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Medicaid

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Explanation

Medicaid is a federal/state cost sharing benefit program for health and medically necessary services for low-income individuals that was established as Title XIX of the Social Security Act in 1965.

What agencies can be reimbursed by Medicaid?

AEAs and LEAs are able to seek reimbursement for services provided to children requiring special education with services identified on an IEP.

Completing an IEP that meets Requirements for Medicaid Reimbursement

IEP Form

Print out the IEP form that shows where to document each step below.  IEP with Medicaid Captions

Page A

1. The duration dates of the IEP will be the range of dates when the services are allowed reimbursement from Medicaid by either the AEA or the LEA

2. The team listing should include a health care professional for the appropriate Medicaid covered service for which reimbursement will be claimed. For example, if there are Physical Therapy services in the IEP, then a Physical Therapist should be listed on the team.

Page B  PFAAFP

3. If the student has behavior services provided by LEA staff, Medicaid requires there be a Behavior Intervention Plan (BIP) that addresses the interventions.

4. If the student has health services provided by LEA staff, Medicaid requires a formal plan of care (health plan) designed by a health care professional and carried out by staff.

Goal Page

5. For those AEA services that are discipline specific, there should be a related goal that outlines their services. For example, there would be a speech or language goal if the AEA Speech Language Pathologist is claiming Medicaid reimbursement for their services

Page F – Special Education Services

6. If supplementary aids and services are being provided to the student, this line should be checked “Y” for Yes. This is the indication of health or behavior paraprofessional services by the LEA.

7. If support or related services are being provided to the student, this line should be checked “Y” for Yes. This is the indication of health professional services, such as a Physical Therapist or School Nurse, by the AEA or the LEA.

8. As each service is checked with a “Y” for Yes a text box is added below. A description of how the service is provided to the student is entered into the text box.

  • In some cases, one staff member may provide both educational and health/behavior related services. These should be entered in two separate text boxes. One text box for the education related services, such as extra time for class assignments, and one text box for the health/behavior related services, such as assistance with personal hygiene or to monitor his/her safety.
  • If the service is an AEA or LEA professional service (whether direct or consultative), the description should reflect the discipline related service.
  • For most services, the option of “Service - no LRE minutes” should be selected from the drop-down box for this section. “Service - no LRE minutes” is used be for any service, support or activity that is provided in a general education setting.
  • LRE minutes would be entered on the IEP for those services that are provided in a pull-out situation where the student is removed from a general education setting

 

9. Enter all possible staff positions that will be providing the service. For example, if health paraprofessional services are being provided the entry should be “Teacher and trained staff”. For discipline specific services, such as Physical Therapy, the entry should reflect the appropriate discipline, Physical Therapist. The Web IEP also requires the name of the service provider be entered. This name will not appear when the IEP is printed.

10. A time and frequency entry is required for Medicaid reimbursement and should reflect the amount of time staff will be providing this service. For those services with varying frequencies, it would be acceptable to lengthen the range, such as entering 200 minutes monthly instead of 10 minutes daily (10 minutes X 20 school days in a month equals 200 minutes a month), in order to blend the various times into an average amount of time. This entry will be the maximum amount of time allowed for reimbursement from Medicaid.

11. If a student receives special transportation service, it would be noted in this section of the IEP. Medicaid will only reimburse the transportation cost on an IEP for trips to and from a Medicaid provider for a medical service.

Printed from the Iowa Department of Education website on April 19, 2014 at 1:45pm.