In 1988, Congress passed Section 411(k)(13) of the Medicare Catastrophic Coverage Act to ensure that Medicaid would cover medically necessary health-related services provided to a child under the Individuals with Disabilities Education Act (IDEA) and specified in a child’s individual educational plan (IEP) or family support plan. The intent of Congress was to enable Medicaid and IDEA to be used together to meet the educational and health-related needs of children with disabilities. Some services on a student’s IEP or family support plan are educationally relevant and are also medically necessary, and thereby reimbursable by Medicaid.
The 1995 Florida Legislature provided authorization, with revisions made in 1997 (ss. 236.0812, 409.9071, 409.908, 409.9122 and 409.9126, Florida Statutes), to the Florida Agency for Health Care Administration (AHCA) and the Florida Department of Education (DOE) to develop a category of school-based services termed the Medicaid Certified School Match Program to reimburse school districts for services provided to Medicaid-eligible students who qualify for services under IDEA, Part B or C. Under the Medicaid Certified School Match Program, school districts are reimbursed for the federal portion, or approximately 56 percent, of the Medicaid established reimbursement fee for medically necessary services covered under the program. Only school districts may enroll as providers and receive reimbursement under the Medicaid Certified School Match Program.
Since the enactment of the legislation, DOE has been working with AHCA and school district staff to define the direct services that will be reimbursable to school districts. This process has included determining provider qualifications, documentation requirements, and reimbursement procedures. The reimbursable services are
- Speech/language therapy (S/L) – group and individual services
- Physical therapy (PT) – group and individual services
- Occupational therapy (OT) – group and individual services
- Behavioral services – group and individual services
- Nursing services (including medication administration)
- Transportation services
Medicaid reimburses school districts for certain Individuals with Disabilities Education Act (IDEA)-related medically necessary services provided to eligible children. The Medicaid agency also reimburses school districts for activities conducted that assist in the administration of the Medicaid program. The program through which reimbursement to school districts is available is known as the Medicaid Certified School Match Program.
The MCSM program consists of two components
- Reimbursement for direct services (known as fee-for-service)
- Reimbursement for administrative activities (known as school district administrative claiming)
SIMPLIFY SMP (School Match Program for Direct Services)
SIMPLIFY SMP is a comprehensive program to help school districts in Florida as Medicaid providers in receiving reimbursement from Medicaid for therapy services (speech/language, occupational, physical), behavioral services, nursing services, transportation and access Exceptional Student Education (ESE) service documentation with the expectation of maintaining compliance with the Individuals with Disabilities Education Act (IDEA) mandates. The end results of this program will be: 1) to give your teachers and therapists an automated tool to capture required information on all ESE students whereby increasing the integrity of the district’s student service data and, 2) use the same data to transparently bill Medicaid for health/behavioral related services rendered to eligible students without having your personnel use a separate reimbursement system.
SIMPLIFY SMP is a single point of data entry that will capture the individual processes needed to refer, evaluate, place and service all exceptional education students while transparently increasing district revenues in the number of billed Medicaid claims, while adhering to all State and Federal laws, as well as to all regulatory requirements imposed by IDEA and Medicaid. This will require a completely new approach of working with the district’s existing database applications that collect student information to create several formats using the related data that will correspond with the both IDEA and Medicaid direct service documentation. This will also include a time efficient technological shift in the way that district employees collect and input data utilizing computer applications.
The process of collecting data needs to be easy and tightly integrated with all other tasks that are performed on a daily basis. This will require collecting data for all students that are seen by providers / therapists in the district. For example, many Guidance Counselors are responsible for every single student in their school, which could easily be several hundred children. They also play a critical role for ESE students, and must somehow collect information from meetings with those students so that claims may be submitted. The new data collection process should be easy enough to use a routine basis, but also robust enough to collect all data required for a Medicaid claims in a completely transparent manner while also increasing the number of eligible Medicaid direct service claims made each year, which will ultimately help offset the loss of funding from other funding sources. Since the data collection application was designed to not detract from the time that each special education provider spends helping students in the district, the system will help insure that ESE students achieve a quality education.
SIMPLIFY SMP gives all ESE Providers the ability to collect data for all children, train them on the process and technology, support them whenever a problem occurs, and help them to use the system to achieve district objectives. This will result in a more efficient use of resources and improve the overall quality of education in your county.
SIMPLIFY SMP addresses the following items for the School districts:
- Eliminates redundant activity in data collection for IDEA and Medicaid
- Maximizes data quality and integrity via solid data collection process – make data the business of the end user
- Meets all CMS guidelines for Medicaid direct service claims
- Makes Medicaid claiming work behind the scenes and not viewed as extra work
- Provides point and click data entry, eliminate date entry screens
- Makes the application in real time
- Insures that only appropriate people have access to student records
- Provides performance management data for IDEA/ESE
- Makes it easy to accommodate changes by Feds/State.
SIMPLIFY SMP caters the Exceptional Services of any school district by capturing the electronic forms to collect data for Admission, Placements, Assessments, Evaluations, to comply with State and Federal regulations for IEP, EP, Behavioral Support, Health Administration, and Daily Service needs.
Features and Benefits
- Administrator controls and reports
- Student Information
- Servicing provider/Therapist Information
- Multi- level Security access
- Review and approve capabilities
- Electronic Eligibility and Billing
- Scheduling Services
- Reminders and alerts for the services
- Integration with any IEP/Medicaid system
- Fully compliant with HIPAA
- Voice to text tool to speed up the service documentation