INFANTS & TODDLERS PROGRAM IFSP SERVICE COORDINATION MEDICAID BILLING MANUAL

Transcription

1 Prince George's County Public Schools INFANTS & TODDLERS PROGRAM IFSP SERVICE COORDINATION MEDICAID BILLING MANUAL Prince George's County Public Schools Medicaid Office School Lane, Temp # C Upper Marlboro, MD Phone Fax

2 IFSP SERVICE COORDINATION MEDICAID BILLING MANUAL Contents INTRODUCTION & OVERVIEW Program Background & Description Program Mission Our Values Overview of Eligibility Requirements Other Requirements IFSP SERVICE COORDINATION Certification / Licensure Requirements What Is Service Coordination or Case Management? What Types of Case Management Services Are Billable For Medicaid? Description of IFSP Service Coordination Types MEDICAID BILLING PROCESS & RESPONSIBILITIES Medicaid Office - Internal Process Medicaid Coordinator s Responsibilities IFSP Service Coordinator Responsibilities Managing Parental Consent Managing IFSP Service Coordinator Notification Medicaid Record Retention Documentation Requirements - IEP Coordination FRAUD & FALSE CLAIMS STATEMENT SAMPLE MEDICAID BILLING FORMS Revised 2/16/2017 Medicaid Billing Manual

3 INTRODUCTION & OVERVIEW PROGRAM BACKGROUND & DESCRIPTION The Prince George s County Public School (PGCPS) System participates in a Federal health insurance program called Medicaid. The program assists school districts by providing reimbursement for medically-related services listed on a participant s Individualized Family Service Plan (IFSP). Although this reimbursement is available only for participants who are Medicaid eligible, services are provided to ALL Infants and Toddlers participants with developmental delays regardless of their Medicaid eligibility status. The Medicaid Recovery Office (MRO) within Business Operations (Office of the CFO) in collaboration with the PGCPS Infants & Toddlers Program (ITP) within the Office of Special Education are tasked with maximizing recovery of the Medicaid funds. Currently, there are around 800 Medicaid eligible participants within PGCPS Infants & Toddlers Program. The school district can bill Medicaid for case management and health related services identified in a student's IFSP. These services include speech/language therapy, occupational therapy, physical therapy, and health-related evaluations. PROGRAM MISSION We support student achievement by maximizing the recovery of Medicaid funds through collaborative relationships within the school district s community. OUR VALUES We agree to always operate with high integrity; show respect for each other s ideas and feelings; hold each other accountable for performing with excellence; and always communicate clearly and concisely with each other and our stakeholders. OVERVIEW OF ELIGIBILITY REQUIREMENTS In order for PGCPS to receive Medicaid reimbursement under IDEA Part C, the services billed must be: o o o o o o Provided to a Medicaid eligible participant between birth and 3 years old Provided to a participant with an active IFSP Provided by a qualified practitioner (possess proper licensure/certification) Medically necessary and address a participant s delay Consistent with the intent of the IFSP identified services and planned goals Documented to support that the services billed relate directly to the IFSP Revised 2/16/2017 Medicaid Billing Manual

4 OTHER REQUIREMENTS Parental Consent Federal regulations (34 CFR (d)) require PGCPS to obtain written consent from the parent before billing Medicaid. PGCPS does this through the Medicaid Parental Consent form (page 16) or the MA Authorization page from the IFSP. Parental Notification On February 14, 2013, Federal regulations were revised to require PGCPS to provide written notification to each parent prior to the parent s consent and annually thereafter. This notification explains all of the protections available to parents under Part C, as described in 34 CFR (d)(2)(v) to ensure parents are fully aware of their rights. IFSP Service Coordinator Notification - State of Maryland regulations (COMAR ) require PGCPS to provide notification, as well as, obtain approval from the parent regarding the family s assigned service coordinator and the parent s acceptance of coordination services related to the IFSP. The Service Coordinator Notification form (page 17) documents the parent s approval and must be renewed for each change in case manager during the IFSP. Revised 2/16/2017 Medicaid Billing Manual

5 IFSP SERVICE COORDINATION CERTIFICATION / LICENSURE REQUIREMENTS In order to submit billing for IFSP Service Coordination, the service provider must be: o o o A professional who has a current license or certification in accordance with COMAR : Occupational therapist, physical therapist, or speech-language pathologist or other health professional licensed in the State of Maryland; OR A special educator with a MSDE issued teaching certificate (Advanced Professional Certificate, Standard Professional Certificate or a Conditional 2-year Certificate). A nonprofessional who has a high school diploma or its equivalency as outlined under COMAR (C)(2). Both the professional and nonprofessional should demonstrate training or experience in providing case management or other early intervention services to infants and toddlers with special needs and participate in ongoing training as required under COMAR (C). WHAT IS SERVICE COORDINATION OR CASE MANAGEMENT? Service Coordination is defined as case management services that assist participants in gaining access to the full range of Medical Assistance services, as well as to any additional needed medical, social, mental health, financial assistance, counseling, educational and other support services. COMAR (B)(1). WHAT TYPES OF CASE MANAGEMENT SERVICES ARE BILLABLE FOR MEDICAID? Initial IFSP Periodic IFSP Review Ongoing Service Coordination DESCRIPTION OF IFSP SERVICE COORDINATION TYPES Initial IFSP This service consists of convening and conducting an IFSP team meeting to perform a multi-disciplinary assessment, which results in the development of an initial IFSP for a family. This service is billed once in the lifetime of the child. Revised 2/16/2017 Medicaid Billing Manual

6 Periodic IEP Review This service consists of convening and conducting an IFSP team meeting (other than the initial IFSP meeting) to review the child s progress towards IFSP goals. This may result in a revised IFSP. The team performs a multidisciplinary re-assessment of the IFSP status and service needs. No more than three (3) IFSP meetings (of any type) can be billed to Medicaid within a 12-month period. Ongoing Service Coordination This service consists of activities throughout the month by the service coordinator to assist families in gaining access to the services indicated in his/her IFSP. The following IFSP service coordination activities are billable only if included in a documented telephone call or visit with the participant's family. Maintaining contact with the participant and family through home visits, telephone calls, and follow-up services regarding IFSP. Referring the participant to direct service providers specified in the IFSP. Assisting the participant in gaining access to services specified in the IFSP. Discussing with direct service providers the services needed and available for the participant. Assessing the quality and quantity of services being provided. Following up to identify any obstacles to a family's utilization of services. Coordinating the service delivery. Performing ongoing monitoring to determine whether the services are being delivered in an integrated fashion as recommended on the IFSP, and meet the family's current needs. Providing a family with information and direction that will assist them in successfully accessing and using the services indicated in the IFSP. Informing the participant s family of their rights and responsibilities in regard to specific programs and resources recommended in the IFSP. Revised 2/16/2017 Medicaid Billing Manual

7 MEDICAID BILLING PROCESS & RESPONSIBILITIES MEDICAID OFFICE - INTERNAL PROCESS The Medicaid Office s internal process begins with the identification of Medicaid eligible Infants & Toddlers Program (ITP) participants. Identification of this population is generally achieved in two ways: Conducting a data match with the State of Maryland Department of Health and Mental Hygiene (DHMH) & Maryland State Department of Education (MSDE). Identifying those ITP participants as having Medicaid and an active IFSP in Maryland Online IFSP. On a monthly basis, the ITP service coordinators and other service providers complete their contact logs, billing forms along with any additional paperwork. Prior to billing, the Medicaid office ensures each claim meets the minimum requirements such as parental notification of service coordinator, parental consent, adequate service coordinator qualifications, and student s Medicaid eligibility. Once claims are verified, the Medicaid Office submits the claims to DHMH for reimbursement on a bi-weekly basis. Payments are received via wire transfer and are recorded into the appropriate Medicaid fund within the Oracle financial system. MEDICAID COORDINATOR S RESPONSIBILITIES Supervisors of ARC Service Coordinator are responsible for the following tasks: Ensuring each participating family is assigned to an IFSP Service Coordinator and Maryland Online IFSP (MDIFSP) within 48 hrs. Ensuring all Medicaid Billing Form and supporting documentation for each Medicaid eligible participant are adequately documented and submitted to the ARC biller by the 5 th of the subsequent month. Collaborating with the Medicaid Office to resolve any outstanding Parental Consents and Medicaid numbers. Facilitating changes to Maryland Online IFSP to reflect changes in participant status within 48 hours. Communicating Medicaid policies and procedures to the service coordinators. Revised 2/16/2017 Medicaid Billing Manual

8 IFSP SERVICE COORDINATOR RESPONSIBILITIES IFSP Service Coordinators are responsible for the following tasks: Obtaining outstanding parental consent(s) as needed. Completing IFSP Contact logs in MDIFSP by the 5 th of the following month. (At least one claim is needed for each participant per month): o Conducting IFSP Team Meetings; or o Qualifying telephone call to parents regarding IFSP; or o Home visits to meet with parents/guardians regarding IFSP. Submitting Add/Change Form for updates to MDIFSP for any changes in the student's IFSP status. MANAGING PARENTAL CONSENT As of February 14, 2013, Federal regulations (34 CFR (d)) require PGCPS to obtain a one-time written consent (or Parent Permission) form for each participant prior to billing Medicaid. The consent specifies the participant s information disclosed to the State of Maryland s Department of Health and Human Services (DHHS) for Medicaid billing purposes as well as the parent s understanding and agreement to allow PGCPS to access their medical assistance benefits to pay for services. The Service Coordinator s responsibility is to obtain the written parental consent for each participant. This consent may be obtained in two ways: Medicaid Parental Consent Form, signed by the parent (maintain original in EIR folder); or Medical Assistance Authorization page of the IFSP, signed by the parent The latest version of the Medicaid Parental Consent Form in both English and Spanish can be located on our website The Medicaid Office will inform The ARC of any participants with outstanding parental consents on at least a monthly basis. The ARC biller should scan and these forms to sas.medicaidfax@pgcps.org Revised 2/16/2017 Medicaid Billing Manual

9 MANAGING IFSP SERVICE COORDINATOR NOTIFICATION An updated IFSP Service Coordinator Notification form is required anytime the service coordinator changes. A template of the service coordinator notification letter is available on the Medicaid Office website The first notification form is completed at the initial IFSP meeting by the attending service coordinator (or lead provider or special educator). No further action is required by the Service Coordinator after the initial notification form, as the Medicaid Office will facilitate this process by mailing the notification forms directly to the parent(s)/guardian(s). The Service Coordinator Notification Form provides the parent the option to return a signed copy of the letter to the Infants and Toddlers Program within fifteen (15) days. In the instance these forms are received from the parent, a copy should be sent to the Medicaid Office and a second copy maintained in the student s EIR folder. Copies of the service coordinator notification forms are readily available from the Medicaid Office and the service coordinator can request copies at any time. Revised 2/16/2017 Medicaid Billing Manual

10 COMPLETING AND SUBMITTING IEP SERVICE CLAIMS Medicaid billing forms are required to be completed for each participant by the 5th of the following month. Services will then be entered into the Compuclaim Service Portal by the designated biller: You are required to complete the MDIFSP Parent Contact Log for every Medicaid eligible participant. If there were no billable services for the month you should still complete the MDIFSP Parent Contact log as no contact and indicate the reason in the comments section. Some non-billable instances include: Family was unable to be reached Family has indicated that they no longer wish to receive services Participant no longer has an active IFSP MEDICAID RECORD RETENTION Service Coordinator should maintain current logs of any contact with the parents in MDIFSP, as well as signed copies submitted for billing. The ARC s designated biller should scan and to sas.medicaidfax@pgcps.org any Medicaid Billing Forms and supporting documentation within 72 hours of them being entered into Compuclaim. Medicaid related documentation must be maintained for a minimum of six (6) years. DOCUMENTATION REQUIREMENTS - IEP COORDINATION Initial IFSP When billing for an Initial IFSP meeting, scan and the following forms to the Medicaid Office at sas.medicaidfax@pgcps.org Copy of the Parental Consent form (or Medical Assistance Authorization page of the IFSP) Copy of the Signature Page from the IFSP meeting with parent s signature and participating providers signatures Copy of the IFSP Service Coordinatior Notification form Copy of the associated service coordinator s signed Parent Contact Log from MDIFSP Copy of the associated service coordinator s signed Medicaid Billing Form Revised 2/16/2017 Medicaid Billing Manual

11 IFSP Review When billing for an IFSP Review meeting, scan and the following forms to the Medicaid Office at If the biller is unable to locate the student in the Service Portal, please contact the Medicaid Office for guidance. At times, adjustments or corrections may need to be made in MDIFSP. The following dates should match on the submitted paperwork: o Signature Page of the IFSP o Signed MDIFSP Parent Contact Log o Signed Medicaid Billing Sheet Ongoing Service Coordination Case Managers will document at least one contact per month in MDIFSP Parent Contact Log. This contact should be regarding the participant s progress pertaining to their IFSP goals and objectives, in addition to any services provided to the family. The contact from the Case Manager can be: in person, by telephone Documenting Parental Contacts Documenting any parental contacts for Service Coordination (for Medicaid billing purposes) requires a minimum of the following: Child s name Name of the person contacted Date of the contact Summary of the discussion. Topics must be IFSP related and the progress of the student should be noted. Name and title of the person making contact. Contact must be with the child s parent or legal guardian. Revised 2/16/2017 Medicaid Billing Manual

12 When describing a phone call, indicate to whom you spoke, the nature of the call and how it relates to meeting the goals detailed in the student s IFSP. Document the discussion with the parent regarding the child s progress towards mastery of the IFSP goals. (Contact must be with parent/guardian only. Voice mail messages cannot be used as a contact type). Here are examples of adequate documentation for the Contact Log in MDIFSP: Example 1: Called Mom. We discussed David s progress David is one year old. David is having problems with his feet. Karen (PT) saw that David's feet do not go flat on the floor. Karen (PT) suggested that David's muscles are tight. David is still not sitting yet. Karen (PT) came to see David today and he was alert. Karen (PT) suggested to continue tummy time and working time on sitting. Karen (PT) said to put him in his playpen to get used to standing. Karen (PT) also suggested to use a diaper box to help David sit up straight. David saw his Pediatrician for his one year checkup, who recommended that if David s feet don't improve, to see a Neurologist....Raven Jones (SC) When describing a face to face meeting, indicate with whom you met, the nature of the meeting and how it relates to meeting the goals detailed in the student s IFSP. Document the discussion with the parent regarding the child s progress towards mastery of the IFSP goals. (Contact must be with parent/guardian only.). Example 2: Went to the family's home for a home visit. Rosita (child), her father and 3 siblings, Melissa Watts (PT), Cathy Green (SE) and I were present. I explained the TPM, Transition testing, IEPEM, and Extended IFSP/IEP options. We reminded Dad that we still need copies of her Birth Certificate and updated Immunization Record. I gave him the Child Find brochure in order to refer his two older children. Rosita is receiving PT 2x monthly with Melissa (PT) and SI 2x monthly with Cathy (SE). Dad says he can see her progress and is happy with it. I also reminded dad of Rosita s upcoming meeting on March 12, 2017 at 11:00 am. Theresa Thomas - Service Coordinator Revised 2/16/2017 Medicaid Billing Manual

13 FRAUD & FALSE CLAIMS STATEMENT The purpose of this statement is to comply with Section 6032 (Employee Education about False Claims) of the Deficit Reduction Act of 2005 (DRA) in relation to the Prince George's County Public Schools (PGCPS) Medical Reimbursement Program. Section 6032 of the DRA requires providers that make or receive annual Medicaid payments of five million dollars or more during a federal fiscal year (October 1 to September 30) to educate employees and certain contractors about federal and state false claims laws and whistle blowing protections available under those laws. The False Claims Act (FCA) prohibits any individual or company from knowingly submitting false or fraudulent claims, causing such claims to be submitted, making a false record or statement in order to obtain payment from a federally funded program for such a claim, or conspiring to get such a claim allowed or paid. Knowing or knowingly means that a person (1) has actual knowledge of the information; (2) acts in deliberate ignorance of the truth or falsifies the information. Examples of the type of activity prohibited by the FCA include billing for services that were not provided and up coding, i.e., billing for a highly reimbursed service in lieu of the service actually provided The FCA imposes civil penalties on individuals and companies who knowingly submit a false claim or statement to a federally funded program, or otherwise conspire to defraud the government, in order to receive payment The FCA also protects individuals who report suspected fraud. Any person who lawfully reports information about false claims or suspected false claims that are submitted by others, may not be retaliated against, demoted, suspended, threatened, or harassed for making such a report. The FCA provisions are generally enforced by the US Department of Justice. False representations include knowingly and willfully: Concealing, falsifying, or omitting a material fact; Making a materially false or fraudulent statement; or Using a document that contains a statement of material fact that the user knows to be false or fraudulent. Revised 2/16/2017 Medicaid Billing Manual

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15 SAMPLE MEDICAID BILLING FORMS Revised 2/16/2017 Medicaid Billing Manual

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