As a result of requirements imposed by the federal Centers for Medicare and Medicaid Services, Wisconsin Medicaid is making changes to the school-based services benefit. This Wisconsin Medicaid and BadgerCare Update provides information on the following changes:

• A new cost reporting system and a revised Medicaid Administrative Claiming/School- Based Services time study that will be detailed in future Updates.
• A revised terms of reimbursement, effective for dates of service (DOS) on and after July 1, 2006.
• New requirements for psychology, social work, and counseling services, effective for DOS on and after January 1, 2007.
• New requirements for providers of speech and language pathology services, effective for DOS on and after January 1, 2007.
• Discontinued coverage of durable medical equipment in schools, effective for DOS on and after January 1, 2007.

Preview of Cost Report and Medicaid Administrative Claiming/School-Based Services Time Study

Based on federal Centers for Medicare and Medicaid Services (CMS) guidelines, Wisconsin Medicaid will require school-based services (SBS) providers to complete a cost report. Randomly selected staff will be required to participate in Medicaid Administrative Claiming (MAC)/School-Based Services time studies. Based on CMS guidelines, school districts will be required to:

• Submit cost reports after the close of the school year.
• Have staff complete MAC/SBS time studies developed by the Department of Health and Family Services (DHFS) to provide information for each cost report. The time study is used to estimate the average percentage of time personnel spend performing educational and SBS medical activities and to provide documentation for administrative claiming.
• Identify, for certain personnel classifications such as special education teachers and secretaries, those employees who are expected to perform school-based services. The DHFS will send districts a list of their employees prior to each time study period and the districts must indicate whether or not each employee is expected to perform school-based services. Wisconsin Medicaid will use the list of employees to select the time study participants for the time study period.
• Cost settle their SBS reimbursement based on their cost report. Some districts will receive additional money and others will be required to return funds so that no district is paid more than its costs.

Note: School districts should continue to submit claims for all Medicaid services to receive interim payments and document the services that were provided.

To ensure that accurate information is obtained, the CMS will require Wisconsin to achieve an 85 percent statewide response rate on the time study. This response rate is needed for the time study to be statistically valid. If the 85 percent response rate is not achieved, CMS guidelines require the DHFS to code all non-responses as having spent zero time performing MAC activities and school-based services.

Failure of providers to respond to time study requests will decrease Wisconsin’s response rate and reduce federal funding of MAC and SBS payments statewide. Therefore, it is critical that SBS/MAC providers participate and return the time studies to ensure that an 85 percent response rate is achieved. Wisconsin has adopted this statewide time study because it reduces the number of time studies that school staff must complete.

It is anticipated that the CMS will be performing audits of the SBS benefit. Therefore, all documentation in the cost report and time study must be complete and accurate to assure full compliance in the event of an audit. Supporting documentation must be maintained to support all claims and time study activity.

Further information about the cost report and MAC/SBS time study will be issued in future Wisconsin Medicaid and BadgerCare Updates.

Revised Terms of Reimbursement

Effective for dates of service (DOS) on and after July 1, 2006, Wisconsin Medicaid is changing the terms of reimbursement (TOR) for SBS providers per CMS requirements. The revised TOR reflects the new cost reporting and cost settlement requirements. Refer to the Attachment (PDF, 16 KB) of this Update for the new TOR; this replaces the TOR in the current School-Based Services Certification Packet.

Requirements for Counseling, Social Work, and Psychological Services

Effective for DOS on and after January 1, 2007, to be Medicaid covered as school-based services, counseling, social work, and psychological services must have been ordered or recommended by a physician or other licensed practitioner with the authority to do so under his or her state license.

Counseling and social work services must be performed by a licensed Department of Public Instruction (DPI) counselor or social worker. Psychological services must be performed by a licensed DPI school psychologist.

Speech and Language Pathology Provider Qualifications

Effective for DOS on and after January 1, 2007, Medicaid reimbursement is available for speech and language pathology services only if provided by or under the direction of a practitioner who has completed the educational requirements and the work experience necessary for the American Speech-Language-Hearing Association certificate, and has passed the PRAXIS exam in speech-language pathology.

Durable Medical Equipment

Effective for DOS on and after January 1, 2007, Wisconsin Medicaid will no longer reimburse for durable medical equipment (DME) under the SBS benefit. Historically, virtually no DME has been claimed under the SBS benefit because children can obtain DME from their HMO or fee-for-service provider.

Information Regarding Medicaid HMOs

This Update contains Medicaid fee-for-service policy and applies to providers of services to recipients on fee-for-service Medicaid only. School-Based Services are not included in the HMO capitation rate; therefore, school-based services are delivered to all Medicaid recipients under fee-for-service.

Attachment — School-Based Services Terms of Reimbursement (PDF, 16 KB)