Medicaid Messenger

If you need assistance, have questions or would like to schedule training, please contact a member of the Wayne RESA, Medicaid School Services Program Team.

Feel free to contact us with any questions.

Michelle Maxfield - (734) 334-1461 ~maxfiem@resa.net

Leanne Smith - (734) 334-1464 ~smithle@resa.net

Tia Williams - (734) 334-1397 ~williat@resa.net

When billing Medicaid for a direct service you have provided, there are policy requirements that must be followed:

1. The need for the service must be listed in the student's medical plan of care (IEP/IFSP, Caring for Students {C4S} Plan, Individual Health Plan {IHP}, Medical Management Plan {MMP}, etc.). The medical plan of care must also include the Authorization for Medicaid Services:

• For MISTAR Forms users, the Authorization for Medicaid Services form:

1. must be attached to the IEP/IFSP, IHP, MMP or any other medical plan of care;
2. is built into the MISTAR forms C4S plan.

• For MISTAR Lite users,

1. download the attached Authorization for Medicaid Services fillable pdf using the Directions Sheet to guide you through successfully completing the Authorization.

2. The direct care service must be ordered in writing by the student’s medical provider (physician, physician assistant, nurse practitioner or clinical nurse specialist).

a. downloadable or print the Authorization for Medical Treatment at School form and provide it to families or forward it to their physician’s office for completion.

The rules for an Authorization of Medical Treatment, or written orders, include all of the following:

• The order date
• The student's personally identifiable information (name, birthdate, District/school, teacher, grade)
• A description of the student's condition or medical diagnosis,
• when applicable, the order must identify the treatment, dosage, and service frequency and duration
• The medical provider's personally identifiable information (name, address, national provider identification number, phone/fax number), signature and date.

***Since medical orders enable Medicaid billing to process, please contact Wayne RESA’s Medicaid office for a secure email link to forward copies of medical orders***

Medicaid billing for Direct Service Staff Pool nurses has always been a program requirement. During the pandemic, nurses could not bill Medicaid. However, now that pandemic protocols have been lifted, nursing billings have not returned to the pre-pandemic level.

a. One of the reasons why nurses have never billed at the level of other direct service providers (social worker, speech therapist, occupational therapist, etc.) is directly related to the way nursing services are identified in the student’s Medical Plan of Care (IEP/IFSP, C4S Plan, IHP, MMP, etc.) and the Medicaid requirements for reporting services in each of these care plans.

Medicaid has always required Medicaid reimbursable services to be prescribed as direct or direct/consult services with frequency and duration, with goals and objectives, and a plan for reaching them.

b. Now that School Nurse Coordinators have helped the Medicaid office meet the plan of care requirement using multiple medical documents (individualized student plans, nursing care plans, and physician orders) Wayne RESA Medicaid office is working hard to make sure nurses are aware of the program’s plan of care requirements for Medicaid billing.

i. Special Education Plan Of Care = IEP/IFSP + IHP/MMP + physician orders

ii. General Education Plan of Care = C4S/504 plan + IHP/MMP + physician orders

One of the requirements for billing Medicaid is also participating in the Random Moment Time Study (RMTS) process. Please check your email, searching for an email from MIAOP@PCGUS.COM.

A link to quick tips and a training video on how you can successfully complete and submit your survey responses for RMTS is included below.