Medicaid Messenger

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

With the January to March 2025 Staff Pool now open for editing, we need to share Random Moment Time Study (RMTS) response rate statistics from the April to June 2024 quarter, as we could be at risk of not meeting the statistically sound threshold of 85% responses submitted within 48 hours.

First, recall that there are four different Cost Pools that make up your Staff Pool List:

• Administrative Outreach Program
• Case Management
• Direct Service
• Personal Care

For a survey response to be compliant, each selected participant has 48 hours, or two scheduled school days, to complete and submit their assigned RMTS survey. Surveys that are replied to after the 48 hour timeframe and staff who are no longer with your district and need to be exited during an active RMTS quarter, count against our response rate, which must be at a minimum 85% across Wayne County for each Cost Pool. If we fall below the 85% requirement, the State and Federal Government could require additional surveys be sent to participants, in an effort to return the County to a statistically sound response rate.

While the chart above indicates that we are within the percentage of timely responses range, we are at risk of becoming non-compliant with the State and Federal guidelines of the 85% on-time responses. It is important that the percentages continue to go up, otherwise we will be asked for participants to complete more surveys than they are already being asked to complete.

Steps that you can take to reduce the number of non-working moments in Wayne County include:

1. In addition to PCG and Wayne RESA monitoring assigned moments, please have a member of your staff also monitor responses and communicate with those who have not submitted a response and communicate the importance of meeting the 48-hour timeframe for a compliant, countable submission

• For new staff on your Staff Pool List, please communicate with them that they have a district provided email and that they should check their access to their email account
• Please advise all staff, especially Personal Care/Paraprofessional staff, to check their district email daily and the emails from MIAOP@PCGUS.COM are safe and the link within this email will direct them to their assigned survey

1. Review your shifts on the PCG web site and make sure that the shifts capture the hours your staff pool participants are working
2. Review your Staff Pool List and remove any vacancies that will not be filled within the upcoming quarter, currently the January - March 2025 quarter

• if you do not have a candidate before the Staff Pool List closes on November 8, please consider removing the vacancy; the new staff member can be added to the next open quarter for April-June 2025

During the recent school year, we introduced the Authorization for Medicaid Services form, which is available to Special Education staff in MISTAR Forms. The Authorization for Medicaid Services form provides the required authorization for billing and must be completed for every student, regardless of Medicaid eligibility, when the following scenarios are included on the IEP/IFSP and/or Amendment:

Please note, when MISTAR was updated prior to the start of the current school year, the Personal Care Authorization form was removed as this information is now included in the Authorization for Medicaid Services form.

A member of the IEP team who provides direct services is responsible for completing this Authorization form when Support Services are listed as Direct or Direct/Consult and/or Personal Care is indicated as Yes on the IEP. The Case Manager, Special Education Teacher who is coordinating the meeting, is responsible for making sure this form is included with the IEP/IFSP or Amendment documentation for the student's file.

When the Direct Service Provider (fully licensed Speech Pathologist, Social Worker, OT or PT, etc.) completes the Authorization for Medicaid Services form in MISTAR, they must always:

1. Indicate the type of meeting this document references and the date of the meeting,

2. Click Yes or No if one or more direct medical/behavioral support is needed,

3. Click Yes or No if Personal Care services are authorized as medically necessary, (the personal Care Services box has a place to add each service the team indicates the student needs by clicking Add),

4. List all of the participants who provided a report for the development/continuation of the IEP/attended the meeting,

5. Be titled, signed and dated by a Medicaid qualified provider. (The qualified provider signature demonstrates their agreement to authorize the services for Medicaid billing. The signing provider is not responsible for overseeing implementation of the IEP).

• The professional who is authorized to sign this form when Personal Care Services are needed and detailed: Licensed Physician, Registered Nurse, Licensed Occupational Therapist, Licensed Physical Therapist, Licensed Masters Social Worker, Fully Licensed Speech & Language Pathologist can sign. The list of approved authorized professionals will be in the Title drop down box when you select Yes for Personal Care Services.
• The professional who is authorized to sign this form who no Personal Care Services are needed: Licensed Audiologist, Board-Certified Behavior Analyst, Certified Orientation and Mobility Specialist, Licensed Occupational Therapist, Licensed Physical Therapist, Licensed Physician, Licensed Professional Counselor, Limited Licensed Professional Counselor, Licensed Psychiatrist, Licensed Psychologist, Limited Licensed Psychologist, MDE-Credentialed School Psychologist, Licensed Speech Language Therapist, Licensed Marriage and Family Therapist, Licensed Social Worker, Limited Licensed Social Worker, Licensed Social Worker, Registered Nurse, Qualified School Nurse, Certified Clinical Nurse Specialist. The list of approved authorized professionals will be in the Title drop down box when you select No for Personal Care Services.

Lastly, the reason we need the Authorization for Medicaid Services to be completed for every student as listed above is that we never know when a student may become eligible for Medicaid, and if this form is already completed and signed by the appropriate authorized provider, then everyone is following the policy and compliant for billing.

In the past, prescriptions, referrals and physician's orders were able to be back dated by 90 calendar days from the authorized provider signature date. An authorized provider is a physician, physician's assistant, nurse practitioner, clinical nurse specialist.

New policy states that we can no longer back date prescriptions, referrals or physician's orders and must use the qualified practitioner's signature date as provided on these forms. While this change will not have a direct impact on your direct service providers who are required to have a prescription, referral or physician's orders, the Medicaid Team wanted to help provide guidance to help bridge the 90 day gap.

• Nursing Services and Physical Therapy Services - provide a copy of prescriptions and physician's orders via the Medicaid Secure Email as soon as possible.
• Occupational Therapy and Orientation & Mobility service providers who may be having difficulty in obtaining a prescription from families, we are advising these practitioners to wait no more than 30 days before reaching out to Michelle for assistance in obtaining a signed prescription from one of the Wayne RESA contracted physicians.

In a recent communication with Dr. Taiariol, Assistant Superintendent Special Education and Early Intervention Services, we asked how staff should proceed with documenting the need for Personal Care Services in the IEPT/IFSP when staffing is falling short of district and academy needs.

Dr. Taiariol advises, "staff should be checking yes (when the IEP or IFSP teams determine the student needs Personal Care Services). The district's lack of staff has no relationship to the fact that the student's IEP has determined a need for adult support."

Personal Care Staff/Paraprofessionals who are employed or contracted by the district or academy can be on your Staff Pool list. We recommend providing contracted staff with a district email for the purpose of receiving Random Moment Time Study emails as well as for communicating about their Medicaid billing, and that you ensure they have access to their district email. In addition, these staff must also bill for Medicaid in MISTAR>Service Tracker.