Medicaid in Schools

Medicaid is a federal/state program overseen federally by the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services and administered by the Rhode Island Department of Human Services (OHHS).

Local Education Agencies (LEAs) in Rhode Island have been able to enroll as Medical Assistance providers with the Executive Office of Health and Human Services since 1992 when the Rhode Island General Assembly passed enabling legislation, RIGL 40-8-18.Participation by LEAs, including Public Charter Schools is voluntary.  Currently all LEAs participate in the program. The State Department of Education works collaboratively with the OHHS to ensure that school providers understand the program and to ensure program integrity for both IDEA and Medicaid. 

Enrolling as a Provider

Enrolling as a Medicaid provider enables LEAs to submit claims for certain services provided to students with disabilities. These include: physical therapy, occupational therapy, speech and language therapy, orientation and mobility, counseling, nursing, personal care, assistive technology devices and assistive technology services. LEAs can also participate in the administrative claiming program. The State provides guidance to the LEAs by issuing Medicaid Claiming Guidebooks for Direct Services and for Administrative Claiming. These Guidebooks are posted on the OHHS website

To enroll as an LEA Provider:

An LEA enrolling for the first time as a Medicaid provider should go to the provider section of the OHHS web site. This site gives access to most of the forms required for completion. LEAS must enroll as a provider prior to submitting any claims for reimbursement.

Also prior to submitting claims, Local Education Agencies must sign an Interagency Agreement with the Executive Office of Health and Human Services. LEAs must sign an initial Interagency Agreement with OHHS and once enrolled, may be required periodically to sign an updated Interagency Agreement.

 

Medicaid Reviews for LEAs

The Rhode Island State Medicaid Agency, the Executive Office of Health and Human Services (OHHS), conducts annual reviews of the LEA Medicaid provider programs.  The purpose of these reviews is to ensure program integrity and adherence to the policies and procedures provided in the Rhode Island Medicaid Guidebooks for LEA claiming. 

Parental Consent Documents

Resources

Rhode Island Guidebooks

The Rhode Island Executive Office Of Health and Human Services (OHHS), the state Medicaid agency, has issued two Medicaid claiming guidebooks for Local Education Agencies (LEAs) in Rhode Island: an Administrative Claiming Guidebook and a Direct Services Guidebook.These can be accessed below or on the EOHHS web site.

Claiming Guides

Federal:

CMS Administrative Claiming Guide May 2003 

1997 HCRFA School Guide 

EPSDT -A  Guide for States:  Coverage in the Medicaid Benefit for Children and Adolescents, June 2014 

State:

EOHHS 2014 LEA Direct Services Guidebook

EOHHS 2014 LEA Direct Services Guidebook Addendum 

EOHHS 2014 LEAD Administrative Claiming Guide 

 

 

 

Audits

Audits

FEDERAL

Office of the Inspector General (OIG) Role: Since its 1976 establishment, the Office of Inspector General of the U.S. Department of Health & Human Services (HHS) has been at the forefront of the Nation's efforts to fight waste, fraud, and abuse in Medicare, Medicaid and more than 100 other HHS programs. This includes conducting audits for the Medicaid Program, including school providers.  To find more information, go to Office of Inspector General website General Website     

Executive Office of Health and Human Services (OHHS) Reviews 

OHHS conducts periodic reviews of all LEA providers for direct service claiming and administrative claiming. 

 

Websites:

Websites:

The web sites listed below are included for information only. These include state, local and national web sites to assist individuals and families in accessing information about Medicaid, health care, special education, disabilities and advocacy issues:

National Alliance for Medicaid and Education (NAME)

US Department of Education Office of Special Education and Rehabilitative Services 

Federal Department of Health and Human Services 

Federal Medicaid

The Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program for Medicaid eligible children birth to 21 years old: http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html 

Health Insurance Portability and Accountability Act (HIPAA)

Comprehensive Parent Toolkit: resources for education, medical and social/emotional needs of children; available in Spanish. 

A Guide to Disability Rights Laws

Social Security Administration programs for people with disabilities 

Substance Abuse and Mental Health Services Agency (SAMHSA):

RI's Health Exchange: Health Source Rhode Island 

Consortium for Citizens with Disabilities