Schools and Medicaid Quarterly Call
March 6, 2019
Introductions - AHCA and FDOE/SSS staffFFS Updates and Q and A from districtsSDACAHCA MonitoringAAC concurrenceSB290/ H587
Put your name and district or company represented in chat boxPhone lines will be muted during most of call, so enter questions in chat boxIf you have questions as the meeting progresses, please enter them into the chat box. We will pause periodically during the call to answer questions.
AAC services: Billing and IEPFFS reimbursement reports on AHCA website (status of updating)Behavioral evaluations performed prior to development of IEP (answer from previous call)Provider credentials/title in documentation
Is the reduction of billable units as reflected in the January 2019 fee schedule and our claim denials final?Is billing allowed for a therapy (SL/OT/PT) evaluation when the outcome is that the student does have an IEP, but does not have SL/OT/PT services on the IEP?
FFS-Questions from Districts
When can charter schools begin billing for services?If charter schools want to participate in the school-based program, where should we direct them to get assistance in enrolling and billing?Telemedicine-Is the GT modifier in the system so that districts can bill for service provided through telemedicine?
FDOE: AAC Concurrence
Entities presenting forms to districts to signMedicaid requires that school districts concur with the AAC device being proposed (for students under age of 21 and in public school)There is no additional guidance, so how district handles is a district decision
Matching titles: attestation will be required beginning Q2 2019Removing examples from forms and systems beginning Q2 20197 day response time (paper or electronic) beginning Q2 2019Student names in sample responsesInvalid response: outside of school hours“Scheduling”- when is it code 5 and when is it code 10?Code 11 vs. code 12Code 12 vs. code 13Payroll submissionSample Pool
New Monitoring Tool language/design beginning Q2 2019Administrative Claiming (SDAC)Medicaid Certified School Match (MCSM)Annual Fee-for-Service (MCSM) MonitoringDocumentation checklist/monitoring toolsOrganizationTurnaround time
SB 290 and H 587 are identical billsCurrent: Florida Statute allows for school districts, private schools and charter schools to seek Medicaid reimbursement for services provided under an IEP or IFSP and to certify match for these services.Allows for alignment with Medicaid SPA, allowing for districts, private and charter schools to seek Medicaid reimbursement and certified match per upcoming rule for services outside of the IEP/IFSPAmends 409.9071, F.S.: deletes requirement that certified funds are available only for services to students with IEPs/IFSPsAmends 409.9072, F.S.: deletes requirement that Medicaid reimbursement is only available for services provided to students with IEPs/IFSPsProvides effective date of July 1, 2019Current status:1/25/19: SB referred to Education, Health Policy and Appropriations2/6/19: HB referred to Health Market Reform Subcommittee, Health Care Appropriations Subcommittee, Health and Human Services Committee.
AHCA Contact Information
Ami Flanigan-School district administrative claiming, transportation ratesMartinFanburg-PolicyLeila Jett-MonitoringAmi.Flanigan@ahca.myflorida.comMartin.Fanburg@ahca.myflorida.comLeila.Jett@ahca.myflorida.com
FDOE Contact Information
Anne Glass-FDOE liaison with AHCA, school districtsThomas Garrett-PEER, Medicaid Tracking System 3.0Richard Gary-EMACS, Medicaid Tracking System 2.0Anne.Glass@fldoe.orgThomas.Garrett@fldoe.orgRichard.B.Gary@gmail.com