Maryland Medicaid Officials In Dispute With CMS Over Billing For School Services

July 10, 2007 – 8:37 pm | posted in Medicare, Pediatrics

Health officials in Maryland are “embroiled in a dispute” with CMS over Medicaid reimbursements to public schools that provide health care services to low-income, special-education students, the Baltimore Sun reports. Public school systems receive Medicaid funds to cover part of the cost of medical services — including speech, physical and occupational therapy, and psychological counseling — provided to such students, as well as students’ transportation to receive services on school days. The federal government usually reimburses about 50% of the cost of services, and the state provides the remainder.

An audit in 2005 indicated that from 2001 to 2004, the state’s billing rate for health services, which it has used since 1994, allowed for extra costs “associated with educating children beyond the specific cost of their health services,” according to the Sun. As a result, CMS is seeking $32.8 million in overpayments. Maryland officials “vigorously dispute the methodology that the auditors used, arguing that systems spent far more than they applied for in reimbursement,” the Sun reports.

According to the Sun, many other states are in similar disputes. Greg Morris, a California attorney who consults on Medicaid programs in schools, said that public school systems and the federal government have long disagreed on what is considered to be a medical necessity and there is “little instruction from the federal government” (Neufeld, Baltimore Sun, 7/5).

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