Proposed Changes to the Medicaid School Program
This week the Ohio Department of Medicaid provided a state-wide webinar regarding changes to the Ohio Medicaid School Program (MSP). Beginning with the 2016-2017 school year, MSP provider claims submitted to the Ohio Department of Medicaid for Medicaid-covered therapy services must contain the name and National Provider Identifier (NPI) of the practitioner who ordered the service. Additionally, the provider that ordered or referred the service must be enrolled as either a Medicaid billing provider or as an ordering, referring, and prescribing (ORP) provider.
The “practitioner” must be a physician, advanced practice registered nurse, physician assistant, or other practitioner (see 42 CFR 440.110) in order for Medicaid enrolled children to obtain Medicaid covered services in a school.
This means the IEP team must obtain an order or referral for therapy services from a physician, advanced practice registered nurse, physician assistant, or other practitioner in order for these services to be considered for reimbursement.
The Federal Centers for Medicare and Medicaid Services provided this directive and the State of Ohio and its MSP providers must come into compliance with the federal requirements by August 1, 2016. Failure to comply will result in the federal government halting payment for services provided under the Medicaid School Program.
We are very concerned about this proposed change as it has the potential to negatively impact Ohio students who receive audiological and speech-language therapy services as well as occupational and physical therapy services.
Currently we are working with the Ohio Speech and Hearing Governmental Affairs Coalition (OSHGAC) and our lobbyist Kelly O’Reilly, the Ohio Board of SPA and the other Speech and Hearing Professional Organizations in the state to determine how we can contest this proposed regulation.
We will provide updates as they become available. A recording of the webinar is currently available by clicking HERE. Additionally, view a copy of the slides from the presentation along with a Policy Brief from the federal CMS and a letter released from the Ohio MSP (Click Below).