04/08/16: IEP Care Coordination/Physician Referral Form

IEP Care Coordination/Physician Referral Form

From the start of the Ohio Medicaid School Program (MSP) back in 2009, there has been a program requirement that districts must document their efforts to coordinate IEP Related Services with each Medicaid student’s Primary Care Physician (OAC 5160-35-06(E)(7)). Some districts have been doing this “Care Coordination”, but most have not, and I think that with the latest “Order, Refer, Prescribe” (ORP) controversy, this may be a requirement that the State may start enforcing. We have developed a simple procedure that would meet the Care Coordination requirements of 5160-35-06, while at the same time initiate the process of obtaining an ORP referral from the student’s physician.

We looked at forms used by various districts and in other States, and have come up with a one-page “IEP Care Coordination/Physician Referral Form”. The form is designed to be sent to the parent for coordination consent, then the parent would give the signed form to the physician for referral, who would then send the signed form back to the school. I know that the likelihood of getting all of these forms to the physician and back from the physician are slim, but just sending the forms out would meet the requirements of 5160-35-06, and could be the initial step in getting the ORP referral. Although we still have very few answers to our ORP questions, here are some assumptions that we have made:

  • You are only required to coordinate services and obtain a physician referral for your Medicaid Related Service students. Typically, billing vendors do not share student Medicaid eligibility information with districts, but with the Parental Consent and ORP requirements, it has become necessary to share this information so districts are not running down forms for students that do not even qualify for Medicaid. You would only need to send the ‘Care Coordination/Physician Referral Form” for your IEP Related Service Students that have Medicaid insurance. Your billing vendor should be able to provide you a list of all Medicaid Related Service Students, and then track Medicaid students that need a referral.
  • We have purposely left off a beginning date and an ending date on the Referral Form. It is assumed that the order will be valid for no longer than one year from the signature date, but the IEP effective date may be a factor also. This is one of the questions that we are still waiting to have answered, and until we know for sure, we have left off any effective dates.
  • Some physicians may sign the Referral Form with no questions asked, while others may want to see the IEP or ETR testing. Others may actually want to see the student, if they have not been seen in a while. Keep in mind that this is only for Medicaid students, and any additional services provided by the physician would be billed to Medicaid directly by the physician. This will be a good test to see what type of response and cooperation you receive from the students’ primary physicians.
  • Some students may not have an actual primary care physician, or their physician may be an Urgent Care or Hospital. This initial request will not net 100% of the Medicaid student referrals, and districts may eventually need to develop a relationship with physicians in their area who can provide the referral in situations where there is not a primary care physician. Many ESC’s are looking into providing this service for their districts, and some county health departments can also provide physician referrals.

I recommend that you put the attached form on your district’s letterhead. There are four areas on the form that you will need to change from the sample school district name to your specific district. The student name is listed one time on the form above the Physician Signature, and will need to be changed with each student. Check the box next to each service that the student is receiving. ETR testing does not require a physician referral. Be sure to put your specific “Please return to” information on the bottom of the form.

I still have not given up on the possibility that the State may reverse their ORP decision and restore the MSP therapist’s ability to “Order, Refer, and Prescribe”. If the State does reverse their decision, this will still be a worthwhile process, as this type of Care Coordination is a requirement of the program. Some districts have already developed a similar form and process. What I have attached is just a sample, and you can customize the form to fit your district’s needs. We will make modifications to the process and form as we get more direction from the State and feedback from physicians.

When you are ready to start this process, contact your billing vendor and get a listing of you IEP Related Service Medicaid Students. We will continue to keep you informed of any new information and the result of the extension request.

Healthcare Billing Services, Inc.


Sample Physician Referral Form