Services Unit.................. A-7-8
Appendix B: Skilled Nursing
Services:
.
B
Appendix
C: Sample Forms:
C
Provider Agreement
.C-1-2
Statement of Reassignment
.C-3-4
Consent
for Release
.C-5
Monthly
Service Report Form
C-7
Annual
Monthly Service Report Form
.C-9-10
Certification of Under the Direction Of
..C-11
Ongoing Service Coordination Notes
Documentation
..C-13
Sample
Daily Log
..C-15
Sample
Skills Check List
..C-17
Individualized Health Care Plan (IHCP)
.C-19
Appendix D: Reports:
.D
Appendix E: Error Messages:
..E
Appendix F: Exceptions to
School Districts Claiming Medicaid Reimbursement:
.F
Appendix G: Medicaid Contact
Staff:
.G