Ask Me Anything:
Medicaid Edition

Aurora: The policy shift that occurred in 2014, Free Care Expansion, allows School-Based Medicaid to expand its state’s program: service areas, other student plan types, and provider types. With the expansion, school districts can gain more reimbursement for services that were previously prohibited from billing because they were not based on an IEP.

April: Every member of Frontline’s Medicaid team stays up to date and informed on new regulations, and, when needed, gets answers to clarifying questions from state Medicaid officials. As a company that supports Medicaid billing in a diverse array of states, Frontline has vast experience with all of the changes that a district might face, and is always ready to quickly update Frontline Medicaid & Service Management to comply with those changes.

Aurora: In addition to the Frontline team staying up to date on regulations, we communicate relevant changes to our clients, too. For example, we send consistent email updates to clients regarding school-based regulatory updates for their state, and every client has a designated monthly meeting with their assigned Frontline representative during which they can review claims, ask questions, and any potential additional revenue opportunities.

Mary: My top three: the focus on the expansion of Free Care, Federal Audits of state practices, and Rehabilitative Behavioral Health Services (RBHS) claiming for mental health.

Aurora: It’s all about Free Care for me. There are trends happening within Free Care expansion. Ordering, Prescribing, and Referring (OPR) providers are having to register for a National Provider Identifier (NPI), and/or enroll with their state Medicaid as an OPR provider. These ORP providers’ NPI are also required on the claim line when submitting services and/or evaluations. The Mental Health service area is expanding with new providers, services, and/or evaluation services.

Aurora: To start, I would focus on updating job descriptions and NPI requirements along with updating parent consent forms to reflect non-IEP services. And knowing that Free Care is one of the most common changes coming to districts, it would be in their best interest to implement universal documentation at the district level when your state plan amendments are approved. That way, you can claim any expanded services, provider types, and student plans.

Lynda: Districts are under a lot of pressure due to Medicaid’s compliance and budgetary implications, but here are a few things that come to mind that would benefit districts the most:

• Standardized practices and universal documentation to ensure that IEP’s are audit-compliant.
• Refer to your state’s Medicaid manual — in Texas, it’s the Texas Medicaid Provider Procedures Manual (TMPPM) — for guidance on the required documentation.
• Have a person dedicated to overseeing the Medicaid program, and make sure they work closely with your vendor to maximize revenue (your vendor should be able to help you spot reimbursement potential!).

Stephanie: The first thing that comes to mind is budgeting and appropriation of funds. Making this a proactive process is key. Secondly, staffing federally funded positions has implications for requesting reimbursements, so it’s in your district’s interest to prioritize those. Lastly, participant lists come to mind. Those lists of your service providers can feel tedious, especially if your district experiences a lot of turnover. Keeping those up to date can be crucial in making sure billing goes smoothly.

April: No staff shortages!

Aurora: No turnover! But also, it would be wonderful if Local Education and State Medicaid Agencies would host monthly or quarterly meetings on updates. I’d also like to see regulatory update training for program administrators.

Dzeraldina: It all comes down to assumptions. Unfortunately, providers aren’t always documenting everything in a way that program directors need them to, so making that assumption can come back to bite the district. Also, if you’re not analyzing the data to ensure that your returns are maximized, you’re likely missing out on potential revenue! Finally, assuming that the student demographic data between the state and their SIS matches.

April: Provide training! The initial investment of time pays off throughout the year.

Mary: Make sure that new providers know how to utilize their learning centers.

Stephanie: This process can be challenging, but here are two things you can do to make it less painful:

• Understand the data that is needed and ensure the previous vendor provided clear, understandable data that they can use.
• Request your data from your previous vendor prior to alerting them that you are transitioning to a new vendor.

Dzeraldina: If you have a solid understanding of the data flow between your district, your vendor, and the state, you’ll be well-positioned.

Stephanie: If a district gets paid more in Interim payments than their overall expenses related to Medicaid (provider salaries, Medicaid allowable purchases, transportation, etc.) they must give money back to make up the difference.