Important Memorandum on School-Based Medicaid Claiming and Out-of-District Students- Massachusetts Department of Elementary and Secondary Education

Special Education

Important Memorandum on School-Based Medicaid Claiming and Out-of-District Students

To:Administrators of Special Education, Directors of Education Collaboratives, Private School Directors, and Interested Parties
From:Marcia Mittnacht, State Director of Special Education
Date:June 24, 2010

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I write this letter in cooperation with the State Office of Medicaid, the Massachusetts Association of Special Education Administrators, and the Massachusetts Association of 766 Approved Private Schools (MAAPs). We are working in partnership to seek the best methods for the most accurate claiming information to assist public schools in obtaining Medicaid reimbursement for appropriate medical services provided to Medicaid eligible students.

We have moved into a fee-for-service model of Medicaid claiming this past year. When the public schools send students out of district, we have identified as a concern the large variation in how public schools document the services provided to students with disabilities. MassHealth policies have not required service providers to maintain service documentation in a specific format (See MassHealth Bulletin 9). However, service providers have been required to keep required service documentation data elements on file to support claiming in the event of an audit. Because multiple school districts send students to the private special education school, and because each school district may have developed an independent format for gathering required documentation information, the approved private special education schools are now finding themselves having to provide documentation of service delivery for different students in different formats. Unfortunately, juggling different formats requires more time and resources than any school currently has available. As we became aware of this issue, we began to meet together to try and simplify the claiming documentation. We have agreed to a partnership approach that we believe will be more effective beginning with the next school year in September 2010. However, in the meantime, some of this 2009-10 year's claiming has been disrupted by disagreements on format for claiming documentation.

Because MassHealth has not required a specific service documentation format, I write now to request your assistance in allowing the private schools to provide their encounter documentation to you in the form in which they currently have it, so that your end of year cost report fully reflects any claimable services provided during this past year. We realize it may make some extra work for you in this year's claiming, but we hope to have that resolved with our new partnership approach in the coming year and we want to make sure you receive the best possible level of Medicaid reimbursement for this past year. MAAPs will request all its member districts to get the documentation to you as soon as possible. With your mutual cooperation, we can move this process forward more effectively. Thank you in advance.





Last Updated: June 25, 2010



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