9/25/15: Current and Future Reimbursable Services

The majority of Ohio Medicaid Reimbursement is generated through Speech, OT, PT, and Psychology services. Nursing costs are reimbursable, but only for those nurses serving students with IEP’s and physician prescriptions. Most districts do not offer clinical Counseling or Social Work services, and very few IEP students qualify for Targeted Case Management services. Transportation services became Medicaid billable starting with the 2015/16 school year.

Three new services may be added to the program in the near future, but will require specific rules to be developed by the Ohio Department of Medicaid (ODM), approval by The Centers for Medicaid and Medicare Services (CMS), and implementation by the Ohio Department of Education (ODE). All this will take time, and the soonest we should expect any MSP expansion would be next school year (2016/17), or more realistically the 2017/18 school year.

Current Reimbursable Services

Speech-Language Pathology Services

  • Licensed Speech-Language Pathologist
  • Licensed Speech-Language Pathology Aide
  • Conditional Licensed Speech-Language Pathologist

Audiology Services

  • Licensed Audiologist
  • Licensed Audiology Aide

Occupational Therapy Services

  • Licensed Occupational Therapist
  • Licensed Occupational Therapy Assistant

Physical Therapy Services

  • Licensed Physical Therapist
  • Licensed Physical Therapy Assistant

Nursing Services

  • Licensed Registered Nurse
  • Licensed Practical Nurse

Mental Health Services

  • Licensed Psychologist
  • Licensed School Psychologist
  • Licensed Clinical Counselor
  • Licensed Counselor
  • Licensed Independent Social Worker
  • Licensed Social Worker

Targeted Case Management
Individuals eligible for Medicaid coverage in Ohio for TCM services must be determined to have Mental Retardation or a Developmental Disability. Ohio is unique, in that the majority of students that qualify for TCM are being served in a DD Board, and the County DD Board bills the TCM directly to Medicaid themselves, and therefore does not bill school districts for the service. There are very few, if any, Ohio school districts that provide Medicaid reimbursable Targeted Case Management services. With so few eligible providers, the RMTS hits would overwhelm the therapists, and generate very little in Medicaid reimbursement. We do not recommend that school districts seek Medicaid Reimbursement for Targeted Case Management services in the current Ohio Medicaid School Program.

Specialized Transportation
Specialized Transportation became MSP billable beginning with the 2015/16 school year, and is Medicaid reimbursable for students that have a medical disability that prevents them from riding on the regular bus route. Specialized Transportation is only reimbursable on the days the student is transported and they also received another billable MSP service.

Future Reimbursable Services

Delegated Nursing and Personal Care Services
There is an “MSP Stakeholder Committee” consisting of the Ohio Department of Education, Ohio Department of Medicaid, MSP Billing Vendors, MSP CPA Audit Firms, School Associations, and School District Representatives that meet monthly. We have made great progress on a number of issues. MSP expansion into Delegated Nursing and Personal Care Services is currently our main agenda item. There is still a pending House Bill that attempts to force the Department of Medicaid into expanding the Ohio Medicaid School Program to include these two services. We do not support this legislation and we continue to urge all parties to work together as a team to expand the program in a responsible manner that benefits all Ohio school districts.

Intensive Behavioral Services
This service will soon be added to the entire Ohio Medicaid Program including the Ohio Medicaid School Program. With the growing number of students with Autism Spectrum Disorders, this service will help offset the enormous cost of providing service to autistic students. I am hopeful that this new service will be available by the beginning of next school year.

Make certain that your district is seeking MSP reimbursement on all eligible service providers, and that you are not billing for services provided by non-eligible providers. Also, be careful budgeting for services that are not currently included in the Medicaid School Program.