Section He-W 589.06 - Documentation and Payment for Services(a) Reimbursement to enrolled school providers shall be the lesser of the following: (1) One half of the actual cost, or(2) The rate established by the department, in accordance with RSA 161:4, VI(a).(b) Enrolled school providers shall bill by unit of service, using the current procedural code for the service delivered, and submit claims for payment that include the actual cost of the service to the department's fiscal agent.(c) Enrolled school providers shall submit claims for medicaid covered services consistent with this rule and with federal medicaid law pursuant to 42 CFR 455, 42 CFR 456, 42 CFR 431, and 42 CFR 1001.(d) Enrolled school providers shall maintain unique documentation in accordance with He-W 520 and this part for the delivered services in each student's individual record, with such documentation to include:(1) A copy of the care plan and, if an IEP, evidence of implementation of the IEP as required by Ed 1109.04(b);(2) The name of the student, the medical assistance ID number, and documentation demonstrating receipt of each unit of the covered service;(3) The names, qualifications, and credentials of all performing providers for each service delivered for which the school sought FFP;(4) The documentation of the qualifications, names, and signatures of persons directing or supervising the individuals providing the covered services if direction or supervision is required under this part or applicable law, and the date of supervisory approval;(5) Date(s) of each service delivered and the location where the services were performed;(6) The type of covered service provided and a description of each service provided;(7) The duration of the provision of the each covered service, number of units performed, and the number of minutes for each delivered service;(8) The start and stop times of the delivered services, and whether there was a break in services or time away by the performing provider;(9) Indication whether the services were delivered in a group setting or individually;(10) Indication of whether the student was actually present for the service and indication whether the student was present for at least 51% of the time;(11) In the case of group services, documentation of the number of participants in the group who received the covered service regardless of the participants' medicaid eligibility;(12) A copy of a physician's or other licensed clinician's order if required; and(13) Documentation of the qualifications and the handwritten signature of the individual(s) attesting to the medical non-academic nature of the covered rehabilitative assistance services.(e) Enrolled school providers shall submit claims for physical, occupational, and speech-language therapy services in accordance with the following: (1) Only units of direct treatment performed by a physical therapist, occupational therapist, SLP, a physical therapy assistant, occupational therapy assistant, or speech-language assistant shall be billed, meaning the time the therapist or physical therapy assistant, occupational therapy assistant, or speech-language assistant spends providing direct treatment to one student;(2) Therapists working as a team to treat one or more students shall not each bill separately for the same or different service provided at the same time to the same student; and(3) If a student requires co-treatment simultaneously by 2 therapists, the total number of units shall be divided between the therapists and billed separately by each therapist to equal the total time the student was receiving actual therapy services.(f) Enrolled school providers shall only bill covered service time provided simultaneously by more than one licensed clinician and a rehabilitative assistant as follows: (1) If rehabilitative assistance is provided simultaneously with another covered service, the rehabilitative assistance shall be billed in addition to the covered service; or(2) If rehabilitative assistance is provided by more than one rehabilitative assistant simultaneously, each assistant's service shall be billed separately.(g) In calculating the cost for transportation, the enrolled school providers may include the following actual costs related to the trip:(3) Driver's salary and benefits;(4) Salary and benefits of other persons working on the bus;(h) The total cost calculated in (g) above shall then be divided by the total number of miles for the trip both ways, and then divided by the total number of students on the bus, regardless of the students' medicaid eligibility, to determine the cost per mile per student.(i) In accordance with 34 CFR 300.154(d)(2)(iv), Ed 1120.08, and 42 CFR 300.154(d)(2)(v), informed parental consent shall be obtained prior to the enrolled school provider billing the student's medicaid.(j) Enrolled school providers shall maintain records in support of claims submitted for reimbursement for a period of at least 6 years from the date of service or until the resolution of any legal action(s) commenced in the 6-year period, whichever is longer.(k) As applicable, the creation, storage, retention, disclosure, and destruction of documentation required by this part shall comply with all federal and state privacy and security laws and rules including the substance use disorder patient records regulations pursuant to 42 CFR Part 2, Family Educational Rights and Privacy Act, and the Health Insurance Portability and Accountability Act of 1996.N.H. Admin. Code § He-W 589.06
Derived from Volume XL Number 11, Filed March 12, 2020, Proposed by #12994, Effective 2/21/2020, Expires 2/21/2030.