Federal law makes Medicaid reimbursement available for health-related services that schools provide to address the educational needs of students. By law, Medicaid claiming for Individualized Education Program (IEP) services cannot affect the student’s Medicaid eligibility or benefits. Subject to parental consent, participating Indiana public school corporations, including public charter schools, may claim Medicaid reimbursement for covered IEP services, such as therapies, nursing, mental health, audiology, and specialized transportation. Indiana public school corporations may also participate in school-based Medicaid Administrative Claiming (IndianaMAC) to recover a portion of their state and local costs for administrative support activities to help students with unmet health needs. Federal Medicaid dollars help schools fund a variety of student supports, including specialized equipment, qualified personnel, professional development, on-site medical services, and supplies.
IEP Telemedicine Services During COVID-19 Outbreak
- During the COVID-19 outbreak, IEP-required medical services, such as therapies, nursing and psychologist services, may be provided via telemedicine within the scope of practice of the licensed medical professional, in accordance with guidance issued by the U.S. Department of Health and Human Services. The following excerpts from this federal guidance give examples of technologies that may be used to provide telemedicine services under this temporary, emergency telemedicine expansion:
“… any non-public facing remote communication product that is available to communicate with patients” ... “covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without ... penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.” [NOTE:] “ Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth ...”
- Indiana Governor’s Executive Order 20-13, COVID-19 Medical Surge clarifies that Occupational, Physical and Speech Therapists licensed in Indiana may provide telemedicine services but only in accordance with the telemedicine definition in state law IC 25-1-9.5-6(a). This means that OT, PT, and Speech Therapists licensed by the Indiana Professional Licensing Agency may NOT use audio/voice-only or text (paper-based, text, email) communications to provide healthcare services via telemedicine. Please also note: Executive Order 20-13, Section 2.a. permits certain retired healthcare professionals with inactive licenses to provide healthcare services in Indiana during this public health emergency. Click here to view full details of Executive Order 20-13.
- As announced in Indiana Health Coverage Programs Bulletin BT202022 Indiana Medicaid has temporarily expanded coverage for telemedicine services during the COVID-19 outbreak, in accordance with the federal and state guidance referenced above. Additional information and details are available online, under “Past Webinars (Recorded Presentations),” at https://www.in.gov/medicaid/providers/1014.htm More details on claiming Medicaid reimbursement for IEP-required services are available in the Medicaid Billing Tool Kit (click link under Manuals below) and at the IDOE Office of Special Education Moodle community.
- For information on Medicaid billing codes for IEP Telemedicine services furnished under the temporary COVID-19 coverage expansion, click here: Emergency COVID-19 Billing Codes for IEP Telemedicine Services
- To help families determine if their child qualifies for Medicaid/Hoosier Healthwise benefits and for help enrolling in public health coverage programs, click these links:
- Medicaid Reimbursements per School Corporation Report – First Half of State Fiscal Year 2020, as of 12/31/2019: IEP Services (pages 1-10) & IndianaMAC (last 5 pages)
Additional Resources and Information
- Federal Medical Assistance Percentage (FMAP) Rates 2009-2020
- Frequently Asked Questions: Medicaid Funds Use; Federal Medicaid Match Rates; and State Medicaid Match Funding Sources
- Frequently Asked Questions: School Corporation Medicaid Provider Enrollment
- Indiana Medicaid Coverage Policy Q&A: IEP Speech-Language Services
- Healthy Students, Promising Futures: State and Local Action Steps and Practices to Improve School-Based Health - U.S. Department of Education web site
- What is IndianaMAC? A one-page overview of school-based Medicaid Administrative Claiming
- Indiana MAC Time Study Participant Manual - Updated July 2016
- Medicaid Billing Guidebook - Updated December 2017 - The Guidebook is a high-level overview of Medicaid claiming for school-based health services and related administrative activities in Indiana.
- Medicaid Billing Tool Kit, 21st Edition – June 2019 – The Tool Kit discusses Indiana Medicaid billing requirements for covered health-related services in a student’s IEP. It includes general billing guidelines for all IEP-required medical services, as well as coverage limitations, Medicaid provider qualifications, and other billing details applicable to each type of Medicaid-covered IEP service.
- Update Log for the 21st Edition of the Medicaid Billing Tool Kit – Updated June 2019 – The Update Log identifies what changed from the previous edition of the Medicaid Billing Tool Kit.