SCPCSD�

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Medicaid School-Based Services

PowerPoint

Training

2-15-2024

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Medicaid �School-Based Therapy Services ��February 15, 2024�

Deitrich Drayton

Medicaid and Health Services Administrator

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Agenda

• LEA School-Based Services – Overview
• Medicaid – Web Portal Instructions
• Staff / Provider Qualifications and Credentials
• Clinical Records and Maintenance
• Monitoring and Quality Assurance Reviews
• Medicaid – Contracts and Subcontracts
• Medicaid Program Overview
• Resources

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LEA-School-Based Services

• This presentation is designed to enhance the understanding of the Medicaid standards regarding the Local Education Agencies Policy (LEA) Manual, all aspects and policies are not covered in this presentation. Please review the LEA Manual and the Administrative and Billing Manual.
• This meeting does not take the place of reading the provider policy and procedure manual.
• All information in this presentation pertains to the South Carolina Department of Health and Human Services (SCDHHS) Healthy Connections Medicaid beneficiaries.

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Medicaid Services Overview

• 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 (South Carolina or State) State Medicaid Plan allows an array of behavioral health services under the Rehabilitative Services Option, 42 CFR 440.130(d).
• Rehabilitative Services are medical or remedial services that have been recommended by a Physician or other Licensed Practitioner of the Healing Arts (LPHA) within the scope of their practice under South Carolina State Law and as further determined by the South Carolina Department of Health and Human Services (SCDHHS) for maximum reduction of physical or mental disability and restoration of a beneficiary to their best possible functional level.

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Medicaid Eligibility for 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 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.

Note: The student’s Medicaid eligibility must be checked twice a year and copies must be kept in the student’s file. The copy must include the date and time the document is printed. (Check the settings on the printer application to ensure the header and footer settings has been checked.)

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Medicaid Eligibility Update

• The Department of Health and Human Services (DHHS) sent out a Medicaid Notice on February 13, 2023, to notify Medicaid members that DHHS will start reviewing Medicaid eligibility in April. The COVID-19 Federal Public Health Emergency (PHE) end date will be May 11, 2023. Medicaid members will be notified to update their information with DHHS. This project may take up to a year to complete. Schools may remind Medicaid members to update their addresses, phone numbers, and email addresses online at apply.scdhhs.gov.
• We recommend the General Medicaid consent form be placed in the student’s registration packet for the next academic year. This will keep the information current.
• We recommend the schools appoint a staff member to enter the student’s Medicaid numbers into PowerSchool.
• Schools can access the Medicaid webportal to check the student’s Medicaid eligibility before school starts next academic year. A copy of the student’s eligibility form should be scanned or placed in the student’s file.

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Medicaid – DHHS Web Portal Instructions

• Each school will be given access to the Medicaid webportal to check eligibility.
• Each school will be given a user ID and a temporary password to access the DHHS webportal.
• You may access the South Carolina Medicaid Web-Based Claims Submission Tool at: https://portal.scmedicaid.com.
• You will be able to check the student’s eligibility.
• All programs will use the same ID number and password.

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Medicaid – DHHS Password Rules

Once you have accessed the webportal, you must change the password. You will be responsible for keeping this password. If it is lost, you must contact the Medicaid district office to reset the password.

Below are the password rules:

• The new password must be at least 8 characters
• First character must be an upper-case letter
• Must contain a lower-case letter
• Must contain a digit
• Must contain a special character i.e. [",'!@#$%^&*().+_-{}|\></?:;](
• Cannot contain your User ID. (e.g., if your ID is “Fred,” then Fred#007” is not allowed)
• Make sure you write down the password and save the password and username to the computer system.

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Medicaid -Web Portal Log-In Screen

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Instructions:

• Put in your User number and password. Click log in. The system will direct you to change your temporary password to a new password. You may have to re-enter the password to enter the application.

Medicaid – Access Web Portal

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• Once you are in the system the next screen is the web portal.
• See “Select One” and click the drop-down symbol (v) – select South Carolina public charter school and click – Select

This will allow you to review the categories

• You can click the Eligibility button to check the student’s Medicaid eligibility and insurance. You can check an individual student or multiple students. You can check the claims remittance of the student by clicking the Report button. This will allow you to see the claims that were billed according to the student’s Medicaid number. It is not categorized by the school’s name.

The Eligibility screen provides the student’s identifying information and insurance information.

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Medicaid – Eligibility Screen- Web Portal

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You can check the student’s eligibility start date and types of insurance. You will be able to view other identification information. If the student’s page has an alert, you will be able to notify the parent or contact the district office for support. This information will alert you to whether the student is eligible for Medicaid services. Please review the student’s status at least twice a year and make a copy of the eligibility report and keep a copy on file. If you have any questions or concerns, contact Dee Drayton at ddrayton@sccharter.org

Note: If the student has other health insurance carriers, make sure to receive a copy of the other insurance information from the parent. Medicaid is the payer of last resort. The parent does not have to pay a co-payment or a deductible, but Medicaid will require that we send a bill to the insurance company. The insurance company will pay a portion of the bill and Medicaid will pay the additional cost. The parent nor the school pays any money for services.

Example of the Medicaid Edibility Form – without�TPL-with the date and time stamp

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Third Party Billing (TPL) for Medicaid Services

“Third-party liability” (TPL) refers to the responsibility of parties other than Medicaid to pay for health insurance costs.

Medicaid is always the payer of last resort, which means that Medicaid will not pay a claim for which someone else may be responsible until the party, liable before Medicaid has been billed.

If a student has another insurance, make sure that you get the information from the parent. Make a copy of the insurance card and keep it in the student’s file.

When completing the student roster, always add this information to the document.

The district office along with CGM will bill the third-party insurance on behalf of the school. The parent and school are not responsible for paying for services. The district office will receive the insurance letters and submit them to CGM for billing purposes. CGM will bill Medicaid for services.

Note: Always add the student’s Medicaid number to the student’s file in PowerSchool.

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Example of the Medicaid Edibility Form – with�TPL-with the date and time stamp

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Staff Credentials�

• Providers must maintain documentation that verifies that all staff is properly qualified, screened, trained, and supervised, including subcontractors, volunteers, students and/or interns, and other individuals under the provider’s authority.
• Providers must maintain a staff file, and make it available upon request, appropriate records, and documentation of such qualifications, training, and investigations.
• The staff’s credentials must be verified before rendering services. The staff’s credentials must be submitted to the district’s Medicaid office for review before services are rendered.

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Medicaid Staff Credential Reports

Staff rendering Medicaid services must have the following credentialing reviewed and filed.

• An annual copy of their SCLLR License must be on file. A copy must be submitted to the Medicaid and Health Administrator annually. (Check your printer status to ensure the documents have the heading and footer settings checked.) The SCLLR link is https://llr.sc.gov.
• A copy of the SC-Office of Inspector General (OIG) report must sent to the Medicaid and Health Adminisrator annually (before school starts). A copy must be filed by the school. The link is located at the Office of the Inspector General Provider Exclusion Database: https://exclusions.oig.hhs.gov/.
• A copy of the SC DHHS Excluded Providers List must be reviewed and copied twice a year. A copy must be filed by the school. The link is located on the SC-DHHS website under FOR PROVIDERS or at this link (Provider Information | SC DHHS).

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Recommendation: The SCDHHS excluded provider list is a long report. Download the file and save a copy to your computer. A copy of the staff’s OIG check must be completed twice a year, and a copy must be kept in the Medicaid file. When Medicaid reviews the file, they will request a copy of the reports.

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Staff Supervision

• In accordance with the Centers for Medicare and Medicaid Services (CMS) directives, CMS has interpreted the term “under the direction of” to mean that the provider is individually involved with the patient and accepts ultimate legal responsibility for the services rendered by the individuals that he or she agrees to direct. The supervisor is responsible for all the services provided or omitted by the individual that he or she agrees to directly supervise.
• At no time may the individual being supervised perform tasks when the supervisor cannot be reached by personal contact, phone, e-mail, pager, or other immediate means. The supervisor must make provisions, in writing, for emergency situations including the designation of another qualified provider who has agreed to be available on an as-needed basis to provide supervision and consultation to the individual when the supervisor is not available.
• All clinical service notes and progress summary entries made by a staff who requires supervision must be cosigned by the supervisor unless otherwise indicated for a specific Medicaid reimbursement service.
• Note: Medicaid requires that the staff’s license be on file and checked bi-annually. A copy must be submitted to SCPCSD annually. A supervisory log must be maintained.

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A copy of �the Professional License from the SC Department of Labor, Licensing and Regulation must be submitted to the district office. It must include the date, and time when the report is run.

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Medicaid Signature Page

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Providers must maintain a signature sheet that identifies all staff names, signatures, and initials. This document must be submitted to the Medicaid office at the beginning of the school year and when new staff are added. This must be done for all Medicaid services.

Staff Supervision Form – Example�The supervisor is responsible for documenting activities. This must be submitted to the Medicaid office.

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�Medicaid Records and Maintenance

Requirements for Clinical Records and Maintenance

• Each clinical entry must be typed or legibly handwritten in dark ink,
• Clinical records must be arranged logically,
• All clinical entries must be filed in the student’s clinical records, and
• Each entry must stand on its own and not include arrows, ditto marks, etc.
• Schools are required to maintain a clinical record on every student that is rendered services.
• Clinical records must be current, meet documentation requirements and provide a clear descriptive narrative of the services provided.
• It is essential that an internal records review be conducted to ensure that the services are medically necessary and appropriate both in quality and quantity, and that services are documented.

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Family Educational Rights and Privacy ACT (FERPA)/Healthcare Insurance Portability and Accountability Act (HIPAA)

• All records must follow the HIPAA/FERPA security criteria.
• All clinical records must be secured under lock and key and in locked cabinets.
• The staff must sign a signature form when accessing the student’s Medicaid file. This form must be kept in the student’s Medicaid file.
• Schools must grant access to the SCPCSD, or its designees for the purpose of reviewing and/or investigating and allowing for copying and reproducing Medicaid documents.
• Schools must have a retention policy. Staff should review the General Records Retention Schedules for School District Records, Subarticle 6 Student Records for additional information. The webpage is located at https://scdah.sc.gov/sites/scdah/files/Documents/Records%20Management%20(RM)/Schedules/genskedskldist.pdf.

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Medicaid Clinical Records

Clinical Records

• As a condition of participation in the Medicaid program, providers are required to maintain and allow appropriate access to clinical records that fully disclose the extent of services provided to the Medicaid beneficiary. The maintenance of adequate records is regarded as essential for the delivery of appropriate services and quality medical care. Providers must be aware that these records are key documents for post-payment review.

The records must follow these criteria:

• Errors must be corrected according to Medicaid policy and procedures (draw a line through the error, initial the error, date the error, and document the correction, if applicable).
• The school must have an abbreviation key available in the student’s file. (List of the most common abbreviations used for each program must be available.)
• The school must have a signature sheet or logbook that identifies the staff’s name, signature, and initials in the student’s file or logbook.

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Medical Documentation- Monitoring

• Each school must set up a system on how to file medical records for the students and staff.
• These records must be accessible for review.
• Before new schools are allowed to bill for services, the district office will randomly select files to review and request Medicaid documents. This review ensures the school is prepared and has the appropriate documents needed for billing. Once this process has been completed the district office will notify CGM to bill for services.
• If documents are not in compliance with Medicaid policy, training and support will be provided to ensure the Medicaid files are correct. Training can be provided to each school.
• Schools using SNAP and need training on documentation, there are manuals and online training provided by SNAP. The district office can provide basic training on documenting Medicaid services and billing.
• Schools using CGM, you can receive training and support by contacting the district Medicaid office.

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Quality Assurance and Monitoring

SCDHHS, SCDE, or the SCPCSD will conduct reviews to ensure that schools/providers comply with applicable laws, regulations, and policies.

Other authoritative entities may conduct reviews of LEA-Mental Health /RBHS providers, including the State Auditor’s Office, the South Carolina Attorney General’s Office, the United States Department of Health and Human Services, the Government Accountability Office, and/or their designees.

SCDE will conduct an annual Medicaid Quality Assurance Review on the Medicaid program. The Medicaid files which include all Medicaid documents and the staff’s credentials must be available.

SCPCSD will conduct random reviews of the program throughout the school year and provide feedback to assist the staff.

Upon request, information must be furnished regarding any claim for payment to SCDHHS.

All providers must grant access to SCDHHS, or its designees to review Medicaid files and for copying and reproducing documents.

Failure of the provider to comply with this provision may result in the immediate termination of enrollment.

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SCDE-Annual Medicaid Review

Each year the SCDE Office of Medicaid Services reviews the school districts to determine if the schools are following the Medicaid guidelines. They provide technical support and interpret Medicaid policies for schools. The charter schools are under the guidance of SCDE and SCDE has a contract with DHHS to provide these services.

When will the SCDE–OMS Annual Medicaid Review?

• The SCDE-OMS reviews the SCPCDS Medicaid files annually. The school will have 30 days to submit the Medicaid documents for review. SCDE will provide a random list of files to be reviewed. The files must be at the district office and uploaded into the system by the due date. SCPCSD will notify the schools of which files have been selected and will assist the schools in checking the files.
• The SCDE staff will be on-site at the district office during the review. A day before the review, SCDE-OMS will request two random files to be added to the review. The schools will be notified and will have to upload the files immediately. We ask that each school has a representative available to answer questions or provide documents on the day of the review.
• Note: Review the Medicaid Document slide to ensure the Medicaid student’s file has the appropriate documents before billing for services. CGM and SNAP have templates that provide the Medicaid criteria.

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Charter School’s Contract and Subcontracts

• Schools are responsible for ensuring the staff rendering Medicaid school-based services are approved, credentialed, or licensed.
• The school must have a contract with every subcontractor providing Medicaid services. Schools must submit a copy of the contracts to the district’s Medicaid office.

Why does the district office need a copy of the private provider contract?

• Schools must ensure that subcontractors meet all Medicaid provider qualifications, as well as the applicable state licensure criteria.
• Schools must ensure the contracts follow the specified requirements set by the South Carolina Department of Education.
• The school must provide a copy of the private provider’s staff and subcontractors’ credentials.

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Medicaid Documentation Requirements

• 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.
• Each provider shall have the responsibility of maintaining accurate, complete, and timely records and ensuring the confidentiality of the beneficiary’s clinical record.
• All providers should self-monitor adherence to applicable Federal and State Laws and Regulations and in accordance with the South Carolina Plan for Medical Assistance, alerts, bulletins, SCDHHS policies, procedures, and Medicaid Provider Manuals. Any findings of non-compliance, as a result of self-monitoring activities, shall be communicated to the SCPCSD staff –Student Services Compliance Administrator.

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The Medicaid Order of Services

Medicaid services can only be billed when the following process has been met and the documents are in place:

• Medicaid consent form must be signed and dated.
• The Referral form must be completed by an LPHA – dated after the Medicaid consent form.
• The Re-evaluation completed by another LPHA dated after the referral.
• The IEP must be completed after the annual re-evaluation. 

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Addendum Process:

When services are added during the year, the Medicaid sequence must be followed.

Once the Medicaid sequence has been established, the IEP can be amended to reflect that the Medicaid services have been added. This can be done by adding language to the IEP or adding a supplementary page as an attachment to the IEP that explains the Medicaid services.

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Medicaid School-Based Forms

• Student Medicaid Eligibility Form
• Medicaid Consent and Annual Notification Letter
• Referral for Services form signed by an LPHA
• Evaluation and other assessments
• Treatment Plan (IEP, or IFSP) (when services are recommended)
• Clinical Service Notes (CSN) (document services)
• Progress Service Notes (summarize therapy services at least every 90 days)
• Other documents relevant to the care and treatment of the student (Lab reports, medical reports, additional assessments, and court orders)
• Staff Credentials

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Medicaid Therapy School-Based Services

The following services are listed under School-based therapy services.

• Speech-Language Therapy
• Occupational Therapy
• Physical Therapy

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Staff Qualifications – Speech-Language Therapy

• The licensed speech-language pathologist can supervise the licensed speech-language pathology intern and speech-language pathology assistant or speech-language pathology therapist.
• A speech-language pathology assistant is an individual who is currently licensed by the South Carolina Board of Examiners in speech-language pathology. The speech-language pathology assistant works under the direction of a qualified speech-language pathologist pursuant to 42 CFR 440.110(c)(2)(i) and (ii).
• A speech-language pathology intern is an individual who is currently licensed by the South Carolina Board of Examiners in speech-language pathology and is seeking the academic and work experience requirements established by the American Speech and Hearing Association for the Certification of Clinical Competence in speech-language pathology. The speech-language pathology intern works under the direction of a qualified speech-language pathologist pursuant to 42 CFR 440.110(c)(2)(i) and (ii).
• A speech-language pathology therapist is an individual who does not meet the credentials outlined in the 42 CFR 440.110(c)(2)(i)(ii) and (iii) that must work under the direction of a qualified speech-language pathologist.

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Fee Schedule School-Based Rehabilitative �Services (SBRS)�Speech- Language �Procedure Codes

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Staff Qualifications - Occupational Therapy

Occupational Therapist

• An occupational therapist is a person licensed to practice occupational therapy by the South Carolina Board of Occupational Therapy. In accordance with 42 CFR 440.110(b)(2)(i)(ii), a qualified occupational therapist is: (i) certified by the National Board of Certification for Occupational Therapy, or (ii) a graduate of a program in occupational therapy approved by the Committee on Allied Health Education and Accreditation of the American Medical Association and engaged in the supplemental clinical experience required before certification by the National Board of Certification for Occupational Therapy.

Occupational Therapy Assistant

• An occupational therapy assistant is an individual who is currently licensed as a certified occupational therapy assistant by the South Carolina Board of Occupational Therapy who works under the direction of a qualified occupational therapist pursuant to 42 CFR 440.110(b)(2)(i) or (ii).

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Fee Schedule School-Based Rehabilitative �Services (SBRS)�Occupational Procedure Codes

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Staff Qualifications- Physical Therapy

Physical Therapist

• A physical therapist is a person licensed to practice physical therapy by the South Carolina Board of Physical Therapy Examiners. In accordance with 42 CFR 440.110(a)(2)(i)(ii), a qualified physical therapist is an individual who is (i) A graduate of a program of physical therapy approved by both the Committee on Allied Health Education and Accreditation of the American Medical Association and the American Physical Therapy Association or its equivalent; and (ii) where applicable, licensed by the State.

Physical Therapist Assistant

• A physical therapist assistant is an individual who is currently licensed by the South Carolina Board of Physical Therapy Examiners. A physical therapy assistant provides services under the direction of a qualified physical therapist.

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Fee Schedule School-Based Rehabilitative �Services (SBRS)�Physical�Therapy Procedure Codes

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Medicaid Consent Form and the Annual Notification Form

Consent Form

A Release of Information form and consent to provide services must be signed by the child’s parent or guardian to authorize the release of any medical information necessary to process Medicaid claims and request payment of government benefits on behalf of the child.

Annual Notification Form

The Annual notification form documents that the parent has been informed of their Medicaid rights.

• Must be signed annually, given to the parent, and a copy placed in the student’s file.

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Copy of the Medicaid Consent Form

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Copy of the �Annual Notification Letter

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Medicaid Referral for Service

Referrals must be made by a licensed provider working within the scope of their licensure utilizing their knowledge, experience, and expertise.

The health professional must be currently and appropriately licensed in South Carolina and located within the South Carolina Medical Service Area (SCMSA), which is defined as the state of South Carolina and areas in North Carolina and Georgia within 25 miles of the South Carolina state border.

• The presence of licensure/certification means the established licensing board in accordance with the South Carolina Code of Laws has granted the authorization to practice in the state.

The three codifying agencies responsible for licensure within South Carolina are the South Carolina

• Department of Labor and Licensing Regulation (SCLLR) www.llr.sc.us, South Carolina Department of Health and Environmental Control (SCDHEC) www.scdhec.gov, and South Carolina Area Health Education Consortium (SCAHEC) www.scahec.net.
• Licensed professionals must maintain current licensure/certification for the appropriate authority to practice in the State of South Carolina and must operate within their scope of practice.

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Who can provide a Referral for Service?

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Referral for Service Documentation Criteria

The referral documentation must follow these criteria:

• The referral(s) for service must cover the academic year of the service.
• Signed, titled, and dated (electronically or handwritten) by a physician or other Licensed Practitioner of the Healing Arts (LPHA).
• Completed by an LPHA other than the direct provider of services.
• Completed and dated before the evaluation or re-evaluation.
• Completed and dated before the annual IEP/IFSP/ITP/IPOC.
• Completed and dated before the first date of service rendered in the year.

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Example of a Referral Form

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Evaluation Documentation Criteria

The evaluation/re-evaluation must cover the academic year in review.

Completed after a referral from an LPHA.

Completed and dated before the IEP or the IFSP and must be in the student’s file.

Completed and dated before the first date of service listed on the IEP.

Completed and dated before the provision of the Medicaid rehabilitative therapy service.

The document must include the following:

• The title, date, and signature (electronically or handwritten) of the Therapist.
• A medical history.
• A written report with recommendations. (Goals / Objectives and Frequency)
• A diagnostic testing and assessment. (Standardized assessment)
• The results of the evaluation must include a narrative summary.
• The documentation must justify the number of units billed.

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Example of the Evaluation�front cover

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Evaluation Results �with Recommendations

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Evaluation with the �Staff Signature

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IDEA and Medicaid Documentation Requirements

• The development of an Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP) is a requirement of the Individuals with Disabilities Education Act (IDEA).
• Medicaid requires school-based services to be indicated on the IEP or the IFSP.
• Medicaid will not reimburse for any administrative or direct services performed for pre-IEP or IFSP activities. Medicaid will not reimburse for the IEP team member meeting, or the cost related to attendance at those meetings by medical professionals.

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Medicaid Treatment Plan Requirements

• The development of an Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP) is a requirement of the Individuals with Disabilities Education Act (IDEA). Medicaid requires school-based services to be indicated on the IEP, or the IFSP.
• If an evaluation indicates that therapy is warranted, the therapist must develop and maintain a treatment plan that outlines long-term goals and short-term objectives, as well as the recommended scope, frequency, and duration of treatment.

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Medicaid Treatment Plan Documentation Requirements

The treatment plan must be reviewed and updated according to the level of progress. If a determination is made during treatment that additional services are required, these services should be added to the treatment plan. It must cover the academic year and be completed prior to the first date of service.

The treatment plan must include the following components:

• Individualized – student specific by including the student’s name must be included.
• Specific problems to be addressed (Therapy service listed from the evaluation, OT, PT, and Speech/Language.)
• Goals – Goals must address the physical and/or functional impairment, deficit, limitation, or clinical condition (Must state the Medicaid service - OT, PT Speech/Language.)
• Short-term objectives, (Only required for students on South Carolina Alternate Assessment [SC-Alt] & required when the IEP is used as the Individual Plan of Care [IPOC] for Rehabilitative Behavioral Health Services.),
• List the types of interventions to be utilized in treating the medical condition (Include the types of interventions in the assessment and goals in the IEP).

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Medicaid Treatment Plan Documentation Requirements- Continued

• Planned frequency of service delivery (example: 300 units per month)
• Estimated duration (example: 30 minutes per session)
• Criteria for achievement – (example: Johnny will achieve 70% out of 100%)
• Exact service the student should be receiving (must list the Medicaid service: Speech, OT, and PT and is the service provided in a group or individual)
• Signature, date, and title of the therapist (Electronically or handwritten) on the treatment plan, or a supplemental excusal statement signed by the therapist must be on file.
• List the student’s strengths and weaknesses in the treatment to explain the medical necessity for services.

Note: CGM will allow the user to upload the treatment plan and other documents into the MediEd application for continuity.

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Example of the �IEP

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IEP – Explains the Medicaid Service

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IEP - Goals

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IEP – �List of �the Medicaid Services�and Frequencies

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IEP Supplemental Statement

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Medicaid Clinical Service Note (CSN) - Purpose

The purpose of these notes is to record the nature of the child’s treatment by capturing the services provided and summarizing the child’s participation in treatment.

CSN must be sufficient to support the number of units billed for the service.

The CSN must reflect a Medicaid billable service and the appropriate modifier as identified in the evaluation notes. (Ex: 97165)

If the service needs to be revised during the year, the student should be re-evaluated to determine the need for service or the need to cancel the service. The IEP must be amended to reflect the change. The CSN must be amended to reflect the revision.

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CSN – Requirements

The following are required components of the CSN:

• Provide a clinical description of the activities that took place during the session (list the objective the student is working on and a narrative on what type of therapy is being utilized).
• Student’s level of participation/response to treatment (document how the student responds to therapy). Narrative/summary of the activity.
• Reflect delivery of a specific Medicaid reimbursable service as identified in the referral, evaluation, and the IEP or IFSP. (The name of the service must be listed: Speech, OT, or PT).
• Date of service (Document the date of the service on the note).
• Type of service and number of units billed (example: OT- 2 units billed).
• Start and Stop times (example: 2:00 pm to 3:00 pm).
• Individualized and student-specific (The information cannot be cookie-cutter and must be student-specific to include the student’s name in the narrative.)
• Need all signatures, professional title, and date of the provider delivering the service. If a co-signature is required, the supervisor must also sign the document. If it is electronically signed, the supervisor must sign the document electronically.

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Example of the CSN

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CSN – Staff Signatures.�DHHS requires the provider of service to electronically sign the CSN. CGM has a new template that displays “Electronically Sign By”. This has been done for all CSNs for the academic year�2022-23.

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Medicaid Progress Summary Notes - Documentation

The progress summary is a written note outlining the child’s progress that must be completed by the therapist/provider at least every 90 days from the start date of treatment. (The start date of treatment is listed on the IEP. If the service does not start on this date, the therapist must document the reason for the delay.)

The progress summary documentation must include:

• The progress summaries must be completed at least every three months from the start date of treatment or when medically necessary. (The timeline starts from the start date of treatment listed on the treatment plan. The date range should be added to the note to show the timeline of service: August 12, 22 to October 15, 22).
• Each progress summary must be dated, titled, and signed (electronically or handwritten) by every provider/therapist) who rendered services during the progress period and the supervisor (if applicable).
• Each progress summary must state the number of times the student attended the therapy, and the number of times therapy was scheduled. (Attended 23 sessions out of 30).
• Each progress summary must document the student’s progress toward treatment goals.
• Each progress summary must establish the continued need for treatment. (A narrative must be written to explain why services must continue or be discontinued.)
• Signature, professional title, and date of the provider delivering the service. If more than one staff provides services during the progress time, all staff must sign the progress summary note.

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Staff Signature Sheet -Progress Summary Note (PSN)

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Example of the Progress Summary.�

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PSN – Staff Signatures.�DHHS requires the provider of service and the supervisor to electronically sign the PSN.

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Staff Signature Updates Effective Immediately on the PSN

• New interpretation of the policy by SCDE-OMS. If more than one staff provides services during the progress time, all staff must sign the progress summary note.
• CGM has developed a process that will allow staff to sign more than one name to the progress summary note.
• The note must say “Electronically signed by” or it must say “ Signed by” and this can be done electronically or handwritten.
• Staff using ENRICH, must document the names of the staff providing services during the period in the drop-down box.
• If the note is signed by hand, the revised note must be uploaded into MediEd.
• A stamped signature is unacceptable.

Date

The signature should be dated as required by the specific provider type. Documentation must contain enough information to determine the date when the service was performed or ordered.

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Example from the Clinical Service Note in the �CGM MediEd System

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School-Based Resources

SCPCSD – Medicaid Webpage for updates - School Resources - Medicaid Rehabilitative Therapy (google.com)

SCDE Resources:

• SCDE OMS Webpage - Medicaid - South Carolina Department of Education - (sc.gov)
• SCDE – Medicaid Forms – Forms - South Carolina Department of Education - (sc.gov)
• SCDE School District Preparation Guide and the QA Checklist - Quality Assurance (QA) - South Carolina Department of Education - (sc.gov)
• SCDE- Fee/Rate Schedule - Additional Resources - South Carolina Department of Education - (sc.gov)
• SCDE- Monthly Newsletters - Monthly Newsletter - South Carolina Department of Education -(sc.gov)

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SCDHHS Resources:

• SCDHHS website - https://www.scdhhs.gov/ and Providers | SCDHHS
• SCDHHS LEA Manual and forms website -Local Education Agencies (LEA) Services Provider Manual | SCDHHS
• SCDHHS Bulletins - Providers | SCDHHS
• SCDHHS Medicaid Provider Education webpage - Trainings | SCDHHS and Healthy Connections Medicaid E-Learning (remote-learner.net)
• SCDHHS contact for the Medicaid Provider Education - Healthy Connections Medicaid E-Learning (remote-learner.net) and contact for Provider services 1 (888) 289-0709.

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Contact Information�

Deitrich (Dee) Drayton

ddrayton@sccharter.org

(803) 212-5482

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