See below for information about Massachusetts school based Medicaid, including coverage, eligibility, and billing. Also, discover how to bring Relay to Massachusetts!
• Psychology and Counseling
• Applied Behavior Analysis (for students with an autism spectrum disorder diagnosis)
• Audiological Services
• Occupational Therapy
• Physical Therapy
• Speech Therapy
• Dental Assessments/Screenings
• Medical Nutritional Services
• EPSDT Health Screenings
• Nursing (Skilled)
• Personal Care Services
Eligibility defined as Medicaid-eligible children ages 3 to 22 for covered services that are medically necessary in the State Plan, provided pursuant to an IEP, IFSP, Section 504 plan, Individual Healthcare Plan (IHCP), or where medical necessity has been met (without an IEP). The billing providers are the Local Education Agencies (LEAs).
Direct Service Claiming (DSC) program generates approximately 60% of SBMP revenue.
Throughout the year, Local Education Agencies (LEAs) submit claims to MassHealth for Medicaid-reimbursable services. These claims are paid quarterly. At the end of the year, LEAs submit an annual Direct Services Cost Report that includes all eligible direct service costs and LEA-specific Medicaid eligibility rates.
The Cost Report determines the LEA’s total reimbursable costs for the year. LEAs then receive a final payment equal to the difference between total reimbursable costs and the claim payments already received during the year.
Please fill out the form below if you are interested in talking to one of our team members about bringing Relay to your state. We will aim to answer all requests as soon as possible.
*This information is based upon review of publicly available documents as of 2021 and is subject to change at any time. This information should not be considered as legal or compliance advice. Contact individual states or Relay to verify Medicaid program requirements.
Healthy Students Promising Futures
https://healthystudentspromisingfutures.org/map-school-medicaid-programs/#0Healthy Students, Promising Futures “Free Care” Rule:
https://healthystudentspromisingfutures.org/free-care-rule/