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July 6, 2006
 
 
MEDICAID INFORMATION RELEASE MA06-26
 
TO:                 Providers of School Based Services
 
FROM:           Leslie M. Clement, Administrator
 
SUBJECT:     CHANGES TO MEDICAID COVERAGE AND REIMBURSEMENT
 
NOTE:            This information release replaces the letter mailed to all Idaho Medicaid School-Based Service providers dated June 26, 2006.
 
This information release is to notify providers of School-Based Services (SBS) of upcoming changes to Idaho Medicaid coverage and reimbursement.  SBS providers have been recently informed of new administrative process requirements, referred to as intergovernmental transfer (IGT).  The IGT process requires new procedures for both schools and Medicaid regarding payment transactions.  A requirement related to the IGT process is that rates paid to schools are aligned with other community-based rates to non-school providers.  The following table reflects the adjustments which will be effective on July 1, 2006 consistent with IGT regulations:
 
 
CODE
Mod
DESCRIPTION
New Rate
90801
 
PSYCH DIAG INTERVIEW EXAM, 1 UNIT = 15 MIN
$16.46
90847
 
FAMILY PSYCH THERAPY, 1 UNIT = 15 MIN
$12.84
90853
 
GRP PSYCH THPY  2 STUDENTS, 1 UNIT=15 MIN
$3.89
90899
 
IND. PSYCH THPY,  1 UNIT = 15 MIN
$16.74
V5008
 
HEARING EVAL,  1 UNIT = 15 MIN
$14.00
92506
 
SPEECH EVAL, 1 UNIT = 15 MIN
$14.00
92507
HO
IND SPCH/HEARING PROF THERAPY, 1 UNIT=15 MIN
$14.00
92507
HM
IND SP/HEAR THERAPY TECH, 1 UNIT = 15 MIN
$8.00
97001
 
PHYSCIAL THERAPY EVAL,  1 UNIT=15 MIN
$14.00
97110
HO
IND PHYSICAL THERAPY PROF,  1 UNIT = 15 MIN
$14.00
97110
 
IND. PHYSICAL THERAPY/TECH,  1 UNIT = 15 MIN
$8.00
97003
 
OCC. THERAPY EVAL,  1 UNIT = 15 MIN
$14.00
97530
HO
IND OCC. THERAPY/PROF,  1 UNIT = 15 MIN
$14.00
97530
 
IND OCC. THERAPY/TECH,  1 UNIT = 15 MIN
$8.00
 

There are other policy changes that impact schools as well:
 
·        CMS has informed the State of Idaho that it will no longer share in the cost of IEP plan development.  Effective July 1, 2006, Idaho Medicaid will remove IEP plan development from its covered services.

·        CMS has approved Idaho’s request to share in the costs of its Healthy Schools grant program.  This program will provide grants to school districts that have a disproportionately high number of low-income students.  Initially, grants will offset the cost of 10 full-time equivalent (FTE) professional nurses to provide prevention and wellness services in schools.  The design of this program is being finalized this summer in partnership with the State Department of Education and the initial grant will be made this fall.
 
 
If you have any questions please contact Eric Anderson, Senior Financial Specialist for the Medicaid Office of Reimbursement Policy, at (208) 364-1918. Thank you for your continued participation in the Idaho Medicaid program.
 
LMC/ea/sw