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



03/04/16: New Methodology for computing “IEP Medicaid Eligibility Rate” (MER)

The Medicaid Eligibility Rate (MER) data for the 2015/16 school year must be submitted to the Ohio Department of Medicaid by March 31, 2016. Billing vendors collect this EMIS information directly from the district, or from their Information Technology Center (ITC), and submit one mass file to ODM. The data submitted contains Student Name, DOB, Zip Code, and IEP Status, as of the 2nd week in October, and is used to compute each district’s IEP Medicaid Eligibility Rate (MER) percentage. This is the only Cost Report factor that is district specific, and its accuracy is critical to maximizing MSP reimbursement.

The standard MER calculation is “Total IEP Medicaid Students” divided by “Total IEP Students”

Example: 48 IEP Medicaid Students divided by 100 Total IEP Students = 48% IEP MER.

Beginning with the 2014/15 school year Cost Report, the MER calculation has changed, and districts will now be penalized for not having a paid claim for all IEP Medicaid students. This is what I have been calling the “Interim Claiming Cost Adjustment”, and is why I have been stressing to districts to obtain a signed Parental Consent Form for all IEP students and make certain that Related Service Therapists are documenting for all MSP billable IEP services.

The new MER calculation will be “Total Number of IEP Students with a Paid Claim” divided by “Total Number of IEP Students with an MSP Billable Service.

Example: 75 Students with an MSP Paid Claim divided by 150 IEP Students with a Billable Service = 50% MER.

Here is an example of the new Cost Report IEP MER calculation. Keep in mind that not all IEP students receive “Billable MSP Services” (green section below), so those students need to be factored out of the equation (denominator).


*Note that the column in red is for AUP audit adjustments. When an auditor disallows a claim in the AUP audit, the “Number of IEP Students with a Paid Interim Claim” will be reduced by one, therefore additionally reducing the district MER.

We are getting ready to start the preparation of the 2014/15 MSP Cost Reports, and we need to get a list from each district that shows, as of the second week in October 2014, the IEP students that were receiving a Related Service, and a second list that shows the IEP Related Service students that were receiving “Consult Only” services. To maximize your MER percentage, we want our denominator to show only those students that received an MSP Billable Service. IEP Students that do not receive a Related Service or had “Consult Only”, would have no possibility of having an MSP Billable Claim, and therefore should not negatively affect the district IEP MER.

Not only are we going to use this new data to compute MER percentages, but we are also going to mark the students in our system as a “Related Service Student”, and make sure that there are claims for all related service students. This new methodology has the potential to reduce district’s overall MSP reimbursement, but at the same time, if tracked properly, it could actually increase overall Medicaid reimbursement. Three key components are:

  • Provide an accurate list of IEP Related Service Students.
  • Make sure that you are obtaining signed Parental Consent forms for all IEP students.
  • Make sure that therapists are documenting for All Students.

Most of your IEP software programs should be able to accumulate this new information. IEP Anywhere has an “IEP Related Services Report” that should be able to provide this data. I would suggest accumulating the information for the 14/15 school year (October 2014), and the 15/16 school year (October 2015) at the same time.

It is extremely important that your district and your billing vendor understand this new methodology, and is working towards getting your “Total Number of IEP Students with a Paid Interim Claim” as high as possible. There are still several more months that districts could file Interim Claims for the 2014/15 school year (365 day filing limit). Claims can still be submitted for March, April, May, and June of 2015, but after that, your “Total Number of Students with a Paid Interim Claim” is final.