32.1-326.3 - Special education health services; memorandum of agreement between the Department of Education and the Department of Medical Assistance Services.
§ 32.1-326.3. Special education health services; memorandum of agreementbetween the Department of Education and the Department of Medical AssistanceServices.
A. The Department of Medical Assistance Services, in cooperation with theDepartment of Education, shall, consistent with the biennium budget cycle,examine and revise, as necessary, the regulations relating to the funding andcomponents of special education services.
Any revisions shall be designed to maximize access to health care for poorchildren who are eligible for medical assistance services and are disabledand have been identified as eligible for special education, and to assistschool divisions in the funding of medically necessary related services bymaking use of every possible, cost-effective means, Medicaid reimbursement orother program administered by the Department of Medical Assistance Services,including, but not limited to, the State Children's Health Insurance Planpursuant to Title XXI of the United States Social Security Act, as approvedby the federal Health Care Financing Administration at the time. Anyrevisions shall be based on the flexibility allowed to the states and befocused on avoiding large costs for acute or medical care and increasingchildren's access to health care, and shall include, but need not be limitedto:
1. Rates for services which shall clearly identify that only the federalshare shall be reimbursed for the special education health services and shalldemonstrate that local governments are funding the state match for thespecial education health services provided by school divisions.
2. The benefits and drawbacks of allowing school divisions to provideservices as Medicaid providers to disabled students.
3. The appropriate credentials of the providers of care, in compliance withfederal requirements and with the approval of the Health Care FinancingAdministration, for special education health services; e.g., licensure by theBoard of Education and licensure by the appropriate health regulatory boardwithin the Department of Health Professions.
4. Delivery of medically necessary related services for special educationstudents who are eligible for medical assistance services.
The services shall be limited to those services which are required by thestudent's Individualized Education Plan (IEP), shall be covered under thethen-current state plan for medical assistance services, and may be provided,consistent with federal law and as approved by the Health Care FinancingAdministration, by a school division participating as a special educationhealth services provider. Such services shall include, but need not belimited to, speech therapy, including such services when delivered by schoolspeech-language pathologists licensed by the Board of Audiology andSpeech-Language Pathology or those individuals who are directly supervised,at least twenty-five percent of the time, by such licensed speech-languagepathologists; physical therapy; occupational therapy; psychiatric andpsychological evaluations and therapy, including such services when deliveredby school psychologists-limited licensed by the Board of Psychology;transportation between the student's home, the school or other site wherehealth-related services are to be provided on those days when the student isscheduled to receive such services at the school or such other site; andskilled nursing services, such as health assessments, screening activities,nursing appraisals, nursing assessments, nursing procedures, medicationassessment, medication monitoring, and medication administration.
5. The role of the Medallion, Medallion II, Options or other managed careprograms in regard to the special education health services and coordinationwith school divisions regarding any required referrals.
B. Any funds necessary to support revisions to the special education healthservices shall be included in the budget estimates for the departments, asappropriate.
C. The Director of the Department of Medical Assistance Services or hisdesignee and the Superintendent of Public Instruction or his designee shalldevelop and execute a memorandum of agreement relating to special educationhealth services. This memorandum of agreement shall be revised on a periodicbasis; however, the agreement shall, at a minimum, be revised and executedwithin six months of the inauguration of a new governor in order to maintainpolicy integrity.
D. The agreement shall include, but need not be limited to, (i) requirementsfor regular and consistent communications and consultations between the twodepartments and with school division personnel and officials and school boardrepresentatives; (ii) a specific and concise description and history of thefederal Individuals with Disabilities Education Act (IDEA), a summary ofschool division responsibilities pursuant to the Individuals withDisabilities Education Act, and a summary of any corresponding state lawwhich influences the scope of these responsibilities; (iii) a specific andconcise summary of the then-current Department of Medical Assistance Servicesregulations regarding the special education health services; (iv) assignmentof the specific responsibilities of the two state departments for theoperation of special education health services; (v) a schedule of issues tobe resolved through the regular and consistent communications process,including, but not limited to, ways to integrate and coordinate care betweenthe Department of Medical Assistance Services' managed care providers andspecial education health services providers; (vi) a process for theevaluation of the services which may be delivered by school divisionsparticipating as special education health services providers pursuant toMedicaid; (vii) a plan and schedule to reduce the administrative andpaperwork burden of Medicaid participation on school divisions in Virginia;and (viii) a mechanism for informing primary care providers and other casemanagement providers of those school divisions that are participating asMedicaid providers and for identifying such school divisions as Medicaidproviders that are available to receive referrals to provide specialeducation health services.
E. The Board of Medical Assistance Services shall cooperate with the Board ofEducation in developing a form to be included with the IndividualizedEducation Plan (IEP) that shall be accepted by the Department of MedicalAssistance Services as the plan of care (POC) and in collecting the datanecessary to establish separate and specific Medicaid rates for the IEPmeetings and other services delivered by school divisions to students.
The POC form shall (i) be consistent with the plan of care required by theDepartment of Medical Assistance Services of other Medicaid providers, (ii)allow for written updates, (iii) be used by all school divisionsparticipating as Medicaid providers of special education health services,(iv) document the student's progress, and (v) be integrated and coordinatedwith the Department of Medical Assistance Services' managed care providers.
F. The Department of Medical Assistance Services shall consult with theDepartment of Education in preparing a consent form which (i) is separatefrom the IEP, (ii) includes a statement noting that such form is not part ofthe student's IEP, (iii) includes a release to authorize billing ofschool-based health services delivered to the relevant student by the schooldivision, and (iv) shall be used by all school divisions participating inMedicaid reimbursement. This consent form shall be made available to theparents upon conclusion of the IEP meeting. The release shall allow forbilling of school-based health services by Virginia school divisions to theVirginia Medicaid program and other programs operated by the Department ofMedical Assistance Services.
G. The Department of Medical Assistance Services and the Department ofEducation shall also develop a cost-effective, efficient, and appropriateprocess to allow school divisions access to eligibility data for students forwhom consent has been obtained.
H. The Board of Medical Assistance Services shall, when in compliance withfederal law and regulation and approved by the Health Care FinancingAdministration, also (i) include, in its regulations which provide forreimbursement of school divisions participating in Medicaid as specialeducation health services providers, a provision for reimbursement of mentalhealth services delivered by licensed school psychologists-limited and aprovision for reimbursement for services rendered to Medicaid-eligiblestudents of speech-language pathology services delivered by schoolspeech-language pathologists or those individuals who are directlysupervised, at least twenty-five percent of the time, by such licensedspeech-language pathologists; (ii) revise the limitations, establishedpursuant to relevant regulations and Virginia's state plan for medicalassistance services, on services delivered by school divisions participatingin Medicaid as special education health services providers, in effect onJanuary 1, 1999, for physical therapy, occupational therapy, and speech,hearing, and language disorders when such services are rendered to childrenwho are eligible for special education services and have IEPs requiring suchservices; (iii) cooperate with the Board of Education in developing a form tobe included with the IEP that shall be accepted by the Department of MedicalAssistance Services as the plan of care when signed by a physician or, whenunder such physician's supervision, his designee; (iv) cooperate with theBoard of Education in collecting the data necessary to establish separate andspecific rates for the IEP services delivered by school divisions to studentswith disabilities who are eligible for special education and for medicalassistance services; and (v) analyze the data necessary for such rates andestablish new rates for reimbursement of IEP meetings based on such data.
I. Services delivered by school divisions as participating providers in theMedicaid program or any other program operated by the Department of MedicalAssistance Services shall not include any family planning, pregnancy orabortion services.
(1999, cc. 967, 1005; 2002, c. 457.)