Author: Dan Thomas

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.

The Ohio Medicaid School Program (MSP) requires that therapists assign an ICD-9 Code to each student that they document medical services for under MSP. ICD stands for “International Classification of Diseases”, and is an alphanumeric code that corresponds to the symptom or diagnosis related to the medical service being provided. These classifications are used worldwide and are developed by the “World Health Organization”, and in the U.S. are overseen by the National Center for Health Statistics, which is part of CMS (Centers for Medicare and Medicaid Services). All medical services worldwide uses this coding system.

An example of an ICD-9 Code is: Expressive Language Disorder – ICD-9 = 315.31

Beginning with services dated October 1, 2015, the ICD-9 coding system will change to ICD-10 Codes. There are currently approximately 18,000 different ICD-9 Codes and they have been in use since 1979. There will now be over 140,000 ICD-10 codes which are more clinically accurate and include more recent medical terminology.
Many of the ICD-9 Codes have a one-on-one cross match with an ICD-10 Code, but some ICD-9 Codes will now be broken down into several ICD-10 Codes. In our MSP documentation system, the ICD-9 Codes with a one-on-one match will automatically update to the new code. For those that do not have a one-on-one match, the user will be given the corresponding ICD-10 Codes to choose from, which will then be automatically saved in the student file. Since we have 365 days from the date of service to process MSP claims, we will be using both codes until 10/01/2016. The system will automatically choose the ICD-9 or ICD-10 Code based on the service date.

This ICD-10 conversion is taking place nationwide and all medical services provided after October 1, 2015 will require the new coding. We have tried to make this transition as transparent as possible, as we realize that therapists do not have a lot of time to change codes manually. The Ohio Department of Medicaid has spent a lot of time and effort to get their payment system (MITS) ready for this changeover. We are confident that we will have a smooth transition on October 1st.

We have just begun the seventh year of the Ohio Medicaid School Program (MSP). The Ohio Department of Medicaid (ODM) is still behind on doing Desk Reviews and issuing Final Settlement Payments, but they are making progress. We are currently finalizing an agreement with ODM that sets strict deadlines on both Cost Report Filing and Final Settlement Payments.

Below is the current status of the open MSP years:

MSP Reporting Periods:

July 1, 2011 – June 30, 2012     Year 3     ODM Desk Review

July 1, 2012 – June 30, 2013     Year 4     Final Due Date is 09/30/2015

July 1, 2013 – June 30, 2014     Year 5     Cost Report is due 12/31/15

July 1, 2014 – June 30, 2015     Year 6     Last School Year

July 1, 2015 – June 30, 2016     Year 7     Current School Year

2011/12 (Year 3) – ODM is just starting to issue Settlement Letters, so Final Settlements checks should start to be released sometime over the next few months.

2012/13 (Year 4) – Most all Cost Reports and AUP Audits have been filed and completed. The final due date after extensions is 09/30/2015. Hopefully Cost Settlement for this year will occur before the end of the 15/16 school year.

2013/14 (Year 5) – Cost Reports are being completed and sent to CPA firms for AUP Audit completion. The initial due date for this Cost Report is 12/31/2015.

2014/15 (Year 6) – Although the school year has ended, a Cost Report cannot be completed until the 365 day claim filing limit has ended. It is not too late for therapist to submit Service Documentation or parents to sign Parental Consent Forms so additional Interim Claims can be processed for this school year.

2015/16 (Year 7) – Districts should start seeing regular Interim Claiming payments each month based on therapist service documentation and Parental Consent forms received.