All NAME Regions have full concern over the possible repeal and replacement of the Affordable Care Act. Many of us have been actively working with the press and our colleagues to tell the story of how School-Based Services supports our local districts along with the physical and mental health needs of our children in schools. Interestingly, two Region 2 states, Texas being number one and Michigan number six, are in the top ten states for receiving Medicaid school funding in the nation.
Now that the U.S. Senate was unable to get the votes to repeal this Act, what’s next? The Senate will continue to try to come up with a compromise that will appeal to both sides of the aisle. As you know, NAME is working to protect Medicaid coverage for the student population, but that isn’t the only component of this repeal. The bill is not dead it’s in a coma, waiting to be revived, if we want to use an unfortunate analogy. Stay tuned…
News From Indiana-
The Indiana Division of School and Community Nutrition Programs has received permission from USDA to pilot the use of Medicaid Data for the purposes of Direct Certification. While Medicaid has been used for Direct Verification purposes for a decade, this will be the first time that Medicaid eligibility will be used for Direct Certification and the initial eligibility determination for Free and in some cases Reduced-Price Meals. To implement these changes, some small changes need to be made and implemented by Software Vendors who supply services to Indiana School Districts operating the National School Lunch or School Breakfast Programs.
Flint Water Crisis The USDOE press release dated October 7, 2016 stated USDOE’s Office of Safety and Healthy Students has awarded $480,000 to Flint Community Schools in Flint, MI. According to the press release the grant will be “used to restore the learning environment following the water crisis that began in 2014.” Further information on the award other federal efforts to assist Flint can be found at https://www.ed.gov/news/press-releases/us-department-education-awards-480000-flint-michigan-schools.
Genesse Intermediate School District Genesee Intermediate School District is also part of another exciting project currently under development. This new project is a combined effort with non-profit Flint Kids Learn, Charles Stewart Mott Foundation, Community Foundation of Greater Flint, University of Michigan-Flint (UM-Flint), Flint Schools and Genesee Intermediate School District. These organizations and foundations have continued to be a part of developing projects to assist Flint children, which has made a tremendous impact in the Flint community.
The project is a new school located in Flint expected to open in the Fall of 2017. The school will be servicing Flint student’s ages 8 weeks to 3 years old. It will also include an adult education learning space, a need identified by community organizations. Genesee Intermediate School District will provide educational programming and services to an expected 200+ children. UM-Flint will collect data and conduct research needed by policy makers.
Florida Match Funding for Private and Charter Schools The 2016 Florida Legislature appropriated funding to be used for the state match for Medicaid-reimbursable services provided by private and charter schools. The state Medicaid agency is submitting a Medicaid state plan amendment to add the private and charter school providers.
Greetings from Region 2! We are pleased so share with you, news from our Region that was submitted by our members. We look forward to hearing from you with your thoughts and feedback.
Region 2 Policies and Procedures Committee Members Did you know? Two of your fellow Region 2 NAME members— Anne Glass (FL) and Kathy Merry (MI)—serve on the NAME Policies and Procedures Committee (P&P). The P & P Committee is in the process of organizing all of NAME policies and procedures that are relevant to our members. The Committee hopes that knowledge is power, and sharing such information will keep you interested and quench your curiosity about the internal workings of NAME. Once completed, the Committee will post those relevant policies and procedures on the NAME website.
Healthy Schools Campaign: Headquartered in Illinois The Healthy Schools Campaign is a key member of a coalition of like-minded organizations working to “…ensure that all children have access to healthy schools where they can learn and thrive…”. With headquarters in Chicago, Illinois, the Campaign was one of those organizations that worked to persuade the Centers for Medicare and Medicaid Services to “revise” their “free care policy” (see link below). The Healthy Schools Campaign continues to provide guidance as the new ‘free care’ policy initiative is implemented around the country. To learn more about the Healthy Schools Campaign, visit their website: https://healthyschoolscampaign.org/programs/national/national-collaborative/.
Telehealth in Indiana Indiana is exploring the possibility of adding Medicaid coverage for telehealth services provided in the school setting.
Ohio Medicaid Agency Changes Medical Necessity Requirements Impacting IEP Claiming
Beginning August 1, 2016, all speech, audiology, occupational therapy, and physical therapy services reimbursed by the Ohio Medicaid in the Schools Program (MSP) will require an order, referral, or prescription to establish medical necessity. Previously, the Individual Education Plan (IEP) served as the prescribing document for services delivered to students and reimbursed to Ohio schools.
The change has come about after discussions between the Centers for Medicare and Medicaid Services (CMS), and the Ohio Medicaid agency on the state’s use of the IEP. The CMS indicated their decision was due in part to requirements of the Affordable Care Act (ACA). While Ohio school therapists meet the federal Medicaid regulations as “licensed practitioners of the healing arts”, current Ohio laws do not authorize therapists the ability to diagnose, which falls short of meeting Medicaid’s requirement for medical necessity.
So beginning in the 2016-17 school year, schools will be required to obtain an order, referral, or prescription from a medical practitioner whose scope of practice covers diagnosing those previously-mentioned services. This will affect approximately 60,000 children and students in order for Medicaid reimbursement for their therapies to continue.
Both educational and medical stakeholders are working together to design a process for obtaining referrals, prescriptions or orders, that does not disrupt the existent IEP processes for all children and students in special education that also meets the new Medicaid requirements. One approach is to use another state’s practices, so both the Ohio Department of Medicaid and the Department of Education are reviewing other states’ School Based Services policies.
Flint, Michigan Water Crisis The high lead level water crisis in Flint, Michigan has a direct impact on Flint schools and school aged children and their families. The astronomical amount of local and national coverage of this story makes it impossible for us to summarize it, so we are providing you some links to some news articles and resources that have been developed as a result of this tragedy:
1. Bilal Tawwab, superintendent of schools in Flint, was interviewed on February 8, 2016 by Renee Montagne, co-host of NPR’s Morning Edition radio show. They talked about how the Flint lead water crisis is affecting schools in his district. The interview can be found here: http://www.npr.org/2016/02/08/465974192/school-superintendent-in-flint-worries-about-water-crisis-irreversible-harm
2. The State of Michigan submitted a request for a waiver to the Centers for Medicare and Medicaid Services (CMS) to allow for expanded Medicaid eligibility for those up to age 21 and pregnant women who have been served by the Flint water system. The press release is at this link: Taking Action on Flint Water
3. The State of Michigan has created a website about the crisis which is updated daily. Information includes how to help; press releases from the Governor; the reports of lead water levels in Flint school buildings; videos for residents showing how to gather samples of their water and how to change water filters; all at this link: http://www.michigan.gov/flintwater
4. To provide important information to the Flint community and others, the State of Michigan has developed an inventory of communication materials to meet the needs of the city’s diverse populations. Key informational materials related to the Flint water crisis are available in Spanish, Mandarin Chinese, Arabic and Hmong, American Sign Language (ASL), and for individuals with no or limited English proficiency. Some of the materials being developed include:
A video in ASL to meet the needs of students at the Michigan School for the Deaf located in Flint, which is also home to a large population of individuals who are deaf.
Translated documents are available in the “Alternative Language Resources: Español - 中文 - ألعربي” section of this website: www.michigan.gov/flintwater. Further, the federal Environmental Agency which is assisting in this crisis has resources available in Spanish, traditional Chinese, simple Chinese, Vietnamese, and Korean available here: www.epa.gov/flint.
5. As of this writing, the Michigan Legislature has allocated almost $70M for a wide variety of the community’s immediate and short-term needs, including reimbursement or payment of 65% of the water bills for families and businesses who are in arrears for their water bills from April 2014 through April 2016; covering the costs of testing residential and commercial water; purchase of water filters; increased staffing of school nurses; and increased funding for Part C of IDEA services, to name a few.
6. The State of Michigan’s crisis response team was mobilized to deal with the crisis. Departments involved are: Education, Environmental Quality, Health and Human Services, Treasury, Technology-Management and Budget, and Agriculture and Rural Development, all to deal with the effects of this unprecedented situation.
7. All major news outlets, large city newspapers, TV stations and other sources have covered the Flint water crisis. Many have compiled their stories and posted on their websites with updates and timelines. Some are here:
Did you know NAME has a list of all members on the website? You may also find a listing of many state Medicaid school based services (SBS) program websites. We have begun to update the Region 2 states SBS resource links on the NAME website. You never know when you may want to contact a neighbor to see how they interpret/train/update/communicate with their state’s stakeholders. We want to make your networking as easy as possible.
If you find that we've listed any information incorrectly, please let us know and we will correct it. If you have information for a state where no website is listed, please share that information with us. And, as usual, don't hesitate to contact any NAME member when you need a helping hand. We are here to serve and collaborate.
For those of us who have been shivering a lot this cold winter, remember: Spring is coming!
Region 2 Representatives on the NAME Board of Directors,
Jim Donoghue (IA) Kevin Bauer (MI) Kathy Merry (MI) Jennifer Haase (MI) Education Medicaid Local Education Agency LEA at-Large
by Kathy Merry (MI) Tracy Brunner (IN) and Jim Donoghue (IA)
NAME’s Region 2 consists of these states: Alabama; Arkansas; Florida; Georgia; Illinois; Indiana; Iowa; Louisiana; Michigan; Minnesota; Mississippi; Missouri; Ohio; Oklahoma; Puerto Rico; Texas; US Virgin Islands; and Wisconsin.
NAME National Survey of the States in Region 2. One of the most important projects NAME does is conduct the biennial national survey of the states—in which the individuals in each state’s Medicaid and Education agencies who work in the Medicaid school based services program, are asked to complete a survey collecting data about their program. NAME has learned over the years that the turnover in these positions is somewhat frequent, so it is not always easy to find the right individuals to participate in the survey.
Members of the NAME Leadership Team are charged to assist the Survey SubCommittee locate the appropriate people. In Region 2 we are pleased we made contact in early 2014 with many new colleagues from states in the Region, listed below. All of them committed to work on completing the 2013 survey which closes on April 15, 2014 (see other article elsewhere in this issue). For those new to NAME’s survey, we welcome your expertise and insights. For the veteran members, thank you for your continued participation. • Arkansas: Martha Kay Asti from Arkansas Department of Education • Florida: Anne Glass works at the University of South Florida • Illinois: Marie Von DeBur and Betsy Wilding from Illinois Department of Healthcare and Family Services • Minnesota: Ruth Ellen Luehr from the Minnesota Department of Education • Missouri: Amy Kessel from the Missouri Department of Social Services • Texas: Dario Avila is with the Texas Health and Human Services, School Health and Related Services • Wisconsin: Allison Markoski (NAME member) from the Wisconsin Department of Public Instruction
OIG Audit of Michigan SBS. In September 2013, Michigan’s Department of Community Health, where the State Medicaid Agency is located, was informed that Michigan had been selected for a federal Office of the Inspector General (OIG) audit of the School Based Services (SBS) Program. This will be the first review of the program since Michigan converted from a true fee-for-service reimbursement methodology to a new cost-based reimbursement plan effective July 2008.
Iowa's LEA Medicaid Program is in its 10th Year & Continues to Grow- Jim Donoghue (IA)
The program here recognizes a broad range of IEP-ordered services, audiology, behavioral health paraprofessional, medical transportation, nursing, nutrition, occupational and physical therapies, personal health paraprofessional, school psychology, school social work, speech/language services, vision/orientation/mobility services and primary and preventive care services at school-based health centers. During the 2011-12 school year, Iowa began transition to 5010 registration and testing (Iowa LEAs can choose to self-bill through free software or use a vendor), and also increased its monitoring of the DHHS/OIG/DHHS Exclusions Database while weathering the first wave of Exclusions findings (so far, the state has found only two issues where an excluded individual provided billed services). Program Integrity audits by the Single State Medicaid Agency have resulted in reports of very limited instances of unsupported documentation and need for recoupment.
From Region IV (AL, FL, GA, KY, MS, NC, SC, TN) Representative Nora Poisella (NC)
Georgia: Terri Portis, Department of Community Health - Georgia's Administrative Claiming for Education Program was authorized by CMS on April 1, 2011, and the State is currently seeking approval for Cost Settlement with the fee-for-service program.
Tennessee: Holly Christopher, Stellar Therapy Services, -- This past school year was the first year our company assisted in obtaining TennCare-Medicaid reimbursements for Special Ed services. We are working hard to build relationships with the Managed Care Organizations and are still awaiting payment from one. We have met with the State Special Education Deputy Commissioner and believe that office is now "on board". Since the Medicaid reimbursement process is not defined statewide, implementation is difficult for schools.
From Region V (IN, WI, MN, MI, OH) - Representative Mark Smith (OH)
Indiana: During May, Department of Education officials John Hill and Tracy Brunner conducted three daylong trainings throughout various regions of Indiana on Medicaid in education programs. John and Tracy worked in cooperation with representatives from the state's Medicaid agency claims contractor and the Education agency's IEP and MAC coordination areas. Additionally, CMS Region V's Lead Funding Specialist provided an overview of federal auditing at each session.
Wisconsin: Carlynn Higbie, a Wisconsin-based school therapy consultant with MJ Care, is collaborating with Medicaid in education officials both within and beyond the Region V area to begin discussing the topic of medical progress reporting and goal writing. While states vary in how they interpret these requirements, she hopes the discussion will help add perspective and clarify the benefits for both IDEA requirements as well as Medicaid's requirements for medical necessity of services delivered in schools.
May 3, 2018: NASDSE Executive Director Job Announcement: The National Association of State Directors of Special Education (NASDSE) Board of Directors, which represents the special education directors of the 50 states and 11 federal jurisdictions, is seeking to fill the position of executive director for 2019 and beyond: