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Prince George's County Public Schools

MEDICAID BILLING TRAINING MANUAL SY 2012-2013

Prince George's County Public Schools Medicaid Billing Office

14201 School Lane, Trailer # C05-451 Upper Marlboro, Md. 20772

301- 952-6349 Phone ▪ 301-780-5925 fax http://www1.pgcps.org/medicaid/

Sasscer Administration Building • C05-451 • 301-952-6349 • Fax 301-780-5925 07/12

Table of Contents

Introduction and Overview

Program Overview ............................................................... 1

Coordinators Responsibilities ............................................. 4

Case Manager Responsibilities ............................................ 7

IEP Service Coordination

Instructions ...................................................................... 13

Sample Forms ................................................................... 18

Essential Information

Completing the IEP for Nursing Services……………………… 47

Audit Requirements .......................................................... 49

Fraud Statement Summary .................................................. 50

FAQ’s Frequently Asked Questions ................................... 51

Incentive Funds ……………………………………………………. 52

Attachments and Sample Forms

Change in Status Form ..................................................... 55

New Student Form ............................................................ 56

Medicaid Parental Consent ................................................ 57

Parent Information Handout ............................................. 58

Case Management Letter ................................................... 59

Monthly IEP Progress Note ................................................. 60

Incentive Requisition Form ............................................... 61

Administrative Procedure False Claims Recovery ................ 62

Medicaid Coordinator Checklist .......................................... 67

Case Manager Checklist ...................................................... 68

IEP Meeting Checklist ......................................................... 69

Billing Calendar .................................................................. 70


Program Background & Description

In 1994, Prince George's County Public Schools system began a system wide effort to recover costs for health related services, and IEP/IFSP coordination services for Medicaid eligible students. Currently, there are approximately 4,600 Medicaid eligible special education students identified in Prince George's County Public School system. These students constitute 31% of the Special Education population and 3.7% of all students attending Prince George County Public Schools. Medicaid reimbursement funds supplement existing programs and enhance the learning experience for special education students by providing additional staff, supplies and equipment.

Program Mission

The mission of the Medicaid Billing Office is to recover funds for health related and IEP coordination services provided to Medicaid eligible special education students in order to expand and enhance the services offered to all PGCPS special education students.

Program Goals

Our goal is for the Medicaid Billing Office to operate with integrity, excellence

and professionalism and to provide quality service that is effective, efficient accountable to all stakeholders;

To increase and maximize efforts to recover Medicaid revenue in order to enhance services provided to PGCPS Special Education

To improve efforts in order to meet regulatory compliance in accessing Medicaid reimbursement funds;

To increase children and youth’s access to comprehensive health services through the PGCPS school-based Medicaid reimbursement program;

To increase collaboration among schools, families, and state agencies, where each partner has a defined role and demonstrates commitment and accountability to the Special Education students of PGCPS;

To develop and implement a long-range plan for helping to ensure sustainability of a comprehensive Medicaid reimbursement program

Overview of Eligibility Requirements

In order for PGCPS system to receive Medicaid reimbursement, the services billed must:

Be provided to a Medicaid eligible student under the age of 21 Be provided to a student with an active IEP/IFSP Be provided by a qualified practitioner (possess proper licensure/certification) Address a student’s physical, mental or emotional disability Be consistent with the intent of the IEP/IFSP identified services and planned

goals Have documentation that supports that the services billed relate directly to the

IEP/IFSP

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Other Requirements:

Parent permission is a federal requirement and must be obtained prior to submitting billing for reimbursement. Parent permission is valid for one year from the date that it was originally signed; therefore, parent permission must be renewed on an annual basis.

Case Management Notification is a federal mandate requiring that

parent/guardians must be notified of the special educator serving as case manager for the implementation of their child’s IEP services. When the case manager changes, the parent/guardian must be notified of this change as well.

Provider Credential/Licensure Requirements

In order to submit billing for IEP coordination services, a special educator or a related service provider must hold a current MSDE issued teaching certificate (Advanced Professional Certificate, Standard Professional Certificate or a Conditional 2-year Certificate).

Medicaid Billing Overview

What services are appropriate for MA billing?

Development of the initial IEP Annual Review/IEP Team Meetings Service Coordination

What is service coordination?

Services Coordination is defined as “case management services” that assist students’ in gaining access to the services recommended in his or her IEP. The case manager will monitor the delivery of the student’s goals and objectives and ensure that they meet the student’s current needs.

Description of Medicaid Billable Services – IEP Service Coordination

Initial IEP

The service consists of convening and conducting an IEP team meeting to perform, a multi-disciplinary assessment, and to develop an initial IEP for a participant. This service is billed once in the lifetime of the student. When submitting, we will need: a completed, IEP Coordination Record billing form, a copy of the Sign-In Sheet from the IEP meeting, a copy of the Notice of IEP Meeting, a copy of the parent permission form, and a copy of the case management letter. (Parent must attend this Initial IEP meeting and sign the sign in sheet).

You must also include a summary outlining the purpose and the outcome of the meeting. (You may use the Prior Written Notice if it contains this information.) The signature on the billing form and the case manager letter must match. If the case manager changes, a new case manager letter needs to be submitted.

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IEP Interim Review/Annual Review/Formal Meeting

This service is a completed initial 60-day, interim, or annual IEP review as evidenced by a signed IEP. If a revised IEP was not completed, team-meeting records should document a meeting in which there was participation by at least two different disciplines and at least one contact by the service coordinator or IEP meeting in person, by telephone, or by written progress notes or log with the participant or the participant’s parent, on the participant’s behalf.

When submitting this billing, we will need: a completed IEP Coordination Record form, a copy of the Sign-In Sheet from the IEP meeting, and a copy of the Notice of IEP Meeting. In addition, a summary must be written outlining the purpose and the outcome of the meeting. If the Prior Written Notice has a summary that specifically states the purpose and outcome of the meeting, please attach it to the billing form.

The dates on the billing form, the Sign-In sheet and the Notice of the IEP Meeting must match. If the case manager changes, a new case manager letter needs to be submitted. This is also an appropriate time to renew parent permission.

If the parent did not physically attend the meeting, nor did they participate by telephone (as evidenced by a notation on the Meeting Sign-In Sheet), please include a Prior Written Notice that confirms the parent was notified of the meetings’ outcome.

The interim IEP review cannot be billed more than 3 times in a 12-month period and more than once in a given month. Additionally, it cannot be billed in conjunction with ongoing service coordination.

Ongoing Service Coordination

The following are billable ongoing service coordination services:

At least one contact per month by the case manager in person, by telephone, or by written progress note or log with the student’s parent, relating to overseeing the implementation of the student’s IEP and the progress made towards the student’s IEP goals and objectives;

Coordinate ongoing monitoring of the IEP by discussing with parent and service providers, the services needed and identifying any obstacles to utilization of these services.

Completing the quarterly progress reports, forwarded to the parent, regarding the IEP goals and documenting the student’s progress toward the goals.

Non-Billable Services for ALL IEP Service Coordination

Exit IEP meetings for students graduating or aging out.

Meetings that determine medical/mental health-related services are no longer required.

Meetings that result in IEP’s with only consultative or evaluative services.

IEP meetings for students with “gifted” as the only exceptionality.

IEP meetings held without the required IEP Team or the designated LEA representative present.

Manifestation IEP Meetings, and SIT meetings.

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Medicaid Billing Office Internal Process

The Medicaid billing office’s internal process begins with the identification of

Medicaid eligible Special Education students. Identification of this population is generally achieved two ways, by conducting a data match with Maryland Department of Health and Mental Hygiene (DHMH, which can be performed up to four times per year) and through a school referral process.

Medicaid eligible Student Lists are compiled for case management/service

coordination services. Student Lists are forwarded to the assigned Medicaid Coordinator in each school. Student Lists provide each school the name, student number, DOB, Medicaid number, status, parent permission expiration date, case management notification status and case manager assignment of each Medicaid eligible student assigned to their schools.

On a monthly basis, Student Lists, IEP Coordination and Health-Related Service

Record billing forms are forwarded to Medicaid Coordinators for dissemination to Special Education staff.

All Medicaid billing forms are reviewed for accuracy and are checked into our

billing check-in spreadsheet by school. Any forms that need correction or clarification are given to the Medicaid Program Liaisons for follow up and/or return to the assigned Medicaid Coordinator.

The Medicaid Billing Office staff tracks and monitors the following elements

prior to the submission of claims for reimbursement: case manager notification, parental consent status, provider credentials, and Medicaid eligibility status.

Medicaid billing claims are submitted to DHMH for reimbursement via the

Medicaid billing system on a weekly basis. Payments are received via wire transfer and are recorded into the appropriate Medicaid fund.

The Medicaid Office determines the health related services for each student

identified in the data match and compiles an eligibility listing managed through our billing system.

Special Education & Medicaid Coordinator Responsibilities

Special Education Coordinators are responsible for the following tasks:

Special Education Coordinators are responsible for identifying a Medicaid Coordinator in each school and are accountable for the distribution and completion of the Medicaid forms, as well as, the implementation and communication of school based Medicaid program policies and procedures.

Medicaid Coordinators are responsible for the following tasks:

Reviewing the Student List Medicaid Coordinators should review the monthly student list for accuracy, communicating any changes in status to the Medicaid Billing Office. For example, notify the Medicaid Office of the following:

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New Medicaid eligible students Students that no longer receive Special Education services Students whose IEP has expired and has yet to be renewed Students that have transferred to another school or withdrawn

from the school system

“New Student Forms”, and “Change is Status”, forms are available on line at the Medicaid Billing Office website. http://www1.pgcps.org/medicaid/. In addition, you are able to indicate changes in student status on the IEP Coordination Record form in the box towards the bottom of the form. Managing Parent Permission Medicaid Coordinators should ensure that parent permission is current for all Medicaid eligible students enrolled in his or her respective schools. The student list indicates the date that parent permission is scheduled to expire. In order to avoid a lapse in billing, the Student List should be reviewed to determine the number of students whose parent permission is scheduled to expire within the next few months. The Case Manager should proceed with updating parent permission prior to the expiration date. A student 18 years of age can legally provide consent for Medicaid billing. In addition, if an annual review is scheduled prior to expiration date, please select “yes” for receiving Medicaid in MD On-Line to ensure that the Medicaid section will print on the authorization page. In other instances, please use a separate parent permission form, which can be located on our website http://www1.pgcps.org/medicaid/. Parent Permission forms and Parent Education Handouts are available in English and Spanish. Federal regulations prohibit us from billing for Medicaid services without the appropriate parent permission. DO NOT REPRODUCE A PERMISSION FORM THAT IS OUTDATED (7/11r AND BEFORE). ALL CURRENT FORMS (7/12) ARE ON THE WEBSITE. Managing Case Manager Notification The Medicaid Student List identifies the name of the assigned case manager for each student and indicates whether the Medicaid office has received a case management notification letter. Please review the Medicaid student list for accuracy. If the case manager has changed, please forward an updated case manager notification letter for the newly assigned case manager to the Medicaid Office and to the student’s parent/guardian. A template of the Case Manager Notification Letter is available on the back of the IEP Coordination Record, as well as on the Medicaid Billing Office website http://www1.pgcps.org/medicaid/.

Typically, the Medicaid office facilitates schools in securing the initial case management notification letters. The Medicaid office produces pre-printed Case Management Notification Letters. The assigned case manager should sign the letter and make two copies. The original letter should be forwarded to the Medicaid Office; the first copy should be forwarded to the parent/guardian, and the second copy should be filed in the student’s LAF. An updated case management letter is required every time the case manager changes regardless of the reason (e.g., new student, transfers, or if the school personnel changes).

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If an updated case management letter is required, the new case manager will complete the blank case management letter on the back of the IEP Coordination form. Please be sure to send a copy of the newly completed letter to the parent and place a copy of the form in the LAF. Lastly, speech providers serving as the case manager for students need to hold a current teaching certificate (SPC or APC) or possess a provisional contract for conditional status in order to be qualified to complete the IEP Coordination Record form. Managing the Dissemination, Completion & Accuracy of Medicaid Billing Forms Medicaid Coordinators are responsible for disseminating IEP Coordination Record forms to the assigned case managers for each Medicaid eligible student. IEP Coordination Record forms are completed from the month after the student enters the school. In cases of lost or damaged forms, blank forms are available and should be printed from the Medicaid Billing Office website http://www1.pgcps.org/medicaid/. A major responsibility of the Medicaid Coordinator is to ensure that Medicaid forms are complete, accurate and submitted on time. Upon receipt, the Medicaid Office reviews every Medicaid billing form for completeness and accuracy. Incomplete and inaccurate forms are returned to schools for correction. The following are the most prevalent reasons for forms being returned:

Case manager’s signature is omitted Service date is omitted Service date listed is a no teacher duty day. (weekends,

holidays, etc...) Documentation is not attached or insufficient Date on documentation does not match the date of service.

The Medicaid Coordinator should make every effort to establish quality assurance measures for completion and submission of Medicaid forms. A checks and balance system will alleviate the administrative burden of returning forms to school staff, as well as, for the Medicaid Office. Additionally, the Medicaid Coordinator should develop an internal checks and balance system to ensure timely submission of Medicaid forms. When forms are submitted to be processed that have been delayed for several months or more, it creates an administrative burden on Medicaid staff and significantly delays the reimbursement process. Medicaid Coordinators should always communicate to case managers, health related service providers, and administrative staff any change in policies and or process from the Medicaid Billing Office. It is imperative that Medicaid information is “posted” and made available to all special education staff. Many school staff have limited access to computers and these measures will guarantee information received by all staff persons.

Lastly, when Medicaid forms cannot be completed due to special circumstances, (e.g., Medicaid status changes, expired IEP, school personnel changes, transfers, withdrawn students or if the student has been dismissed from Special Education), Medicaid Coordinators should clearly note the circumstances in the appropriate

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space on the form and return the IEP Coordination Record forms to our office by the 5th of the following month. The Medicaid office will give credit to your school for returning the forms and it will not negatively reflect on your school’s performance.

Case Manager Responsibilities

Case managers are responsible for the following tasks: Reporting Changes

Case Managers should review the monthly Student List for accuracy, and communicate any corrections to the Medicaid Billing Office. Please use the “Change in Status Form”, and the “New Student Form” located on our website http://www1.pgcps.org/medicaid/ ,as well as, in the back of this handbook.

Update Parent Permission

Case managers should be diligent in obtaining parental permission for IEP Coordination/Case Management services prior to the expiration date. The Student List provides a quick reference of permission expiration dates. Medicaid Coordinators receive a Medicaid Student List every month. The permission expiration date column details the date in which parent permission is expected to expire.

When an “*” asterisk appears next to the parent permission date it indicates that permission has expired and an updated permission should be obtained immediately. All signed parent permission forms can be faxed to 301-780-5925. Parent permission must be obtained for all IEP meetings on an annual basis as well as every time there is a change in the frequency and duration of a related service. Case managers can easily update permission at the IEP meeting by using the Authorization page of the IEP from Maryland Online. The Authorization page prints out with the IEP when the Medicaid button is selected as “yes” in the Maryland–Online IEP. If the permission will expire prior to the IEP meeting, or you need to update permission, you may use a separate parent permission form. Parent permission forms and a Parent Education handout are available in English and Spanish on our website. http://www1.pgcps.org/medicaid/ Federal regulations prohibit billing for Medicaid services without the appropriate parent permission.

Complete Case Management Notification Letter

A case manager notification letter should be completed for all Medicaid eligible students serviced in your school. Send a copy of the letter to the parent and a copy should be forwarded to the Medicaid Billing Office. Additionally, file a copy of the Case Management Letter in the student’s LAF. The Medicaid Billing Office will need a copy of the letter sent to the parent/guardian regarding any changes in the case manager assignment. A template of this letter is available on the back of the IEP Coordination Record and at the Medicaid billing office website http://www1.pgcps.org/medicaid/.

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Sample: Monthly Student List IEP Coordination Form Completion & Submission

Medicaid billing forms should be submitted to the Medicaid Office by the 5th of the following month. If a Medicaid form cannot be completed (for any reason), please indicate the reason using the bottom box section of the IEP Coordination Record form and forward it to Medicaid office. On the 10th of each month, a performance report is disseminated to respective principals (see sample on page 9). The report details the number of MA forms received, the number of MA forms that are delinquent, the number of MA forms returned for correction, students with expired parent permission and the projected loss of revenue due delinquent and/or inaccurate forms. Additionally, on the 15th of each month, a performance report is forwarded to the Assistant Superintendents which details each school’s cumulative performance. During IEP meetings or Annual Reviews, case managers should ask the parent/guardian if their family is a recipient of Medicaid and if there are any changes to their child’s Medicaid status. (i.e., new number, Medicaid eligibility changes or the Medicaid number has expired). Please report these changes to the Medicaid Billing Office as soon as possible. This information has a significant impact on our ability to have an accurate accounting of the Medicaid population.

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Sample: Principal’s Monthly Performance Report

Educate Parent about MCHP/MMAF

Case managers should inform the parent/guardian about the Maryland Children’s Health Program (MCHP) or the Maryland Medicaid Assistance for Families (MMAF) during IEP meetings, or any time of the year. The case manager should provide interested parents the contact information for MCHP and MMAF. The parents can call the phone number listed below to find out about the eligibility requirements and see if they qualify for Medicaid Insurance for their children. The contact phone number is 800-456-8900.

Medicaid Record Retention

Case Managers should make copies of all completed forms and attached documentation and file them in the student’s Limited Access File (LAF).

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10


IEP Service Coordination

Billing Form Instructions and Samples

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Instructions for the “IEP Coordination Record” Form

Complete the following: Demographics – most forms will be preprinted in the demographic area. However, we have given you directions to complete the entire form. Please use black or blue ink to complete the form. Please remember that the Medicaid Billing form is an official document therefore, do not use pencils, crayons or colored markers to complete the form. Demographics Student's Name: Print the students' full name.

Student Number: Clearly write the student's number from the student list.

Medicaid #: Copy the Medicaid number from the student list.

Recent Annual Review Date: Fill in the Annual Review date from the most current IEP

DOB: Fill in the student's date of birth.

School: Print the name of the school where the student is attending.

Case manager: Print your full name clearly (no abbreviated names, please)

Certification: Circle one of the choices; APC, SPC or CONDITIONAL

The Form

Date of Service: Enter the date of service for the month. (Hint: Be sure to check the calendar in the back of the manual as well as you attendance records for billable dates.

Nature of Service Coordination Contact

Select the service contact that is appropriate. Use the column to the left for Ongoing Service Coordination. Use the column to the right for IEP meetings.

Method of Communication: (Ongoing Service Coordination)

Select the appropriate method of communication: Written: All written communications need to be attached. They must include the student’s name, the date of the communication and the case manager’s signature. The date on the attachment must match the “Date of Service” on the billing form. Phone Call: Write the goal and progress discussed in the phone call in the “Telephone Call Summary” box, or attach a phone log with the summary included regarding the discussion with the parent about the goal and progress.

Method of Communication: (IEP Meetings ONLY)

For IEP Meetings, check the appropriate box. If the parent participated by teleconference please write that information on the sign in sheet. If the parent/guardian did not attend or teleconference the meeting, attach the Prior Written Notice that states/documents the parent was notified about the meeting’s outcome.

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IEP Supporting Documentation For IEP meetings check the box marked “Coordinated Implementation of IEP services.” Attach a copy of the IEP Team Meeting Sign-in sheet and the Notice of IEP Team Meeting. In the “IEP Meeting Outcome Summary” box, document the purpose and outcome of the meeting. If this information is in the Prior Written Notice, attach the notice instead. (For Initial IEP meetings include a current parent permission and case management letter.)

IEP Supporting Documentation (continued)

If the parent does not attend the IEP meeting in person or by teleconference (noted on the IEP Meeting Sign-In Sheet) attach the Prior Written Notice that states/documents the parent was notified of the meeting’s outcome. For billing purposes, Parents must be notified about the outcome of the IEP meeting if they do not attend the meeting.

IEP Meeting Outcome Summary

Document the purpose and outcome of the IEP meeting. If this information is included in the Prior Written Notice, attach the document to the billing form and leave the box blank.

Boxes stating exceptions: Use this section to communicate to the Medicaid Office why the form cannot be completed. All forms must be returned to the Medicaid Office. If none of these reasons fits the allowable circumstance, please write a brief note and attach it to the IEP Coordination Record form.

SIGN, AND PRINT YOUR NAME AT THE BOTTOM OF THE FORM. DATE THE FORM ON OR AFTER THE DATE OF SERVICE.

The Back Of The Form

Case Manager Letter (on the back of the billing form)

Case Managers will sign this form for all students. Sign and print your full name clearly. Abbreviations and “nick names” are not accepted by auditors.

Documentation Requirements

Here is some direction, and examples of correct documentation for the IEP Coordination Record form: Assisted student in gaining access to IEP services – any method of communication with the parent/legal guardian, such as phone calls, letters, logs, or e-mails. (Copies of any written communication must be attached. Written communication must include the name of student, date it was completed and the case manager’s signature. ) The “Date of Service” and date on the documentation must match.

Example: “Telephone contact with Parent regarding that Brittany has begun OT services prescribed in the revised IEP. We will discuss the progress made by next month to ensure she has all the service time she needs.”

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Example: “I contacted Delmar’s mother regarding his excessive absenteeism and how it is greatly impacting on the completion of his IEP goals for this year. He is delayed in his progress and he may not be able to make up all the work he has missed to achieve his goals. She has agreed to make sure that he comes to school more consistently and on time.”

Example: “See attached note.” The note attached was sent home to the parent. (Please remember that the attached documentation must contain a salutation to the parent/guardian, the student’s name, a date and the case manager’s signature. We encourage you to use the “Monthly IEP Progress Note” each month. The date on any documentation and the “Date of Service” must match.)

Example: “E-mail sent to Parent to discuss progress in school this week”. (A copy of the email addressed to the parent or guardian must be attached. The date of the e-mail must match the “Date of Service”. ) All e-mails must contain a response from the parent. Please also sign the bottom of the e-mail when attaching it for billing.

Disseminated formal progress report – used when copies of the Maryland-Online progress report is sent to the parents.

Example: “Progress report sent to parent. See attached.” (The date of the progress report paragraph and the Date of Service must match. Attach a copy of 2 or 3 pages of the progress report to the billing form.)

Coordinated implementation of IEP Services – this includes IEP team meetings, Annual Reviews or other formal meetings regarding the student.

Example: “Annual Review IEP meeting was held to review the current IEP and determine if there was a need for revision. The current IEP was appropriate and no revisions were made.” (Attach an IEP Team Meeting Sign-In Sheet, the Notice of IEP Team Meeting a Prior Written Notice, outlining the purpose and outcome of the meeting and an updated parent permission form. Please note that if the parent participated by telephone, this must be indicated on the IEP Meeting Sign-In Sheet. If the parent did not participate, include information on the Prior Written Notice that confirms the parent was notified of the meeting’s outcome. The date of the meeting and the “Date of Service” on the billing form must match. For Initial IEP meetings also attach a case management letter.)

OTHER POINTS TO REMEMBER:

When using “IEP Meeting” as the service coordination contact, please be sure to attach a copy of the IEP Team Meeting Sign-In Sheet, the Notice of IEP Team Meeting and the Prior Written Notice that contains the purpose and outcome of the meeting. Additionally if the parent did not attend or teleconference the IEP meeting, provide confirmation the parent was notified of the meetings outcome in the Prior Written Notice. Please be sure that the date of the IEP meeting, the date on the Sign-In Sheet, the date on the Notice of IEP Team Meeting, and the Date of Service on the billing form match. Remember to document the purpose and outcome of the meeting in the “IEP Meeting

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Outcome Summary” box on the billing form, if it is not included in the Prior Written Notice.

When using a formal progress report make sure the date on the progress paragraph matches the date of service used on the billing form. Please note that only the printed date embedded in the progress report paragraph can be used. We cannot accept dates that are written in. Make sure you attach a copy of 2-3 pages of the actual progress report.

When describing a phone call, indicate to whom you spoke, the nature of the call and how it relates to meeting the goals detailed in the students’ IEP. Document a discussion of progress with the parent. (Contact must be with parent/guardian only and voice mail messages cannot be used as a contact type).

Please send ALL billing forms for the month together in one package rather than allowing individual case managers to submit forms separately. This will help alleviate confusion regarding what has been submitted or is currently due.

All billed services must relate to the IEP and involve case management!

Examples of unacceptable attachments or contacts:

Field Trip Notices or Flyers

PTA meetings/Open House or Back to School Notices

Announcement of resource fairs (for example, for transition planning)

Homework assignments without a corresponding note detailing how the assignment related to the case management of the student’s IEP goals and progress.

Requests to parents for items such as: diapers, lunch money or extra clothing.

Verifying the student’s attendance status without discussing how it relates to the student’s progress towards their IEP goals and objectives.

Notice of IEP Team Meeting. (Please note that inviting parents to or arranging the upcoming IEP Meeting is not a billable service).

Face to face contact or any other contact with the student.

Examples of unacceptable documentation:

Do not document information or encounters that are unrelated to the student’s progress towards IEP goals and objectives:

Unacceptable: “I spoke to Jessie mother about her graduation gown. We were concerned if it would fit her. It fits and she looks great. We will be taking pictures today.”

Instead write: “Jessie’s parent and I discussed Jessie’s upcoming graduation and the requirements that must be met. She has completed her goals and has displayed great progress She is on target to complete all requirements by the deadline.”

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Do not document or summarize communication or contact regarding scheduling IEP meetings:

Unacceptable: “The letter was sent to the parent to set up an IEP meeting. I also called the parent to confirm.”

Instead write: “I spoke with the parent about her concerns that she would like to have addressed at the upcoming IEP Meeting and to discuss the student’s current progress. Mary is responding well to most objectives on her IEP and will need more concentration on her math goals. In addition, I reconfirmed that she will be in attendance.”

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IEP Coordination Record SY 2012-13

Method of Communication (Ongoing Service Coordination)

DATE of SERVICE:


IEP Supporting Documentation

note/letter/email/telephone call log or monthly progress note

IEP Meeting Outcome Summary:

Please choose one (1) only:

CERTIFICATION:

IEP Team Meeting Sign-In Sheet and Notice of IEP Team Meeting

documentthe purpose and the outcome of the meeting.

Prior Written Notice.


Method of Communication (IEP Meeting ONLY)


Telephone Call Summary:

February 2013

Emma Watson 000001

12345678901 03/18/2005

Hogwarts Elementary

Ronald Wheasley APC

2/19/2013

✔

✔

✔

See Prior Written Notice for meeting summary

RonaldWheasleyRonald Wheasley 2/28/13

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1319

Notice of Individualized Education Program (IEP) Team Meeting

Date of Notice:

Date(s) of additional contact(s):

To the Parent(s)/Guardian(s) of :

The IEP team would like to invite you to participate as a partner at an IEP Team meeting to discuss your child's educational program at (time) on (date) at (location).

Your attendance at this meeting is encouraged. You are entitled, by state law, to notification 10-days prior to any IEP team meeting. You are also entitled to notification in your native language.

review existing information to determine the need for additional data.

review written referral and/or existing data and information, and, if appropriate, determine eligibility for special education services.

develop the IEP. review and, if appropriate, revise the IEP. consider reevaluation to determine need for additional data,

determine services and/or determine continued eligibility.

conduct a manifestation determination. address functional behavioral assessment and/or behavioral

intervention plan. consider Extended School Year services. consider postsecondary goals and transition services. Other:

The purpose of this meeting is to:

Title TitleThe following agency and/or school personnel are expected to attend:

If you wish, you may invite others who have knowledge or special expertise regarding your child to attend this meeting with you. If others will attend, please indicate their names below.

Beginning no later than the first IEP to be in effect when the student turns 14 or younger, if appropriate, your child will be invited and expected to attend.

"Procedural Safeguards Parental Rights" booklet enclosed Yes No

Please indicate below whether or not you can attend this meeting and return one copy of this letter to the school. Check all that apply.

I will attend the meeting. I am unable to attend the meeting. Please proceed with the meeting. I will call the school to arrange a more convenient time. I would like to participate via teleconference. Please call me at (phone).

This is an expedited meeting that has been scheduled with less than ten (10) days notice and was mutually agreed upon by parent/guardian and IEP team.

Signature:

Please return a signed copy of this document as soon as possible

If you have any questions about this form or have a disability under the ADA and need further assistance, please contactphone number

Additional Information:

1420

PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS

Prior Written Notice

Student's Name: Date:School: Grade:SASID Date of Birth:Local Student ID:

Purpose of the notice: (In response to or as a result of)

________________________________________________________________________________ ________________________________________________________________________________

PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS proposed or refused an action or actions in the following areas:

Identification/Eligibility

Evaluation/Re-Evaluation, Assessments

Review/revise Individualized Education Program (IEP) (Provision of FAPE)

Educational Placement (includes change in educational placement, graduation and termination of eligibility)

Discipline

Parent revocation of consent for the provision of special education and related services.

Other

Description of the action proposed or refused by the school system:

________________________________________________________________________________ ________________________________________________________________________________

Explanation of why the school system proposes or refuses to take this action:

________________________________________________________________________________ ________________________________________________________________________________

Description of any options the school district considered prior to this proposal:

________________________________________________________________________________ ________________________________________________________________________________

Reasons the above listed options were rejected:

________________________________________________________________________________ ________________________________________________________________________________

Description of evaluation procedures, tests, records, or reports the school district used as a basis for the proposal or refusal:

________________________________________________________________________________ ________________________________________________________________________________

Other factors relevant to the action proposed are:

________________________________________________________________________________ ________________________________________________________________________________

As parents of a child with a disability, you are entitled to certain procedural safeguards as outlined in the enclosed brochure entitled "Parents Rights – Maryland Procedural Safeguard Notice." Your rights include the right to request mediation or file a due process complaint if you disagree with proposed and/or refused decision(s).

If you have any questions about the information provided, please call ___________________ at ___________________. If you want help understanding this document or your rights, you may contact the local Partners for Success Center at

21

Prince George’s County Public Schools

Sasscer Administration Building • C05-451 • 301-952-6349 • Fax: 301-780-5925

Case Manager Information: Dear Parent(s)/Guardian(s) of ___________________________________ Student #______________

Print student’s name In an effort to provide on-going service coordination and to monitor your child’s overall progress in meeting the goals and objectives identified in his/her IEP, I will be serving as your child’s Case Manager for the 2012-2013 school year.

Should you have any concerns or questions please feel free to contact me at your child’s current school placement. With Sincere Thanks, __________________________________________ ______________________________________ Case Manager Print Name Case Manager Signature __________________________________________ ______________________________________ Alternate Case Manager Print Name Alternate Case Manager Signature (Only if an alternate Case Manager is assigned) School Name: _______________________________________________________________________

22

7/12 Sasscer Administration Building ▪ 14201 School Lane, C05-451 ▪ 301.952.6349 (office) ▪ 301.780.5925 (fax)

MEDICAID PARENTAL CONSENT As you may know, the Prince George’s County School system provides service coordination and health-related services outlined in your child’s Individualized Education Plan (IEP). Parent consent must be obtained before Prince George’s County School system can disclose, for billing purposes, your child’s personally identifiable information to the Maryland Department of Health and Mental Hygiene (DHMH). DHMH is the State agency responsible for the administration of the Medical Assistance Program, consistent with the Family Educational Rights and Privacy Act (FERPA) and the Individuals with Disabilities Act (IDEA). Your consent to release the information in order to bill Medicaid, will allow Prince George's County School system to receive the maximum Medicaid reimbursement for services provided rather than covering the costs solely from your local tax dollars. Medicaid funding will help Prince George's County Public Schools expand and enhance the services to your child.

In order to provide a free and appropriate public education to your child Prince George School system may not: • Require you to sign up for or enroll in State’s Medicaid Assistance in order for your child to receive FAPE under IDEA. • Require you to incur an out of pocket expense such as the payment of a deductible or co-pay amount incurred in filing

a claim for services, • Use your child’s benefits under Medical Assistance if that use would:

o Decrease available lifetime coverage or any other insured benefit; o Result in your family paying for services that would otherwise be covered by Medicaid Assistance and that are

required for your child outside of the time your child is in school; o Increase premiums or lead to the discontinuation of benefits or insurances; or o Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.

I give my consent for Prince George’s County School system to disclose my child’s personally identifiable information to the State’s Medical Assistance Program in order to access Medicaid Assistance Benefits.

I give permission to the Prince George’s County School system to recover costs from Medicaid for service coordination, as well as health-related services, related to the implementation of my child's IEP goals.

I understand that if I refuse to allow the provider agency access to MA funds, it does not relieve the public agency of its responsibility to ensure that all required services are provided to my child at no cost to parent.

I understand that this service does not restrict or otherwise affect my child's eligibility for other Medical Assistance benefits. I also understand that my child may not receive a similar type of case management service under Medical Assistance if he/she qualifies for more than one type.

I understand that the Prince George’s County School System will submit information that will be used for the special services information system. This system will be used by the MSDE and other State Agencies, as appropriate; to enable funding of programs and to assure my child's rights to any needed assessment.

I hereby authorize Prince George’s County Public Schools to share information with the MD State Department of Health and Mental Hygiene (DHMH) and for purposes of billing Medicaid for Medicaid covered case management and health related services that are identified in my child's Individualized Education Plan (IEP).

I understand that the use of my Medicaid insurance to recover costs for special education services does not restrict or otherwise affect my child’s eligibility for other Medicaid insurance benefits.

I also understand if I choose to deny consent, Prince George’s County Schools is obligated to provide all required special education services at no cost to me.

I give my consent voluntarily and I understand that I may withdraw that consent at any time. I also understand that my child's entitlement to a free appropriate public education (FAPE) is in no way dependent on my granting consent.

Parent/ Guardian Signature: __________________________________________ Date: ______________________________ Student’s Name ___________________________________________ Student # __________________ Date of Birth _____________ School Name: ____________________________________________________ Medical Assistance# _____________________________ My child does not receive Medicaid



DATE of SERVICE:






CERTIFICATION:








May 2013

Wendy Checkers 0000001

12345678901 1/11/2000

King Middle School

McDonald Berger APC

5/2/2013

✔

✔

✔

Telephone conference with parent and IEP Team.This was an Annual Review. Behavior interventionplan was added. Wendy's IEP was amended to reflectchanges needed based on new data and input. Pleasesee attachments for requested documentation.

McDonaldBergerMcDonald Berger 5/23/2013

24

IEP

TEA

M M

EETI

NG

SIG

N-IN

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EET

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of M

eetin

g:______/______/_________

Mon

th

/ D

ay

/

Y

ear

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ent’s

Nam

e: ___________________________________________________________________

Stud

ent’s

ID# __________________________

DOB______/______/________

Mon

th /

Day

/

Yea

r Sc

hool

:______________________________________________

ATTE

NDEE

SNa

me

Plea

se P

rint

Sign

atur

eTi

tle o

r Rol

eEx

ample

s: P

aren

t, Le

gal G

uard

ian, P

aren

t Sur

roga

te, S

pecia

l Edu

catio

n Te

ache

r, Ge

nera

l Edu

catio

n Te

ache

r, Ad

mini

strat

or, S

tude

nt, e

tc.

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1325


Date of Notice:



















Signature:




1426





________________________________________________________________________________ ________________________________________________________________________________






Discipline


Other


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________



27






28



DATE of SERVICE:






CERTIFICATION:








April 2013

Lindsay Lohan 0000004

12345678910 04/22/1997

Hollywood High School

Perez Hilton APC

4/8/13

✔

✔

✔

The meeting was an annual review. No changes weremade to the IEP.

See Prior Written Notice for confirmation that parentwas notified of the meeting discussion and outcome.

Perez HiltonPerez Hilton 4/8/2013

30

IEP

TEA

M M

EETI

NG

SIG

N-IN

SH

EET

Date

of M

eetin

g:______/______/_________

Mon

th

/ D

ay

/

Y

ear

Stud

ent’s

Nam

e: ___________________________________________________________________

Stud

ent’s

ID# __________________________

DOB______/______/________

Mon

th /

Day

/

Yea

r Sc

hool

:______________________________________________

ATTE

NDEE

SNa

me

Plea

se P

rint

Sign

atur

eTi

tle o

r Rol

eEx

ample

s: P

aren

t, Le

gal G

uard

ian, P

aren

t Sur

roga

te, S

pecia

l Edu

catio

n Te

ache

r, Ge

nera

l Edu

catio

n Te

ache

r, Ad

mini

strat

or, S

tude

nt, e

tc.

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1331


Date of Notice:



















Signature:




1432





________________________________________________________________________________ ________________________________________________________________________________






Discipline


Other


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________


________________________________________________________________________________ ________________________________________________________________________________



33






34



DATE of SERVICE:






CERTIFICATION:








October 2012

Ali Gator 000005

12345678911 12/12/2003

Reptile Elementary School

Steve Irwin APC

10/22/2012

✔

✔

✔

Ms. Gator and I discussed Ali's progress in her mathgoals. Ms. Gator is very pleased. Ali will continue toapply herself in her studies. Her IEP meets her needsand does not need any revision at this time.

36


Parent Contact Log

Student's Name: Date: School: Grade: Local Student ID: Date of Birth: Unique Student ID:

Date Printed:

Date/Time Name of person making contact Name of person being contactedNotifications

Notice 1 2 3

phone

email

face to face

written correspondence

Purpose/Response:


Notice 1 2 3

phone

email

face to face


Purpose/Response:


Notice 1 2 3

phone

email

face to face


Purpose/Response:

Page 1 of 1Case Management - Printout

7/23/2012https://www.online-iep.com/maryland/CM/print.aspx?Page=PrintParentContactLog_Blank

37



DATE of SERVICE:






CERTIFICATION:








November 2012

Miley Cyrus

12345678910 01/01/1996

Hollywood High School

Phil Mcgraw APC

11/20/2012

✔

✔

✔

PhillipMcgrawPhillip Mcgraw 11/20/2012

38

Monthly IEP Progress Note

Date: ___11/20/12___

From: ___________Phil Mcgraw______________

Print Case Manager Name

To the Parent/Guardian of: ______Miley Cyrus______________________________

This is a note to inform you of how your child is progressing with his/her IEP goals and

objectives. If you have any questions or concerns, please feel free to contact me at:

________555‐555‐5555_____.

IEP Goal Progress for the month of: ___November 2012___________

Your child’s progress was monitored in the area(s) of:

Academics (Math, Reading) Social / Behavior Goals Transition Services / Post Secondary Goals Accommodations Other: __________________________

Your child’s progress is as follows:

Assistance required to increase mastery level New IEP goal(s) and/or expectations have been reviewed/implemented with the student Progress is adequate at this time Mastery has been demonstrated Progress is inadequate at this time. Please contact me at your earliest convenience. Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________________

___Phil Mcgraw___________________________

Case Manager Signature



DATE of SERVICE:






CERTIFICATION:








December 2012

Katy Perry 000002

12345678911 11/16/2000

Fireworks Elementary School

Elizabeth Hudson SPC

12/5/2012

✔

✔

✔

Elizabeth HudsonElizabeth Hudson 12/10/12

40


December 5, 2012

Dear Mrs. Perry, I am writing to inform you about Katy’s progress regarding her Math IEP goals. She is attentive in class and beginning to voluntarily raise her hand to answer questions. Please continue to work with Katy and the flash cards. She is making great strides with her progress. I will continue to monitor and update you on her IEP goals. Please contact me if you have any questions. Elizabeth Hudson

Elizabeth Hudson Fireworks Elementary

41



DATE of SERVICE:






CERTIFICATION:








December 2012

Lisa Simpson 000001

12345678901 3/12/2004

Shadyside ES

Patrick Starr APC

12/12/2012

✔

✔

✔

Patrick StarrPatrick Starr 12/12/2012

42


SIMPSON, LISA (IEP Meeting Date: 02/15/2013)

• Given grade level math word problems involving fractions, decimals and percents, Lisa will solve problems, on 4 out of 5 trials.

Academic and Functional Areas Assessed Evaluation Method By With

ESY Goal?

Academic - Math Problem Solving Classroom-Based Assessment

05/23/2013 4 out of 5 trials

No

• Objectives

1. Given math word problems, Lisa will identify the important numerical data and the question in order to make a plan to solve the problem.

2. Given word problems involving various operations, Lisa will correctly apply taught strategies to solve math word problems, on 4 out of 5 trials.

Progress on IEP Goal

o 12/12/2012: Making sufficient progress to meet goal

Lisa is making some progress in math problem solving. She has to be reminded to circle

all important numerical data and underline the question. When she is asked what the cue

words are in the word problem, sometimes she is able to say them. She needs diagrams

or pictures to understand the more difficult word problems. She finds addition the

easiest and gets mixed up with the rest of the operation. A lot of word problems have to

be given for Lisa to remember the operation being asked for. Math vocabulary words

have been posted to aid her look for the appropriate operation. At times Lisa also is able

to determine which data is not important. All her accommodations are in place during

instruction and assessments.

Given instructional level materials, Lisa will identify, write, solve, and apply equations and inequalities in 4 out of 5 trials.

Academic and Functional Areas Assessed

Evaluation Method By With

ESY Goal?

Academic - Math Problem Solving Informal Procedures 05/23/2013 4 out of 5 trials

No

Objectives

1. Given 5 problems, Lisa will write equations and inequalities to represent relationships using a variable, the appropriate relational symbols (>, =, <) and one or two operational symbols (+,-,×,÷).

43




Given instructional level word problem using equations. Lisa is able to interpret them

and write them clearly as an equation with the correct symbols. When she was assessed

on 9/2011, she got a score of 8/10 and 9/16. The 2nd score showed Lisa’s weakness in

understanding math vocabulary and comprehension of word problems. She is able to use

the <, > and = signs when comparing numbers up to thousands place. Her greatest

challenge is understanding the word problem.

Given grade level math exercises Lisa will describe, analyze and apply mathematical problems involving patterns and basic operations, without the use of a calculator, in and out of content areas, on 4 out of 5 trials.

Academic and Functional Areas Assessed Evaluation Method By With

ESY Goal?

Academic - Math Calculation Classroom-Based Assessment

05/23/2013 4 out of 5 trials

No

Objectives

1. Given grade level math exercises, Lisa will add, subtract, multiply, and divide integers.

2. Given grade-level math exercises, Lisa will add, subtract, and multiply positive fractions and mixed numbers.



Lisa understands and is able to apply concepts in math when she is listening and not

distracting herself. She knows her multiplication facts up to 6 times table and can add

with regrouping. She is able to subtract with regrouping when the minuend has no

zeroes. Subtracting numbers with zeroes confuses Lisa. When the steps are explained,

she is able to do them well. The same is true for division with 3-digit dividends. She is

able to do them during small group instruction. However, when she is in the classroom,

she works too fast that she makes errors. An adult has to check on her to ask, "Do you

need to borrow? What will the new number be if you borrow from it?" Even if she knows

subtraction, the subtraction part in division confuses her. If that subtraction part is

isolated, she will be able to solve well. When it is within the division process, she seems

not to understand the concept. In objective 2, Lisa can turn unlike fractions to like

fractions and add or subtract. She is able to turn mixed numbers into irregular fractions.

44


Essential Information

45


46


Nursing Services

The following are services that are reimbursable by Medicaid and must be reflected in the student’s IEP.

Nursing Assessment Nursing Treatment

Requirements for Billing Nursing Services

■ Nursing Services must be documented as a related service in the IEP. ■ Nursing Services must be delivered in accordance with the IEP/IFSP. ■ Nursing Services must be related to an identified health problem. ■ Nursing Services must be ordered by a licensed prescriber, except for a nursing assessment, which results in a change of nursing care plan. ■ Nursing Services must be indicated in the nursing care plan which must be reviewed every 60 days or more frequently when a student’s medical condition changes.

Billable Nursing Services ■ Urinary Catheterizations ■ Gastrostomy Tube Feedings ■ Endotracheal Suctioning/Tracheotomy ■ Ostomy Care ■ Wound/Decubitus Care

Please Note: Medicaid does not reimburse for the following services: Peak flow monitoring, administration of medication, blood glucose monitoring, nebulizer treatments and oxygen administration. Medicaid does not reimburse for the student’s self administration of any medical service.

Nursing services are billed in 15 minutes increments/units. PGCPS can receive reimbursement for up 8 units (2 hours) of service per day for nursing services provided to Medicaid eligible students.

The Frequency of nursing services must be described as “Daily” in the related services section of the IEP.

Choose “Nursing Service” for Service Nature , and “Nurse” for Provider.

Completing the IEP for Nursing Services

IMPORTANT POINTS TO REMEMBER

47

Sess

ions

:(S

elec

t th

e le

ngth

of

tim

e, in

15

min

ute

incr

emen

ts,

that

the

se

rvic

e is

pro

vide

d du

ring

eac

h se

ssio

n):

tim

e: Hrs

. M

in.

Num

ber

of

Sess

ions

:

Leng

th o

f Ti

me

(Sel

ect

the

leng

th o

f ti

me,

in 1

5 m

inut

e in

crem

ents

, th

at t

he

serv

ice

is p

rovi

ded

duri

ng e

ach

sess

ion)

:

Freq

uenc

y:ot

al s

ervi

ce

tim

e: Hrs

. M

in.

Disc

ussi

on o

f se

rvic

e(s)

del

iver

y (f

or a

ll se

rvic

es):

REL

AT

ED S

ERV

ICES

ESY

Ser

vice

Nat

ure

ESY

Loc

atio

nES

Y S

ervi

ce D

escr

ipti

onES

Y B

egin

D

ate

ESY

End

Dat

eES

Y P

rovi

der(

s):

(P)=

Prim

ary,

(O

)=O

ther

Sum

mar

yof

Ser

vice

Num

ber

of

Sess

ions

:Le

ngth

of

Tim

e(S

elec

t th

e le

ngth

of

tim

e, in

15

min

ute

incr

emen

ts,

that

the

se

rvic

e is

pro

vide

d du

ring

eac

h se

ssio

n):

Freq

uenc

y:To

tal s

ervi

ce

tim

e: Hr. M

in.

Num

ber

of

Sess

ions

:Le

ngth

of

Tim

e(S

elec

t th

e le

ngth

of

tim

e, in

15

min

ute

Freq

uenc

y:To

tal s

ervi

ce

tim

e:

Nam

e:H

anna

Mon

tana

Agen

cy:

IEP

Team

Mee

ting

Dat

e:

07/0

7/20

2348


Audit Requirements

The Maryland Department of Health and Mental Hygiene (DHMH) along with Maryland State department of Education (MSDE), Division of Special Education/Early Intervention Service administer the statewide School Based Medicaid Reimbursement Program. MSDE has assembled an Interagency Monitoring Team to conduct audits statewide in order to determine if local educational agencies are in compliance with COMAR 10.09.36, COMAR 10.09.50 COMAR 10.09.52 and COMAR 10.09.40 regulations. PGCPS system can be subject to audits from federal, state and local authorities at any time. All records for Medicaid billing need to be retained for 6 years. Based on findings of audits conducted by the Interagency Monitoring Team, DHMH may request reimbursement for Medicaid school-based services in accordance with the terms of applicable federal regulations and state Medicaid rules. Additionally, DHMH can request that a “Corrective Action Plan” be established to address any identified findings. The Medicaid Billing Office is also expected to implement self-monitoring process in order to address identified concerns and improve regulatory compliance. In addition, the Medicaid Billing Office also utilizes the PGCPS Internal Audit Office to assist in our independent monitoring process. In order to meet the requirements for state and federal audits: Billing Records must contain:

Name of Medicaid Recipient

Name of Provider

Qualifications of Provider

Date of Service

Type and Description of Service The audit file must contain:

A copy of the IEP or IFSP

Notes of an IEP meeting if a child is not found to be eligible under IDEA

Notes of the meeting with the multidisciplinary team and family if an Infant or toddler is found not eligible under Part C of IDEA

Monthly Medicaid Encounter Form

Record/copy of Provider Qualifications

Notes of an emergency meeting when billing for an emergency IEP review and ongoing care coordination during the same monthly period of time

Transportation logs

Documentation to support the services indicated on all billing forms At a minimum, the record must contain a signed IEP or IFSP, name of recipient, recipient’s medical assistance number, type of service, date of service, name and signature of the provider (with credentials and co-signature as appropriate), description of the face-to-face health related service provided.

49


Fraud Statement Summary

The purpose of this statement is to comply with Section 6032 (Employee Education about False Claims Recovery) of the Deficit Reduction Act of 2005 (DRA) in relation to the Prince George's County Public Schools (PGCPS) Medical Reimbursement Program. Section 6032 of the DRA requires providers that make or receive annual Medicaid payments of five million dollars or more during a federal fiscal year (October 1 to September 30) to educate employees and certain contractors about federal and state false claims laws and whistle blowing protections available under those laws. The False Claims Act (FCA) prohibits any individual or company from knowingly submitting false or fraudulent claims, causing such claims to be submitted, making a false record or statement in order to obtain payment from a federally funded program for such a claim, or conspiring to get such a claim allowed or paid. “Knowing” or “knowingly” mean that a person (1) has actual knowledge of the information; (2) acts in deliberate ignorance of the truth or falsify the information. Examples of the type of activity prohibited by the FCA include billing for services that were not provided and up coding, i.e., billing for a highly reimbursed service in lieu of the service actually provided… The FCA imposes civil penalties on individuals and companies who knowingly submit a false claim or statement to a federally funded program, or otherwise conspire to defraud the government, in order to receive payment… The FCA also protects individuals who report suspected fraud. Any person who lawfully reports information about false claims or suspected false claims that are submitted by others, may not be retaliated against, demoted, suspended, threatened, or harassed for making such a report… The FCA provisions are generally enforced by the US Department of Justice. False representations include knowingly and willfully:

Concealing, falsifying, or omitting a material fact; Making a materially false of fraudulent statement; or Using a document that contains a statement of material fact that the user

knows to be false of fraudulent. Please see the Attachments section of this manual for the complete Administrative Procedure Bulletin and policy explanations.

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F.A.Q’S- FREQUENTLY ASKED QUESTIONS?

How are students identified for the Medicaid billing process? The identification process begins with all Medicaid eligible Special Education students. Further identification of this population is generally achieved two ways, through a school referral process and by conducting a data match with Maryland Department of Health and Mental Hygiene (DHMH). The data match can be performed up to four times per year.

How long does it take to complete an IEP coordination form? Student demographics and Case Manager’s name & school are pre-printed on the current form. It will take less than 5 minutes to complete the current form.

Can incentive funds be utilized for items in departments or programs other than Special Education? No, incentive funds can only be used for items, and equipment that expand or enhance the services provided to special education students. The federal government initiates audits on how Medicaid funds are utilized; therefore, funds should only be used for Medicaid related expenditures.

How does the Medicaid Billing Office determine the loss of Medicaid funds for each school? The Medicaid reimbursement rate for each IEP coordination form is $150.00. One IEP coordination form should be completed for each Medicaid-eligible student per month. For example, 10 Medicaid-eligible students x 11 months (Aug-June) = 110 forms. 110 forms x 150 = $16,500 in possible MA revenue.

How does the Medicaid Billing Office track school performance? Once IEP coordination forms have been processed, each school’s audit form is updated to reflect the number of forms submitted for each student per month. Principals are notified on a monthly basis of their schools performance and compliance.

How does the Medicaid Billing Office communicate changes/modifications in the policies or process to special education staff? The Medicaid Liaisons communicate changes primarily through email and the pony. Additionally changes are often posted on the Google groups sites for each related service. The Medicaid Billing Office website also provides a wealth of information related to our program.

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Incentive Funds For SY 12-13 (all order requests due by 3/1/2013

As an incentive for participating in the school-based Medicaid Reimbursement Program, schools can earn 5% of its total Medicaid reimbursement. The Medicaid Incentive Money is now available at the beginning of the school year. The funds designated for each school is based on the school’s performance the year before. The Medicaid Coordinator as well as SPED staff at each school has discretion regarding how this money is spent. At some schools, Medicaid Coordinators have purchased items such as copiers, Woodcock-Johnson assessments, didactic materials and equipment, toner, ink cartridges, copy paper and even reward/accomplishment stickers and certificates for the students. The Medicaid Coordinator will be informed in the beginning of the school year regarding the balance. Each coordinator is responsible for keeping track of their spending and continuing balance.

Incentive Requisition Forms are located on our website at: http://www1.pgcps.org/medicaid/

Susy Crump is the contact in our office; please submit purchase orders via fax# 301.780.5925. If you have any questions, Susy’s telephone number is 301.952.6349.

When filling out purchase orders for use with the incentive funds, please remember to add shipping & handling costs when applicable. If there is no shipping & handling costs, please put 0 (zero) on that line.

Please use current catalogs when selecting items for the use of incentive funds. Please do not use catalogs from previous school years, as the prices of items change annually.

You may only select approved PGCPS vendors. You are not permitted to select items from Target.com, BarnesandNoble.com, Amazon.com or Staples etc;

In addition, when ordering from OfficeMax, you will need to access the online catalog from the PGCPS Intraweb, which is located on the bottom far-right corner of the PGCPS website. Once you click on Intraweb, select OfficeMax catalog which is located under the subheading Purchasing.

Do not forget to put your name and your school’s name on the requisition form. Only people designated as “Authorized Purchaser” on our Authorized Purchaser form will be allowed to submit orders.

Please include the catalog numbers that are associated with the items or products that are interested in ordering on the requisition form.

The Medicaid office does not research items, vendors/ catalog or items numbers. The requisition must be completed in its entirety before it can be processed. Incomplete requisitions will NOT be processed.

When your order arrives, you must contact Susy Crump immediately so that she can complete the process in Oracle. (E-mail [email protected] , fax 301-780-5925, phone 301-952-6349)

INCENTIVE FUND REQUESTS NEED TO BE RECEIVED IN THE MEDICAID OFFICE BY MARCH 1, 2013

52


Attachments

53


54

Prince George’s County Public Schools Office Of Medicaid Billing

7/12 Sasscer Administration Building 14201 School Lane, C05-451 301.952.6349 (office) 301.780.5925 (fax)

Medicaid Billing Office CHANGE IN STATUS FORM

This form may be completed online, printed, and faxed to the Medicaid Billing Office. Be sure to PRINT before closing.

School: ____________________________________________ Date of Status Change ____________

Teacher/IEP Service Coordinator: ______________________________________________________

Student: _____________________________________________ Date of Birth_____/_____/_____ Last /First /MI Month/Day/Year

Medical Assistance Number ___________________________ Student Number _______________

Reason (s) (check all that apply):

Student is no longer eligible for Medical Assistance (if student becomes M.A. eligible at a later date, please notify the Special Education Medicaid Office at 301-952-6349).

Student has withdrawn from school:

transferred within PGCPS jurisdiction to: ____________________________________P. G. School

transferred to private school within PG jurisdiction: ___________________________ Private School

transferred out of PGCPS jurisdiction.

Student on Home/Hospital Teaching.

Student has graduated.

Student has a disability under Section 504 and does not have an I. E. P.

Student is not eligible for special education.

Student is transitioning from IFSP to the age 3-21 program: __________________________ School

Student dismissed from special education.

Other ______________________________________________________________________

PLEASE RETURN TO: Medicaid Billing Office

55

Prince George’s County Public Schools Office Of Medicaid Billing

7/12 Sasscer Administration Building 14201 School Lane, C05-451 301.952.6349 (office) 301.780.5925 (fax)

Medicaid Billing Office NEW STUDENT FORM

This form may be completed online, printed, and faxed to the Medicaid Billing Office. Be sure to PRINT before closing.

School: ______________________________________________________________

Date Student Became Eligible for Services: __________________________________

Teacher/IEP Service Coordinator: _________________________________________

Student Name: ________________________________________________________

Date of Birth (mm/dd/yyyy): _____________________________________________

Student Number: ______________________________________________________

Medical Assistance Number: ______________________________________________

Check Current Services Rendered Audiology

Infant Toddler Services

Nursing

Occupational Therapy

Physical Therapy

Psychology

Speech

Other __________________

PLEASE RETURN TO: Medicaid Billing Office

56

Sasscer Administration Building • 14201 School Lane, C05‐451 • 301.952.6349 (office) • 301.780.5925 (fax)

Understanding PGCPS & MedicaidParent Information

WHY IS PGCPS PERMITTED TO BILL MEDICAID?

The Individuals with Disabilities Education Improvement Act (IDEA) allows some Individuals Education Plan (IEP) services to be covered by Medicaid. Schools districts optimize the use of financial resources by billing Medicaid when possible.

WHAT SERVICES ARE BILLABLE? PGCPS can only bill for IEP coordination services and medically related services that are outlined in your child’s IEP. The following are services that PGCPS may bill Medicaid : case management services, audiological services, nursing services, speech /language therapy, occupational services, physical therapy and psychological services.

HOW DOES PGCPS USE THE FUNDS RECEIVED FROM MEDICAID?

The Medicaid reimbursement funds are used to expand and enhance special education programs and services for PGCPS special education students.

DOES PGCPS NEED PARENTAL CONSENT TO BILL MEDICAID?

Yes. PGCPS is required by the Family Educational Rights and Privacy Act (FERPA) to obtain parental consent before providing information to Medicaid.

WILL THE MEDICAID SERVICES THAT MY CHILD RECEIVES OUTSIDE OF THE SCHOOLS BE AFFECTED?

No. Your child’s Medicaid services received outside of the school setting will not be affected and will result in no cost to you.

DOES THIS IMPACT THE SCHOOL SERVICES MY CHILD RECEIVES? No. PGCPS is requires to provide all IEP services even if you do not provide consent to bill Medicaid.

THE WORD “MEDICAID” IS NOT PRINTED ON MY CHILD’S INSURANCE CARD. HOW DO I KNOW IF MY CHILD HAS MEDICAID?

There are Managed Care Organizations (MCO) that are sponsored by Medicaid. If your child has one of the following plans and their membership number has 11 digits, then your child is a Medicaid recipient. Amerigroup, Priority Partners, United Health Care, Maryland Physicians Group, Diamond Plan, MedStar Family Choice, and Jai Medical Systems.

HOW DO I GIVE CONSENT?

You may give consent at anytime and in the following ways: During your child's IEP annual review, request a parental consent form from your child’s IEP case manager, assess the form from the PGCPS Medicaid website and mail it to our office, or respond to the annual mailing requesting parental consent to bill Medicaid.

HOW DOES BILLING MEDICAID HELP MY CHILD?

All children benefit either directly or indirectly from the expansion of health care services in our schools.

HOW MUCH DOES IT COST ME?

There is NO cost to you! Your child is entitled to a free and appropriate public education under the Individuals with Disabilities Education Act (IDEA).

WHAT IF MY CHILD IS NO LONGER A MEDICAID RECIPIENT?

Just let your child’s case manager know. This will not affect the services your child receives.

0712

58






59


MONTHLY IEP PROGRESS NOTE From: ________________________________ Date: _____________

Print Case Manager Name To the Parent/Guardian of: ________________________________________ This is a note to inform you of how your child is progressing with his/her IEP goals and objectives. If you have any questions or concerns, please feel free to contact me at: ______________________. IEP Goal Progress for the month of: ___________________________ Your child’s progress was monitored in the area(s) of:

Academics (Math, Reading) Social / Behavior Goals Transition Services / Post Secondary Goals Accommodations Other: __________________________

Your child’s progress is as follows:

Assistance required to increase mastery level Independence demonstrated towards mastery level Progress is adequate at this time Mastery has been demonstrated Progress in inadequate at this time. Please contact me so that we can discuss your child’s progress. Comments:_________________________________________________________________________________________________________________________________________________________________________________________________________

_____________________________________ Case Manager Signature

60

ADMINISTRATIVE PROCEDURE

3703 Procedure No.

March 26, 2008 Date

EDUCATION REGARDING

FALSE CLAIMS RECOVERY- MEDICAID REIMBURSEMENT PROGRAM

1

PRINCE GEORGE’S COUNTY PUBLIC SCHOOLS

I. PURPOSE: To comply with Section 6032 (Employee Education About False

Claims Recovery) of the Deficit Reduction Act of 2005 (DRA) in relation to the Prince George's County Public Schools (PGCPS) Medicaid Reimbursement Program.

II. BACKGROUND: Section 6032 of the DRA requires providers that make or

receive annual Medicaid payments of five million dollars or more during a federal fiscal year (October 1 to September 30) to educate employees and certain agents and contractors about federal and state false claims laws and whistle blowing protections available under those laws. A summary of relevant laws, including the federal False Claims Act (FCA), is contained in the Attachment. In general, these laws serve to detect and prevent waste, fraud and/or abuse in the administration of federal health care programs.

III. DEFINITION: For the purpose of this Administrative Procedure, a “contractor”

or “agent” includes any contractor, subcontractor, agent or other person which or who, on behalf of PGCPS, furnishes or otherwise authorizes the furnishing of Medicaid health care items or services, performs billing or coding functions or is involved in monitoring of health care provided by PGCPS. This definition includes supply vendors that provide products used in the furnishing of Medicaid health care services.

IV. PROCEDURES:

A. Filing an Internal Report

1. Any PGCPS employee, agent, or contractor who knows or reasonably believes that PGCPS or any of its employees, agents, or contractors is involved in any activity prohibited by the FCA, any state law, or other fraud and/or abuse law, is required to immediately report such belief by calling the PGCPS Compliance Hotline using the toll-free number, 1-866-646-2512, or by making an online report at the PGCPS website. http://www.pgcpshotline.com/

2. Upon receipt of the report, the Office of Internal Audit will conduct

an investigation into the matter, and will issue a written report summarizing its findings.

62

http://www.pgcpshotline.com/

ADMINISTRATIVE PROCEDURE

3703 Procedure No.

March 26, 2008 Date

EDUCATION REGARDING

FALSE CLAIMS RECOVERY- MEDICAID REIMBURSEMENT PROGRAM

2

PRINCE GEORGE’S COUNTY PUBLIC SCHOOLS

3. If a finding of waste, fraud, or abuse is substantiated, PGCPS will report the finding to appropriate law enforcement and/or designated agencies responsible for enforcement of the applicable statutes.

B. PGCPS will not tolerate any intimidating or retaliatory act against an

individual who, in good faith, makes a report of practices reasonably believed to be a violation of the FCA or other applicable law. These individuals will be entitled to any and all protections available under applicable laws.

V. RELATED PROCEDURES: None. This is a new Administrative Procedure.

VI. MAINTENANCE AND UPDATE OF THESE PROCEDURES: These

procedures originate with the Office of the Chief Financial Officer and will be updated as needed.

VII. CANCELLATIONS AND SUPERSEDURES: None. This is a new

Administrative Procedure.

VIII. EFFECTIVE DATE: March 26, 2008. Approved by: John E. Deasy Superintendent of Schools Attachment: Laws Relating to Filing False Claims Distribution: Lists 1, 2, 3, 4, 5, 6, 9, 10, and 11

63

Attachment to A.P. 3703

LAWS RELATING TO FILING FALSE CLAIMS

I. Federal False Claims Act

A. The federal FCA prohibits any individual or company from knowingly submitting

false or fraudulent claims, causing such claims to be submitted, making a false

record or statement in order to obtain payment from a federally funded program

for such a claim, or conspiring to get such a claim allowed or paid. “Knowing”

and “knowingly” mean that a person (1) has actual knowledge of the information;

(2) acts in deliberate ignorance of the truth or falsity of the information; or (3)

acts in reckless disregard of the truth or falsity of the information. Examples of

the type of activity prohibited by the FCA include billing for services that were

not provided and upcoding, i.e., billing for a highly reimbursed service in lieu of

the service actually provided. The FCA applies to billing and claims sent from the

hospital to any government payor program, including Medicare and Medicaid.

B. The FCA imposes civil penalties on individuals and companies who knowingly

submit a false claim or statement to a federally funded program, or otherwise

conspire to defraud the government, in order to receive payment. Any person or

company determined to have violated the FCA may be fined between $5,500.00

and $11,000.00 for each such claim submitted, regardless of the size of the false

claim, plus up to three times the amount of damages sustained by the federal

government.

C. The FCA also protects individuals who report suspected fraud. Any person who

lawfully reports information about false claims or suspected false claims that are

submitted by others, may not be retaliated against, demoted, suspended,

threatened, or harassed for making such a report. The FCA also protects

individuals who assist in an investigation, provide testimony, or participate in the

government’s handling of a false claim.

D. The FCA provisions are generally enforced by the U.S. Department of Justice.

The FCA provides that an individual may initiate a formal claim if he or she is the

“original source” of the information. This means that the person bringing the

claim must have direct and independent knowledge of the alleged fraud. If any

funds are recovered, a portion of the funds may be paid to the person who

initiated the formal claim, at the discretion of a federal court. If a person wishes

to file a claim regarding fraud or suspected fraud related to a healthcare payment

directly with the government, he or she must first present a formal complaint,

along with all material evidence relating to the alleged fraud, to the authorities at

1 64


the U.S. Department of Justice. The authorities have sixty (60) days to investigate,

during which time the complaint is kept confidential. Upon completion of the

investigation, the government will decide either to pursue the case on its own or

decline to proceed with the case. If the federal government declines the case, the

individual may still proceed with the case on his or her own, but without the

government’s assistance, and at his or her own expense. A private legal action

under the FCA must be brought with six (6) years from the date that the false

claim was submitted to the government. A government initiated claim may be

brought up to ten (10) years after the false claim, depending on the circumstances.

II. Federal Program Fraud Civil Remedies Act

Individuals or companies that commit fraud on the federal government, by false claim

or statement, can be assessed monetary penalties in addition to the penalties of the

FCA under the Program Fraud Civil Remedies Act (the PFCRA). Specifically,

PFCRA penalties of $5,000.00 per false claim or statement apply if an individual or

company submits or causes to be submitted a claim to the federal government that:

the person knows or has reason to know is false, fictitious or fraudulent; includes or is

supported by written statements containing false, fictitious or fraudulent information;

includes or is supported by written statements that omit a material fact, which causes

the statements to be false, fictitious or fraudulent, and the person submitting the

statement has a duty to include the omitted fact; or is for payment of property or

services that were not provided as claimed.

III. Maryland Medicaid Fraud Law

A. Maryland has enacted a law similar to the federal False Claims Act that provides

for criminal and civil remedies for the submission of false and fraudulent claims

to the Medicaid program. Under the Maryland Medicaid Fraud law, it is a crime

for an individual to knowingly and willfully:

• Defraud or attempt to defraud the Medicaid program in connection with

the delivery of or payment for a health care service; or

• Obtain or attempt to obtain by means of false representation anything of

value in connection with the delivery of or payment for a health care

service through the Medicaid Program.

False representations include knowingly and willfully:

• Concealing, falsifying, or omitting a material fact;

2 65


• Making a materially false or fraudulent statement; or

• Using a document that contains a statement of material fact that the user

knows to be false or fraudulent.

B. Remedies for violating the Maryland Medicaid Fraud law include imprisonment,

fines and civil penalties of up to three times the amount of the overpayment.

3 66


Medicaid Coordinator Checklist

Review the student list for accuracy.

Communicate any changes to the Medicaid Billing Office by phone 301-

952-6349, fax 301-780-5925 or by e-mail.

Ensure Parent Permission is current.

Review the student list to make sure the case manager assigned is current.

Ensure new case managers complete a case manager letter.

Disseminate IEP Coordination forms and Health Related Services forms.

Assign a date that completed forms should be returned to you or your

designee, before the end of the month.

Review completed forms for correctness and completeness before

returning to the Medicaid Billing Office. Check each form against the

student list to be sure that every form is accounted for.

Forward completed and reviewed forms to the Medicaid Billing Office

before the 5th of the following month.

Communicate to the case managers all information from mailings and e-mails.

Post communications monthly.

67


Case Manager Checklist FOR EVERY STUDENT ON YOUR MEDICAID CASE LOAD:

Review student list for accuracy.

Communicate any changes to the Medicaid Billing Office

phone 301-952-6349 fax 301-780-5925 or e-mail.

Ensure Parent Permission is current.

Complete a new Case Manager letter for any new student assigned to

your case load.

Review your completed forms before returning it to the Medicaid

coordinator for your school. (signature, dates, teacher certification, and

any attached documentation.)

Return all completed and reviewed forms to your Medicaid Coordinator

or their designee, before the end of the month.

Look for any communications to the case managers from mailings and e-mails

or posted notices.

68


IEP Meeting Checklist FOR EVERY MEDICAID ELIGIBLE STUDENT

STUDENT: Date of IEP:

Bring the Medicaid Parent Permission form and the “Understanding PGCPS & Medicaid” hand out to all IEP meetings. The Spanish language documents are on the website. (http://www1.pgcps.org/medicaid/)

Ask the parent/guardian if they are receiving Medicaid for their child.

Ask for the Medicaid Number.

Ensure the parent/guardian signs the Medicaid Parent Permission located on the last page of the IEP or on a separate form. (visit our web site for the most current forms )

Forward a copy of the parent/guardian permission to the Medicaid Billing Office.

File completed parent/guardian permission forms with the IEP.

Communicate any changes to the Medicaid Billing Office. Phone 301-952-6349 fax 301-780-5925 or e-mail.

69


2012-2013 SCHOOL YEAR CALENDAR

DO NOT SUBMIT BILLING FOR THE

HIGHLIGHTED DATES !!!

AUGUST ‘12 S M T W Th F S

20 21 22 23 24

27 28 29 30 31

SEPTEMBER ‘12 S M T W Th F S

3 4 5 6 7

10 11 12 13 14

17 18 19 20 21

24 25 26 27 28

3 Labor Day

19 MSTA Convention

OCTOBER ‘12 S M T W Th F S

1 2 3 4 5

8 9 10 11 12

15 16 17 18 19

22 23 24 25 26

29 30 31

NOVEMBER ‘12 S M T W Th F S

1 2

5 6 7 8 9

12 13 14 15 16

19 20 21 22 23

26 27 28 29 30

21-23 Thanksgiving Break

24-31 Winter Break

DECEMBER ‘12 S M T W Th F S

3 4 5 6 7

10 11 12 13 14

17 18 19 20 21

24 25 26 27 28

31

JANUARY ‘13 S M T W Th F S

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25

28 29 30 31

1 New Year’s Day 21 M.L. King Jr. Day

18 Presidents’ Day

FEBRUARY ‘13 S M T W Th F S

1

4 5 6 7 8

11 12 13 14 15

18 19 20 21 22

25 26 27 28

MARCH ‘13 S M T W Th F S

1

4 5 6 7 8

11 12 13 14 15

18 19 20 21 22

25 26 27 28 29

29 Spring Break

1-5 Spring Break

APRIL ‘13 S M T W Th F S

1 2 3 4 5

8 9 10 11 12

15 16 17 18 19

22 23 24 25 26

29 30

MAY ‘13 S M T W Th F S

1 2 3 6 7 8 9 10 13 14 15 16 17 20 21 22 23 24 27 28 29 30 31

27 Memorial Day

7 Last Day of School

JUNE ‘13 S M T W Th F S

3 4 5 6 7

10 11 12 13 14

17 18 18 20 21

24 25 26 27 28

PLEASE BE MINDFUL OF SNOW DAYS AND WEEKENDS!

70


Notes

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