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Consultants outline school-based Medicaid billing study to identify barriers to claiming federal reimbursement
Summary
Civic Solutions Group told the work group it is collecting DSS and Department of Education data, surveying and interviewing districts and schools, and reviewing other states to help Connecticut schools capture more Medicaid reimbursement for educationally based behavioral health services.
Zach Mitchell, a consultant with Civic Solutions Group, told the school-based work group that his team is studying why some Connecticut schools are not claiming Medicaid reimbursement for educationally based behavioral health services. The study will use DSS and Department of Education data, surveys, live meetings with school staff, and interviews with stakeholders; consultants are also reviewing policy and operational approaches used by other states.
"We're trying to figure out, or looking through, what the barriers are for why certain schools or any schools in Connecticut are not being able to bill for behavioral health," Zach said. He described a four-phase approach: kickoff and planning; stakeholder engagement and data collection; analysis and framework development; and reporting and recommendations.
Work-group members pressed for clarity about scope. Alice asked whether the study focuses on contracted private providers billing in schools or the schools themselves doing the claiming; Zach confirmed the team is focused on enabling schools to bill directly for school-based services rather than the billing practices of external contractors. Dr. Powers raised questions about authorizations and whether services provided both in school and in the community count against a single Medicaid authorization. Zach said Medicaid considers services together and that ‘‘there's no maximum amount’’ in the way some in the group understand caps, but he said he could not speak for DSS on certain authorization details.
Civic Solutions Group said it has begun collecting data from DSS and will develop and field a survey and schedule live meetings with schools as part of stakeholder engagement. The consultants described interviewing other states that claim behavioral health for benchmarking and said the final report will recommend approaches Connecticut can use to increase federal reimbursement. The work group asked that the team be clear in written materials about the distinction between school-based claiming and other provider billing models; the consultant agreed to include that clarification.
