Medicaid For School Staff
These tip sheets include procedure codes to be used during the COVID-19 shutdown.
- (PDF) 111 - Fully Licensed Speech Pathologist COVID-19
- (PDF) 142 - Limited Licensed Speech Pathologist COVID-19
- (PDF) 119 - Audiologist COVID-19
- (PDF) 113 - Physical Therapist COVID-19
- (PDF) 120 - Physical Therapy Assistant COVID-19
- (PDF) 114 - Occupational Therapist COVID-19
- (PDF) 121- Occupational Therapy Assistant COVID-19
- (PDF) 137 - Orientation & Mobility Specialist COVID-19
- (PDF) 112 - Psychologist COVID-19
- (PDF) 123 - MDE Credentialed School Psychologist COVID-19
- (PDF) 115 - Psychiatrist COVID-19
- (PDF) 116 - Social Worker/School Social Worker COVID-19
- (PDF) 117 - Professional Counselor COVID-19
- (PDF) 126 - Limited Licensed Social Worker COVID-19
- (PDF) 127 - Limited Licensed Professional Counselor COVID-19
- (PDF) 122 - Limited Licensed Psychologist COVID-19
- (PDF) 133 - Licensed Practical Nurse COVID-19
- (PDF) 130, 131, 132, 134 - Nursing Services COVID-19
Personal Care Policy:
Effective July 1, 2008, districts may be reimbursed by Medicaid for personal care services. In Wayne County, the recording of personal care services is mandatory for Act 18 programs. Reporting for non-Act 18 programs is at the district's discretion. Note that if a paraprofessional is federally funded, they cannot record personal care services.
Definition of Personal Care Services:
Personal Care Services are a range of human assistance services provided to persons with disabilities and chronic conditions which enables them to accomplish tasks that they would normally do for themselves if they did not have a disability. Assistance may be in the form of hands-on assistance or cueing so that the person performs the task by him/herself.
- The service must be medically necessary (needed to attain or retain the capability for normal activity, independence or self care).
- Personal care services must be authorized by a physician or other licensed practitioner operating within their scope of practice. The "other licensed practitioner" could be of the same discipline as the service in question. For instance, a licensed occupational therapist could authorize the provision of services, as long as doing so is within their scope of practice.
- The need for personal care services must be documented in the student's IEP. In order to facilitate this documentation, the Indivdualized Educational Plan of the Wayne RESA IEP form includes wording similar to the following:
"Is the severity of the student's impairment such that it requires hands-on assistance with daily living skills redirection and behavior, or health related (not academic) monitoring or cueing by a paraprofessional aide?" Yes or No
- In addition to the checkbox on the IEP, a Personal Care Authorization form must be completed and placed in the student's file.
Personal care services must be medically necessary and the need for the service documented in the student's IEP/IFSP. Each child's school clinical record must contain a completed, signed and dated monthly activity checklist.
All Medicaid documentation must be kept on file for seven years.
Personal Care Checklist:
A completed, signed and dated activity checklist must be completed for each student for whom personal care services will be reported. Below are a monthly and a weekly version of the Personal Care checklist. Districts have the option to use either of these lists or may create their own.
The checklist process should works as follows:
- The district will add the names of the students receiving personal care services to each paraprofessional's checklist so that each has their own checklist for logging encounters.
- Each para-professional will record the services they render to each student on their checklist on a daily basis.
- At the end of the month, the paraprofessional will transcribe the information on their checklist into Service Tracker for monthly billing.
We designed these documents to better assist both the school districts and the Medicaid Reimbursement Office in obtaining all of the necessary information for Medicaid claiming. We hope that school districts will find these forms useful. Fee free edit these documents to add your schools' name, address and contact information to these forms.
Physician Orders for Physical Therapy, Occupational Therapy, medications and medical treatment for students receiving school-based services:
- Physician Prescription (DOC)
- Medication Administration (DOC)
- Authorization for Medical Treatment (DOC)
“Under the Direction of” and "Supervision of "Documentation for Medicaid Billable Services by Limited Licensed Staff:
False Claims Act
Pursuant to Section 1902(a) (68) of the Social Security Act, Wayne RESA, as the Medicaid Provider for School Based Services for 33 districts in Wayne County, is required to comply with Section 6032 of the Deficit Reduction Act (DRA) of 2005. Wayne RESA is subject to this act because we receive or make at least $5 million in annual aggregate payments from the federal Medicaid program.
A section of the law entitled "Employee Education About False Claims" cites three (3) requirements; 1) Establish written policies for employees and contractors about the False Claims Act; 2) Establish detailed provision in these policies for detecting fraud, waste and abuse, as well as administrative remedies for false claims; 3) Inform all providers about these policies and their rights to be protected as whistleblowers.
The Federal False Claims Act, among other things, applies to the submission of claims by healthcare providers for payment by Medicare, Medicaid and other federal and state healthcare programs. The False Claims Act is the federal government's primary civil remedy for improper or fraudulent claims. It applies to all federal programs, from military procurement contracts to welfare benefits to healthcare benefits.
The False Claims Act prohibits among other things:
- Knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment or approval;
- Knowingly making or using, or causing to be made or used a false record or statement in order to have a false or fraudulent claim paid or approved by the government.
- Conspiring to defraud the government by getting a false or fraudulent claim allowed or paid; and
- Knowingly making or using, or causing to made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government.
Any person who knowingly attempts to defraud the federal government is liable to the United State Government for a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages which the Government sustains because of the act of that person.
"Knowingly" means that a person, with respect to information: 1) has actual knowledge of the information; 2) acts in deliberate ignorance of the truth or falsity of the information; or 3) acts in reckless disregard of the truth or falsity of the information.
The United States Attorney General may bring civil actions for violations of the False Claims Act. As with most other civil actions, the government must establish its case by presenting a preponderance of the evidence rather than meeting the higher burden of proof that applies in criminal cases. The False Claims Act allows private individuals to bring "qui tam" actions for violations of the False Claims Act.
Protection for "Whistleblowers":
Federal and state law prohibit any retaliation or retribution against persons who report suspected violations of these laws to law enforcement officials or who file "whistleblower" lawsuits on behalf of the government.
To report Medicaid provider fraud:
Michigan Department of Health and Human Services
Medicaid Provider Manual
General Information For Providers: Section 15 - Record Keeping
15.2 RECORD RETENTION -
Providers must maintain, in English and in a legible manner, written or electronic records necessary to fully disclose and document the extent of services provided to beneficiaries. Necessary records include fiscal and clinical records as discussed below. Appointment books and any logs are also considered a necessary record if the provider renders a service that is time-specific according to the procedure code billed. Examples of services that are time-specific are psychological testing (per hour), medical psychotherapy (20-30 minutes), and vision orthoptic treatment (30 minutes). The records are to be retained for a period of not less than seven years from the DOS, regardless of change in ownership or termination of participation in Medicaid for any reason. This requirement is also extended to any subcontracted provider with which the provider has a business relationship.
15.2 ORDERS, PRESCRIPTIONS AND REFERRALS
Providers rendering or arranging services upon the written order of another provider (e.g., physician) must maintain that order, prescription or referral for a period of seven years.
15.4 AVAILABILITY OF RECORDS (Change made 7/1/15)
Providers are required to permit MDHHS personnel, or authorized agents, access to all information concerning any services that may be covered by Medicaid. This access does not require an authorization from the beneficiary because the purpose for the disclosure is permitted under the HIPAA Privacy Rule. Health plans contracting with the MDHHS must be permitted access to all information relating to services reimbursed by the health plan.
Providers must, upon request from authorized agents of the state or federal government, make available for examination and photocopying all medical records, quality assurance documents, financial records, administrative records, and other documents and records (revised 7/1/15) that must be maintained. (Failure to make requested copies available for examination and duplication and/or extraction through the method determined by authorized agents of the state or federal government may result in the provider's suspension and/or termination from Medicaid.) Records may only be released to other individuals if they have a release signed by the beneficiary authorizing access to his records or if the disclosure is for a permitted purpose under all applicable confidentiality laws.
Version General Information for Providers
Date: July 1, 2015 Page 44
Michigan Department of Health and Human Services