                                 CODE OF VIRGINIA

SPECIAL EDUCATION HEALTH SERVICES; MEMORANDUM OF AGREEMENT BETWEEN THE
DEPARTMENT OF EDUCATION AND THE DEPARTMENT OF MEDICAL ASSISTANCE SERVICES (§
32.1-326.3)

A. The Department of Medical Assistance Services, in cooperation with the
Department of Education, shall, consistent with the biennium budget cycle,
examine and revise, as necessary, the regulations relating to the funding and
components of special education services.
			Any revisions shall be designed to maximize access to health care for poor
children who are eligible for medical assistance services and to assist school
divisions in the funding of medically necessary related services by making use
of every possible, cost-effective means, Medicaid reimbursement or other program
administered by the Department of Medical Assistance Services, including, but
not limited to, the State Children&#8217;s Health Insurance Plan pursuant to
Title XXI of the United States Social Security Act, as approved by the federal
Health Care Financing Administration at the time. Any revisions shall be based
on the flexibility allowed to the states and be focused on avoiding large costs
for acute or medical care and increasing children&#8217;s access to health care,
and shall include, but need not be limited to:

   1. Rates for services which shall clearly identify that only the federal share
   shall be reimbursed for the special education health services and shall
   demonstrate that local governments are funding the state match for the special
   education health services provided by school divisions.

   2. The benefits and drawbacks of allowing school divisions to provide services
   as Medicaid providers to disabled students.

   3. The appropriate credentials of the providers of care, in compliance with
   federal requirements and with the approval of the Health Care Financing
   Administration, for special education health services; e.g., licensure by the
   Board of Education and licensure by the appropriate health regulatory board
   within the Department of Health Professions.

   4. Delivery of medically necessary related services for students who are
   eligible for medical assistance services.
   				The services shall be limited to those services which are covered under
   the then-current state plan for medical assistance services, and may be
   provided, consistent with federal law and as approved by the Health Care
   Financing Administration, by a school division participating as a health
   services provider. Such services shall include, but need not be limited to,
   speech therapy, including such services when delivered by school
   speech-language pathologists licensed by the Board of Audiology and
   Speech-Language Pathology or those individuals who are directly supervised, at
   least twenty-five percent of the time, by such licensed speech-language
   pathologists; physical therapy; occupational therapy; psychiatric and
   psychological evaluations and therapy, including such services when delivered
   by school psychologists-limited licensed by the Board of Psychology;
   transportation between the student&#8217;s home, the school or other site
   where health-related services are to be provided on those days when the
   student is scheduled to receive such services at the school or such other
   site; and skilled nursing services, such as health assessments, screening
   activities, nursing appraisals, nursing assessments, nursing procedures,
   medication assessment, medication monitoring, and medication administration.

   5. The role of the Medallion, Medallion II, Options or other managed care
   programs in regard to the special education health services and coordination
   with school divisions regarding any required referrals.

B. Any funds necessary to support revisions to the special education health
services shall be included in the budget estimates for the departments, as
appropriate.

C. The Director of the Department of Medical Assistance Services or his designee
and the Superintendent of Public Instruction or his designee shall develop and
execute a memorandum of agreement relating to special education health services.
This memorandum of agreement shall be revised on a periodic basis; however, the
agreement shall, at a minimum, be revised and executed within six months of the
inauguration of a new governor in order to maintain policy integrity.

D. The agreement shall include, but need not be limited to, (i) requirements for
regular and consistent communications and consultations between the two
departments and with school division personnel and officials and school board
representatives; (ii) a specific and concise description and history of the
federal Individuals with Disabilities Education Act (IDEA), a summary of school
division responsibilities pursuant to the Individuals with Disabilities
Education Act, and a summary of any corresponding state law which influences the
scope of these responsibilities; (iii) a specific and concise summary of the
then-current Department of Medical Assistance Services regulations regarding the
special education health services; (iv) assignment of the specific
responsibilities of the two state departments for the operation of special
education health services; (v) a schedule of issues to be resolved through the
regular and consistent communications process, including, but not limited to,
ways to integrate and coordinate care between the Department of Medical
Assistance Services&#8217; managed care providers and special education health
services providers; (vi) a process for the evaluation of the services which may
be delivered by school divisions participating as special education health
services providers pursuant to Medicaid; (vii) a plan and schedule to reduce the
administrative and paperwork burden of Medicaid participation on school
divisions in Virginia; and (viii) a mechanism for informing primary care
providers and other case management providers of those school divisions that are
participating as Medicaid providers and for identifying such school divisions as
Medicaid providers that are available to receive referrals to provide special
education health services.

E. The Board of Medical Assistance Services shall cooperate with the Board of
Education in developing a form to be included with the Individualized Education
Plan (IEP) that shall be accepted by the Department of Medical Assistance
Services as the plan of care (POC) and in collecting the data necessary to
establish separate and specific Medicaid rates for the IEP meetings and other
services delivered by school divisions to students.
			The POC form shall (i) be consistent with the plan of care required by the
Department of Medical Assistance Services of other Medicaid providers, (ii)
allow for written updates, (iii) be used by all school divisions participating
as Medicaid providers of special education health services, (iv) document the
student&#8217;s progress, and (v) be integrated and coordinated with the
Department of Medical Assistance Services&#8217; managed care providers.

F. The Department of Medical Assistance Services shall consult with the
Department of Education in preparing a consent form which (i) is separate from
the IEP, (ii) includes a statement noting that such form is not part of the
student&#8217;s IEP, (iii) includes a release to authorize billing of
school-based health services delivered to the relevant student by the school
division, and (iv) shall be used by all school divisions participating in
Medicaid reimbursement. This consent form shall be made available to the parents
upon conclusion of the IEP meeting. The release shall allow for billing of
school-based health services by Virginia school divisions to the Virginia
Medicaid program and other programs operated by the Department of Medical
Assistance Services.

G. The Department of Medical Assistance Services and the Department of Education
shall also develop a cost-effective, efficient, and appropriate process to allow
school divisions access to eligibility data for students for whom consent has
been obtained.

H. The Board of Medical Assistance Services shall, when in compliance with
federal law and regulation and approved by the Health Care Financing
Administration, also (i) include, in its regulations which provide for
reimbursement of school divisions participating in Medicaid as special education
health services providers, a provision for reimbursement of mental health
services delivered by licensed school psychologists-limited and a provision for
reimbursement for services rendered to Medicaid-eligible students of
speech-language pathology services delivered by school speech-language
pathologists or those individuals who are directly supervised, at least
twenty-five percent of the time, by such licensed speech-language pathologists;
(ii) revise the limitations, established pursuant to relevant regulations and
Virginia&#8217;s state plan for medical assistance services, on services
delivered by school divisions participating in Medicaid as special education
health services providers, in effect on January 1, 1999, for physical therapy,
occupational therapy, and speech, hearing, and language disorders when such
services are rendered to children who are eligible for special education
services and have IEPs requiring such services; (iii) cooperate with the Board
of Education in developing a form to be included with the IEP that shall be
accepted by the Department of Medical Assistance Services as the plan of care
when signed by a physician or, when under such physician&#8217;s supervision,
his designee; (iv) cooperate with the Board of Education in collecting the data
necessary to establish separate and specific rates for the IEP services
delivered by school divisions to students with disabilities who are eligible for
special education and for medical assistance services; and (v) analyze the data
necessary for such rates and establish new rates for reimbursement of IEP
meetings based on such data.

I. Services delivered by school divisions as participating providers in the
Medicaid program or any other program operated by the Department of Medical
Assistance Services shall not include any family planning, pregnancy or abortion
services.

HISTORY: 1999, cc. 967, 1005; 2002, c. 457; 2021, Sp. Sess. I, c. 250.