Medicaid Billing Policy

The students’ IEPT/IFSP/NPSP/C4SP and other treatment plans may suffice as the medical plan of care when they include information for each of these requirements:

• Student’s name and date of birth,
• Description of the student’s qualifying diagnosis or medical condition,
• Time-related goals that are measurable and significant to the student’s function and/or mobility,
• Long-term goals that identify specific functional achievement to serve as indicators of when the service is no longer needed,
• Anticipated frequency and duration of treatment required to meet the time-related goals, as applicable,
• A plan for reaching the functional goals and outcomes,
• A statement detailing the coordination of medical and educational services with other providers,
• The signature, title, and date of a "Medicaid Qualified Provider"

Because Medicaid Policy says student education/care plans can serve as Medicaid compliant medical plans of care when they are signed, titled, and dated by a "Qualified Medicaid Provider," Wayne RESA asks specialized staff to consider the Authorization for Medicaid Services for every IEPT/IFSP/NPSP/Amendment they complete.

To determine how much of the form must be completed, the forms user will be required to answer certain questions.

• When the student's age or POC does not allow for Medicaid billing, you will not be required to fill out the remaining sections of the authorization.
• When the students age and POC does allow for Medicaid billing, you will be required to fill out the remaining sections of the authorization.
• When the students IEPT says they need personal care services for a chronic condition/disability, you will be required to add the students personal care service needs to the Authorization form.

• When the form authorizes personal care services, it may only be signed by the providers that Medicaid says are qualified to say the student needs assistive personal care services during the school day.

• Always check to make sure your form meets the validation requirements.

• When the Medicaid-Qualified Provider signs and dates the authorization, the IEPT/IFSP/NPSP qualifies as the Medical Plan of Care.

• A completed Authorization for Medicaid Services means school staff can bill Medicaid for the plans direct support, case management, personal care, and specialized transportation services.

Bests practice dictates that we keep IEPT/IFSP/NPSP titled, signed, and dated Authorizations on file for SEVEN years in case of a Medicaid audit.

For more help, please refer to the "Authorization for Medicaid Services" instructions.

The School Services Programs (SSP) Medicaid Caring for Students (C4S) claiming and billing component says Michigan schools can bill Medicaid for providing medical/behavioral health service for students who do not qualify for them under an IEPT/IFSP/NPSP.

Under C4S behavioral health providers can bill Medicaid for 30 days of Crisis Intervention services. When you have a student who will need services for more than 30 days, you can bill Medicaid when the student has a Medical Plan of Care.

To help with this requirement, the Wayne RESA C4S Medical Plan of Care is available via MISTAR Program Forms. The C4S Plan of Care best practice says providers (behavior analysts, professional counselors, social workers, nurses, speech pathologist, occupational therapist, etc.) should complete the plan for ALL students (crisis, referral, evaluated, and students with existing medical plans of care.) being considered for on-going medical/behavioral health services during the school day.

To help determine how much of the form must be completed, the forms user will have to answer certain questions.

• When it is found that the student does not have a condition/disability that requires ongoing professional counseling/therapy/treatment during the school day, the form is considered complete.
• When it is found that the student does have a condition/disability that requires ongoing professional counseling/therapy/treatment during the school day, the forms user will have to develop the C4S Plan of Care.

The form includes validation rules.

• Always check to make sure your form meets the validation requirements
• When the Medicaid-Qualified Provider signs and dates the C4S Plan and the parent/guardian agrees with the plan and consents to the treatment, school staff can bill Medicaid for the plans direct support and personal care services.
• Medical providers acting in the scope of their practice are the staff who are qualified to develop, write, review, maintain, the students’ Medical Plan of Care.

Medicaid policy requires that qualified providers review/revise medial plans annually.

Bests practice dictates that we keep the titled, signed, and dated C4S Medical Plans of Care on file for SEVEN years in case of a Medicaid audit.

For more help, please refer to the C4S Plan of Care form instructions.

If you performed any Medicaid billable direct service provider, designated case manager, or personal care activities for Medicaid eligible students you should record and mark your services "Ready to Bill" before you leave for the Holiday Break.

If you need assistance, have questions or would like to schedule training, please contact a member of the Wayne RESA, Medicaid School Services Program Team.

We're here to help!

Michelle Maxfield - (734) 334-1461 ~maxfiem@resa.net

Leanne Smith - (734) 334-1464 ~smithle@resa.net

Tia Williams - (734) 334-1397 ~williat@resa.net