Presentation on theme: "Medicaid Document Compliance Requirements. AGENDA Timeline Process Overview Persons Responsible Parent Medicaid Consent Forms Creating Letter of Medical."— Presentation transcript:
Medicaid Document Compliance Requirements
AGENDA Timeline Process Overview Persons Responsible Parent Medicaid Consent Forms Creating Letter of Medical Necessity Forms Q/A RECAP 2
Timeline Documents generated and signed should follow to the BOE within 24 hours of creation. This timeline is required to maintain the accuracy of claiming and compliance. 3
Parent Medicaid Consent The Starting Point… Parent Medicaid Consent form given to parent, explained YesNo 4
The Process Parent Medicaid Consent Form = Yes Initial Meeting or New to District OT, PT, Speech 5 Parent Medicaid Consent form- give form to parent, explain. Yes Letter of Medical Necessity for a New File Consent obtained once per child, not annually.
The Process Parent Medicaid Consent Form = Yes Annual Review OT, PT, Speech 6 Parent Medicaid Consent form previously given Yes Letter of Medical Necessity for an Annual Review
The Process Parent Medicaid Consent Form = Yes Addendum OT, PT, Speech 7 Parent Medicaid Consent form previously given Yes Letter of Medical Necessity for an Addendum
The Process - No 8 Parent Medicaid Consent form No Send original to Robbi Moody at the BOE Keep copy in file material
Persons Responsible Speech Pathologists will originate and obtain the Parent Medicaid Consent (PMC) and originate the Letter of Medical Necessity (LMN) for all students with Speech Therapy. – Speech Only – Speech with OT – Speech with PT – Speech with OT and PT OT and PT only files will be obtained/originated by the OT if both OT and PT exist- and by the PT if only PT exists. -OT and PT will be obtained/originated by OT -PT only will be obtained/originated by PT 9
PARENT MEDICAID CONSENT (PMC) 10
Creating and obtaining the Parent Medicaid Consent form Go to Infinite Campus Go to student file in IC Go to the “Index>Student Information>Special Education>General- documents tab Create “new” document > new simple form > Parent Medicaid Consent – fill out IEP date, save, print Explain form to parent When the parent/guardian signs and returns the form, check for signatures, dates, completed doctor information. If incomplete, contact parent to get updated information Scan and attach completed form to the student file in IC Return original signature form immediately (24 hours) to Robbi Moody at the BOE via interoffice mail See Parent FAQ’s 11
More info…Parent Consent Obtain parent consent using the form within IC ***Do not use old printed forms The Parent Medicaid Consent (PMC) must be created within IC, docs tab, student file… Make a copy for your own file Scanning, copying, sending are all a part of the compliance process A PMC is only required on: 1) new files, 2)students new to the district or 3)as directed by District Office personnel Correct explanation of the purpose of the PMC to the parent is required, seek out information if you are unaware of specifics (see Robbi Moody for training) 12
Explaining The Parent Medicaid Consent Form 14
Purpose 1)Obtain consent from parent / guardian to exchange data about their child to the Department of Community Health (DCH/Medicaid), if requested 2)Request reimbursement for services already delivered to child for OT, PT, Speech 15
The purpose statement in the form… The School System is providing health-related services to your child in accordance with his/her Individual Education Program (IEP) at no cost to you, the parent/guardian. Medicaid is required to help the School System cover the cost of some services provided to your child. The School System is required to share information in your child’s IEP with the Department of Community Health (DCH) and your child’s primary care physician or another physician who has had a face to face visit with your child prior to billing Medicaid for its share of the costs of the services. 16
Parent Choices The choices are ‘yes’ or ‘no’. Neither choice will impact service delivery as reimbursements are claimed on services already rendered No future impact on service delivery if ‘no’ Signature and date are required and signify the choices made 17
The choice statement in the form…. 18 I understand that denial of my consent will not affect delivery of services under my child’s IEP. I further understand that the school district may receive partial reimbursement from Federal Medicaid funds for these services and that this reimbursement will not affect my child’s Medicaid insurance benefits. YES I give my consent for the Paulding County School District to bill Medicaid/Peach Care and for the School System to share information in my child’s IEP with DCH with my child’s primary care physician or another physician who has seen my child face to face. NO I do not give my consent for the Paulding County School District to bill Medicaid/Peach Care and for the School System to share information in my child’s IEP with DCH with my child’s primary care physician or another physician who has seen my child face to face.
Signature statements in the form… Parent/Guardian Name (PLEASE PRINT) Parent/Guardian Signature:Date It is my responsibility as a parent/guardian to notify the Special Education Department in writing if I ever decide to withdraw my permission. I understand that if I do not give permission or if I withdraw by permission, the School System will continue to provide IEP related services to my child at no cost to me. 19
Primary Care Practitioner Doctor Information 20 Primary Care Practitioner (PCP) information is required Some persons do not yet have a doctor, this information can be updated later through phone, or direct contact
21 If you give permission, please provide the information below. DR. NAME student’s physician): DR. PHONE NUMBER: DR. ADDRESS:CITY/ZIP: If you have any questions, please call: Primary Care Practitioner Doctor Information in the form….
22 When parent has chosen ‘yes’ in the Parent Medicaid Consent form, go forward with processing of a Letter of Medical Necessity. If the parent marked ‘no’, then no Letter of Medical Necessity is required.
Letter of Medical Necessity (LMN) 23
Letter of Medical Necessity Annual Review Speech Pathologists will create the Letter of Medical Necessity for any/all OT, PT, Speech services following the annual review IEP meeting or immediately following an addendum in which services for OT, PT or Speech changed. Go to student file within IC>Index>Special Ed>General- Documents tab>Create new form>Create New Simple Form>Letter of Medical Necessity. Create, save, print. Check the services that apply, sign and send the form to Robbi Moody at the BOE via interoffice mail. Notes: 24 hour turnaround time from creation to sending… Supervising OT will sign all COTA served treatment plans before the document will be complete with signatures. 24
Letter of Medical Necessity Amendment At every annual review a Letter of Medical Necessity is required For amendments, a Letter of Medical Necessity (LMN) is only needed if services changed or services were added in the amendment (service related to OT, PT, Speech) Create in IC, save to IC, print/sign and send form to Robbi Moody 25
PMC & LMN Recap-New 27 ONLY for student files who have an IEP / eligibility AND the following services: OT, PT, Speech The Provider responsibilities for new files/new eligibilities/new OT, PT, Speech services are: 1) Provide Parent Medicaid Consent to Parent/Guardian, only needed once at initial IEP or new file created upon entrance to the district (or at any other ‘directed’ time). 2) Explain the Parent Medicaid Consent to the Parent/Guardian. 3) Obtain signatures and doctor (Primary Care Practitioner) information on the Parent Medicaid Consent form. 4) Return the Parent Medicaid Consent form to Robbi Moody at the BOE via interoffice mail within 24 hours of obtaining document signature. 5) Maintain copies of document in the electronic student file (scan and attach to IC), and in the provider file. 6) If the parent marked ‘yes’ then continue to next steps. 7) Create the Letter of Medical Necessity, choose the applicable services (OT, PT, Speech), sign the service line in which you serve the student. In the case of COTA served, the supervising OT must also sign along with COTA. (scan and attach to IC) 8) Return documents within 24 hours to Robbi Moody at the BOE via interoffice mail.
LMN Recap-Annual Review For files in which you are having an annual review that contain OT, PT, Speech and the Parent Medicaid Consent form is ‘yes’: 1)Upon the annual review meeting completion, print, create and sign the Letter of Medical Necessity. 2)Return the Letter of Medical Necessity to Robbi Moody at the BOE via interoffice mail within 24 hours of the meeting. (Scan and attach to the file in IC) 3)Monitor all files routinely for completed paperwork (LMN) 28
LMN Recap-Addendum For files in which you are having an addendum that changes service types, times and delivery methods for OT, PT, Speech and the Parent Medicaid Consent is ‘yes’. 1)Upon the addendum meeting completion, print, create and sign the Letter of Medical Necessity. 2)Return the Letter of Medical Necessity to Robbi Moody at the BOE via interoffice mail within 24 hours of the meeting. 3)Monitor all files routinely for completed paperwork (LMN). 29
Q/A What are the responsibilities? For FY15, Speech Pathologists are required to manage the Medicaid document process if the student receives any combination of services that include speech. Examples: SLD student receiving Speech and OT. Speech only student. Speech student with PT services. SLD student with Speech, OT and PT services. Files with OT and or OT/PT will be the responsibility of the OT/COTA for management of the Medicaid document process. Files with PT only will be the responsibility of the PT for management of the Medicaid document process. Once the Medicaid Parent Consent and Letter of Medical Necessity packet is received by the District, the District office will take up responsibility for getting the document to the doctor and back. 31
Q/A I’m not responsible for anything that happened with a prior case manager nor in a prior year, correct? As an employee of the district, it is our responsibility to make sure that procedures are followed whether we were the case manager, therapist/provider or not. 32
Q/A What happens if the letter of medical necessity gets lost from case manager to the BOE? Routinely we will ask for another letter of medical necessity to be signed if it is missing. An or phone call will be placed if that happens. 33
Q/A The parent waived the Parent Medicaid Authorization form explanation….what do I do? The parent can waive their right to the explanation if they so choose. 34
Q/A The parent said they are not on Medicaid. I don’t need to do anything else, correct? Please note it is not necessary to be on public Medicaid, Peach Care, etc. in order to see if a student qualifies for school based service reimbursement. The CISS eligibility can be an ever changing process. Therefore, there is no question of whether they are currently ‘on Medicaid’ or not. It is a question of whether or not they will allow the district to: A) see if the student qualifies/is eligible and B) request reimbursements if they agreed to ‘A’. 35
Q/A I do not feel comfortable explaining Medicaid forms to the parent. I should leave it to the Principal, Lead, District office to explain it. No, as a Case Manager, Service Provider, Therapist and Administrative Outreach person, you should familiarize yourself with all training and materials available such that you can explain the Parent Medicaid Consent to the parent. You are the person that the parent should rely upon for information. Seek out information to help you do that such as training materials, asking questions, etc. 36