School Health Medical Evaluations

School+Health+Medical+Evaluations%0d%0aMedicaid+and+Department+of+Education+Training+October+2-3%2c+2007+Charlottesville%2c+Virginia%0d%0a%0d%0a%0cChild+Focused+IEP%0d%0a%ef%81%ac%0d%0a%0d%0aMedical+Evaluations+should+determine%3a%0d%0aIf+the+child%e2%80%99s+IEP+is+appropriate+to+meet+the+health+needs+of+the+child%3b+or+%ef%81%ac+If+there+are+medical+services+required+for+the+student+to+receive+a+free+and+appropriate+education%0d%0a%ef%81%ac%0d%0a%0d%0a%0cProviders+of+Medical+Evaluations%0d%0aMedical+evaluation+services+are+covered+as+physicians%e2%80%99+services+%ef%81%ac+Persons+performing+these+services+must+be+licensed+practitioners+(physicians%2c+physician+assistants%2c+and+nurse+practitioners)+acting+within+the+scope+of+practice.%0d%0a%ef%81%ac%0d%0a%0d%0a%0cProviders%2c+cont.%0d%0a%ef%81%ac%0d%0a%0d%0aSchools+must+enroll+as+a+health+services+provider%0d%0aHave+a+school+provider+agreement+completed+and+on+file+with+DMAS+%ef%81%ac+Provide+DOE+Medicaid+Specialist+(Amy+Edwards)+with+copy+of+practitioner%e2%80%99s+license+requesting+to+provide+medical+evaluation+services+%ef%81%ac+Practitioner+may+be+either+employed+or+contracted+with+the+school%0d%0a%ef%81%ac%0d%0a%0d%0a%0cCovered+Services%0d%0aIdentifying+the+nature+or+extent+of+a+recipient%e2%80%99s+medical+or+other+health+related+condition%3b+%ef%81%ac+May+be+face-to-face%2c+chart+review+or+telephonic+consultation%3b+%ef%81%ac+Review+of+a+recipient%e2%80%99s+initial+IEP+as+necessary+to+determine+the+medical+necessity+for+the+medical%2fmental+health+related+services+designated+by+the+IEP+team%3b%0d%0a%ef%81%ac%0d%0a%0d%0a%0cCovered+Services%2c+cont.%0d%0aAnnual+review+of+a+recipient%e2%80%99s+IEP+as+necessary+to+determine+continuing+medical+necessity+for+the+medical%2fmental+health+related+services+designated+by+the+IEP+team%3b+%ef%81%ac+Review+of+additional+documents+related+to+at+recipient%e2%80%99s+medical%2fmental+health+status+either+for+consultative+purposes+or+to+determine+medical+necessity+for+services%3b%0d%0a%ef%81%ac%0d%0a%0d%0a%0cCovered+Services%2c+cont.%0d%0a%ef%81%ac%0d%0a%0d%0aParticipating+in+meetings+with+IEP+providers+or+families+to+provide+medical+input+concerning+a+recipient%e2%80%99s+disability+and+medical%2fmental+health-related+services+needed%3b+%ef%81%ac+Coordinating+medical%2fmental+health+related+services+rendered+outside+the+school+setting.+For+example%2c+talking+to+a+recipient%e2%80%99s+primary+care+physician+about+medication+needs%3b+and+%ef%81%ac+Completion+of+referral+reports+and+documentation+relative+to+the+IEP.%0d%0a%0d%0a%0cMedical+Evaluation+Billing%0d%0aCode%3a+T1024+%ef%81%ac+Maximum+Interim+Rate%3a+%2496.51+%ef%81%ac+Unit%3a+Per+encounter%0d%0a%ef%81%ac%0d%0a%0d%0a%0cDocumentation+Requirements%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0aPositive+and+negative+examination+findings%3b+Diagnostic+tests+ordered+and+the+results+of+the+tests%3b+Diagnoses%3b+An+indication+of+whether+further+treatment+is+needed%3b+Referrals%2c+including+the+name+of+the+referring+physician%3b+and+Any+recommended+IEP+changes.%0d%0a%0d%0a%0cThank+you!%0d%0aBrian+Campbell%2c+EPSDT+Coordinator+Brian.Campbell%40dmas.virginia.gov%0d%0a%ef%81%ac%0d%0a%0d%0a%0cSchool+Health+Contacts%0d%0aAmy+Edwards%2c+Medicaid+Specialist%2c+DOE+Amy.Edwards%40doe.virginia.gov%0d%0a%ef%81%ac%0d%0a%0d%0aAshley+Barton%2c+MCH+Coordinator%2c+DMAS+Ashley.Barton%40dmas.virginia.gov%0d%0a%ef%81%ac%0d%0a%0d%0a%0c