Washoe Country School District

April 16, 2014

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Medicaid

Washoe County School District Medicaid and Nevada Check-Up Programs

WHAT IS MEDICAID?

State and local government organizations are increasingly challenged to deliver the same or additional services with little or no additional funding to support new initiatives. Schools are expected to deliver services accurately, cost-effectively and in a user-friendly, time compliant manner—often with severely limited resources. Medicaid is an important supplementary source of revenue for Washoe County School District .
Washoe County School District (WCSD) participates in a State Medicaid Program called Direct Fee-For-Service (AKA: School Based Medicaid). To follow is a brief description of the program:
 
The Direct Fee-For-Service Medicaid and Nevada Check-Up programs involve WCSD Medicaid eligible students, the student's IEP's, Related Service documentation, and the Consent for Release of Information and Medicaid Reimbursement form (SSS-F009). The required documentation per student is requested from the school sites and sent to the WCSD Medicaid Department. All IEP's and documentation that include billable Related Services are submitted to an outside contracted doctor for authorization of medical necessity prior to Medicaid billing. These billable Related Services include Speech Therapy, Occupational Therapy, Physical Therapy, Audiology, and Nursing services.

LEGALITIES?

New laws and regulations have been implemented by State and Federal government agencies changing some billing methods for school-based Medicaid programs. One of these changes includes the requirement of annual parental consent for a school district to bill for Medicaid eligible students. The Consent For Release of Information and Medicaid Reimbursement form (SSS-F009) can be located on-line within the District's Special Education Form pages. The revised Parent Consent form includes a second page of the most frequently asked questions to help clarify Medicaid billing procedures and issues for both parents and teachers.

CHANGES?

Family Educational Rights and Privacy Act (FERPA) and State Medicaid requires the notification of Medicaid billing to parents/guardians when their Medicaid benefits are accessed. This notification is in the form of the signed Consent For Release Of Information And Medicaid Reimbursement form (SSS-F009). This form must accompany the submitted IEP and/or documentation in order for WCSD to bill Medicaid. During the student's IEP meeting and prior to signing the parental consent form, parents are advised why schools bill Medicaid, what services schools can bill Medicaid for, and how the money is spent. Parents are also informed that the student/parents private insurance will not be affected and that their students services will not be impacted. All IEP services are provided even if the parent/guardian refuses to sign the parental consent and the school cannot bill Medicaid for those services.

WHAT ARE WCSD RESPONSIBILITIES?

Teachers are required to ask parents to sign the Consent For Release of Information and Medicaid Reimbursement form (SSS-F009) form during each IEP meeting or revision. If consent is given, the teacher will copy the IEP and the Parent Consent form and submit them to the WCSD Medicaid Department. If consent is refused, the unsigned consent form is submitted to the Medicaid Department with a note stating that the parent refused consent. Without the parental consent, WCSD will not bill for Medicaid eligible student IEP's or Related Services.

Submitted IEP's, documentation, doctor authorizations, and receipt of the parental consent forms are logged into the Medicaid database for record history verification and/or audit purposes. After compilation of the required data, the Medicaid Department submits all hardcopy data to Computer Automation Systems (CAS), WCSD's third party vendor. CAS acquires the Pre-Authorizations necessary for Related Service billing and monitors Remittance Advice (RA) accounts for audit purposes.

First Health, our State Medicaid Provider, requires all IEP's and documentation to be submitted to them within 180-days from the date of service in order for WCSD to receive Medicaid reimbursements.

WCSD Medicaid reimbursements are directly related to the cooperation and collaboration of each parent and the school sites. Without the involvement of the school sites in the timely submission of Medicaid eligible student IEP's and/or documentation, in addition to the receipt of a signed parental consent, WCSD will forfeit Medicaid reimbursements.  This revenue is used to pay for services provided, books, supplies, and other school related expenses. The school needs parental consent to help offset the costs of services.

COMING EVENTS?

With the growing number of Medicaid eligible students in our district, there has been a protest against the paper waste or the "killing of trees" and the time consuming process of making the additional required copies of IEP's and documentation. We are currently working on a solution that uses State IEP forms on the Internet and is able to electronically submit them to the Medicaid department. This will expedite the billing process and comply with the new federal mandates and tighter regulations on reimbursable services.

The Medicaid department is ready to assist in any way possible to make this an effective and efficient process. If you have questions, please contact the WCSD Medicaid Department.