Medicaid Consulting for Schools

School districts contracting with Boothby Therapy Services for Medicaid consulting services have access to the member benefits below, as well as access to exclusive tools and resources.

Contact us for a customized pricing breakdown for your district.

I. Targeted education in small groups on regulatory components

A. Directors & Building Coordinators Directors and building level coordinators will be reacquainted with the major regulatory components of the Medicaid to Schools program. Topics include:

• Understanding the parameters of covered services definitions and activities
• The importance of ordering covered services in a child’s care plan with a good supporting rationale
• The necessity of applicable referrals
• Parental consent
• Credentials of staff, including the importance of obtaining the credentials of “out of district” and contracted staff
• The importance of accurate daily covered service delivery documentation
• Address issues that can arise when documenting the consultations between licensed practitioners of the healing arts and paraprofessionals
• Address issues that can arise with the “supervision” of assistants (SLAs, etc.) relative to Medicaid documentation

Participants will be provided with pertinent updates to the program such as recent regulatory changes or proposed regulatory changes at the state and/or federal level.

• We recommend directors schedule Boothby Therapy Services to meet with building level case managers in October/November and with related services providers in November/December.

B. Case Managers Case manager meetings will focus on topics such as:

• Managing the documentation in a child’s file and the necessity of making sure that the documents are compiled and signed preferably at the care plan meeting (i.e., referral, parental consent).
• The need to make sure covered services are ordered in the child’s care plan with a good rationale that ties those services back to the covered services definitions.
• The care plan is foundational to justifying the covered services as Medicaid reimbursable.

C. Related Services Team Related services team meetings will focus on the professionals delivering the services and documenting those services for the purposes of Medicaid reimbursement. Meetings will cover:

• Covered services definitions
• Services definitions in the context of medical necessity
• Scope of practice concerns from the perspective of state law and regulations

II. The Simulated Audit Process

Simulated audit meetings with directors, building coordinators and case managers

• Pre-meeting, the district will identify students for which the district has received Medicaid reimbursement.
• Typically, students who have drawn down substantial amounts of reimbursement should be reviewed.
• Out of district children should also be reviewed as they typically have files that are more poorly documented.

The simulated audit meeting will require one, full day. 

• The day begins with an opening meeting to discuss the scope of methodology of the audit.
• Student files that have been prepared prior to the meeting will be brought to the meeting, preferably by case managers.
• A Boothby Therapy Services representative will lead a facilitated discussion and review student files wherein a checklist is utilized by case managers to review their respective files.
• Questions concerning what is discovered or missing from the files that would create exposures to Medicaid paybacks in an actual audit will be the focus.
• Facilitated simulated audit discussion will ensure understanding of Medicaid requirements by district administrators and case managers through self-review of files.
• At the conclusion of the day, a review of the findings and discussion of strategies to improve the documentation in the files will take place.

III. The Actual Audit

In the event that a district participating in our program receives a Medicaid to Schools audit letter, they will be prepared.  Our Emergency Audit Response Includes:

• Initial audit letter meeting with special education director(s), preceded by a memo whereby important documentation that needs to be gathered is identified.
• Support to the district in the collection of requested data, as well as making sure the audit response materials are delivered, in hand, in a timely fashion. This delivery starts the process of the auditor’s review of the documentation.
• Once the preliminary audit findings are authored and distributed to the district by the auditor, assist the district in providing a written response. The response includes agreement with findings as appropriate, disagreement with findings where such disagreement is supported by regulations and guidance and the provision of additional documentation where such documentation can correct preliminary findings.
• Make corrective action recommendation to the district in light of the outcome of the preliminary audit findings.
• Prompt the district to start thinking about potential appeal items based on preliminary findings.
• After receipt of final findings letter, review final findings with the district and special education director(s) after assisting the district with a written reply to the final findings letter.
• Ensure that the district understands and agrees to the response as proposed.
• Provide contextual guidance on whether an appeal to any part of the finding is appropriate.
• Provide input to the district in regard to implementation of a corrective action plan based on audit final findings.