The Arkansas Department of Human Services (DHS), Division of Medical Services (Medicaid Office), has contracted with Arkansas Foundation for Medical Care (AFMC) to conduct the required post-payment reviews (audit) of school-based services billed to and reimbursed by Medicaid (Occupational Therapy (OT), Physical Therapy (PT) and Speech Therapy (ST) Services). In order for AFMC to adequately audit the provision of and reimbursement for these services, its staff must have access to medicaid eligible student's records maintained by the public education agency that received reimbursement for rendering the services (school district or education service cooperative). This may necessarily include student specific general education, special education, and/or specific medical records, as well as financial/business office records.
It is not a breach of student privacy rights or confidentiality for the public education agency to make these records available to AFMC for the purpose of this Medicaid post-payment review/audit. When a parent signs his/her child up for participation in Medicaid, the parent provides written consent that allows staff of the state and federal Medicaid programs, including their contracted agents or representatives such as AFMC, to have access to a Medicaid eligible student's educational and medical records maintained by the public education agency. The specific documentation that must be maintained and made available for audit is set forth in the attached excerpt from a June 11, 2001 Official Notice issued by the DHS, Division of Medical Services pertaining to the removal of prior authorization (PA) requirements for OT, PT, and ST and maintenance of required documentation. This Official Notice was issued to all enrolled providers of these services, including public education agencies.
In addition, for each school-based Medicaid reimbursable service, the Arkansas Department of Education (ADE), Special Education Unit, and the Arkansas Department of Human Services, Medicaid Office, have entered into a Memorandum of Understanding which provides that public education agencies under the general supervision of the ADE will make available such records and reports as are necessary to comply with Medicaid Prior Authorization (P.A.) and post-payment reviews (audits).
For each student with a disability for whom the district received Medicaid reimbursement for the provision of OT, PT, or ST services, it would be advisable for the district to the person(s) conducting the Medicaid audit to sign the Record of Access sheet contained in the student's special education due process file to document that he/she was in the record.
If you have any questions about this or need additional information, please contact your ADE Area Supervisor.