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Contact NDSEEC

Email: ndseec.info@k12.nd.us

3170 43rd St. S. #103
Fargo, ND 58104

Phone: 701.997.2210

Fax: 701.404.5366

Medicaid Admins

As part of the SEEC School-Based Medicaid Consortium we offer support to Medicaid Admins within each Unit whose role is behind the scenes ensuring paperwork, timely filing, training, and more is completed accurately and efficiently. Without these staff a special education unit and/or district is not able to obtain the full reimbursement potential through school-based Medicaid eligible services. Here we've worked to develop and provide simplified tools and resources along with quick links/directions to help get the work done.

If there is something missing that you think could be helpful for all others, please reach out to Brooke Tayer at brooke.tayer@k12.nd.us.



INDIVIDUALIZED EDUCATION PROGRAM MEDICAID SERVICES BILLED BY SCHOOLS

Schools, for purposes of billing ND Medicaid for health services, means a public school district or special education unit.

The Department of Human Services (DHS), Medical Services Division (ND Medicaid) is responsible for the payment of services for Medicaid-eligible children who receive Medicaid covered health services that are described in the child’s Individualized Education Program (IEP), per the Individuals with Disabilities Education Act (IDEA).

ND Medicaid will pay the school for services based on claims submitted by the school. Payment will be based on fee schedules developed by ND Medicaid.

To receive ND Medicaid payment, the services must be part of a special education program and otherwise covered by ND Medicaid. ND Medicaid will not directly pay private schools but can make payments to the public school district for IEP-related services for children in that district who are attending private educational facilities.

Medicaid-covered services must be provided by school personnel who meet ND Medicaid provider qualifications as well as all applicable state licensing standards and are enrolled as ND Medicaid providers. Personnel can be either an employee of or contracted through the school; however, all claims must be submitted by the school.

Qualified services must:

  • Be provided to student who is eligible for Medicaid on the date of service;
  • Be authorized or prescribed in the eligible Medicaid student’s Individualized Education Program (IEP);
    • The IEP must be updated as Medicaid-eligible services are initiated or discontinued.
  • Be rendered by an enrolled Medicaid provider who is either an employee of or contracted through a school;
  • Be a service covered under the North Dakota Medicaid State Plan;
  • Be documented appropriately; and
  • Be billed to Medicaid by the school.

COVERED SERVICES:

Services must be medically necessary and outlined within an IEP that has been developed by the school’s IEP team. Nursing services require a written order that documents medical necessity. Other health-related services must be authorized by a licensed practitioner of the healing arts operating within their scope of practice:

  • Therapies (physical therapy, occupational therapy and speech-language pathology)
  • Audiology;
  • Behavioral Health;
  • Nursing Services that support the child’s needs to access free appropriate public education provided by Registered Nurses to children with complex medical needs.
  • Transportation from school to IEP services provided at an offsite location, and transportation back to school. Inclusion of the service in the child's IEP is mandatory; and
  • Applied behavior analysis for children with an Autism Spectrum Disorder

NON-COVERED SERVICES:

Services that are not covered include:

  • Services provided that are not documented in the Medicaid-eligible student’s IEP.
  • Services not authorized by the appropriate authorization or written order.
  • Services that are not provided directly to the child such as attendance at staff meetings, IEP meetings, staff supervision, member screening, development and use of instructional text and treatment materials.
  • Communications between the provider and child that is not face-to-face.
  • Transportation to and from home to school.
  • Population screenings such as lice checks.
  • Services considered experimental or investigational.
  • Services considered educational or instructional in nature.
  • Medication administration.