Issue Analysis
A comprehensive explanation of the current policy issues that are affecting Medicaid reimbursement and billing programs. Each item includes an objective summary, related news and events, Paradigm Policy publications, regulations, and other source documents pulled from the Library.
Federal Budget Control Act of 2011
Signed into law on August 2, 2011, the Budget Control Act of 2011 will reduce federal spending over the next 10 years by $917 billion. The act also increased the federal debt limit by $2.1 trillion, and includes an additional $1.2 trillion in automatic trigger cuts (excluding Medicaid) which were instituted after the Deficit Reduction "Super" Committee failed to propose an alternative package to trim the budget by the same amount by November 23, 2011.
Third Party Liability in Medicaid
The Medicaid program by law is intended to be the payer of last resort for health services to individuals with dual insurance coverage. This population represents approximately 13% of Medicaid recipients at any given time during the year. Medicaid requirements for billing services to this population can block otherwise eligible reimbursements for school health services.
Medicaid's Free Care Practice
This Medicaid payment practice by CMS limits reimbursement to schools for medically necessary health services to regular education students with Medicaid coverage. Medicaid's free care practice prohibits reimbursement for covered services if a school provides those same services at no charge to other students.
Parental Consent and IDEA
Current regulations for parental consent under the Individuals with Disabilities Education Act (IDEA), 34 CFR § 300.154(d) (iv) (A), state that a school must obtain consent each time that access to public benefits or private insurance is sought. This regulation unintentionally restricts Medicaid billing for school health services by LEAs. Proposed changes to federal education regulations may alleviate an inequity for schools as health care providers.
Reinvesting Medicaid Payments in California
To support provision of school health services, Local Education Agencies (LEAs) often reinvest their Medicaid reimbursements in additional health treatments and administration costs. The state of California recently amended reinvestment rules that had negatively affected Medicaid reimbursements.
Speech-Language Equivalency
In California, speech-language equivalency refers to an opinion issued by the state Attorney General in 2006 acknowledging that certain types of credentialed speech language pathologists (SLPs) were equivalent to the federal standard for speech pathologists, and the efforts made to incorporate this equivalency by removing restrictive billing requirements on credentialed SLPs participating in the LEA Billing Option program.