On January 27, 2016, the Director of the Department of Medicaid and ODE’s Director of the Office for Exceptional Children hosted a webinar that detailed the Medicaid billing changes coming to school districts as a result of changes to the Affordable Care Act (ACA) made in 2012, but only recently being applied to Ohio’s Medicaid Schools Plan (MSP).
Previously, in an October 2015 letter, the Centers for Medicare and Medicaid Services (CMS) found that Ohio’s MSP is out of compliance with its own state plan and the federal regulations because claims lack an appropriate prescription or referral from a medical practitioner. CMS is the federal entity that provides states with federal funds for Medicaid services, including the MSP. CMS concluded that claims filed under the MSP that do not contain this requirement after August 1, 2016 (the deadline set in the letter for full compliance) will not be reimbursable by Medicaid.
The Ohio Department of Medicaid was working with CMS to obtain an exemption or waiver of the requirements of the ACA as it relates to the MSP, but was unable to do so. The result of this unsuccessful negotiation has significant implications for all schools that provide services to students with disabilities pursuant to an IEP and eligible for Medicaid claim reimbursement.
If the State of Ohio is not in compliance with the ACA requirements, CMS will begin deferring IEP claims and Ohio could lose federal financial participation for Medicare through CMS. In fact, the federal regulations that require a prescription for services are not new requirements. Federal regulations state that Ohio’s State Medicaid Plan must require, among other things, all providers to be enrolled as participating providers, and that all claims for payment for services contain the national provider identifier (NPI) of the physician or professional referring or ordering the services. The change in the federal regulations occurred in 2012; however, Ohio’s noncompliant practice and procedure did not come to the attention of CMS until October.
The specific services for which a prescription, referral or order will be required from a medical provider are audiology, speech/language pathology, physical therapy, and occupational therapy. The provider may order multiple services if those services are in the IEP: for example, speech pathology and audiology or a combination of any of the services that requires a prescription. ODE reiterated during the webcast that services in the IEP must be delivered and cannot be denied, changed or modified based on the ability/inability to submit claims for reimbursement to Medicaid for services through the MSP.
A “provider” was defined in the January 27th webcast conducted by the Department of Medicaid Services and ODE as; a physician (MD or DO) an advanced practice nurse (APN), or a physician assistant (PA). School nurses who are RNs or LPNs are ineligible to order, refer or prescribe for these services. School therapists with a national provider number may not prescribe, order or refer the services either. School therapists will, however, continue to evaluate and provide services to students with disabilities, and document services for Medicaid school reimbursement.
On February 3, 2016, the Office for Exceptional Children issued guidance to school districts whose students with disabilities are, or may be, confined to community corrections facilities or juvenile detention centers.
Generally, the law provides that the school district of residence (the district in which the student’s parent(s) reside) maintains the ultimate responsibility to provide a free appropriate public education (“FAPE”) to the student and remains responsible for the student’s access to appropriate special education and related services while the student is confined. Absent a specific exception, the school district of service (defined as the school district in which the facility is located) provides the special education and related services and charges the cost of those services to the district of residence. Keep in mind, however, that it remains the ultimate responsibility of the district of residence to ensure that students with disabilities are receiving the services to which they are entitled pursuant to their individualized education programs (“IEPs”).
The guidance further emphasizes that school districts must identify, locate and evaluate students in community corrections facilities and juvenile detention centers who may have a disability and may need special education and related services under the Individuals with Disabilities Education Act (“IDEA”). In short, if there is a suspicion that a student has a disability and is in need of special education and related services, the district of residence must evaluate that student in a timely manner.
School districts should review their special education policies and procedures to ensure that they provide FAPE in a timely and appropriate manner to all students with disabilities, including students in these facilities, and in accordance with the Ohio Operating Standards for the Education of Children with Disabilities.
For additional information and access to ODE’s guidance, please visit:
The Thomas Moore Law Center, on behalf of John and Melissa Wood and their minor daughter, filed suit against the Charles County Public School District Board of Education and the High School Principal and Vice-Principal alleging that the La Plata High School “promoted Islam” by implementing a pro-Muslim lesson plan in its World History class. The Woods claim that the school concealed that it promoted Islam by leaving the topic out of a course syllabus and that students were forced to use a separate textbook for the segment on Islam but were not permitted to take it home. To that end, the Woods allege that their daughter was forced to profess and to write out the Shahada, the Islamic creed, in worksheets and quizzes.
By way of background, the lawsuit alleges that after the Woods learned of the Islamic subject matter being taught, Mr. Woods immediately contacted the school to voice his objections and to obtain an alternative assignment for his daughter. He maintains that the school ultimately refused to allow his daughter to “opt-out” of the assignments and subsequently enforced its “No Trespass” policy on him so that he was no longer permitted to enter onto school premises.
In a January statement, President and Chief Counsel of the Thomas More Law Center Richard Thompson said the school “forced Wood’s daughter to disparage her Christian faith by reciting the Shahada, and acknowledging Mohammed as her spiritual leader.”
“The Woods believe that it is a sin to profess commitment in word or writing to any god other than the Christian God,” the Thomas Moore Society says on its website. “Thus, they object to their daughter being forced to deny the Christian God and to her high school promoting Islam over other religions.”
The Woods seek a court declaration that the Defendants violated their constitutional and statutory rights, a temporary and permanent injunction barring Defendants from endorsing Islam or favoring Islam over Christianity and other religions, and from enforcing the no trespassing order issued against Mr. Wood.