Introduction
Through the Medicaid school-based services (SBS) benefit, local education agencies (LEAs or agencies) may submit claims to Wisconsin Medicaid for covered services provided to Medicaid-eligible students. 34 CFR § 300.154(d)(1). Use form M-5 to obtain parental consent to release education records to Wisconsin Medicaid and to obtain consent to bill Medicaid for covered services. The services must be listed in a student’s IEP. Letter to Smith,48 IDELR 134 (OSEP 2007); Letter to Guess, 47 IDELR 135 (OSEP 2007).
Implementation Considerations
Agencies must obtain consent before billing Medicaid. 34 CFR § 300.154(d)(2)(iv); 78 Fed. Reg. 10,525 (2013). Consent may be obtained one time for the specific services and the duration of the services identified in a student’s IEP. Letter to Smith,48 IDELR 134 (OSEP 2007); Letter to Guess, 47 IDELR 135 (OSEP 2007). The consent is effective until the parent revokes consent or specific conditions apply. Please refer to the Department's medicaid bulletin for further guidance.
Form Content and Explanations
Content: Identification of services that will be claimed under Wisconsin Medicaid. Explanation: The agency may submit a claim to Medicaid through the school-based services (SBS) benefit for attendant care services, nursing services, physical therapy, occupational therapy, speech and language pathology services, specialized medical transportation, psychological services, counseling, social work services, and developmental testing and assessment. 34 CFR § 300.154(d)(2)(iv). The services that may be claimed to Medicaid through SBS are determined by Wisconsin Administrative Code and the ForwardHealth Online Handbook and are subject to change. Enter the specific schoolbased services in the student’s IEP to be billed to Wisconsin Medicaid.
Content: Consent is needed before releasing education records to the Medicaid agency. Explanation: Both the Family Educational Rights and Privacy Act (FERPA) and IDEA prohibit LEAs from releasing a student’s education records to a State Medicaid agency for insurance billing without parental consent. 34 CFR § 300.154(d)(2)(iv). List education records which the LEA may disclose to Wisconsin Medicaid. The parents must be informed of the reason for the disclosure, and that upon request they may receive copies of the records disclosed.
Content: Consent is needed before billing Wisconsin Medicaid. Explanation: The LEA may not bill Medicaid for covered services in a student’s IEP unless and until it obtains parental consent for billing. 34 CFR § 300.154(d)(2)(iv).
Content: Explanation regarding consent is voluntary, the right to revoke that consent, and the effect of refusing consent. Explanation: The LEA must inform parents the granting of their consent is voluntary and may be revoked at any time. Parents must be informed they are not required to give their consent. Revocation of consent is not retroactive. Revocation does not negate an action that has occurred after the consent was given and before the consent was revoked. Therefore, it does not negate any billing that occurred after consent was given and before it was revoked. If the parent refuses to consent, the LEA must ensure that all required special education and related services are provided at no cost to the parent. 34 CFR § 300.154(d)(2)(iv).