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

04/01/16: Home Health Aide Services

Home Health Aide Services in Schools

There has been much talk over the past few years regarding adding “Aide Services” to the Ohio Medicaid School Program (MSP), and I have written about it often. The concern has always been that if Ohio added “Delegated Nursing” and “Personal Care” services to the school program, they would also be required to add the services to all of the State’s Medicaid programs. Adding services to MSP does not cost the state any additional dollars, because school districts have their own “matching funds” (State and Local Tax Revenue). However, when adding these services to Ohio’s entire state Medicaid program, the State of Ohio would be required to pay those non-MSP provider’s matching funds (around 40% of the claim). This could potentially cost Ohio millions of dollars, as all of the other state Medicaid programs represent over 99% of Ohio’s total Medicaid spending. In comparison, the Ohio Medicaid School Program generates about $70 million dollars per year, whereas the entire state’s Medicaid program spends over $23 billion dollars per year. It doesn’t take a mathematician to realize that Ohio’s budget exposure is huge, and that is why they have been reluctant to add these aide services. They have been looking at ways to use existing Medicaid approved service types that are already part of the State plan to help cover the costs of medical aide services being provided in Ohio school districts.

The Ohio Department of Medicaid (ODM) is proposing that medical aide services in schools be covered under the State’s current Medicaid “Home Health Services” plan. Currently, home health services (which includes home health nursing, skilled therapies, and home health aides) are covered by Medicaid only when provided in the home, and/or a licensed day care for a child under age three. Under this proposal, the rule [OAC 5160-12-01(E)(4)] would be revised in order for home health aide services to be covered when provided in the school setting, and it would allow for coverage up to age twenty-one.  The rule language would read:

“Home health aide services may be provided by the MCHHA in a school setting for an individual over the age of three and under the age of twenty one, where the individual is in receipt of special education services as indicated in an individualized education plan. “School setting”, for the purposes of this rule refers to a community school, state school, or a setting operated by a local education agency pursuant to OAC 5160-35, a private school or CPST provider setting.”

This is a very interesting concept, and although the medical aides would need to be provided by a “Medicaid Certified Home Health Agency” (MCHHA), the services would be provided at no cost to the district. Many districts already contract for nursing services through an MCHHA, such as Maxim Healthcare. The aide services would be free to the district because the MCHHA would be billing Medicaid directly and would be accepting the Medicaid dollars as payment in full. The no-cost medical aide services would only apply to Medicaid students, but perhaps the 100% savings on the Medicaid students could help offset the costs for the non-Medicaid students. Do not expect all of the billing vendors to support this change, since this would effectively eliminate billing fee revenues for aide services, but we always need to make sure that issues like this are resolved in the best interest of the school districts and not just the best interest of the billing vendor.

The MCHHA aide services could be available as early as July 1, 2016. This methodology may not work for every district, but if setup properly, it could provide trained and certified health aides at no cost to school districts. The Ohio Department of Medicaid (ODM) would like to hear your opinion regarding this potential program expansion. Please send your questions, comments, and concerns to our general email address at TeamHBS@aol.com, and we will consolidate everything into one email to ODM, and then do a “Topic of the Week” follow-up on this issue in April based on ODM’s response.

03/18/16: Medicaid Revalidation Update

Medicaid Revalidation Update


This is an update to the February 19, 2016 MSP Topic of the Week titled Medicaid Revalidation for all MSP School Districts. The Ohio Department of Medicaid (ODM) has verbally agreed to rescind the requirement that districts provide the “Social Security Number” and “Date of Birth” of all School Board Members on the MSP revalidation application. However, the list of School Districts that will need to revalidate their Ohio Medicaid Provider Agreement in 2016 has grown from 39 districts to 196 districts.  Attached is the current list of districts that require revalidation in 2016, and we will also keep an updated list posted on our website. 2016 Revalidations

My assistant Debbie Miller can walk you through the online application, which takes about 30 minutes to process from start to finish. You will need your board office address/phone information, as well as the Superintendent and Treasurer DOB and SS#, and a completed W-9 Form. The revalidation fee charged by ODM is $554, and must be paid by credit card (Visa, Master Card, Discover). For those districts that do not have a credit card available, HBS can use their card and then bill your district directly for the state revalidation fee.

Districts that do not have their revalidation complete by their due date will have their State Medicaid Provider Number turned off, and all MSP reimbursement checks/EFT’s will be halted. Districts will receive a letter from ODM approximately 30 days before the expiration of your current Medicaid Provider Agreement. Please do not wait until the last day to submit your application, as it will take ODM time to process your application. Once your revalidation is accepted, your Ohio Medicaid Provider Agreement is good for another five years.

If you have any questions on the MSP Provider Revalidation process, please contact Debbie Miller.


Healthcare Billing Services, Inc.

To see past “MSP Topics of the Week” go to www.TeamHBS.com