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MEDICAID SCHOOL-BASEDADMINISTRATIVE CLAIMING GUIDE
May 2003
MEDICAID SCHOOL-BASEDADMINISTRATIVE CLAIMING GUIDE
TABLE OF CONTENTS
I. INTRODUCTION...............................................................................................................................................................1II. MEDICAID IN THE SCHOOL SETTING.....................................................................................................................3III. INTERAGENCY AGREEMENTS...........................................................................................................................5A.
IV. PRINCIPLES OF ADMINISTRATIVE CLAIMING..................................................................................................7A.
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V. CLAIMING ISSUES.......................................................................................................................................................37A.
APPENDIX..............................................................................................................................................................................50A.
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Sections
« prev | next »- II. MEDICAID IN THE SCHOOL SETTING
- III. INTERAGENCY AGREEMENTS
- A. General
- B. Elements of the Interagency Agreement
- IV. PRINCIPLES OF ADMINISTRATIVE CLAIMING
- B. Operational Principles
- 1. Proper and Efficient Administration
- 2. Capture 100 Percent of Time
- 3. Parallel Coding Structure: Medicaid and Non-Medicaid Codes for Each Activity
- 4. Duplicate Payments
- 5. Coordination of Activities
- 6. Performing Direct Services v. Administrative Activities
- a. Case Management as Administration
- b. Case Management as a Service
- 7. Allocable Share of Costs
- 8. Enhanced FFP Rates
- b. Claiming for Administration of Family Planning Services
- 9. Provider Participation in the Medicaid Program
- 10. Individualized Education Program (IEP) Activities
- 11. Review and Approval of Program and Codes by CMS
- 12. Free Care
- C. Activity Codes: Descriptions and Examples
- 1. Introduction
- CODE 1.a. NON-MEDICAID OUTREACH - U
- CODE 2.a. FACILITATING APPLICATION FOR NON-MEDICAID PROGRAMS – U
- CODE 3. SCHOOL-RELATED AND EDUCATIONAL ACTIVITIES – U
- CODE 5.a. TRANSPORTATION FOR NON-MEDICAID SERVICES – U
- CODE 6.a. NON-MEDICAID TRANSLATION - U
- CODE 8.a. NON-MEDICAL/NON-MEDICAID RELATED TRAINING - U
- CODE 9.a. REFERRAL, COORDINATION, AND MONITORING OF NON-MEDICAID SERVICES - U
- CODE 10. GENERAL ADMINISTRATION - R
- V. CLAIMING ISSUES
- A. Documentation
- B. Sampling/Time Studies
- 1. Sample Universe
- 2. Sampling Plan Methodology
- 3. Treatment of Summer Period
- 4. Time Study Documentation
- 5. Training for Staffing Time Study
- 6. Monitoring Process
- C. Offset of Revenues
- D. Cost Allocation Plans
- E. Administrative Claiming Implementation Plan
- F. Timely Filing Requirements
- G. State Law Requirements
- H. Contingency Fees
- I. Provider Agreements
- J. Third Party Liability (TPL)/Medicaid as payor of last resort/Free Care
- K. Transportation as Administration
- APPENDIX
- A. Medicaid
- 1. Medicaid’s Role In School-Based Health Services Programs
- 2. Early and Periodic, Screening, Diagnostic and Treatment (EPSDT)
- a. EPSDT Screening
- b. EPSDT Treatment
- c. EPSDT Administrative Claiming
- 3. State Children’s Health Insurance Program (SCHIP)
- B. Individuals with Disabilities Education Act (IDEA)
- 1. Purpose of IDEA
- 2. Child Find
- 3. Evaluation and Assessment Activities
- 4. Individualized Education Program (IEP)
- b. Development of IEP
- c. Review/Revision of IEP
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