Schools - Budget Forms

January 24, 2012

In order for a school or school district to participate in the Medicaid program and receive Medicaid reimbursement, there must be a provider agreement between the state Medicaid agency and the actual health care provider. Schools may enroll as Medicaid providers, either by qualifying to provide services directly, or, under certain conditions, by contracting with independent practitioners to provide the services. There are four models schools may choose to provide Medicaid services. For Maine, there is also a requirement to complete a budget form which was recently sent out to each public school.

MODEL 1, Direct Employment of Health Professionals: The school (or school district) itself employs health professionals such as physicians, nurse practitioners and nurses, or operates a clinic, i.e., has direct supervision and control over the clinic activities. The arrangement between schools and providers governs how and by whom Medicaid is billed for services and to whom payment may be made. Where the school employs the staff which provides the health services (or operates a clinic), the school can enter a provider agreement with the Medicaid program and receive Medicaid payments for the covered services provided.

MODEL 2, Contracting with Health Practitioners or Clinics: The school (or school district) contracts with health practitioners or clinics to furnish services. Under this type of arrangement, the health practitioner or the clinic (not the school) is the provider of services, and payments under Medicaid must be made, with limited exception, only to the provider of the services.

MODEL 3, Combination of Direct Employing and Contracting The school (or school district) uses a combination of employed health professionals and contract health professionals to furnish services. In general, when a school provides a service through employed staff and contracts with additional health professionals to supplement the care and services being provided by its own employees, the school can qualify as the provider.

MODEL 4, Mix of Employed and Contracted Providers: This model is similar to model 3 in which the school (or school district) uses a mix of employed and contracted providers. This model is used where the school provides some services directly but wishes to contract out entire service types without directly employing even a single practitioner in a service category. The school may establish itself as an organized health care delivery system under which it provides at least one service directly, such as case management, but provides additional services solely under contract.