Reimbursement to Balto. County schools declines

Drop in Medicaid repayments may prompt more local spending

December 05, 2007|By Gina Davis | Gina Davis,Sun reporter

Medicaid reimbursements to the Baltimore County school system for services to certain special-education students were down last year by about $1 million from the year before, and the system might need to change the way it covers those expenses, according to a report presented during last night's school board meeting.

As recently as the 2003-04 school year, the system's third-party billing program collected as much as $10.5 million toward services such as speech therapy and counseling for children receiving special-education services and Medicaid benefits. During the past school year, 5,004 children - or nearly 40 percent of all special-education students - met that criteria, but the system recovered only about $7 million.

Several factors have contributed to the dwindling revenues, including new federal and state requirements for schools to annually get parental consent to bill for the services, fewer Medicaid-eligible students and lower billing rates, the report indicated.

In recent years, the money has been used to hire special-education teachers, psychologists, school social workers and health assistants.

To address the reduction in revenue, Superintendent Joe A. Hairston likely will ask the county for money to pay for those jobs within the system's operating budget for the fiscal year that starts in July, according to an executive summary attached to last night's report.

"The movement of these positions from the Third Party Billing budget to the operating budget may be necessary to maintain the same level of services delivered to students," the summary states.

The third-party billing office was created in 1992, four years after changes in federal law that enabled schools to collect reimbursements for school-based health services from Medicaid.

Services that the office bills for include audiology, nursing, occupational therapy, physical therapy, speech pathology, social work and counseling.

The office also bills private insurance companies and Medicaid for health centers, which are based at 14 locations across the school system. The centers generally provide services to children who lack health coverage or whose parents may have to lose time from work to take their children to the doctor.

Last school year, the office collected the second-highest amount among school systems in Maryland, according to the report.

In recent years, the funds have gone toward hiring 54 special-education teachers, 23 health assistants, 21 para-educators, 11 school social workers, six psychologists, billing office staff and school supplies, materials and equipment, the report indicates.

But with fewer eligible students, and a state change in billing rates from $82 per service to $45 per service, the third-party billing office is collecting less money.

The office has developed numerous strategies to collect as much as possible in reimbursements. Those efforts include training school staffs to identify and document services provided to eligible students, increasing the research of rejected claims and creating incentives by returning a portion of the recovered funds directly to the schools and recognizing principals who submit at least 95 percent of potential cases.

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