Medicaid School Based Services (SBS)
About
The Medicaid program, as established by Title XIX of the Social Security Act, provides quality health care to low-income, and disabled individuals by utilizing state and federal funds, to reimburse providers for approved medical services.
The South Carolina Department of Health and Human Services (SCDHHS) provides Medicaid reimbursement for medically necessary services provided to Medicaid-eligible individuals in the Local Education Agency (LEA). Medical Necessity means the need for treatment services is necessary to diagnose, treat, cure, or prevent an illness, or participation in services is reasonably expected to relieve pain, improve and preserve health, or be essential to life. This includes, but is not limited to, children under the age of 21 years who have or are at risk of developing sensory, emotional, behavioral or social impairments, physical disabilities, medical conditions, intellectual disabilities or related disabilities, or developmental disabilities or delays. The South Carolina (South Carolina or State) State Medicaid Plan allows an array of behavioral health services under the Rehabilitative Services Option, 42 CFR 440.130(d).
Local Education Agencies (LEA)
The SCPCSD is recognized as an LEA by the South Carolina Department of Education (SCDE) and has contracted with SCDHHS to provide Medicaid-reimbursable school-based services to Medicaid-eligible children with special needs. Individual Charter Schools must sign an annual contract with the South Carolina Public Charter School District each year.
Individual service providers employed or contracted by an LEA must meet the specified Medicaid provider qualifications.
Individuals With Disabilities Education Act and Medicaid
The development of an Individualized Education Program (IEP), Individualized Family Service Plan (IFSP) is a requirement of the Individuals with Disabilities Education Act (IDEA). The development of an Individualized Health Plan (IHP) is a requirement of Section 59-63-80 of the South Carolina Code of law. Medicaid requires school-based services to be indicated on the IEP, IFSP, IHP or the Individualized Treatment Plan (ITP).
Eligibility and Special Populations
In order to be eligible for school-based rehabilitative therapy services, a Medicaid-eligible individual must:
Be under the age of 21 years.
Have a current and valid IEP, IFSP, or an Early and Periodic Screening, Diagnostic and Treatment (EPSDT) examination that identifies the need for rehabilitative therapy services.
Current Updates
Click the link above for current information.
How the SCPCSD supports the Medicaid Program?
●Identifying opportunities for Medicaid reimbursement.
●Maximizing the reimbursement and scope of healthcare services in schools.
●Monitoring the quality of school-based Medicaid services (documentation and billing process).
●Promoting continuous improvement and best practices methods.
●Providing training, resources, and guidance on the Medicaid process.
●Providing access to electronic software for tracking student data and billing Medicaid services.
Medicaid Services
The following services are listed under School-based services.
Speech-Language Therapy
Occupational Therapy
Physical Therapy
Nursing Services - Children under 21 years of age
Rehabilitative Behavioral Health Services (RBHS)-Mental Health Services in Schools
Reimbursement for Medicaid Services
The reimbursement obtained for rendering these services may support funding in other critical areas for the school.
The district has contracted with two entities to assist schools with Medicaid documentation and has contracted with another agency that bills and document therapy services.
Medicaid Staff Requirements
Staff must meet all applicable Medicaid provider qualifications, as well as the applicable state licensure regulations, in addition to any specified requirements by the South Carolina Department of Education for the provision of Medicaid school-based services. The contracted LEA is responsible for ensuring the individuals rendering Medicaid school-based services are approved, credentialed, or licensed.
All subcontracts (e.g., billing contracts, contracted providers, etc.) are subject to the terms of the LEA’s contracts with SCDHHS, and the LEA provider is held solely responsible for the performance of the subcontractor. The LEA must utilize the subcontract format approved and provided by SCDHHS.
All providers shall maintain a clinical record for each Medicaid-eligible beneficiary that fully describes the extent of the treatment services provided.
The clinical record must contain documentation sufficient to justify Medicaid participation and should allow an individual not familiar with the beneficiary to evaluate the course of treatment.
Staff Supervisory Requirements
All supervisory staff licensed by Labor, Licensing and Regulation (LLR) must adhere to any provisions as required by LLR.
In addition to the above requirements, South Carolina Medicaid requires a supervising entity (physician, dentist, or any program that has a supervising health professional component) to be physically located in South Carolina or within the 25-mile radius of the South Carolina border.
Technical Assistance
Training and support are provided by the district office. Contact the district office point of contact for additional information.
School-Based Resources
SCDE Resources:
•SCDE OMS Webpage: Medicaid - South Carolina Department of Education - 07/25/2023 2:28 PM (sc.gov)
•SCDE – Medicaid Forms: Forms - South Carolina Department of Education - 07/25/2023 2:29 PM (sc.gov)
•SCDE School QA Checklist: Quality Assurance (QA) - South Carolina Department of Education - 07/25/2023 2:31 PM (sc.gov)
•SCDE- Fee/Rate Schedule - Additional Resources - South Carolina Department of Education - 07/25/2023 2:31 PM (sc.gov)
SCDHHS Resources:
•SCDHHS website: SCDHHS - South Carolina Department of Health and Human Services
•SCDHHS LEA Manual and forms website: Local Education Agencies (LEA) Services Provider Manual | SCDHHS
•SCDHHS Medicaid Provider Education webpage: Trainings | SCDHHS
•SCDHHS contact for the Medicaid Provider Services - 1 (888) 289-0709.
Medicaid Contact
Deitrich Drayton
Medicaid and Nursing Administrator
Phone#: 803-212-5482
Email: ddrayton@sccharter.org