Current through Register Vol. 41, No. 3, September 23, 2024
A. In order to receive reimbursement from
federal or state Part C funds as the payor of last resort, early intervention
service providers shall:
1. Have a
contractual relationship with the local early intervention system;
and
2. Submit a contact log or
contact notes to the local lead agency no later than the 21st of each month for
all services provided in the previous month, including any service for which
reimbursement is sought from Part C funds.
B. Early intervention service providers shall
accept Medicaid reimbursement for medically necessary early intervention
services as payment in full.
C. In
order to bill Medicaid for early intervention services other than service
coordination, the provider shall:
1. Be
certified as an early intervention practitioner;
2. Enroll with the Department of Medical
Assistance Services and Medicaid contracted managed care organizations as an
early intervention provider;
3.
Provide services to children who are determined eligible for early intervention
services under Part C;
4. Provide
covered services as listed on the child's IFSP and, with the exception of the
assessment for service planning and IFSP meetings, services that are approved
by a physician, physician's assistant, or nurse practitioner; and
5. Comply with all other applicable
Department of Medical Assistance Services requirements.
D. In order to bill Medicaid for service
coordination, the provider shall:
1. Be
certified as an early intervention case manager;
2. Enroll with the Department of Medical
Assistance Services and Medicaid contracted managed care organizations as an
early intervention provider;
3.
Deliver service coordination in accordance with a signed initial early
intervention service coordination plan or a signed individualized family
service plan (IFSP);
4. Provide at
least one activity during the month being billed to the child, the family,
service providers, or other organizations on behalf of the child or family in
order to coordinate supports and services and assist the family in accessing
needed resources and services;
5.
Document the contact or communication completely and correctly in accordance
with
12VAC35-225-180;
6. Make a phone, email, text, or face-to-face
contact with the family at least one time every three calendar months, or
document attempts of such contacts;
7. Ensure documented face-to-face interaction
between the service coordinator and the family at the development of the
initial IFSP and the annual IFSP along with documentation that the service
coordinator observed the child during the calendar month that the IFSP meeting
was held;
8. Submit the health
status indicator questions to the child's physician every six months;
and
9. Comply with all other
applicable Department of Medical Assistance Services requirements.
E. Children who are dually
enrolled in Virginia's early intervention system and in Medicaid or FAMIS shall
receive service coordination under the early intervention targeted case
management program.
Statutory Authority: §
2.2-5304
of the Code of Virginia.
