For the SBRS MaineCare Program
Please Keep In Mind…
1. District Information Form*: Please help us update our records by filling out the form with the current
school year’s information.
2. Practitioner Packets Form: Please let us know how many practitioner-training packets you will need
for the upcoming school year.
* Please fill out these forms and mail or fax them back to us at (207) 698-9941.
3. IEP: Please keep annotated IEP’s (or copies) for students for whom you have received MaineCare
reimbursement for five years for audit purposes.
4. Authorization of Services: You’ll also want to make sure that Speech, OT, PT and rehabilitative
assistance are specified in an IEP and authorized each year by a physician or licensed practitioner of
the healing arts (therapist) operating within the scope of his/her license. We’ve included a sample of an
authorization form for your review and use. Recent federal audits in surrounding states have
emphasized the need for documentation of medical necessity through these authorizations. When
authorizations have been found lacking during audits, paybacks have resulted.
5. Service Records: Even though Maine’s School-Based Rehabilitative Services Program is a per diem
model (pg. 10 in Regulations), Service Records are key documents for post-payment audits. Please
make sure each practitioner delivering covered services is documenting his/her time and services on
the correct service record and therapy notes forms. We suggest that you send us documentation of
service records as your practitioners complete those records. If you have not been utilizing our service
in this regard, please feel free to begin to do so. Recent federal audits in surrounding states have
emphasized the need for documentation of service delivery via Service Records. When Service
Records have been found lacking during audits, paybacks have resulted.
6. Credentials: Please make sure to retain copies of credentials of staff delivering covered health-related
services. We recommend retention of these credentials for five years for audit purposes.
7. Parental Consent Forms: Remember that parental consent to bill Medicaid is required annually.
Keep in mind that MSB? is willing to catalogue consent forms for you. Please find a sample consent
form included in this packet.
8. Attendance Baseline: Please forward your COMPLETED SBRS Baseline to us NO LATER THAN
Monday, October 5, 2009. Your baseline should include all students in your district with an active IEP.
Also, in the event of an audit, school attendance records for all children being audited must be available
for the auditor’s review to demonstrate that the child was present and received covered services.
9. Reduced Rate: As you know, students who receive IEP-ordered Speech/Language services from a
Speech Clinician who is not licensed by the State of Maine as a Speech/Language Pathologist must be
billed at a reduced rate. Each of your students will fall under one of these three categories:
a. No Speech services given…FULL RATE
b. Speech services, prescribed on an IEP, given by a licensed Speech/Language
c. Speech services, prescribed on an IEP, given by an unlicensed Speech Clinician…REDUCED
For the MaineCare Program
Now that the 2009-2010 School Year is upon us . . .
What do we need to do to get started?
As your consulting and billing agent, MSB? would like to make you aware of the meetings that we believe are necessary to successfully launch the new school year. This is especially important to
those having NEW Special Education Staff. Following is a list of those meetings and respective personnel who should plan to attend:
; Director’s Meeting: 1 Hour
We’d like an opportunity to sit with you (or your designee) to go over any changes in our forms or
procedures for the new school year. Regional meetings should suffice, but if you would like an
individual meeting, please advise us. Your contact person (the person who will be responsible for
the monthly submissions) is cordially invited to attend this meeting with you. MSB? will
continue to provide you and your practitioners with sample forms and training we believe
helpful for state and federal compliance by your school district.
; Regional Training(s): (Optional, but Strongly Encouraged)
These trainings are held with those service practitioners whose services are included in Maine’s
“School Based Rehabilitative Services Program.” We recommend all new practitioners attend
a regional training in the fall. We provide several sessions throughout the day for your
providers’ convenience. The agenda includes review of regulations as well as proper data entry
for Medicaid documentation. Registration for these trainings may be completed on www.case-
Field Meeting Request/
Person to contact
regarding this meeting:
Type of Meeting Requested
(please check all that apply)
Staff training for Medicaid service documentation
Date: Time: Location:
Reporting visit with an MSB Representative
Date: Time: Location:
Complimentary internal audit* / comprehensive file review
Date: Time: Location:
*MSB? complimentary audits are designed to simulate, as closely as possible, an actual audit by either state or federal regulators. Our goal is to provide pertinent feedback that the districts can use to strive for a high level of compliance with Medicaid regulations and to help minimize negative audit findings should there be an actual audit. Should you request a complimentary audit, our specialist will contact you in advance of the meeting to request the needed information to be available on the day of the on-site review.
This form may be mailed directly to the following address:
97 High Street
Somersworth, NH 03878
Attn: Program Specialist
This form may also be faxed to MSB? at (207) 698-9941.
Commonly Asked Questions and Answers
School-Based Rehabilitative Services Program
Q: Do our practitioners still need to fill out Service Records?
A: The published rules regarding the SBRS program do not list documentation of service delivery as
a records requirement, but the General Administrative Policies and Procedures section of the
MaineCare Benefits Manual indicates that documentation of service delivery is a requirement for
provider participation in the MaineCare program. Understanding that records are key documents
for post-payment audits, MSB? strongly recommends that you continue/begin to use our
“Service Delivery Record” forms to substantiate service delivery to students. Recent federal
audits of surrounding states have been critical of School Medicaid programs that do not require
documentation of service delivery as a records requirement. What we have advised you all along
with regard to this is now coming more to the forefront as federal auditors visit states and provide
input in this matter. In short, documentation of service delivery is crucial.
Q: Do these moneys have to go back to into Special Education?
A: The Balanced Budget Act of 1997 placed a ban on spending for non-health-related items. An
explicit ban was imposed on the use of Federal Medicaid matching funds for non-health-related
items such as bridges, roads, stadiums, or other items not covered by a State’s Medicaid plan.
Schools are unique in that the federal matching funds are reimbursements rather than payments.
However, to be safe, the DOE has advised that you establish an audit trail for these funds and
enter them back into your Special Education Budget.
Q: How do I find out which children are Medicaid-eligible?
A: Policy at DHHS prohibits MSB? from obtaining eligibility information directly. We would suggest
that, as much as possible, you obtain the MaineCare numbers from parents at the IEP meetings.
We will continue to explore other options for obtaining MaineCare numbers as those opportunities
Q: Can we bill MaineCare for 504 children under the SBRS program?
A: No. The SBRS program is restricted to children identified under the IDEA with Individualized
Education Programs who are present in school within the month being billed.
Q: How soon do we need to have Parental Consent forms on file?
A: As soon as possible. You can use either the sample forms that we have provided for you or your
own parent letter. We suggest that you have the consent forms signed at your annual IEP
Q: Do our practitioners have to do therapy notes in addition to Service Record forms?
A: The General Administrative Policies and Procedures section of the MaineCare Benefits Manual
indicates that service or progress notes are required whenever services are provided. We do
recommend the use of service record forms as well as progress notes as a good audit trail,
especially in light of recent federal audits in surrounding states.
Q: The local hospital provides physical therapy services pursuant to the IEP and bills
MaineCare directly. Is that a problem?
A: Yes. A student cannot be billed for by two providers for the same time. Since the SBRS Program
covers a nine-month timeframe, duplication of claims would certainly result. Either the hospital or
the district would have to stop billing for those particular students. If, however, the physical
therapist provided services outside the IEP, then he or she could bill MaineCare. The school
district could, of course, continue to bill for IEP-ordered services as well.
Q: How important is it to have all appropriate services specified in the IEP?
A: Very important! The IEP is essential because MaineCare regulations require a process to
determine medical need for the service and to authorize delivery.
Q: How often do we have to obtain parental consent?
A: A district only needs to obtain parental consent once per year unless the intensity of services
Q: Can we bill for Day Treatment and the SBRS Program for the same child?
A: No. If a child is billed under Day Treatment, he/she cannot be billed under SBRS; and vice versa.
This is why it is very important that you give us that information on your Baseline attendance list
for October 5. A district may, however, bill some students under its Day Treatment Program and
bill the rest of the students under the SBRS Program.
School District (MSAD, Union*, Individual):
*Please fill out a separate form for each town in a Union unless the information is the same for all districts.
Special Education Secretary: Tel: E-mail address: Fax: Mailing address:
SBRS Contact: Tel: E-mail address: Fax: Mailing address:
Day Treatment Contact: Tel: E-mail address: Fax: Mailing address:
Superintendent: Tel: E-mail address: Fax: Mailing address:
Special Education Director: Tel: E-mail address: Fax: Mailing address:
Business Manager: Tel: E-mail address: Fax: Mailing address:
Please send MaineCare reimbursement checks to: (Check one) Name and Complete Mailing Address:
____ Superintendent ______________________________________________________
____ Special Education Director ______________________________________________________
____ Business Manager ______________________________________________________
____ Other (________________) ______________________________________________________
I have unlicensed and licensed Speech practitioners in my district. I will indicate the students who are seen
by the unlicensed speech clinicians on my attendance baseline.
I have only licensed Speech practitioners in my district.
I have only unlicensed Speech practitioners in my district.
I would like MSB to bill for my SACs.
I do not want MSB to bill for my SACs.
2009–2010 School Year
School District: Tel: Special Ed Director: Fax: Person who handles Medicaid service records: Please list all staff members who will be providing any of the services listed below that pertain to the Medicaid
School-Based Rehabilitative Services Program and/or a Medicaid Day Treatment Program.
Service Service Practitioner Name Area Program Practitioner Name Area Program Mr. Sample Practitioner OT SBRS
Please use the following abbreviations for each program:
SBRS Day Treatment Covered Service Qualified Staff Abbreviation Covered Service Qualified Staff Abbreviation Behavioral Rehab Licensed Psychiatrist PSYCH Day Treatment Licensed Psychiatrist PSYCH Services (BR) Services (DT)
BR Licensed Psychologist PSYCH DT Licensed Psychologist PSYCH
BR Licensed Psych PSP DT Licensed Psych PE
Service Provider Examiner
BR Social Worker SW DT Licensed Social SW
School Health Registered Nurse / RN / PN DT Licensed Clinical Prof. LCPC
Practical Nurse Counselor S/L Path Services S/L Pathologist / SLP / SLPA DT Registered Nurse RN
OT Services Occupational OT / COTA DT Licensed Practical LPN
Therapist / Assistant Nurse
PT Services Physical Therapist / PT / PTA DT Psych Nurse PN
Interpretation Cert. Interpretor or INT DT Speech/Language SLP
Supervised Pathologist Rehabilitative Education RA DT Lic. Substance Abuse LSAC
Assistant Technician I, II, III Counselor
DT Occupational OT
DT Other Qualified Mental OQMHP
CONSENT FOR RELEASE OF INFORMATION
TO ACCESS MAINECARE REIMBURSEMENT
FOR HEALTH-RELATED SUPPORT SERVICES
Our school district continues to participate in a system whereby the Federal Government’s Medicaid program
reimburses local school districts for a portion of the costs of health-related special education services provided to Medicaid-eligible children. Your child continues to receive services at no cost to you under this system.
This initiative simply helps us maximize federal funds in support of local education, as well as offset some of the costs of special education paid for by the local property tax. The information you voluntarily provide by completing this consent form will only be used for the purposes identified. Our district has contracted the services of MSB? to confidentially administrate our Medicaid Program.
Please fill in the information below, sign the form, and return it to the address indicated.
(Name of parent or person in parental relationship)
STUDENT’S OFFICIAL NAME:
(First) (Middle Initial) (Last)
STUDENT’S MEDICAID NUMBER:
CHILD’S DATE OF BIRTH __ __/__ __/__ __ __ __ (MM/DD/YYYY)
As parent/guardian of the child named above, I give permission to disclose information from my child’s educational records to school districts and designees, State, and Federal Medicaid administration representatives for the sole purpose of claiming MEDICAID reimbursement for health-related support services
in my child’s Individualized Education Program (IEP) or other programs funded by MaineCare. This consent covers the _____-_____ school year. (Check applicable programs below.)
Program Maximum Claim Potential
MaineCare Benefits Manual Chapter 1 and Chapter 2, Section Up to 9 monthly claims per year
104, School Based Rehabilitative Services (SBRS)
MaineCare Benefits Manual Chapter 1 and Chapter 2, Section Maximum 1 claim per school day
41, Day Treatment Services (DT)
This permission is authorized now and in the event that my child becomes eligible in the future for purpose of the release of information relative to the above services. I also understand that if I refuse to consent to the release of this information, my refusal does not relieve the school district of its responsibility to provide the above IEP-ordered or other services at no cost to me (34 C.F.R. ?300.154 (2006)). I also understand that this consent is voluntary and may be revoked at any time, but that such revocation would not be retroactive (34 C.F.R. ?300.9 (2006)).
Signature: ___________________________________ Date: ____________
(Parent or person in parental relationship) (Month/Day/Year)
Please return this form to:
BASELINE TO: Special Education Directors
included in FR: MSB?
DT: August 2009 this package
RE: Attendance Baseline
Beginning with the month of October, MSB? will be submitting MaineCare claims based on the
student enrollment of MaineCare-eligible special education students in your district on a monthly
By October 5 will need a list of all special education students enrolled in your district at that time.
Please send a complete list with the following information:
; Date of Birth
; Disability Code
; Medicaid Number, if known
; Town or District to Receive Reimbursement
; Reduced Rate: Please indicate children receiving speech therapy services from
an unlicensed therapist or clinician. Otherwise, please indicate somewhere on
your baseline that all of your speech practitioners are licensed.
; Day Treatment: Please indicate if a child is either in an out-of-district placement
or in your own regional or district Day Treatment program.
; State Agency Clients: Identify them and indicate whether we are to bill
MaineCare for them or not.
; Tuition Students: Please identify the students whom you tuition out, and
please identify the students who are being tuitioned in, indicating the correct
; Unorganized Territories: If you have a child who attends your school district
who is tuitioned in from the Unorganized Territories, please indicate that on your
baseline. Do not claim students who belong to the Unorganized Territories.
Each month thereafter - beginning in the first week of November - fill out and send to us SBRS
Addition, Deletion and Change Reports for the previous month. (The first reports will be for October.)
Use the forms in this packet to make enough copies for the entire year.
Important: We will continue to submit claims for all MaineCare-eligible students on your baseline along with all additions on a monthly basis unless a child appears on a deletion form. Please
submit SBRS Addition, and Deletion reports every month, even if there are NONE. Submit SBRS Changes reports only if applicable.
If you would like us to deal directly with individual schools within your district for attendance, then please develop your baseline list according to the individual school enrollments.
Keep in mind that “outside” practitioners should not be billing MaineCare on your behalf;
otherwise, there will be a duplication of payment from MaineCare.
Thanks for all your help. Please give us a call (1-800-618-3111) if we can be of further assistance in our mutual quest for a clean attendance report each month!
IMPORTANT ATTENDANCE REMINDERS!
; Please make sure you fill in every column on the Attendance forms. Please
make sure you indicate a choice for every column that asks for a Y, N, or NS.
; Please send in an Additions and Deletions Report every month, even if you
don’t have any changes to your Special Education Department. You may use
the “two-in-one” form for your convenience. Send in the Changes Report only
Each of your Special Education Students who receive covered services falls under one of the following categories:
NO Speech Services ；；；;FULL Rate (“NS” on Additions Report)
Speech services given by a
；；；;Licensed Speech Provider FULL Rate
(“N” on Additions Report)
Speech services given by
REDUCED an Unlicensed Speech ；；；;
Provider Rate (“Y” on Additions Report)