Health ISSUES
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WHAT IS MSP ANN CONNELLY
Supervisor, School Nursing Program, ODH
MSP=MEDICAID SCHOOLS PROGRAM
ral or order is required prior to the service being provided, or there MSP is a way that schools can receive payment from Medicaid for will be no reimbursement by MSP for the services rendered. health-related services provided in the school setting. Some schools have used their MSP funds to hire more healthcare staff, to pur- Specific direct services covered under MSP include physical (PT), occupational (OT), and speech and language therapy (SLP); nurschase equipment, or to use for other purposes. ing services; audiology; medical equipment and supplies; medical MSP has been available to Ohio schools since 2009. It is similar— transportation; and administrative activities such as service coordibut not identical—to the old “CAFS” program that ended in 2005. nation. Medical equipment and supplies could include items such As with any other fiscal program, there are conditions that must be as insulin strips, modified utensils, walkers, and assistive devices if met for schools to receive reimbursement from MSP for healthcare they are included on the Medicaid–eligible student’s IEP and used only in the school setting. Schools can also bill for the licensed services provided. healthcare provider’s time spent documenting and any other paperwork required for participation in the program. MSP reimburses schools for medically necessary health services: 1. provided to Medicaid–eligible students ages 3 to 21 years;
HOW DO WE PARTICIPATE?
To participate in MSP, school staff must participate in a Random Moment Time Study (RMTS) that helps determine the amount of 2. written on an Individualized Education Program time spent providing services to eligible children. School healthcare (IEP); and providers will be contacted during the RMTS and asked three ques3. provided by a licensed healthcare professional. tions about what they are doing at the moment and with whom. In a process much too complicated to address here, this information is Only entities that have responsibility for a student’s IEP can be an used to calculate the reimbursement rate. For further details, please MSP provider, which limits MSP to traditional public school dis- see the Ohio Department of Education link in the resources at the tricts and community, or charter schools. While Educational Ser- end of this article. vice Centers (ESCs) and other entities may provide licensed healthcare providers and deliver care in these schools, they must work WHAT ABOUT SCHOOL-BASED HEALTH CENTERS? through subcontracts with school districts to deliver services on If your school is lucky enough to have a School-Based Health Centheir behalf. ter (SBHC), services provided there are NOT typically eligible for MSP reimbursement. SBHCs have other mechanisms for payment All school-based services reimbursed by Medicaid must be ordered, for services that are not part of MSP. referred, or prescribed by a physician or “licensed practitioner of the healing arts.” These prescribers include physicians (MD or DO), WHAT IS THE FREE CARE RULE? advanced practices nurses (NP or CNS), or physician’s assistants You may have heard discussions about federal changes to what is (PA) with a Medicaid National Provider Identifier (NPI) or with an called the Free Care Rule. Historically, schools have been unable to “ordering, referring, and prescribing” (ORP-only) provider num- bill MSP for services provided to eligible students if the same serber. The prescriber’s name and number must be included on claims vices have been provided to all students for free. In late 2014, The in order for the school to receive reimbursement. A medical refer- US Department of Health & Human Services Centers for Medi-
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