Note: The School-Based Medicaid program provides payments to the public entity that has the financial responsibility for providing services to the student. In general, if a student resides in one district and attends school in another, and the district where the student resides is paying for the student to attend school in the other district, only the district in which a student resides may file a Medicaid claim. If a student is attending a regional vocational/technical or agricultural school or charter school, only the regional vocational/technical or agricultural school district or charter school is eligible to file a Medicaid claim on behalf of the student. The local public school district is not permitted to submit claims for any such student. The following chart describes a variety of situations that occur with student enrollment and identifies which entity may file a claim. Financial Responsibility Determination Chart Sending School District (SD) Receiving School District (SD) School District with Financial Responsibility District Claiming the Student under Medicaid (included in the Eligibility Statistics) Public SD Public SD (School Choice) Sending Public SD Sending Public SD Public SD Charter School ** Sending Public SD Charter School Public SD Home School Sending Public SD Sending Public SD Public SD Private School (Sped placement) Sending Public SD Sending Public SD Public SD Private School (other private/religious school - not a SPED placement) Private School * N/A Public SD Regional SD (School Choice) Sending Public SD Sending Public SD Public SD Regional Voc/Tech Sending Public SD Regional Voc/Tech Regional SD Public SD (School Choice) Sending Regional SD Sending Regional SD Regional SD Charter School ** Sending Regional SD Charter School Regional SD Home School Sending Regional SD Sending Regional SD Regional SD Private School (SPED) placement) Sending Regional SD Sending Regional SD Regional SD Private School (other private/religious school not a Sped placement) Private School * N/A *
providing information as requested to EOHHS or its designee related to potential RMTS participants; ensuring that RMTS participants who are engaged in Direct Services Claiming activities on behalf of the Provider have completed the online RMTS training; and ensuring an RMTS response rate of participants who are engaged in Direct Service Claiming activities on behalf of the Provider at a minimum of 85%. EOHHS will provide Interim Rate payments for Direct Services on a quarterly basis. Interim Rate payments are based on per-unit-service claims filed by the Provider in accordance with sub-regulatory guidance and the following requirements. The Provider shall only submit claims for Interim Rates for Direct Services provided in accordance with Section 2.2.A of this Contract. After the close of each State Fiscal Year, any Interim Rates paid to the Provider will be reconciled to actual costs as determined by EOHHS based on the Provider’s submitted Massachusetts School-Based Direct Services Cost Report. Interim Rates will be reconciled according to the following process. Certified costs on the Massachusetts School-Based Direct Services Cost Report will be compared to the Provider’s Interim Rate claims for services delivered during the reporting period, as documented in the Commonwealth’s Medicaid Management Information System (MMIS). The Provider’s Interim Rate claims will be adjusted to reflect, in the aggregate, the total Medicaid-allowable actual incurred costs based on the certified Massachusetts School-Based Direct Services Cost Report. If EOHHS determines that an underpayment has been made, the difference between the value of the Interim Rate and the value of the certified costs on the Massachusetts School-Based Direct Services Cost Report will be paid to the Provider. If EOHHS determines that an overpayment has been made, EOHHS will recoup the amount of the overpayment from the Provider. Administrative Activities Claiming Final payment for Administrative Activities is based on Medicaid-allowable actual incurred costs related to Administrative Activities. To receive payment for Administrative Activities, the Provider must submit actual costs using the Massachusetts School-Based Administrative Activities Cost Report on an annual basis and in accordance with timelines issued by MassHealth; submit actual costs using the Massachusetts School-Based Administrative Activities Cost Report in accordance with the Instruction Guide for the Massachusetts School- Based Administrative Activities Cost Report, issued by MassHealth; and participate in the Massachusetts statewide RMTS, including:
Appendix 2: Reference Contact Information Contact Name For Information On Contact Information Massachusetts Individualized Education Plans Special Education Planning and Policy Department of Development Office Elementary and Secondary Education E-mail: Web-site: Telephone: 781-338-3375 Fax: 781-338-3371 Mailing address: 75 Pleasant Street, Malden, MA 02148 Massachusetts Rules regarding sharing Program Quality Assurance Office Department of Elementary and Secondary Education educational related information (FERPA) and parental consent Telephone: 781-338-3700 Mailing address: 75 Pleasant Street, Malden, MA 02148 MassHeatlh Enrollment Obtaining a provider enrollment package Updating your contact information with MassHealth E-mail: and Credentialing Fax: 617-988-8974 Telephone: 1-800-841-2900 Hours: Monday – Friday 8:00 A.M. – 5:00 P.M. Mailing address: MassHealth, Provider Enrollment and Credentialing, P.O. Box 9118, Hingham, MA 02043 MassHealth Provider and Member Customer Service MMIS Claims submission and processing Claims remittance advice MassHealth Customer Service E-mail: (for non- member-specific questions only) Telephone: 1-800-841-2900 Hours: Monday – Friday 8:00 A.M. – 5:00 P.M. Mailing address: MassHealth, Provider Services, P.O. Box 9118, Hingham, MA 02043 University of General School-Based Medicaid questions Information regarding the Massachusetts School- Based Medicaid Cost Report Information regarding AAC claiming Information on quarterly payments Information regarding RMTS E-mail: Massachusetts Medical School Fax: 508-856-7643 Telephone: 1-800-535-6741 Hours: Monday – Friday 8:00 A.M. – 4:30 P.M. Mailing address: 333 South Street, Shrewsbury, MA 01545
Practitioner Relevant Regulation on Qualifications Relevant Regulation on Supervision Requirements (as of 5/1/09) Speech/ Language Therapists 130 CMR 432.404(C) or 130 CMR 432.405 In State Must be currently licensed by the Massachusetts Division of Registration in Speech-Language Pathology and Audiology and have obtained either a Certificate of Clinical Competence (CCC) from the American Speech, Language, and Hearing Association (ASHA), or a statement from ASHA of certification equivalency. Out of State Must be currently licensed by the provider’s own state in Speech-Language Pathology and Audiology and have obtained either a Certificate of Clinical Competence (CCC) from the American Speech, Language, and Hearing Association (ASHA) or a statement from ASHA of certification equivalency. Speech- Language Pathology Assistants or Audiology Assistants Must be currently licensed by the Massachusetts Board of Registration in Speech-Language Pathology and Audiology Supervision required by a Supervising Speech- Language Pathologist or Supervising Audiologist, in accordance with 260 CMR 10.02 Must be currently licensed by the Massachusetts Board of Registration in Speech-Language Pathology and Audiology