Current through Register Vol. 56, No. 18, September 16, 2024
(a) Every school district and CVSD, with the
exception of any school district that obtains a waiver of the requirements of
this section pursuant to (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
as set forth in (d) below and to comply with all program requirements as set
forth in (e) below.
(b) School
districts and CVSDs may seek, in the prebudget year, a waiver of the
requirements of this section 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 the
requirements of this section 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 as required by (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
http://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 (Department certification is not required for SEMI);
ii. Occupational Therapist-copy of license
and Department certification;
iii.
Physical Therapist-copy of license and Department certification;
iv. Psychologist-copy of Department
certification;
v. Social
Worker-copy of Department certification;
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 Department certification as a speech-language
specialist (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
Department certification or endorsement issued and an American
Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence;
or
(B) Copy of Department
certification or 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. These 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.
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 certifications, 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 set forth in (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 under (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.
