Ethan is on the North Carolina Medicaid Waiver (CAP-MR/DD). For those who don't know what that is, the waiver gets you Medicaid under a specific program and it does not have income limits. Ethan does not have the full waiver, but for now we are extremely grateful.
I have found out that our school district does a "blanket" billing to medicaid for ALL children in school that are receiving EC services (ie., Speech, OT, PT...). If the school gets paid, great, if not- oh well. They do not have my permission to do this! They say they can do it because they are not asking specifically which child has medicaid and which ones don't, therefore not violating any HIPAA laws.
So, why do I care? I care because if my PRIVATE therapy services bill after the school, then my private service will be denied! This is NOT ok!
I just got Ethan into a private speech therapy office 3 times a week (yay!). When the therapist submitted to medicaid, they wanted to know exactly how often Ethan was getting speech at school and she then had to justify why the school therapy wasn't enough! NOT.OK.
Does anyone else have this issue? Someone tell me how this is ok. They very well could mess up my child's given budget for services! And, what doctor is signing off on all of this? I know that the school district isn't contacting every student's pediatrician to have them sign off on the services rendered, so someone PLEASE tell me how this is legal????!!!
omg!!!!!! that is crap!! sure seems illegal to me!! something needs to be done!!!!
ReplyDeleteThat is not legal. In our IEP meetings, we have to sign off on a specific form allowing them (or not allowing them) to bill to Medicaid. I have never allowed them to do it.
ReplyDeleteWow. Like Bethany, we also have a form to sign off on. I always sign saying it is fine because Max does not receive Medicaid. Here (in Kansas) it is income based until a certain age.
ReplyDeleteI hope you get it all worked out. Sounds like a load of crap to me!!