In a partnership effort between the Department of Elementary and Secondary Education, the Office of Medicaid, the Massachusetts Association of Approved Private Schools, and the Massachusetts Association of Administrators of Special Education we have agreed upon a format for providing service delivery information that conforms to the required service delivery documentation required for billing under the School-Based Medicaid Program. Out-of-district settings serve students from multiple public school districts and the task of providing service delivery information in multiple formats to meet various school district needs has demanded too many resources from out-of-district programs. *
The attached form is now a "mandated" form (28M/12), reserved for use by out-of-district programs operated by approved private schools or educational collaboratives. By developing this as a mandated form, any out-of-district program may use this form to document service delivery. If this form is used, all public school districts must accept this documentation in this form and may not insist on another format of their choice. This form and format is the only format that an out-of-district program may insist upon. Public school programs are not required to use this form for in-district service delivery documentation. While out-of-district programs are not required to use this form, it is highly recommended and clearly outlines required data that is provided by the out-of-district staff (Parts I & II) and data that the public school district provides (Part III).
Two forums were held in October to introduce the form and gather questions regarding the documentation of service delivery. A couple of items were raised that deserve mention here:
I hope this information is helpful. Our partnership members continue to work on additional technical assistance to help school districts and private approved schools to work together in our participation in the School-Based Medicaid program.
Massachusetts School Based Medicaid Service Documentation for Day/Residential Special Education Schools (28M/12) (revised February 2012)
* See memorandum at: http://www.doe.mass.edu/news/news.aspx?id=5606
Massachusetts Department of Elementary and Secondary Education
75 Pleasant Street, Malden, MA 02148-4906
Voice: (781) 338-3000
TTY: (800) 439-2370
Disclaimer: A reference in this website to any specific commercial products, processes, or services, or the use of any trade, firm, or corporation name is for the information and convenience of the public and does not constitute endorsement or recommendation by the Massachusetts Department of Elementary and Secondary Education.