Looking for a U.s. Department Of Education Forms And Templates? Download it for free!

School Health Services Program Manual - General Information - Colorado Department Of Education - Department Of Health Care Policy Page 4

School Health Services Program Manual Section 1

The total cost identified in the annual cost report for direct health services, TCM and

transportation is reconciled against the interim payment total the district or BOCES

received throughout the year. If the district or BOCES interim payment total was less

than the total cost identified on the cost report the district or BOCES will receive a

payment for the difference. If the district or BOCES interim payment total was more

than the total cost identified on the cost report the district will be required to pay back

the difference.

 See Section 5 for additional information on Annual Cost Report, Reconciliation

and Settlement.

1.1 Student Eligibility and Requirements

To be eligible for SHS Program benefits, the student must meet all of the following

criteria:

1. Enrolled in Medicaid;

2. Enrolled in a public school or a participating district or BOCES;

3. Under the age of 21;

4. Has a disability or is considered medically at risk; and

5. Received a referral for school health services according to an IEP or IFSP.

Districts participating in the SHS Program can verify student Medicaid eligibility through

one of three electronic methods:

1. Colorado’s Web Portal

2. Fax-Back: 1-800-493-0920

3. Client Medicaid Eligibility Response System (CMERS): 1-800-237-0044

Information regarding the Web Portal, Fax-Back and CMERS systems can be found at:

Provider Services on HCPF Website

1.2 Medical Necessity Criteria

School health services provided to the student shall be medically necessary. A medically

necessary service is:

1. Reasonably expected to prevent, diagnose, cure, correct, reduce or

ameliorate the pain and suffering, or the physical, mental, cognitive or

developmental effects of an illness, injury or disability;

2. Intended when there is no other equally effective or substantially less costly

course of treatment suitable for the child’s needs;

3. Determined as the result of a service furnished under the Early and Periodic

Screening, Diagnostic and Treatment (EPSDT) benefit, by a qualified health

professional operating within the scope of his/her practice; and

4. Referred by a physician or qualified licensed practitioner of the healing arts.

3 |

P a g e

School Health Services Program Manual - General Information - Colorado Department Of Education - Department Of Health Care Policy Page 4