1. Terri Stewart: Medicaid Coordinator: thstewar@access.k12.wv.usthstewar@access.k12.wv.us Chrissy Keller: Medicaid Secretary/Assistant: cmkeller@access.k12.wv.us cmkeller@access.k12.wv.us Phone: 304-267-3595 Fax: 304-267-3599 www.RESA8.org

2. MEDICAID REIMBURSEMENT PROGRAM WV Code 18-2 5b permits the RESA 8 school districts to participate and submit claims for Medicaid Reimbursement via for the following services: Physical TherapyOccupational Therapy Speech Language TherapyPsychological evaluations and counseling Audiological ServicesSpecialized Nursing Services IEP DevelopmentPersonal Care Care CoordinationSpecialized Tranportation/Aide Participation in the program requires specific criteria and guidelines as provided by the West Virginia Department of Education, Office of Special Education in coordination with the Bureau for Medical Services, Health Care Financing Agency (HCFA), and the West Virginia Department of Human Services. Reimbursements accrued through the submission of claims are used to supplement services throughout the school districts.

3. GETTING STARTED Each Child must have an Individualized Education Plan, (IEP), By either testing into, currently active, or testing out, with allowed billable services listed on service page(s) or addendum. (No submissions of claims should be dated past the last active day in special education). Each Child must be identified Medicaid eligible At the beginning of each school year RESA will identify all students that are currently Medicaid eligible, with subsequent updates throughout the year. Each Child must have a completed, signed (Consent For Medicaid Billing). Consents may be requested yearly at the completion of an IEP, or when service units change. Example: next page

4. The Medicaid Consent Form is a stand alone form. This form should be completed upon the creation of a new IEP or if there has been a change to a greater extent of services in a current IEP.

6. WWW.RESA8.ORG 1.Select Programs 2.Select Medicaid Reimbursement 3.Select Forms 4.Click on the Forms Icon 5.Select the form needed, (all forms are in the Word format, you can open the form and print or save to your computer RESA 8 UPDATED MEDICAID REIMBURSEMENT FORMS

7. There has been a change in this billing form due to the fact that a student may be found eligible for learning disability services using the RTI method rather than a psychological evaluation. Therefore language was added to #3 to accommodate the change. Creation of an IEP is an occurrence. The submission for reimbursement includes all the activities and actions leading to the actual development of the finalized IEP.

8. Do not submit for the development of an updated IEP when you have merely added an addendum to the current IEP. Creation of an IEP is an occurrence. The submission for reimbursement includes all the activities and actions leading to the actual development of the finalized IEP.

9. NOTES:________________ _______________________ _______________________ _______________________ _______________________ This form is completed for activities and services provided concerning the implementation of the services from the IEP, Not the development of the IEP

10. NOTES:________________ _______________________ _______________________ _______________________ _______________________