Payment Methodology for Services in the School-Based Access Program
[44 Pa.B. 7976]
[Saturday, December 20, 2014]
The Department of Human Services (Department) is revising the payment methodology used for the School- Based Access Program (SBAP) as required by the Centers for Medicare and Medicaid Services (CMS).
The Medical Assistance (MA) Program covers a broad range of health-related services provided to children with disabilities through the SBAP. Services must be health-related, not educational, and must be provided by a qualified MA provider. To be eligible for MA payment, services must be medically necessary and must be listed on the child's Individualized Education Program.
The Department provides payment to local education agencies (LEA) for school-based services. School-based services are paid on a cost-related basis. The payment methodology includes a cost reconciliation and cost settlement process. Each LEA certifies its costs. See 43 Pa.B. 2524 (May 4, 2013). Currently, LEAs include school districts, charter schools, intermediate units, vocational-technical schools, preschool early intervention programs and approved private schools (APS).
The CMS advised the Department that APSs are not government units for Medicaid reimbursement purposes and, therefore, cannot utilize a certified public expenditure funding mechanism. As a result, effective January 1, 2015, APSs will no longer be eligible to participate as MA providers in the SBAP. APSs can continue to receive payment for school-based services by entering into contracts with LEAs that are enrolled in the MA Program as qualified providers. The participating LEAs will pay the APSs and may include the payments on their cost report as a contracted cost.
The Department anticipates no fiscal impact as a result of this change in payment methodology for SBAP services.
Interested persons are invited to submit written comments regarding the revised payment methodology to the Department of Human Services, Office of Medical Assist-ance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments will be reviewed and considered.
BEVERLY D. MACKERETH,
Fiscal Note: 14-NOT-922. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 14-2645. Filed for public inspection December 19, 2014, 9:00 a.m.]
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