School services Program

Fee For Service Program

Coverage applies to individuals up to the age of 21 who are eligible under the provisions of the Individuals with Disabilities Education Act (IDEA) of 1990 as amended in 2004 and to those enrolled in programs that require an Individualized Education Program (IEP) or an Individualized Family Services Plan (IFSP).

Partial reimbursement applies to the following services:

  • Nursing Services
  • Occupational Therapy Services
  • Orientation and Mobility Services
  • Personal Care Services
  • Physical Therapy Services
  • Psychological, Counseling and Social Work Services
  • Specialized Transportation
  • Speech, Language and Hearing Services
  • Targeted Case Management

Administrative Outreach Program

The School Services Administrative Outreach Program offers partial reimbursement for the cost of administrative activities that support efforts to identify and enroll potentially eligible persons into Medicaid and that are in support of the state Medicaid plan.

These activities fall into several categories:

  • Medicaid Outreach
  • Facilitating Medicaid Eligibility determinations
  • Health-related Referral Activities
  • Medical Service Program Planning, Policy Development, and Interagency Coordination
  • Programmatic Monitoring and Coordination of Medical Services
  • Transportation and Translation Services

Caring 4 Students (C4S)

In 2019, a new program was added to expand the School Services Program.  The Caring 4 Students (C4S) program offers partial reimbursement for the cost of expanding and enhancing emotional and medical services to Medicaid-eligible general education students.

Deficit Reduction Act (Employee Education about False Claims Recovery)

Pursuant to Section 1902(a) (68) of the Social Security Act, Ingham ISD, as the Medicaid Provider for School Based Services for 12 districts, is required to comply with Section 6032 of the Deficit Reduction Act (DRA) of 2005.  Ingham ISD is subject to this act because we received or make at least $5 million in annual aggregate payments from the federal Medicaid program.

A section of the law entitled “Employee Education About False Claims” cites three (3) requirements; 1) Establish written policies for employees and contractors about the False Claims Act; 2) Establish detailed provision in these policies for detecting fraud, waste and abuse, as well as administrative remedies for false claims; 3) Inform all providers about these policies and their rights to be protected as whistleblowers.

The Federal False Claims Act, among other things, applies to the submission of claims by healthcare providers for payment by Medicare, Medicaid, and other federal and state health programs.  The False Claims Act is the federal government’s primary civil remedy for improper or fraudulent claims.  It applies to all federal programs, from military procurement contracts to welfare benefits to healthcare benefits.

The False Claims Act prohibits among other things:
 

  • Knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment or approval;
  • Knowingly making or using, or causing to be made or used a false record or statement in order to have a false or fraudulent claim paid or approved by the government.
  • Conspiring to defraud the government by getting a false or fraudulent claim allowed or paid; and
  • Knowingly making or using, or causing to made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government.

Any person who knowingly attempts to defraud the federal government is liable to the United State Government for a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages which the Government sustains because of the act of that person.

“Knowingly” means that a person, with respect to information: 1) has actual knowledge of the information; 2) acts in deliberate ignorance of the truth or falsity of the information; or 3) acts in reckless disregard of the truth or falsity of the information.

Enforcement

The United States Attorney General may bring civil actions for violations of the False Claims Act.  As with most other civil actions, the government must establish its case by presenting a preponderance of the evidence rather than meeting the higher burden of proof that applies in criminal cases.  The False Claims Act allows private individuals to bring “qui tam” actions for violations of the False Claims Act.

Protection for “Whistleblowers

Federal and state law prohibit any retaliation or retribution against persons who report suspected violations of these laws to law enforcement officials or who file “whistleblower” lawsuits on behalf of the government.

To report Medicaid provider fraud

Call the Attorney General’s 24-hour Hotline at 800.24.ABUSE (800.242.2873), email Health Care Fraud or visit State of Michigan Department of Attorney General.

Random Moment Time Study (RMTS)

The random moment time study (RMTS) is one of the integral parts of the Medicaid reimbursement process.  It is the federally accepted method of documenting the amount of staff time spent on direct service and administrative outreach activities. It is a Medicaid program requirement that helps schools receive federal reimbursement for time spent on allowable related activities.

If your district has identified you as a person who performs activities related to Medicaid and health-related services as part of your job, you have the potential to be randomly selected to participate.  If selected, you will receive an email from miaop@pcgus.com with a link to your moment that will ask you questions about a specific minute in your day.  Your role is to respond to all moments you have been selected for in a timely manner.  You will be asked the following questions:

  1. Were you working during your sample moment?
    • Yes
    • No 
  2. Is the service you provided part of the child's medical plan of care or for which medical necessity has been determined?
    • Yes - IEP/IFSP
    • Yes - medical plan of care other than an IEP/IFSP (i.e. 504, student health plan of care, physicians order, crisis intervention service)
    • Medical necessity established in other method
    • No or N/A
  3. Who was with you?
  4. What were you doing?
  5. Are you the student's designated case manager? (for targeted case management only)

Provide truthful and thorough responses.  There are no wrong answers, but remember to answer completely and accurately.  If your answer is too vague, you may be contacted by PCG staff for additional follow-up information.

Under the Direction of and Supervision (Section 1.4 of the Medicaid Provider Manual)

Certain specified services may be provided under the direction of or under the supervision of another clinician.  For the supervising clinician, "under the direction of" means that the clinician is supervising the individual's care which, at a minimum, includes seeing the individual initially, prescribing the type of care to be provided, reviewing the need for continued services throughout treatment, assuring professional responsibility for services provided, and ensuring that all services are medically necessary.  "Under the direction of" requires face-to-face contact by the clinician at least at the beginning of treatment and periodically thereafter.

"Supervision of" limited-licensed mental health professionals consists of the practitioner meeting regularly with another professional, at an interval described within the professional administrative rules, to discuss casework and other professional issues in a structured way.  This is often known as clinical or counseling supervision or consultation.  The purpose is to assist the practitioner to learn from his or her experience and expertise, as well as to ensure good service to the client or patient.

Contact Us

Nicole Coburn
Medicaid Coordinator
Nicole LaRue
Director, Special Education Finance and Pupil Accounting

Office Hours

7:30am - 4:00pm

EdPlan

To access logging Medicaid services, please select your district or program.

PCG Help Desk

866.303.1940 ext 1