MEDICAID GUIDANCE DOCUMENT (OIEP)

Students whose Medicaid number begins with #17 are NOT candidates for Medicaid reimbursement!
Medicaid views these students as “part of another program” and will not cover services.

Every time a student is transferred, they are assigned a new Medicaid number.
Medicaid contacts need to ensure (in WVEIS), the Medicaid number is updated (remember … 17 denied)

We can bill for IEP (annual review) for any IEP meeting that results in an IEP with a new IEP date.
Even if an IEP is current and was written recently, if a new IEP is written (resulting in a new IEP date) we can bill.

Parental consent obtained for Medicaid billing is applicable to the student, regardless of which WV
school system the student is enrolled, unless the services increase in extent and frequency or unless the
parent revokes consent.

When completing retro-active billing (up to 1 year ago), it is acceptable to get consent signed by a current DHHR
caseworker.
Billable Service (OIEP)
Billed Amount
Care Coordination (1 unit/month)
$98.41
Amount Received
@ current 83.05%
$81.73
IEP: Eligibility (Triennial)
$770.72
$640.08
IEP: Annual Review
$171.00
$142.82
1 on 1 aide
$192.68
160.02
FAQs
1. Can we bill for services in detention centers? Two or three centers were going to bill and see if they’d get paid.
We cannot bill for students who have Medicaid numbers that begin with 17.
2. When is the date Medicaid is actually due?
Medicaid can be billed up to 365 days from the date of the service; however, should be submitted monthly.
3. Can you bill for an adopted IEP?
You can’t bill for amending an IEP since it is accomplished without a meeting. You can bill for any IEP that is written … resulting in
a new IEP date. Even if the student had an IEP written a few weeks prior if you meet and write a new IEP and the IEP date changes,
you can bill. There should, at least, be changes in the present levels of academic and functional performance.
4. What training is available for Medicaid?
There is a lot of information available on the Office of Special Programs (OSP) website: http://wvde.state.wv.us/osp/
under the Medicaid tab. Our state Medicaid specialist, Vicki Mohnacky is available to answer questions and is
willing to provide training. OIEP specific Medicaid training is available and posted in our Filing Cabinet.
6. For the partial months we service students (less than two weeks) can we still bill for services?
Yes. Care coordination can be billed; however, if someone else has billed that month, only the first billing received
will be approved.
7. It is difficult for us to get parent to sign for permission to bill… Can we get the host agency or DHHR to give
consent given any circumstances?
Yes. A memo posted on the OSP website from Jane McAllister, Director, Children & Adult Services, states “if a parent
is not available or unwilling to sign, the DHHR caseworker can sign”. While Ms. Mohnacky is going to seek
clarification, she feels the intent of this memo applies to DJS facilities as well and recommends the director signs.
8. If Part X of the IEP is not signed can we still bill?
No. A signature is required, whether it be a parent signature, DHHR caseworker or DJS director; however, consent is good for 1
year, regardless of which WV County or school the student is enrolled. Vickie Mohnacky will
contact personnel at DJS for a letter similar to the letter from Jane McAllister.
9. Do we bill for Care Coordination monthly?
Care Coordination is billed monthly and must be for 1 unit. The teacher may list more than one activity.
10. When we amend an IEP, can we bill?
No. Amending an IEP without convening a meeting is not Medicaid billable.