RE: Mass. Medicaid - treatment at two facilities simultaneously

[Guest guest]

I practiced in a Rehab Agency fro 11 years. We ran into this situation

frequently. There a a few things to consider in these situations. After much

discussion and research into Medicaid and the IDEA law that provides school

system therapy, we discovered the following (we are in the state of Virginia):

In 1992, IDEA revisions " redefined " or clarified that therapies administered in

the school under IDEA must pertain directly to the performance of educational

tasks or the ability of a student to maximally participate in their education.

This was a change in the interpretation. In our area, the pendulum swung way to

the other side and therapists were forced more into a consultant role than

direct intervention role. We could no longer concern ourselves with quality of

movement and other issues. Our role became consultant, equipment " builders " ,

etc. to adapt the environment to the child. No longer were we providing ongoing

treatment. That has swung back to some degree. But no longer are children's full

rehabilitation needs met through school system services.

In order for the school system therapy to be billed to Medicaid, the

parents/guardians must give written permission. Virginia recognizes that

Medicaid is the child's health insurance. School system therapy is an

educational model (clarified in IDEA in 1992) that applies to the educational

setting, clinical therapy is medical model, focusing on rehabilitation for any

setting. In our area, if the family refuses written permission, then the school

system must pick up the tab for the educational model, leaving the child with

medical model coverage by Medicaid. This makes the system equitable for those

children with private insurance who receive school system therapy under IDEA but

still can recieve medical model services covered by their private insurance.

Families need to make informed decisions regarding the utilization of their

child's Medicaid resources. We routinely found that they did not understand

IDEA, their child's rights, or the diffenrence between

[Guest guest]

IF the school system is billing medicaid then they are biling for medically

necessary services and not educational. This is becoming a problem in some

states and I would refer this person to the Pediatric section representative or

district Chair for their state. I don't have the name here but they can access

info from the pediatric sections web site. There is a book that the section has

published that deals with this " Providing Physical THerapy Services under part

B & C of the individuals with Disabilities Education Act (IDEA) " Mass.

implementation of IDEA will be in their statutes and regulations.

Pat

Pat Corrigan Jobes, PT

Director of Rehabilitation Services

Methodist Healthcare-North Hospital

3960 New Covington Pike

Memphis, Tn 38128

Phone: (901)384-5320

Fax: (901)384-5099

E-Mail: jobesm@...

>>> Kovacek 03/02/01 07:43AM >>>

I've been asked to post this for a Mass. list member who wants to stay anon.

Please respond to the list - not me individually. Thanks

>Good Morning ,

> I'm hoping you can direct me to the Medicaid regulation that

> states a

>patient can not receive services at different facilities and have it

>covered.

>

>We have a pediatric patient who is being seen in the school system and the

>parents brought the child to our hospital-based outpatient speech

>department. The parents feel the child is making progress with the SLP in

>our clinic and wants both services. We realize we will not be paid. Any

>suggestions?

R. Kovacek, MSA, PT

Email Pkovacek@...

313 884-8920

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