~FY 14 ~Medicaid Compliance Requirements

VER: 8/26/2013

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AGENDA

• Persons Responsible• Parent Medicaid Consent• Updating Contact Information• Creating Treatment Plans• Q/A• RECAP

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Persons Responsible

• Speech Pathologists will obtain the Parent Medicaid Consent and create the Treatment Plans for all students with Speech Therapy. – Speech Only– Speech with OT– Speech with PT– Speech with OT and PT

• OT only and PT only will be created by the sole provider such as the Occupational Therapist or the Physical Therapist.

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Creating and obtaining the Parent Medicaid Consent form

• Go to Easy IEP• Go to student file in EIEP• Go to the documents tab within the student file• Create “Paulding Medicaid Consent”• Create final, print, send home to parents• When the signed document is returned, check for

signatures, dates, doctor information. If incomplete, contact parent to get updated information.

• It is NOT necessary to be on public Medicaid to qualify for school based Medicaid services (OT, PT, Speech)

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More info…Parent Consent

• Obtain parent consent – a new form-do not use old forms. Must be created within EIEP, docs tab, student file…

• Make a copy for your own file• Fax the document to Easy IEP and verify attachment• Send original to Robbi Moody at the PCSD BOE office via

interoffice mail• Faxing, copying, sending are all a part of the compliance

process. You will want this document on file in your own file, at the district office and online such that the document can be located at any given moment.

• **Do not create a draft of this document.**

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Creating the Parent Consent

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Treatment Plan-Annual Review• Speech Pathologists will create the treatment plan for any/all OT, PT,

Speech services following the IEP annual review finalization. (Finalize the Annual IEP=create new treatment plan)

• In other words, if speech is a service in the IEP, then Speech Pathologists will obtain the Consent and create the Treatment Plan.

• Print copy the parent consent from Easy IEP, attach to treatment plan.• Either forward to treating providers OR if you see them in person,

have them review for signatures in person. • Supervising OT will sign all COTA served treatment plans before the

document will be complete with signatures. • Forward completed packet to Robbi Moody at the PCSD BOE via

interoffice mail within seven days of annual review finalization.• **Do not create a draft of this document.

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Treatment Plan-Amendment

• If services change or were added in an amendment, a new treatment plan is required. Follow same procedures as annual review

• Only needed if services changed or were added in the amendment in question

• Do not create a ‘draft’ of this document

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Treatment Plan StatementsEach student file is different, however there are some basic generic statements you can use to ‘build’ statement unique to each child:

Statement of Medical Need:• As determined by the IEP team, it is medically necessary that the

student receive the following services:• (Who determined need? What services?)Rehab potential: • The student’s rehabilitation potential is good for goals established with

therapeutic intervention at the prescribed frequency and duration.• (what is the rehab potential when receiving these services as

prescribed? )

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Choose one or all that apply

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Q/A

• What else do I put in the treatment plan? The treatment plan is automatically set to pull goals/objectives/services from the finalized IEP. The only thing you need to add are the selection of services that you want to write the treatment plan for-and-the medical necessity/rehab potential.

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Q/A

• How will I know who the providers are? The providers of each student should be assigned to the student file in Easy IEP. You should be able to see who’s serving the student in the OT, PT or Speech capacity at any given time by looking at the IEP team list.

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Q/A

• What happens if the treatment plan gets lost from case manager to the BOE?

Routinely we will ask for another treatment plan to be signed if it is missing. An e-mail or phone call will be placed if that happens.

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Q/A

• I’m not responsible for anything that happened with a prior case manager nor in a prior year, correct?

As an employee of the district, it is our responsibility to make sure that procedures are followed whether we were the case manager, therapist or provider or not. (That wasn’t /isn’t my file syndrome)

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Q/A• What are the responsibilities?

For FY14, Speech Pathologists are required to manage the Medicaid document process if the student receives any combination of services that include speech. An example would be an SLD student receiving Speech and OT. An example would be a Speech only student.

If the student receives SLD and OT or SLD and PT, then the OT or PT therapists would be responsible for document processing.

Once the Medicaid Parent Consent and Treatment plan packet is received by the District, the District office will take up responsibility for getting the document to the doctor and back.

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Q/A

• The parent said they are not on Medicaid. I don’t need to do anything else, correct?

Please note it is not necessary to be on public Medicaid, Peach care, etc. in order to qualify for school based service reimbursement. Therefore, there is no question of whether they are ‘on Medicaid’ or not. It is a question of whether or not they will allow the district to: A) see if the student qualifies/is eligible and B) request reimbursements if they agreed to ‘A’.

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Q/A

• I do not feel comfortable explaining Medicaid forms to the parent. I should leave it to the Principal, Lead, District office to explain it.

No, as a Case Manager, Service Provider, Therapist and Administrative Outreach person, you should familiarize yourself with all training and materials available such that you can explain the Parent Medicaid Consent to the parent. You are the person that the parent should rely upon for information. Seek out information to help you do that such as training materials, asking questions, etc.

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RECAPChildren’s Intervention in Schools (CIS) is a program funded by Georgia DCH that offersReimbursement to providers (in our case, it is the school district who applies for the reimbursement) for services provided such as OT, PT, Speech.

It is currently not necessary to be on Public Medicaid Assistance for a student with a Disability to qualify for the district to claim reimbursement for services rendered. While Economic factors may play a part, the eligibility rests with the individual students disability and need as noted by the doctor and through the IEP process.

The parent consent gives the district the opportunity to ‘ask’ Georgia DCH/Medicaid if the Student is one that will qualify under CIS for the district to claim reimbursements for Services already rendered. If the parent marks yes, then the district will exchange data withDCH/Medicaid to see if eligible and if eligible, they will claim reimbursements for OT, PT, Speech. If the parent marks no, then no exchange will take place. Prior yes authorizations and data contained from that previous process may still be retained in our system. If the parent marks no, the data exchange stops upon that date. Marking no will not detract from service delivery. Reimbursement is claimed on already delivered services and impacts no future service delivery.