Medicaid Messenger

The Medicaid Team has been working with the RESA IT Team to make student prescription information visible in Service Tracker. We added this feature so that Direct Service providers who are required to have a prescription or referral on file in order to bill Medicaid for eligible students, will be able to see that this requirement has been met.

As you can see in the picture above, when you log into Service Tracker, you will see the Medicaid One-Time Consent box followed by the Student NPI box.

NPI stands for National Provider Identifier, which is a number that identifies a provider such as, physician, physician's assistant, nurse practitioner and clinical nurse specialist, who signs prescriptions and referrals. Each student who requires a prescription and/or referral must have an NPI attached for each billing that is submitted to the State.

The details you will see in the Student NPI box include, the name of the signing provider, the type of service that they are prescribing or referring, the date the provider signed the prescription/referral and the expiration date.

Direct Services that require a prescription or referral include:

• Audiology
• Occupational Therapy
• Orientation and Mobility
• Physical Therapy
• Speech and Language Therapy
• written orders are needed for Nursing Services

The IT Team is developing a MISTAR report that will show students who need a prescription, referral and/or written orders that also includes a signature date and expiration date field. While we're not sure how the report will look, it will help practitioners and the Medicaid Team keep track of current and expiring prescriptions, referrals and written orders.

As the Medicaid Team continues to update the forms in MISTAR that meet the updates made to the Medicaid Policy Manual, there have been more questions from districts and academies about coordinating services that are provided in school with the services students are receiving from an outside healthcare provider or agency.

The following details are designed to help clarify the school service providers role with the coordination and collaboration requirement. From the Medicaid Provider Manual for School Services Program:

3.2 SERVICE COORDINATION AND COLLABORATION

Students with special needs have access to services available in both outpatient and school-based treatment settings. If treatment is provided in both settings, the goals and purpose for the two must be distinct. SSP services are provided to assist a student with a disability to benefit from special education. Outpatient services are provided to optimize the student’s functional performance in relation to needs in the home or community setting and must not duplicate those provided in the school setting. Collaboration between the school and community providers is mandated to coordinate treatment and to prevent duplication of services. This collaboration may take the form of phone calls, written communication logs, or participation in team meetings such as the IEP/IFSP meeting and POC development. If coordination cannot be established, the ISD/LEA should retain documentation of their coordination attempts.

Additionally, School Services are based on the student’s needs as outlined in the evaluations that lead to the development of the IEP/IFSP or other Plan of Care, and will not be dropped based on outside services/ABA therapies, etc., or dropped due to any staff shortage.

Moving forward, when provided with a student’s outside therapy information for Medicaid Eligible students who also have the signed One-Time Consent on file, Direct Service staff should coordinate services to eliminate duplication.

Lastly, over the past several months, we’ve been hearing that outside therapies are informing parents and schools that their services take precedence over school services. This is simply not true. With collaboration and coordination of care, the students can benefit from and receive both school services and outside services.

With the winter break quickly approaching, we wanted to share a few quick reminders:

1. Complete all assigned RMTS within the 48-hour timeframe requirement. Submitting surveys should only take a few minutes of your time, and determines the reimbursement percentage for all of the schools in Wayne County, as well as the State.
2. Enter services into Service Tracker and make any "Open" service "Ready to Bill." Remember, even 'non-billable' services need to be marked "Ready to Bill," even though they are not billable. Following this guidance will remove you from billing reports that list outstanding billings that the Medicaid Team will be sharing with Special Education Departments in January.

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