Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.09 - MEDICAID BASIC PLAN BENEFITS › COVERED SERVICES › SUB AREA: ESSENTIAL PROVIDERS › Section 16.03.09.856 - SCHOOL-BASED SERVICE: PROVIDER REIMBURSEMENT

Current through August 31, 2023
Payment for health-related services provided by school
					 districts and charter schools must be in accordance with rates established by
					 the Department. (3-17-22)
01.
Payment in Full
. Providers of services must accept as payment in full
				  the school district or charter school payment for such services and must not
				  bill Medicaid or Medicaid participants for any portion of any charges.
				  (3-17-22)
02.
Third
				  Party
. For requirements regarding third party billing, see Section
				  215 of these rules.
				  (3-17-22)
03.
Recoupment of
				  Federal Share
. Failure to provide services for which reimbursement has
				  been received or to comply with these rules will be cause for recoupment of the
				  Federal share of payments for services, sanctions, or both. (3-17-22)
04.
Matching Funds
. Federal
				  funds cannot be used as the State's portion of match for Medicaid service
				  reimbursement. School districts and charter schools must, for their own
				  internal record keeping, calculate and document the non-federal funds
				  (maintenance of effort assurance) that have been designated as their certified
				  match. This documentation needs to include the source of all funds that have
				  been submitted to the State and the original source of those dollars. The
				  appropriate matching funds will be handled in the following manner: (3-17-22)
a. Schools will estimate the amount needed to
				  meet match requirements based on their anticipated monthly billings.
				  (3-17-22)
b. School districts and
				  charter schools will send the Department the matching funds, either by check or
				  automated clearing house (ACH) electronic funds transfers. (3-17-22)
c. The Department will hold matching funds in
				  an interest bearing trust account. The average daily balance during a month
				  must exceed one hundred dollars ($100) in order to receive interest for that
				  month. (3-17-22)
d. The payments to
				  the districts will include both the federal and non-federal share (matching
				  funds). (3-17-22)
e. Matching fund
				  payments must be received and posted in advance of the weekly Medicaid payment
				  cycle. (3-17-22)
f. If sufficient
				  matching funds are not received in advance, all Medicaid payments to the school
				  district will be suspended and the school district will be notified of the
				  shortage. Once sufficient matching funds are received, suspended payments will
				  be processed and reimbursement will be made during the next payment cycle.
				  (3-17-22)
g. The Department will
				  provide the school districts a monthly statement that will show the matching
				  amounts received, interest earned, total claims paid, the matching funds used
				  for the paid claims, and the balance of their funds in the trust account.
				  (3-17-22)
h. The school districts
				  will estimate the amount of their next billing and the amount of matching funds
				  needed to pay the Department. (3-17-22)
i. The estimated match requirement may be
				  adjusted up or down based on the remaining balance held in the trust account.
				  (3-17-22)