PRIORITY: MaineCare Enrollment and Completion of Certified Public Expenditure Forms; and Updated MaineCare Documentation Form

ADMINISTRATIVE LETTER: 23
POLICY CODE:  DIC

TO: Superintendents of Schools, Special Education Directors, CDS Regional Boards of Directors, CDS Regional Site Directors
FROM: Angela Faherty, Ph.D., Commissioner
DATE: November 5, 2010
RE: PRIORITY: MaineCare Enrollment and Completion of Certified Public Expenditure Forms; and Updated MaineCare Documentation Form

PRIORITY: Maine Care Enrollment and Completion of
Certified Public Expenditure Form

All school administrative units (SAUs) and Child Development Services (CDS) regional sites must enroll with MaineCare in order to receive reimbursement for medically necessary services for eligible children under MaineCare. The Individuals with Disabilities Education Act (IDEA) requires accessing all third party sources, including State Medicaid, prior to using federal IDEA funds for services.

In addition to the MaineCare enrollment, CDS regional sites and SAUs must complete on a yearly basis certified seed forms for the Department of Health and Human Services MaineCare program. The Department of Health and Human Services is implementing a new data system as of September 1, 2010. The Certified Public Expenditure (CPE) form covering September 1, 2010 to June 30, 2011 must be completed by all SAUs in order for SAUs to receive reimbursement. Some  SAUs have enrolled and completed the CPE form, some have enrolled but not completed the CPE form, and a large number have yet to enroll or complete the CPE form. It is critical that these forms are completed for each SAU.

Form Covering September 1, 2010 to June 30, 2011
The form can be accessed at: http://www.maine.gov/education/medicaid/index.html
The following instructions for completing this form were developed by MaineCare and are contained on the Certified Public Expenditures Agreement form.

Providers:
This form only applies to providers enrolled in MIHMS under the following provider  types:
87 – Public School
88 – Special Purpose Private School
89 – Intermediate Education Unit
90 – Government Agency

I.) You will need to complete a separate form for each NPI number and/or service location ID that you have enrolled in MIHMS.
When it asks for the service location ID for any applicable locations of the Provider, these numbers should have been provided to you in the welcome letter upon enrollment in MIHMS.

II.) The Certified Seed Amount is the amount of your special education budget that pertains to services provided to MaineCare eligible clients/students.

Attention Schools!
A simple calculation for this would be to subtract out any personnel or building related costs from your special education budget, then take that number and multiply it by the percentage of students you know to be Mainecare eligible to get your final seed number.

III.) Have an authorized official, i.e., superintendent, director, certify the funds by providing their name, title, signature and the date.

IV.) Finally, fax the form to the number provided.

Please fax the form directly to Mainecare at 1-877-314-8776.

If you have questions, please call Jaci Holmes, Federal State Legislative Liaison at the Department of Education at 624-6669.

Updated MaineCare Documentation Form

The Departments of Education and Health and Human Services have been working collaboratively to develop refinements to MaineCare policies that will facilitate billing by SAUs for medically necessary services. In addition, the Departments have reviewed the documentation requirements required by MaineCare in relation to the components of the Individualized Educational Program (IEP).

The Department of Health and Human Services has determined that a child’s individualized educational program (IEP) contains all but three pieces of documentation that are necessary for MaineCare billing. The three pieces of additional documentation that are needed for several of the MaineCare policies are: (1) the signatures of the team members and the date of the plan of care; (2) the plan of care; (3) and a crisis/safety plan. A MaineCare Documentation form that covers these three requirements can be found at http://www.maine.gov/education/medicaid/index.html . For each MaineCare eligible child for whom the school administrative unit will seek reimbursement for MaineCare services provided to that child, the MaineCare documentation form must be completed before billing  MaineCare for services rendered  to eligible children. For Section 65 services, the MaineCare documentation should indicate that there is a DSM-IV diagnosis and that diagnosis must be reflected in the billing as an ICD-9 code.  The MaineCare documentation form must be filed with the child’s IEP.

The signatures of all the team members and the crisis/ safety plan are only required for services under Section 28 (Home and Community- Based Services).

The plan of care must contain: the responses to the Medical Necessity Decision Tree; the short term objectives; and the specific services that are medically necessary. For occupational therapy, physical therapy, and speech therapy, the professional of the healing arts will sign the plan of care.  Parents must also sign the plan of care. Related services provided to a child under a Section 504 plan are billable to MaineCare.

If you have questions about this documentation process, please contact Jaci Holmes, Federal State Legislative Liaison, by phone at 624-6669 or by email at jaci.holmes@maine.gov .