Current through Register Vol. 56, No. 24, December 18, 2024
(a) Every school district and CVSD, with the
exception of any school district that obtains a waiver of this section's
requirements at (b) below, shall take appropriate steps to maximize its revenue
from the Special Education Medicaid Initiative (SEMI) program by following the
policies and procedures to maximize participation in the program at (d) below
and to comply with all program requirements at (e) below.
(b) School districts and CVSDs may seek, in
the prebudget year, a waiver of this section's requirements upon demonstration
that for the subsequent school year: the school district projects, based on
reliable evidence, that it will have 40 or fewer Medicaid-eligible classified
students.
1. The application for a waiver of
this section's requirements shall be made to the executive county
superintendent no less than 45 days prior to the submission of the school
district's proposed budget for the school year to which the waiver request
applies. The executive county superintendent shall notify the school district
of the decision on the waiver application within 20 days of receipt of the
waiver request. If the waiver is not granted, the school district shall submit
to the executive county superintendent a SEMI action plan required at (f) below
as part of its annual school district budget submission, or shall demonstrate
to the executive county superintendent that the school district has achieved
maximum participation in the SEMI program in the prebudget
year.
(c) As part of the
annual budget information, the Department shall provide each school district
and CVSD with a projection of available SEMI reimbursement for the budget year,
as determined by the New Jersey Department of the Treasury's third-party
administrator for SEMI.
1. The school district
shall recognize as revenue in its annual school district budget no less than 90
percent of said projection.
2. A
school district or CVSD may seek approval from the executive county
superintendent to use its own projection of SEMI reimbursement upon
demonstration the numbers it used in calculating the projection are more
accurate than the projection provided.
(d) Each school district or CVSD shall strive
to achieve maximum participation in the SEMI program. For purposes of this
section, "maximum participation" means obtaining a 90 percent return rate of
parental consent forms for all SEMI-eligible students. School districts shall
enter all students following their evaluations into the third-party system as
determined by the New Jersey Department of the Treasury to identify the school
district's universe of eligible students. This may be done without parental
consent.
(e) School districts
participating in the SEMI reimbursement program shall comply with program
requirements as follows:
1. Each district
board of education or CVSD board of education shall implement a policy
concerning the effective and efficient administration of the SEMI reimbursement
program consistent with the requirements of this section. A complete listing of
requirements and information are available at the SEMI/MAC website at
https://www.state.nj.us/treasury/administration/semi-mac/semi.shtml.
2. Any service submitted to Medicaid for
reimbursement shall be rendered by a Medicaid qualified practitioner, or
rendered by a provider under the supervision of a Medicaid qualified
practitioner. The following outlines the required documentation for each
related service provider:
i. Nurses--copy of
license (educational services certificate issued by the State Board of
Examiners is not required for SEMI);
ii. Occupational Therapist--copy of license
and educational services certificate issued by the State Board of
Examiners;
iii. Physical
Therapist--copy of license and educational services certificate issued by the
State Board of Examiners;
iv.
Psychologist--copy of educational services certificate issued by the State
Board of Examiners;
v. Social
worker--copy of educational services certificate issued by the State Board of
Examiners;
vi. Speech-language
specialist:
(1) Qualification and
documentation for provision of evaluation services shall include:
(A) Copy of licensed physician's orders,
which shall be maintained with the student's IEP; or
(B) Copy of New Jersey license as a
speech-language pathologist and educational services certificate with a
speech-language specialist endorsement (N.J.A.C.
6A:9B-14.6) for the individual whose
signature appears on the IEP; or
(C) Copy of documentation that identifies the
referral of speech services included in or with the student's
IEP.
(2) Qualification
for provision of related services shall include:
(A) Copy of educational services certificate
or endorsement issued by the State Board of Examiners and an American
Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence;
or
(B) Copy of educational services
certificate with a speech-language specialist endorsement and a valid license
authorized by the State Audiology and Speech-Language Pathology Advisory
Committee in accordance with
N.J.S.A. 45:3B-1 et seq.
vii. Audiologist--copy of license issued by
the State Audiology and Speech-Language Pathology Advisory Committee in
accordance with
N.J.S.A. 45:3B-1 et seq.
3. Practitioners who are not Medicaid
qualified can deliver services under the direction of Medicaid qualified
practitioners. Practitioners who are not Medicaid qualified include only
certified occupational therapist assistants (COTAs), physical therapist
assistants (PTAs), speech-language specialists who do not meet the
qualifications at (e)2vi(2)(A) or (B) above, and licensed practical nurses
(LPNs).
4. Any direct therapy or
other related service shall be prescribed in the related services section of
the student's IEP prior to submitting a claim to Medicaid for reimbursement.
Delivery of nursing services and dispensing of medication shall be referenced
in the IEP and supported by physicians' orders or prescriptions, which shall be
maintained on file. Supporting documentation to be maintained by the school
district shall be the cover/signature page, related services section of the
IEP, therapy logs, and the evaluations and assessments conducted by the
Medicaid-qualified practitioners.
5. Entities where the school district has
placed SEMI-eligible students shall take steps to enable school districts to
maximize participation, including either logging the eligible services provided
directly through the third-party system as determined by the New Jersey
Department of the Treasury or the sending school district, as mutually agreed
upon with the school district, and obtaining SEMI provider qualification
certifications. Every out-of-district placement shall provide copies of SEMI
provider qualifications, certifications, and licenses. This paragraph applies
to the following out-of-district placement options:
i. Approved private schools for students with
disabilities;
ii. Educational
services commissions;
iii. Jointure
commissions;
iv. Vocational
half-time programs;
v. Department
regional day schools; and
vi.
County special services school districts.
6. Each school district that does not have an
approved waiver pursuant to (b) above shall comply with the program
requirements to assure the year-end cost settlement of SEMI claims is properly
calculated with the standardized submission of quarterly and annual cost data,
as well as staff pool lists transmitted directly through the third-party system
as determined by the New Jersey Department of the Treasury.
7. To retain reimbursement, each school
district that does not have an approved waiver pursuant to (b) above shall
ensure compliance with the necessary components of the cost settlement
requirements, which include completion of the online questionnaire -- Random
Moment Time Study (RMTS) -- by staff provided directly through the third-party
system as determined by the New Jersey Department of the Treasury.
8. All supporting documentation for a
Medicaid claim shall be maintained on file and available for audit or State
review for at least seven years from the date of service. Supporting
documentation shall include provider certification (current and historical for
each provider); provider service logs, licenses, and/or certificates issued by
the Division of Consumer Affairs or the Department, as applicable; physician
authorizations for nursing services; parental consent forms; attendance
records; and copies of the student's IEP.
(f) Each school district that has less than
90 percent participation of SEMI eligible students in the prebudget year or
that has failed to comply with all program requirements at (e) above shall
submit a SEMI action plan to the executive county superintendent for review and
approval as part of the school district's proposed budget submission.
(g) The SEMI action plan shall include the
following components:
1. Procedures for
obtaining parental consent forms, such as the parental consent best practices
that are available from the Department.
2. Establishment of a benchmark for the year
of implementation or for the first year the school district does not have an
approved waiver pursuant to (b) above, whichever is applicable, for obtaining
maximum participation of all SEMI-eligible students by the start of the
subsequent school year.
i. The benchmarks for
the first year of implementation or for the first year the school district does
not have an approved waiver pursuant to (b) above, whichever is applicable, for
achieving maximum participation, shall close, at a minimum, the gap between
current participation and maximum participation by 50 percent by the beginning
of the subsequent school year; and
ii. The benchmarks shall be based on the
percentage of parental consent forms collected from eligible students. The
number of parental consent forms shall reflect one parental consent form or one
document noting parental refusal for each eligible student;
3. Procedures to ensure all IEP meetings are
documented in the third-party administrator's system. IEPs are claimable only
if a Medicaid qualified practitioner is present and it is documented that a
health-related service is discussed;
4. Procedures to ensure all SEMI-eligible
services, including services provided by entities where the school district has
placed SEMI-eligible students, are documented in the third-party
administrator's system;
5.
Procedures to ensure a valid IEP is on file and the IEP date is on file in the
third-party administrator's system for each SEMI-eligible student for whom
parental consent has been obtained; and
6. Procedures to ensure service providers
used by the school district and entities where the school district has placed
SEMI-eligible students have valid licenses and certifications documenting SEMI
provider qualifications on file in the third-party administrator's
system.
(h) School
districts that did not achieve 90 percent participation, or achieve their
approved benchmarks in the SEMI program for a given budget year and cannot
demonstrate they fully implemented their Department-approved SEMI action plan
required at (f) and (g) above, shall be subject to review for the withholding
of State aid by the Commissioner, pursuant to
N.J.S.A. 18A:55-3, in an amount equal to the SEMI
revenue projection based on their approved benchmark for the budget year, if
applicable, less actual SEMI reimbursements for the budget year. The State aid
deduction shall be made in the second subsequent year after the budget
year.
(i) School districts that do
not meet the requirement of the cost-settlement components of SEMI may be
required to refund all or part of their SEMI reimbursements.
