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Seek Fair Medicaid for P. S. Districts

To Help Provide Special Need Svcs.

Assemblyman Andrew Hevesi introduced a bill which aims to increase information sharing between schools districts and primary care physicians in Medicaid managed care programs.

The goal of the legislation (A.9567) is to ensure that local school districts are receiving Medicaid payments for reimbursable services they provide as required by the federal Individuals with Disabilities Education Act (IDEA).

Under the federal provisions of IDEA, local school districts are mandated to ensure that all children with disabilities have available to them a free public education that emphasizes special education and related services designed to meet their unique needs. Special needs student services under IDEA can range from audiological testing to occupational therapy.

Currently, a student’s primary care physician needs to consent to the necessity of these services in order for the administering school district to claim Medicaid reimbursement for the service.

If the school district is unable to retrieve a sign off for the service from a doctor, they are still required to shoulder the cost of administering the special needs service, a barrier Hevesi’s legislation aims to rectify.

The original drafting of this legislation was done in response to numerous reports that surfaced towards the end of 2011, indicating that the New York City Department of Education

(DOE) was at the time running a deficit in their special needs services spending of close to $80 million dollars.

This number, according to some at the DOE is expected to rise well over $100 million in the coming years.

A large part of this deficit resulted from an inability of schools to communicate with Medicaid dependent students’ primary care physicians for medical signoffs for their special needs services.

This legislation ensures better communication between the school district, and the physicians in the managed care programs these Medicaid dependent students are enrolled in, which could save schools tens of millions of dollars in unrealized Medicaid reimbursements.

“This Medicaid reimbursement issue related to special needs services in education is unique to New York City,” Hevesi said. “The city’s huge discrepancy in reimbursement payments doesn’t appear so extensive in many of our major upstate cities. I don’t believe that New York City schools should be regularly budget- ing for hundreds of millions of dollars in lost special needs service costs. We need better communication between all parties involved to ensure that Medicaid eligible special needs services are being reimbursed, instead of further draining money from our already overstretched school budgets.”

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