Medicaid Service

School districts are obligated to exercise diligence, care, and integrity when submitting Medicaid claims for payment for services rendered. Federal Medicaid financial compensation generates important revenue for school districts, which cannot be overlooked during this time of economic crisis. School districts must carefully conform their service provision and billing practices governing Federal and State statutes and regulations to ensure continuity of this revenue stream.

BOCES staff will introduce a system of management that will help school district officials provide accountability for tax dollars spent to support district operations, by assisting a district in developing a written process to analyze data, monitor claims, and reconcile claims in an effort to recoup federal Medicaid funds for special education services that are provided to the district’s Medicaid eligible students.

Program Features:

1. Data Analysis:
a. Student Medicaid Eligibility
b. IEP Review
c. Review of Session Notes 
d. Prescriptions/Referrals
e. Parental Consents
f. BOCES Service Providers
g. Student/Provider Attendance
h. Record Retention

2. Medicaid Claims Process:
a. IEP services scheduled and provided but not claimed.
b. Documentation that services were performed.
c. Parental consent. 
d. IEP services scheduled but not documented that they were provided.
e. Special Transportation Services.
f. District Monitoring and Reconciliation Review of disallowed claims.
g. Written procedures for the claiming process when the transportation is identified on a student’s IEP.

Complying with the federal and state Medicaid laws requires that school district employees work together as a team to vigilantly supervise the provision of Medicaid billable services. The service is designed to create a process within the district to monitor the different billable services, and the role of the service provider and the administration with a focus on how to build the partnership between each level in the Medicaid compliance team.

The sustainability of any plan is dependent on identifying issues, and resolving them. The service will help a district build good practices and procedures school districts can use to comply with the Medicaid laws and regulations.