MSP Bulletins

Ohio Medicaid School Program Bulletin — HBS 2025-5

Medicaid Administrative Claiming (MAC) reimburses school districts for the administrative costs of “Referring, Coordinating, and Monitoring of students Medical, Therapy, and Mental Health Services”. We are already capturing these costs for licensed therapists such as OTs, PTs, SLPs, Psychologists, Social Workers, and Licensed Counselors. MAC reimburses for the “Care Coordination” services provided by administrative non-licensed staff such as:

Therapy Supervisor (not doing direct therapy)
Special Education Director
Health or Nursing Assistant
Intervention Specialist
Office Manager
Program Coordinator

We are working with our time study vendor Sivic Solutions to develop a list of “Job Titles” to include in the MSP Time Study Guide. We would like to know the Job Titles of the individuals in your district that would provide the following services for your students:

• Refer adolescents for family planning services.
• Make referrals for medical, therapy, and mental health evaluations.
• Refer and schedule EPSDT screens and immunizations.
• Refer students for medical, therapy, mental health, and substance use services.
• Arrange for medical, therapy, and mental health diagnostic or treatment services.
• Gather the required information for medical, therapy, and mental health referrals.
• Participates in meetings/discussions to coordinate or review a student’s need for health-related services.
• Follows-up to ensure that a student receives the prescribed medical, therapy, and mental health services.
• Coordinate with community the medical, therapy, and mental health services for a student.
• Coordinate the completion, termination, referral required to provide continuity of care.
• Monitor and evaluate the medical components of the IEP.
• Coordinate the medical, therapy, and mental health service provision with students Managed Care Plan (MCP).

Each school district is set up differently, and we want to make certain that we have the Job Titles in the MSP rules that are consistent with whom in Ohio school districts provide MAC activities. We will be sharing more detailed information on MAC as we get the MSP Time Study Guide updated but first would like to get the correct positions identified.

Thank you in advance for your valuable input.

What job positions/titles in your school district “Refer, Coordinate, and Monitor” Medical, Therapy, and Mental Health Services?

REPLY HERE

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If you have any questions or need further information on any of our Ohio MSP Bulletins, please contact our office at (740) 639-4218 or email at Info@teamhbs.com.

Ohio Medicaid School Program Bulletin — HBS 2025-4

The Ohio Medicaid School Program is governed by “The Centers for Medicare and Medicaid Services” (CMS). CMS is a federal agency and is part of the “US Department of Health and Human Services” (HHS). CMS oversees various healthcare programs such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.

In 2023, CMS issued updated guidance for “School-Based Medicaid Programs” releasing a new program guide called: Delivering Services in School-Based Setting: A Comprehensive Guide to Medicaid Services and Administrative Claiming.

You can download a copy here: https://www.medicaid.gov/medicaid/financial-management/downloads/sbs-guide-medicaid-services-administrative-claiming.pdf

Each state’s school-based Medicaid program must comply with this new guidance by July 1, 2026. We are currently collaborating with the Ohio Department of Medicaid (ODM), the Ohio Department of Education and Workforce (ODEW), Sivic Solutions (time study vendor), and other key stakeholders to design and implement the required updates. While some of these changes present opportunities to increase Medicaid reimbursement, others may result in reduced MSP reimbursement. Final decisions will depend on the approval of Ohio’s State Plan Amendment (SPA) by both state officials and CMS. Below are a few of the changes currently under development:

• Expanded Eligibility Beyond IEPs
  Reimbursement will no longer be limited to services provided under an Individualized Education Program (IEP). Under the new rules, Medicaid will now reimburse for therapy services delivered to students with 504 Plans, nursing care plans, mental health plans, or other qualified health service plans. Currently, MSP reimbursement is limited to students on an IEP.
• Reimbursement for Medicaid Administrative Claiming (MAC)
  A more accessible Medicaid Administrative Claiming (MAC) service is being added. Although MAC has historically been part of MSP, it was narrowly defined. Barriers are being removed, and clearer guidelines will be provided to support implementation.
• Significant Changes to Random Moment Time Study (RMTS)
  To comply with CMS’s updated requirements, the RMTS methodology will undergo three major updates:

1. Inclusion of Contracted Therapists
   Previously, only district-employed therapists participated in RMTS; contracted therapists were excluded. The new CMS guide requires contracted therapists to participate in RMTS, and their costs factored down using the RMTS percentage, as is currently done with employed therapist costs. This change is likely to decrease reimbursement for contracted services.
2. Four-Quarter Time Study Implementation
   RMTS is currently conducted in three school-year quarters (Oct–Dec, Jan–Mar, Apr–Jun), with no time study during the summer quarter (Jul–Sep). The updated rules will require year-round RMTS participation, covering all four quarters.
3. Reduced Notification and Response Time
   The advance notice and response window for selected RMTS participants will be shortened from three days to two days, aligning with new CMS expectations.

Timeline & Recommendations

Some elements of the MSP Expansion may be approved and available as early as the 2025–26 school year. We recommend the following phased approach:

• Delay RMTS changes until July 1, 2026, allowing districts time to prepare for the transition.
• Begin gradual rollout of MAC and Non-IEP services during the 2025–26 school year.

Our objective is to ensure that any potential decrease in reimbursement caused by RMTS changes is outweighed by increased funding through MAC and services for students without IEPs.

Stay tuned to future MSP Bulletins for updates on the expansion and the implementation process.

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If you have any questions or need further information on any of our Ohio MSP Bulletins, please contact our office at (740) 639-4218 or email at Info@teamhbs.com.

In 2017, former State School Board members Michael Collins, Bryan Williams, and myself formed the Ohio School Health Services Association (OSHSA). www.oshsa.org

Our association was formed to help promote the growth and success of the school-based health programs and services in Ohio schools. One of our main events is the annual “SBP Summit” scheduled for August 11 and 12 at the Hilton Columbus-Polaris. Over 500 OTs, PTs, and SLPs from school districts across the state will be in attendance networking and experiencing the great lineup of speakers. HBS is a major sponsor of this event, and we will have a booth there to answer any questions your therapists may have.

This popular conference will fill fast, so please have your therapists sign-up early. They will earn 12 CEU credit hours for attending our summit. More info and registration can be found at www.SBPsummit.com.

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If you have any questions or need further information on any of our Ohio MSP Bulletins, please contact our office at (740) 639-4218 or email at Info@teamhbs.com.

Ohio Medicaid School Program Bulletin — HBS 2025-2

The Medicaid School Program (MSP) Final Settlements for the 2022/23 school year (SFY 2023) are now being processed by the Ohio Department of Medicaid (ODM).

The process will be the same as in prior years. Districts will receive via Certified Mail, a “PROPOSED ADJUDICATION ORDER OF THE OHIO DEPARTMENT OF MEDICAID TO IMPLEMENT FINAL SETTLEMENT”. This is usually addressed to “c/o Medicaid School Program Administrator”. Please forward a copy of the final settlement packet to Shelly Jolley (sjolley@teamhbs.com) who will verify the final computation. Upon her final review, she will request that you sign the third page “WAIVER” and fax it to ODM at 614-752-2349.

Most District’s MSP reimbursement and Final Settlement increased for the 2022/23 school year

Most Ohio school districts will see their MSP reimbursement for the 2022/23 school year increase from prior years. This is a result of an increase in the “Random Moment Time Study” (RMTS) percentage for 22/23 Cost Report year. HBS has worked very close with our time study vendor, Sivic Solutions Group, and we are monitoring detailed RMTS data each quarter. The yearly RMTS percentage for Ohio MSP had previously decreased from 56% in 2014 to under 40% for the years of 2017-2022. We are happy to report that the RMTS percentage is up to 49.08% for SFY 2023 and is 55.17% for SFY 2024. The first time-study quarter for the current SFY 2025 (Oct-Dec 2024) is 53.37%.

In an upcoming MSP Bulletin, we will provide a detailed explanation of Random Moment Time Study (RMTS), which is one of the most important components of the Ohio Medicaid School Program.

Current open school years of the Ohio Medicaid School Program (MSP)

At any given time, we are usually working in three different school years with MSP, which are currently: 

July 1, 2022 – June 30, 2023 (SFY 2023) – Currently being Cost Settled and Final Settlements are being processed.

July 1, 2023 – June 30, 2024 (SFY 2024) – HBS is currently gathering data and preparing the MSP Cost Report (due 12/31/2025).

July 1, 2024 – June 30, 2025 (SFY 2025) – Current school year with RMTS and Interim Claiming being processed.

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If you have any questions or need further information on any of our Ohio MSP Bulletins, please contact our office at (740) 639-4218, or email at Info@teamhbs.com.

Ohio Medicaid School Program Bulletin — HBS2025-1

This can be a confusing topic as this term is being used in two different contexts currently in Ohio. There is the Medicaid Expansion that the John Kasich administration did back in 2013, and there is also the Ohio “Medicaid School Program” Medicaid Expansion that ODM and ODEW are currently working on.

2013 “Affordable Care Act” Medicaid Expansion

Prior to 2013, Ohio had two different Medicaid eligibility categories. One was “Regular Medicaid” and the second was “Healthy Start Medicaid”. The 2013 Medicaid Expansion added a third category of Medicaid called “ACA Expansion Medicaid”. Each of the three categories have different eligibility criteria and the Federal Medicaid Assistance Percentages (FMAP) are different for each category of Medicaid. For Federal Fiscal Year 2026, Regular Medicaid reimburses the State at 64.85%, Healthy Start Medicaid at 75.40%, and ACA Expanded Medicaid is reimbursed at 90%. To date, we have not seen any school aged children enrolled under ACA Expanded Medicaid.

The current Federal Administration has threatened to cut the ACA reimbursement percentage from 90% to the Regular Medicaid percentage of 64.85%, which would require Ohio to cover 25% more of the costs of ACA Expanded Medicaid. Governor DeWine has stated that Ohio will pull out of the ACA Medicaid Expansion if the FMAP is reduced by the Feds. Since no students are currently covered under ACA Medicaid, this would have no effect on Ohio Medicaid School Program reimbursement.

Ohio “Medicaid School Program” Expansion

Over 25 States have expanded their “School Based” Medicaid programs to allow for reimbursement for non-IEP services such as 504 Plans, Behavioral Plans, Stand-alone Nursing Care Plans, and other Health Care Plans of Care. Ohio is in the final stages of unveiling it’s plan for MSP Medicaid Expansion with a possible start date of the 2025/26 school year. A few new services and provider types will also be added to Ohio MSP. We will communicate the details in an upcoming MSP Bulletin as soon as final details are released, and subsequent Bulletins will cover implementation and compliance. 

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If you have any questions or need further information on any of our Ohio MSP Bulletins, please contact our office at (740) 639-4218 or email at Info@teamhbs.com.