05/04/16: Medicaid School Program – Eligible Services

Medicaid School Program – Eligible Services

There still seems to be a lot of misinformation regarding the services that are currently reimbursable in the Ohio Medicaid School Program (MSP). In the attached February 3, 2016 memo from Dr. Sue Zake and Mark Smith, the Ohio Department of Education (ODE) clarified that “There is no change in the services provider districts can claim”. The eligible services include:

  • Audiology
  • Counseling
  • Nursing
  • Occupational Therapy
  • Physical Therapy
  • Psychology
  • Social Work
  • Speech-Language Pathology
  • Targeted Case Management
  • Transportation

This misinformation relates to Delegated Nursing and Personal Care Services, which are not currently reimbursable in Ohio. Some districts are being advised to document for these two services because there will be retroactive billing at a later date. In the attached email, ODE makes it very clear that “there will be no retroactive claims for services not yet available for reimbursement”. There was retroactive billing allowed during the initial startup of the MSP, but that was a result of the CAFS lawsuit settlement. The effective date for any new services will be based on the date that Ohio submits its “State Plan Amendment” (SPA) to the Centers for Medicare and Medicaid Services (CMS). “The Ohio Department of Education will notify provider districts about allowed additional eligible services.”

If and when new services are added to the MSP, all billing vendors will work with their client districts to identify, train, and implement the new services based on the specific rules established by the Ohio Department of Medicaid (ODM) and approved by CMS. Documenting any new services prior to the SPA date will not generate any additional MSP reimbursement. I do not like to see districts go through the effort and expense of documenting services that will not result in Medicaid reimbursement. Please let us know if you have any questions regarding billable MSP services, or “Send questions regarding the content of the ODE memo to SchoolMedicaid@education.ohio.gov.”

Healthcare Billing Services, Inc.