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School Health Services Program Manual - General Information - Colorado Department Of Education - Department Of Health Care Policy Page 3

School Health Services Program Manual Section 1

Section 1: General Information

The Colorado School Health Services (SHS) Program administered by the

Colorado

Department of Health Care Policy and Financing (the Department)

allows school

districts and Boards of Cooperative Educational Services (BOCES), herein referred to as

“district,” to access federal Medicaid funds for delivering Medicaid allowable school

health services to Medicaid eligible children. Districts may also receive federal funding

through the Medicaid Administrative Claiming (MAC) component for performing

administrative activities which include service coordination, outreach, enrollment and

administrative functions that support the Medicaid program. Reimbursement received

by a district through the SHS Program shall be used by the district to provide additional

and expanded health services.

The SHS Program serves students up to the age of 21 who are eligible under the

provisions of the Individuals with Disabilities Education Act (IDEA) of 1990 as amended

in 2004 and to those enrolled in programs that require an Individualized Education

Program (IEP) or an Individualized Family Services Plan (IFSP). School health services

provided through the SHS Program must be medically necessary (defined in

Section

1.2) and prescribed in the student’s IEP or IFSP.

Program Overview

Participating districts are reimbursed interim payments based on a monthly rate. The

monthly rate is calculated according to each district’s historical Certified Public

Expenditure amounts and paid in twelve equal monthly installments. See Section 4.3 for

additional information on Interim Payments.

In order to receive interim payments for services, the district documents and submits

Medicaid claims to the Department. The district must first obtain consent from the

parent or guardian of the Medicaid child to bill Medicaid on behalf of the child. The

claim describes the service delivered to the Medicaid child on a specific date, the

medical provider, and additional service information.

 See Section 2 for information on Covered Services.

 See Section 4.1 and 4.2 for additional information on Claims Requirements

and Claims Submission.

Additionally, the district must participate in a Random Moment Time Study (RMTS) and

cost reporting process. District staff that are Medicaid qualified to provide direct health

services, Targeted Case Management (TCM) or Medicaid administrative activities may

participate in the time study and their eligible costs can be identified in the cost report.

The cost report will determine the Medicaid allowable total costs a district should be

reimbursed.

 See Section 3 for additional information on RMTS.

 See Section 6 for additional information on MAC- Quarterly Cost Report.

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School Health Services Program Manual - General Information - Colorado Department Of Education - Department Of Health Care Policy Page 3

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