The following are Albemarle County designated Points of Entry
for identifying potential Medicaid eligible students:
At each point of entry the parent or guardian should be asked
if the student currently receives Medicaid benefits and if appropriate,
the Parental Permission for Medicaid Billing (Form No. 00.01)
presented and asked to be signed. All the corresponding procedures
and forms have been updated to include prompts for information
that would facilitate Medicaid billing.
Special Education Related
Services
Speech and Language, Occupational Therapy, Physical Therapy
An annual Plan of Care (Form No. 00.03) must be written for
each Medicaid eligible student receiving OT, PT, or SLI services
in order to bill Medicaid for those services. A separate Plan
of Care (Form No. 00.03) is required for EACH RELATED SERVICE
the student receives. The "Plan of Care" (Form No.
00.03) is valid for 365 days.
The "Plan of Care" (Form No. 00.03) must be signed
and dated by a qualified therapist. COTA's, PTA's, and Speech
Therapists with a BA may provide services under supervision,
but not sign the plan of care.
A plan of care (Form No. 00.03) must be amended (Form No. 00.04),
much like an IEP, if services change (i.e. 4 sessions are decreased
to 2 sessions due to progress being made). This can be accomplished
by using the Plan of Care Addendum (Form No. 00.04). Most of
the information needed to complete the addendum (Form No. 00.04)
is found in the original Plan of Care (Form No. 00.03).
If there is a significant change (i.e. goals and objectives
in the IEP) the Plan of Care (Form No. 00.03) must be re-written.
This is facilitated by forwarding the Plan of Care Addendum
(Form No. 00.04) or newly re-written Plan of Care (Form No.
00.03) to COB.
Any corrections to the Plan of Care (Form No. 00.03) should
include "Error" written next to the mistake and the
therapist's initials and date written next to the change. Once
the Plan of Care has been signed, changes should only be made
with a Plan of Care Addendum (Form No. 00.04).
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Psychological Counseling
An annual Form Psychological Diagnostic Clinical Interview
(Form No. 00.05) must be written for each Medicaid eligible
student receiving psychological counseling services in order
to bill Medicaid for those services. The Psychological Diagnostic
Clinical Interview is valid for 365 days. The ORIGINAL Diagnostic
Clinical Interview, Medicaid Goals and Objectives, Therapy Notes
and Counseling Logs, once completed, are to be sent to COB no
later than the close of business on the 5th of each month for
processing and copies filed in the student's record that may
be kept in the psychologist's proximity.
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Therapist Progress Notes
Speech and Language, Occupational Therapy,
Physical Therapy
Medicaid requires that documentation of services be maintained
by the school division. This documentation, which includes the
Plan of Care (Form No. 00.03), Plan of Care Addendum (Form No.
00.04), Discharge Report (Form No. 00.09), Progress/Therapy
notes (Form Nos.00.10, 00.11, 00.12), will be maintained in
a Medicaid file for each eligible student with Albemarle County's
Medicaid Billing agent. A copy of the therapist notes/ Treatment
Log & Progress Reports should be kept in the student's educational
record at the base school.
After each session the Medicaid Treatment Log (Form Nos. 00.10,
00.11, 00.12) is to be completed. Sessions are documented for
direct service only. Time to complete paperwork for Medicaid
billing is not part of the session or IEP time. The Treatment
Log and Progress Report Form are to be received by COB by the
close of business on the 5th of every month.
Therapist notes are written and signed by the provider of the
related services (OT by COTA, PT by PTA etc.) on the signature
line of the form. If a service is provided by a COTA, PTA or
Speech Therapist with a BA Degree, the form must also be signed
by an OT, PT or SLP as the professional supervising the delivery
of service. Monthly supervision must be documented on the monthly
notes and consists of a review of documentation to insure the
services are appropriate.
Psychological Services
Medicaid requires that documentation of services be maintained
by the school division. This documentation, Psychologist Diagnostic
Clinical Interview (Form No. 00.05), Psychological Evaluation
(Form No. 00.06), Psychological Evaluative Review of Records
(Form No. 00.07), and the Psychological Therapy Notes (Form
No. 00.08) and Psychological Counseling Log (Form No. 00.14)
are filed in the student's record that may be kept in the psychologist's
proximity. The Psychological Therapy Notes (Form No. 00.08)
are forwarded and to be received by COB by the close of business
on the 5th of every month. A copy of the Counseling Log is to
be kept in the students file along with the other Medicaid paperwork.
After each session the Medicaid Therapy Notes and Counseling
Log are to be completed. Sessions are documented for direct
service only. Time to complete paperwork for Medicaid billing
is not part of the session of IEP time. Psychological Therapy
Notes (Form No. 00.08) and Counseling Log (Form No. 00.14) are
to be received by COB by the close of business on the 5th of
every month.
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Discharge
The Discharge Plan of Care (Form No. 00.09) is
used when services go from direct to consult or when services
are terminated completely.
The service provider is to forward the Discharge Plan to COB
as soon as direct services are determined to be unwarranted
and Medicaid Billing is no longer appropriate.
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Monitoring of Medicaid Procedures
An internal monitoring procedure will be implemented
to ensure related service staff are following guidelines, processing
paperwork appropriately and meeting timelines to facilitate
Medicaid billing. The internal monitoring will focus on records
kept at the school as well as reviews based on feedback from
the Billing Agent.
Internal Monitoring will include:
- Periodic Related Service Provider Interview
- Periodic Records Review
External Monitoring will be accomplished through a process
of scrutiny of submitted paperwork to the COB by the Billing
Agent. Should an error or discrepancy be found the service provider
will be contacted with the source of the error and direction
regarding a remedy to the situation.
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