School-Based Medicaid

Definition

The State Department of Education and the Department of Health and Welfare, Division of Medicaid, come together quarterly as a School-Based Medicaid Advisory Committee. These meetings are necessary to help facilitate better communication between school districts (School- Based Medicaid providers), Medicaid policy, and Medicaid Integrity. This committee meets to address changes in School-Based Medicaid IDAPA rules, discuss audit findings and ways to make practice corrections, as well as providing clarification to districts on School-Based Medicaid policies and procedures. This site provides the minutes to Advisory meetings, documentation that is relevant to the implementation of School-Based Medicaid rules, training material, and other related materials.

For additional resources including IDAPA rule and current forms please visit: www.sbs.dhw.idaho.gov

For School-Based Medicaid questions please contact either:

Frede' Trenkle-MacAllister
Alternative Care Coordinator
Idaho Department of Health and Welfare Medicaid
Phone: (208) 287-1169
Fax: (208) 332-7286
trenklef@dhw.idaho.gov

or

Shannon Dunstan
Early Childhood and Interagency Coordinator Idaho State Department of Education P.O. Box 83720 Boise, Idaho 83720
208-332-6908 (Office)
208-703-1660 (Cell)
sdunstan@sde.idaho.gov

What's New?

Dear Providers,
Idaho Medicaid is in compliance with requirements to update from ICD-9 to ICD-10 diagnosis codes. This means the diagnosis code that you currently submit on your claim will change October 1, 2015.
What you need to do as of 10/1/2015:

  1. Ensure the method you use to submit claims will allow for the new ICD-10 code and format.
    1. If you are submitting claims electronically (EDI) through your Trading Partner Account with Molina Medicaid Solutions, the system has been updated to allow the new code set to be received. 
    2. If you are submitting claims one at a time using the provider portal, you will be required to indicate whether you are submitting an ICD-9 or an ICD-10 coded claim for the date of service.  A radio button will be available for selecting this indicator.  The diagnosis code version to be used on the claim is based on the date of service.
      1. For claims with a date of service of 9/30/2015 or earlier, an ICD-9 code is required
      2. For claims with a date of service of 10/1/2015 or later, an ICD-10 code will be required.
    3. If you submit paper claims, verify you are using the updated (2/2012) CMS 1500 form.
  2. If you submit claims electronically through a different software or tool, you will need to ensure with your vendor that these have been updated to allow for the ICD-10 code and format.
  3. Know and submit the correct diagnosis code on your claims based on the dates of service.  The diagnosis code that you bill with depends on individual participant’s services and health conditions. 
    1. For example:  If you currently bill with the ICD- 9 diagnosis code V60.4 “No other household member able to render care,” effective 10/1/2015 you will need to start using the ICD-10 compliant diagnosis code of Z74.2 “Need assistance at home and no other household member able to render care.”
      1. For dates of service of 9/30/2015 or earlier, continue to use the ICD-9 code on claims
      2. For dates of service of 10/1/2015 or later, use the new ICD-10 code on claims
    2. If you use an ICD-9 diagnosis code other than V60.4, you will need to identify the correct ICD-10 to use. You can find diagnosis code information in the Provider Handbook at www.idmedicaid.com > Provider Handbook > Claim Form Instructions > CMS 1500 Instructions. You may also find additional diagnosis code information in the ICD-10 Coding book or online at www.icd10data.com.    
    3. If you use a billing agency to submit claims on your behalf, please communicate these changes to them.

Idaho Medicaid has also provided several online resources to help you in this transition. Additional information can be found on the Molina Medicaid website at www.idmedicaid.com under the following links:

  1. Idaho Medicaid ICD-10
  2. Provider Handbook > Claim Form Instructions > CMS 1500 Instructions
  3. Training > Training Documents > Claims and Billing

Sincerely,
Idaho Department of Health and Welfare

The Division of Family and Community Services (FACS) is responsible for processing the renewal applications for individuals who hold a Habilitative Intervention (HI) Certificate of Completion as outlined in IDAPA 16.03.10.685.07.

FACS has identified renewal applications that are not consistently meeting the required number of continuing training hours.  FACS will incorporate the following steps to address these renewals that are out of compliance with IDAPA.

When an individual submits the renewal application for their Certificate of Completion, if it is determined that the individual did not meet the HI continuing training requirement during year one (1), and a gap in training hours occurred, a letter will be sent to the HI Certificate of Completion holder and a letter will be sent to the Medicaid provider identifying that the staff’s qualifications are out of compliance with IDAPA. 

It is the responsibility of Medicaid providers (Developmental Disability Agencies, School Districts, and Charter Schools) to ensure that HI providers are qualified to provide services.  The Medicaid provider is responsible for ensuring the accuracy of claims submitted and shall immediately repay the Department for any services the Department or provider determines were not properly provided or documented.

If you have questions with regards to the Habilitative Intervention Certificate of Completion continuing training requirements, please contact Bobbi Hamilton, BCaBA at hamiltob@dhw.idaho.gov or 1 (208) 334-5777.

Documents

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    Trainings

    Title: SPED - Medicaid Webinar
    Date: March 5, 2015
    Presenters: Elaine Eberharter-Maki, Attorney at Law, also presenting: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF) ; Medicaid Position Paper Amended 12 23 14 with Chart (PDF) ;Medicaid Position Paper 2 18 15 with chart (PDF)
    Recording:  Link to view recorded Webinar

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    Medicaid Training:

    The Department of Education in collaboration with the Department of Health and Welfare, Division of Medicaid, have created and posted training material for districts to access in training their staff on the utilization of School-Based Medicaid services.  These trainings are developed to assist Special Education Directors, Special Education Teachers, Behavioral Services, Behavioral Consultants, RN, Related Service Providers (SLP, OT, and PT), and Medicaid billing staff in the implementation of School-Based Medicaid Services.

    Title: Overview of School-Based Medicaid Services
    Date:  March 10, 2015
    Presenters:  Shannon Dunstan, Idaho State Department of Education., also presenting: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF).  Additional files related to this area can be found in the School-based Medicaid Community Portal
    Recording:  Link to view recorded Webinar

    Title: Statewide Processes for Districts (Updated January 20, 2015)
    Presenters: Shannon Dunstan, Idaho State Department of Education and Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF);
    Recording:  Link to view recorded Webinar

    Title: Behavioral Services  (Updated January 20, 2015)
    Presenters: Shannon Dunstan, Idaho State Department of Education and Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF); School Based Services – Behavioral Intervention Chart (WORD)
    Recording:  Link to view recorded Webinar

    Title: Implementing Personal Care Services  (Updated January 20, 2015)
    Presenters: Shannon Dunstan, Idaho State Department of Education and Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF
    Recording:  Link to view recorded Webinar

    Title: Related Services  (Updated January 20, 2015)
    Presenters: Shannon Dunstan, Idaho State Department of Education and Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Medicaid Training: New Rules effective July 1, 2016

    Title: Nursing and Personal Care Services - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: Evaluation_Assessment - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: CBRS - Idaho School-Based Mental Health Services - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: BEHAVIOR-INTERVENTION-and-BEHAVIOR-CONSULTATION - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: Occupational Therapy Physical Therapy and Speech/Audiological Therapy - July 1, 2016 Rules
    Date:  April 8, 2016
    Presenters:  Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: Transportation Services & Interpretive Services EPSDT - July 1, 2016 Rules
    Date:  April 8, 2016
    Presenters:  Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Contact Us

    Frede' Trenkle-MacAllister


    Alternative Care Coordinator
    Idaho Department of Health and Welfare Medicaid
    Phone: (208) 287-1169
    Fax: (208) 332-7286
    trenklef@dhw.idaho.gov

    or

    Shannon Dunstan


    Early Childhood and Interagency Coordinator
    Idaho State Department of Education
    P.O. Box 83720 Boise, Idaho 83720
    208-332-6908 (Office)
    208-703-1660 (Cell)
    sdunstan@sde.idaho.gov
    sde Idaho State Department of Education
    650 W. State Street
    PO Box 83720
    Boise, ID 83720-0027