Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
No, specialized transportation does not include transportation in a non-specialized vehicle with an aide. The Comprehensive Guide clarifies on page 99 that:
"School-based specialized transportation is defined as transportation to a medically necessary service (as outlined in the IEP of an enrolled Medicaid beneficiary) provided in a specially adapted vehicle that has been physically adjusted or designed to meet the needs of the individual student under IDEA (e.g., special harnesses, wheelchair lifts, ramps, specialized environmental controls, etc.,) to accommodate students with disabilities in the school-based setting. Note: the presence of only an aide (on a non-adapted bus/vehicle) or simple seat belts do not make a vehicle specially adapted. Specialized transportation may consist of a specially modified, physically adapted school bus or other vehicle in the specialized transportation cost pool."
For more information about specialized transportation, we recommend you view our Reimbursement for Specialized Transportation Within Medicaid School-Based Services resource on the CMS School-Based Services Resources page.
CMS encourages states to have contingency plans in place for situations when routine RMTS procedures cannot be followed. Such contingency plans can include manual (hand-written) recording of moments by staff if they cannot access the systems typically used for RMTS responses. States are encouraged to present other possible solutions to CMS for consideration and discussion as needed.
If the 85 percent valid response rate is not achieved, all non-responses are required to be included and coded as non-Medicaid. CMS is available to work with states on contingencies if a cyberattack occurs.
The requirement to perform a time study during vacation periods depends on the circumstances the LEA or the claiming unit faces. Each time study is independent, and the sample universe is determined before it is conducted; therefore, only employees performing Medicaid-related activities would be included in the sample universe for that time study period. The Random Moment Time Study (RMTS) must include LEAs that seek to bill and/or be paid for services. If the LEA does not want to participate in providing services, it will not be included in the sample universe.
Any LEA that bills for Medicaid services during any vacation period must be included in the RMTS for the period in question to ensure that all services allocable to Medicaid are captured. However, suppose an LEA will not bill for any services during the vacation period in question and does not include any vacation period expenditures in the cost report. In that case, they may be excluded from the study sample for that period. (For more information, see page 114 of the Comprehensive Guide)
While CMS encourages a zero-notice approach, CMS’ standard is up to 2 days prior notice of a time study moment. CMS will also allow up to 2 business days for participants to respond to the moment. If a state believes that up to 2 days prior notice (and 2 days response) is insufficient, the state should propose an alternative approach to CMS and provide its rationale. CMS understands that states may be limited by technology, geography, and/or funding to meet this time study criteria. CMS will attempt to understand the state’s limitations in reviewing time study proposals. In those instances where a state requests a longer response window, the state should provide details on the timeframe in which moments have historically been completed (i.e., within 24 hours, 48 hours, 72 hours, or beyond). This data, along with a plan for how and when the state will come into compliance with CMS policy, will be analyzed to determine whether to grant an exception. In those instances where CMS approves an exception, the state should take extra measures in its review of time study results to ensure all responses are reported in a non-biased manner and that all responses accurately reflect the activity the participant was performing during the assigned moment.
Generally, the sample universe should include any days for which staff are paid, including in-service days. However, suppose an LEA chooses to exclude certain days (e.g., because no students are in attendance and no students will be receiving services). In that case, it must also exclude the costs associated with those days from the cost pool.
The Comprehensive Guide describes two options for the treatment of staff in-service days on the RMTS on page 112:
The in-service days can be included among the potential days to be randomly sampled, with the related costs included in the cost pool; or
Both the in-service day and the related costs may be excluded from the time study.
There is no prohibition on claiming for administrative activities if the LEA does not also provide direct services. LEAs may choose to participate in only administrative activities, only direct services, or both administrative and direct services.
An LEA can claim the full scope of administrative activities without providing proof of a paid service. Please see Example 3 on page 27 of the Comprehensive Guide:
- Example 3. The school is not a participating provider. The school program refers Medicaid-eligible children to participating Medicaid providers in the community. If the school performs administrative activities related to the services billed to Medicaid by community providers, the costs of such activities are allowable under the Medicaid program. Such activities would be reported under the appropriate Medicaid-related activity code.
Yes, provided the following conditions are met. As noted on page 99 of the 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming under section G. Special Considerations for Transportation and Vaccines as SBS:
“School-based specialized transportation is defined as transportation to a medically necessary service (as outlined in the IEP of an enrolled Medicaid beneficiary) provided in a specially adapted vehicle that has been physically adjusted or designed to meet the needs of the individual student under IDEA (e.g., special harnesses, wheelchair lifts, ramps, specialized environmental controls, etc.) to accommodate students with disabilities in the school-based setting. Note: the presence of only an aide (on a non-adapted bus/vehicle) or simple seat belts do not make a vehicle specially adapted. Specialized transportation may consist of a specially modified, physically adapted school bus or other vehicle in the specialized transportation cost pool.”
Under the Individuals with Disabilities Education Act (IDEA), if a child with a disability is receiving special education and related services, transportation is included in the child’s IEP, and the IEP Team determines that the parent will be providing transportation, the LEA must reimburse the parents in a timely manner for the costs incurred in providing transportation. See the Office of Special Education Programs’ Questions and Answers on Serving Children with Disabilities Eligible for Transportation, November 2009. The LEA may request Medicaid reimbursement if the parent personal vehicle has been specially adapted consistent with the SBS guidance.
Yes, under both IDEA and FERPA, a public agency may accept digital or electronic signatures when obtaining parental consent to disclose PII from the child’s educational records. Such electronic consent must: 1) identify and authenticate a particular person as the source of the electronic consent; and 2) indicate such person’s approval of the information contained in the electronic consent.
As discussed in Section IV. C of the 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming, State Medicaid/CHIP agencies may share applicant and beneficiary information with schools enrolled as Medicaid or CHIP providers, or other Medicaid or CHIP providers, when the use or disclosure of the information is for purposes directly connected with the administration of the Medicaid or CHIP State plan, including establishing eligibility, providing services, or billing for services. Yes; An LEA or a school enrolled as a Medicaid or CHIP provider may receive beneficiary information on the condition that the school adheres to confidentiality standards comparable to those of the SMA or the State CHIP agency. The SMA and the State CHIP agency (in accordance with 42 C.F.R. § 457.1110(b)), as well as recipients of applicant and beneficiary information, must safeguard this information in accordance with the requirements of 42 C.F.R. part 431, subpart F confidentiality when they receive, use, or disclose applicant or beneficiary information.
One of these requirements is that the SMA or State CHIP agency must obtain permission from the individual, or their family, before responding to a request for information from an outside source, as set forth in 42 C.F.R. § 431.306(d). The Medicaid consent for billing purposes is separate from the FERPA and IDEA consent provisions.
IDEA child find requires States to ensure that all children with disabilities residing in the State who need special education and related services are identified, located, and evaluated, regardless of the severity of the disability, and includes identification of children who are suspected of having a disability. States are responsible for implementing child find activities for all children with disabilities residing in the State, including those children who are experiencing homelessness or are wards of the State, highly mobile and migrant children, English learners, and parentally placed private school children with disabilities, as well as those suspected of having developmental delays as defined in 34 C.F.R. § 300.8(b).
Child find activities are defined in 34 C.F.R. § 300.111 and typically involve a screening process to determine whether the child should be referred for an evaluation to determine eligibility for special education and related services. States must identify, locate, and evaluate all children with disabilities residing in the State and who may need special education and related services.