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Policy 4060 - Medicaid Reimbursement for Health-Related Services

The purpose of this policy is to authorize conditions under which the Howard County Public School System may seek reimbursement for health-related services provided to Medicaid eligible children with disabilities.

Policy Document

I. Policy Statement

The Board of Education recognizes its responsibilities to provide services for children with disabilities and to pursue funds available from federal sources for this purpose. Accordingly, the Howard County Public School System (HCPSS) actively seeks reimbursement from the Maryland Medical Assistance Program (Medicaid) for health-related services provided to Medicaid eligible children with disabilities.

II. Purpose

The purpose of this policy is to authorize conditions under which the Howard County Public School System may seek reimbursement for health-related services provided to Medicaid eligible children with disabilities.

III. Definitions

  1. Health-Related Service – Services that include audiology, nutrition, occupational therapy, physical therapy, social work, counseling, nursing, speech and language therapy, psychological and other services approved by federal regulations.

  2. Individualized Education Program (IEP) – An instructional program designed for each child with a disability as recommended by an IEP team.

  3. Individualized Family Service Plan (IFSP) – A service plan designed for each family of a child with a disability as recommended by a multidisciplinary team for a child in the Infants and Toddlers Program.

  4. Medical Assistance (Medicaid) – A Title XIX federal health benefits program administered in Maryland by the Department of Health and Mental Hygiene.

  5. Third Party Billing – The process for billing the Department of Health and Mental Hygiene (DHMH) for reimbursement of health-related services rendered to Medicaid eligible children with disabilities by qualified HCPSS service providers.

IV. Standards

  1. Reimbursement to the HCPSS under the Medicaid Program requires that children, service providers, and the HCPSS are eligible.

    1. To be eligible, a child must be:

      1. Enrolled in Medicaid

      2. Receiving eligible health-related services as required by an IFSP or an IEP.

    2. To be eligible, a HCPSS service provider must be properly licensed or certified in their service field as stated in COMAR 10.09.50.02, "Early and Periodic Screening, Diagnosis and Treatment (EPSDT) School Health-Related or Health-Related Early Intervention Services: Licensure and Certification."

    3. To be eligible, the HCPSS must develop procedures that ensure that all program regulations are met as set forth in COMAR 10.09.36.03, "General Medical Assistance Provider Participation Criteria: Conditions for Participation."

  2. HCPSS will ensure that reimbursed funds received are used to enhance programs and services for children with disabilities.

  3. HCPSS will only seek reimbursement for services that do not result in any additional cost to either the HCPSS or the child’s family.

V. Compliance

The HCPSS Department of Special Education is assigned the overall responsibility for implementing, directing, and maintaining the third party billing process to seek Medicaid reimbursement for health-related services.

VI. Delegation of Authority

The Superintendent is authorized to develop appropriate procedures for the implementation of this policy.

VII. References

  • Individuals with Disabilities Education Act (IDEA) 2004, 20 U.S.C. §§1400 et seq.

  • Public Law 100-360 (Medicare Catastrophic Coverage Act of 1988), Section 411

  • COMAR 10.09.36, General Medical Assistance Provider Participation Criteria

  • COMAR 10.09.50, EPSDT School Health-Related or Health-Related Early Intervention Services

  • COMAR 10.09.56, Home and Community-based Services Waiver for Children with Autism Spectrum Disorder

  • COMAR 13A.05.02.13, Administration of Services for Students with Disabilities 2004

B. Other Board Policies

VIII. History

ADOPTED: March 9, 1995

REVIEWED: July 1, 2015

MODIFIED:

REVISED: January 8, 2009

EFFECTIVE: July 1, 2009