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MaineCare Seed for Special Purpose Private Schools
May 2, 2012
The Department of Health and Human Services (DHHS) Office of MaineCare has been working with the Department of Education (DOE) to find solutions to some fundamental issues regarding the payment of school based services. These issues have been complex and have required systems changes in both state agencies.
Previously, when special purpose private schools (SPPS) billed MaineCare, all allowable claims were paid only the Federal portion of the reimbursement by MaineCare. The special purpose private school then billed DOE for State Agency Clients and the resident school administrative units (SAUs) for students that were not State Agency Clients for the State portion (seed) of the claim.
The Center for Medicare & Medicaid Services (CMS) has advised MaineCare that the process we have been using cannot continue. Therefore, special purpose private schools will be paid 100% of the Medicaid reimbursement rate for allowable claims with a service date beginning July 1, 2011.
There have been some challenges getting the MaineCare payment system adjusted for this change. The backlog of claims that began to pay in December 2011 paid the Federal portion only. SPPS have been advised not to seek payment from SAUs for that State portion (seed) because MaineCare intends to re-run those claims to adjust the claim reimbursement amount to 100% of the allowable claim reimbursement.
The first claims that paid at 100% were processed the first week in February 2012.
DOE and DHHS have developed a system that utilizes DOE State funds as the State portion of the Medicaid reimbursement for medically necessary services delivered to Medicaid-eligible children attending special purpose private schools.
This process is an interim process that may become standard practice for FY 13. Both DOE and DHHS are committed to developing a long-range process to support the provision of school-based services to all children.
DOE intends to conduct rate setting for the educational rate of special purpose private schools this summer, August 15, 2012 thru October 1, 2012.
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