Current through Register No. 40, October 3, 2024
(a) Reimbursement
to enrolled school providers shall be the lesser of the following:
(1) One half of the actual cost, or
(2) The rate established by the department,
in accordance with
RSA 161:4,
VI(a).
(b) Enrolled school providers shall bill by
unit of service, using the current procedural code for the service delivered,
and submit claims for payment that include the actual cost of the service to
the department's fiscal agent.
(c)
Enrolled school providers shall submit claims for medicaid covered services
consistent with this rule and with federal medicaid law pursuant to 42 CFR 455,
42 CFR 456, 42 CFR 431, and 42 CFR 1001.
(d) Enrolled school providers shall maintain
unique documentation in accordance with He-W 520 and this part for the
delivered services in each student's individual record, with such documentation
to include:
(1) A copy of the care plan and,
if an IEP, evidence of implementation of the IEP as required by
Ed
1109.04(b);
(2) The name of the student, the medical
assistance ID number, and documentation demonstrating receipt of each unit of
the covered service;
(3) The names,
qualifications, and credentials of all performing providers for each service
delivered for which the school sought FFP;
(4) The documentation of the qualifications,
names, and signatures of persons directing or supervising the individuals
providing the covered services if direction or supervision is required under
this part or applicable law, and the date of supervisory approval;
(5) Date(s) of each service delivered and the
location where the services were performed;
(6) The type of covered service provided and
a description of each service provided;
(7) The duration of the provision of the each
covered service, number of units performed, and the number of minutes for each
delivered service;
(8) The start
and stop times of the delivered services, and whether there was a break in
services or time away by the performing provider;
(9) Indication whether the services were
delivered in a group setting or individually;
(10) Indication of whether the student was
actually present for the service and indication whether the student was present
for at least 51% of the time;
(11)
In the case of group services, documentation of the number of participants in
the group who received the covered service regardless of the participants'
medicaid eligibility;
(12) A copy
of a physician's or other licensed clinician's order if required; and
(13) Documentation of the qualifications and
the handwritten signature of the individual(s) attesting to the medical
non-academic nature of the covered rehabilitative assistance
services.
(e) Enrolled
school providers shall submit claims for physical, occupational, and
speech-language therapy services in accordance with the following:
(1) Only units of direct treatment performed
by a physical therapist, occupational therapist, SLP, a physical therapy
assistant, occupational therapy assistant, or speech-language assistant shall
be billed, meaning the time the therapist or physical therapy assistant,
occupational therapy assistant, or speech-language assistant spends providing
direct treatment to one student;
(2) Therapists working as a team to treat one
or more students shall not each bill separately for the same or different
service provided at the same time to the same student; and
(3) If a student requires co-treatment
simultaneously by 2 therapists, the total number of units shall be divided
between the therapists and billed separately by each therapist to equal the
total time the student was receiving actual therapy services.
(f) Enrolled school providers
shall only bill covered service time provided simultaneously by more than one
licensed clinician and a rehabilitative assistant as follows:
(1) If rehabilitative assistance is provided
simultaneously with another covered service, the rehabilitative assistance
shall be billed in addition to the covered service; or
(2) If rehabilitative assistance is provided
by more than one rehabilitative assistant simultaneously, each assistant's
service shall be billed separately.
(g) In calculating the cost for
transportation, the enrolled school providers may include the following actual
costs related to the trip:
(1) Fuel;
(2) Insurance;
(3) Driver's salary and benefits;
(4) Salary and benefits of other persons
working on the bus;
(5)
Depreciation, and
(6)
Maintenance.
(h) The
total cost calculated in (g) above shall then be divided by the total number of
miles for the trip both ways, and then divided by the total number of students
on the bus, regardless of the students' medicaid eligibility, to determine the
cost per mile per student.
(i) In
accordance with
34 CFR
300.154(d)(2)(iv),
Ed
1120.08, and 42 CFR 300.154(d)(2)(v), informed
parental consent shall be obtained prior to the enrolled school provider
billing the student's medicaid.
(j)
Enrolled school providers shall maintain records in support of claims submitted
for reimbursement for a period of at least 6 years from the date of service or
until the resolution of any legal action(s) commenced in the 6-year period,
whichever is longer.
(k) As
applicable, the creation, storage, retention, disclosure, and destruction of
documentation required by this part shall comply with all federal and state
privacy and security laws and rules including the substance use disorder
patient records regulations pursuant to 42 CFR Part 2, Family Educational
Rights and Privacy Act, and the Health Insurance Portability and Accountability
Act of 1996.
