School based services
Fee For Service Program
Coverage applies to individuals up to the age of 21 who are eligible under the provisions of the Individuals with Disabilities Education Act (IDEA) of 1990 as amended in 2004 and to those enrolled in programs that require an Individualized Education Program (IEP) or an Individualized Family Services Plan (IFSP).
Partial reimbursement applies to the following services:
Direct Medical Services
- Occupational Therapy Services
- Orientation and Mobility Services
- Physical Therapy Services
- Psychological, Counseling and Social Work Services
- Speech, Language and Hearing Services
- Nursing Services
Targeted Case Management
Targeted case management services are services furnished to assist individuals in gaining access to needed medical, social, educational or other services. The case manager is the person responsible for the implementation of the plan of care/treatment plan.
Personal Care Services
Personal Care Services are a range of human assistance services provided to persons with disabilities and chronic conditions which enables them to accomplish tasks that they would normally do for themselves if they did not have a disability.
Medicaid may reimburse for special education transportation when a beneficiary receives a Direct Medical Service on the same day. Special Education specialized transportation services include transport to and from the beneficiary's pick-up and drop-off site where Medicaid services are provided.
Deficit Reduction Act (Employee Education about False Claims Recovery)
Pursuant to Section 1902(a) (68) of the Social Security Act, Ingham ISD, as the Medicaid Provider for School Based Services for 12 districts, is required to comply with Section 6032 of the Deficit Reduction Act (DRA) of 2005. Ingham ISD is subject to this act because we received or make at least $5 million in annual aggregate payments from the federal Medicaid program.
A section of the law entitled “Employee Education About False Claims” cites three (3) requirements; 1) Establish written policies for employees and contractors about the False Claims Act; 2) Establish detailed provision in these policies for detecting fraud, waste and abuse, as well as administrative remedies for false claims; 3) Inform all providers about these policies and their rights to be protected as whistleblowers.
The Federal False Claims Act, among other things, applies to the submission of claims by healthcare providers for payment by Medicare, Medicaid, and other federal and state health programs. The False Claims Act is the federal government’s primary civil remedy for improper or fraudulent claims. It applies to all federal programs, from military procurement contracts to welfare benefits to healthcare benefits.
The False Claims Act prohibits among other things:
- Knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment or approval;
- Knowingly making or using, or causing to be made or used a false record or statement in order to have a false or fraudulent claim paid or approved by the government.
- Conspiring to defraud the government by getting a false or fraudulent claim allowed or paid; and
- Knowingly making or using, or causing to made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government.
Any person who knowingly attempts to defraud the federal government is liable to the United State Government for a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages which the Government sustains because of the act of that person.
“Knowingly” means that a person, with respect to information: 1) has actual knowledge of the information; 2) acts in deliberate ignorance of the truth or falsity of the information; or 3) acts in reckless disregard of the truth or falsity of the information.
The United States Attorney General may bring civil actions for violations of the False Claims Act. As with most other civil actions, the government must establish its case by presenting a preponderance of the evidence rather than meeting the higher burden of proof that applies in criminal cases. The False Claims Act allows private individuals to bring “qui tam” actions for violations of the False Claims Act.
Protection for “Whistleblowers”
Federal and state law prohibit any retaliation or retribution against persons who report suspected violations of these laws to law enforcement officials or who file “whistleblower” lawsuits on behalf of the government.
To report Medicaid provider fraud
Administrative Outreach Program
The School Based Services Administrative Outreach Program offers partial reimbursement for the cost of administrative activities that support efforts to identify and enroll potentially eligible persons into Medicaid and that are in support of the state Medicaid plan.
These activities fall into several categories:
- Medicaid Outreach
- Facilitating Medicaid Eligibility determinations
- Health-related Referral Activities
- Medical Service Program Planning, Policy Development, and Interagency Coordination
- Programmatic Monitoring and Coordination of Medical Services
- Transportation and Translation Services
7:30am - 4:00pm
To access the web site for logging Medicaid services, please click on your district or program.
- Ingham Itinerant Staff
- Ingham Early On & Heartwood Staff
- East Lansing
PCG Help Desk
866.303.1940 ext 16