May 1997 Memo Regarding Speech/Other Support Services Medicaid Documentation
THE STATE EDUCATION DEPARTMENT/THE UNIVERSITY OF THE STATE OF NEW YORK/ALBANY, NY 12234
OFFICE OF VOCATIONAL AND EDUCATIONAL SERVICES FOR INDIVIDUALS WITH DISABILITIES
|TO:||District Superintendents School District Superintendents Directors of Special Education Committee on Special Education Chairpersons Business Officials|
|Ann Clemency Kohler, Director, Office of Medicaid Management, NYS Department of Health Robert J. Scalise, Coordinator, Finance Unit, NYS Education Department|
|Clarification of Medicaid Documentation Requirements for Speech Services and Other Health Related Support Services Indicated on a Student's Individualized Education Program (IEP)|
This memorandum should clarify issues regarding certain Medicaid documentation required by school districts in order to claim Medicaid reimbursement for speech therapy services, speech evaluations and other health related support services indicated on a student's IEP. This applies to school-age and preschool students.
In order to claim Medicaid reimbursement for the provision of speech therapy, a written referral from a physician, physician's assistant (PA) or a nurse practitioner for the evaluation and the service is the minimum requirement in order to claim Medicaid reimbursement.
Since most annual reviews have been completed for the 1997-98 school year and the speech evaluations have been completed, you do not need to have a referral from a physician, physician's assistant or a nurse practitioner for the speech evaluation for the 1997-98 school year. However, this documentation requirement will be necessary for the 1998-99 school year, effective July 1, 1998.
DOCUMENTATION REQUIREMENTS 1997-98 SCHOOL YEAR ONLY EFFECTIVE - JULY 1, 1997
One of the following three alternatives is required in order to claim Medicaid reimbursement for Speech Therapy Services
First Alternative: Written referral by a physician, physician's assistant, or nurse practitioner for Speech services only, dated on or before the initiation of the service. This represents the minimum requirement.
Second Alternative: Written order by a physician, physician's assistant, or nurse practitioner for Speech Services only, dated on or before the initiation of the service.
Third Alternative: Completion and sign-off by a physician, physician's assistant, or nurse practitioner of the attached form "Recommendation for all health related support services indicated on a student's Individualized Education Program (IEP)". The completion and appropriate signature on this form would preclude the need for any other physician's order required for a health service indicated on the IEP, i.e. Physical Therapy or Occupational Therapy.
There is no additional funding for the first or second alternative indicated above. However, if a physician, physician's assistant or nurse practitioner were to complete and sign off on the attached recommendation form for all health related services indicated on the student's IEP the school district would be able to claim Medicaid reimbursement under Procedure Code 5301 (Medical Evaluation) for such recommendation provided a school age student and the county would be able to claim reimbursement under Procedure Code 5301 (Medical Evaluation) for such recommendation provided a preschool student. A recommendation is defined as an order by the New York State Department of Health.
DOCUMENTATION REQUIREMENTS 1998-99 SCHOOL YEAR EFFECTIVE JULY 1, 1998
One of the three alternatives will continue to be the required documentation necessary for claiming Medicaid reimbursement for Speech therapy services and evaluations under the School Supportive Health Services Program (SSHSP) and the Preschool Supportive Health Services Program (PSHSP) in New York State.
However, in addition to the requirements outlined in each of the three alternatives above, a referral by a physician, physician's assistant or a nurse practitioner for the Speech evaluation will also be required. This referral must be dated on or before the initiation of the Speech evaluation. This would be required in addition to the documentation outlined in the first and second alternatives above.
[The first alternative can be met by procuring one referral from a physician, physician's assistant or nurse practitioner to read as follows:
"I am referring ________________________________to the Committee on
Special Education (CSE) or the Preschool Committee on Special Education (CPSE) for a Speech evaluation and for any Speech services determined to be appropriate as a result of such evaluations.]
One of the three alternatives indicated above is required as documentation for claiming Medicaid reimbursement for speech services indicated on a student's IEP. The health related support services (i.e. physical therapy and occupational therapy) where a physician's order is required by State and/or Federal statutes and regulations; the third alternative would be sufficient (attached form). The health related support services that require specific instructions from a physician, physician's assistant or nurse practitioner (i.e., skilled nursing services identifying a medication requirement or an invasive nursing service) would continue to require an individual order. The documentation requirements must be renewed annually and pertain to continued as well as to new services indicated on a student's IEP.
I trust this memorandum clarifies this documentation issue. If further clarification or information is needed, please contact one of the following individuals:Robert J. Scalise - N.Y.S. Education Department (SED) - (518) 473-6118
Michael Albino - Department of Social Services (DSS) - (518) 473-9059
Juli Elson - Department of Health (DOH) - (518) 474-2262
Thank you for your cooperation and continued efforts to assure that all the appropriate documentation is maintained prior to claiming Medicaid reimbursement.
cc: Sarah VanLeer, Counsel (DOH) Louis DeMeo, DSS Michael Albino Juli Elson RIC Contacts