37.86.2230    EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), SCHOOL-BASED HEALTH RELATED SERVICES

(1) School-based services for the purposes of Medicaid are defined as medically necessary services provided through a public school district, joint board, or cooperative. The public school district or cooperative must receive funds from the state general fund for the purpose of providing special education.

(2) School-based health related services may include:

(a) physical therapy;

(b) speech-language pathology and audiology;

(c) occupational therapy;

(d) private duty nursing;

(e) personal care paraprofessional services;

(f) licensed psychologist services;

(g) school psychologist services;

(h) licensed clinical social worker services;

(i) licensed professional counselor services;

(j) comprehensive school and community treatment;

(k) specialized transportation; and

(l) orientation and mobility specialist services.

(3) School-based health related services provided in the school to a child with disabilities, as that term is defined in Title 20, chapter 7, part 4, MCA, are eligible for Medicaid reimbursement when those services are required by the child's Individualized Education Program (IEP). The IEP is considered the order for health related services.

(4) School-based health related services include services that are not required by an IEP but are provided by schools to students for a fee and billed under the student's name. Schools cannot bill Medicaid for services not required by an IEP that are provided free to other children.

(5) All health related services billed to Medicaid must have PASSPORT approval with the exception of mental health related services and school-based health services.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2003 MAR p. 1316, Eff. 6/27/03; AMD, 2004 MAR p. 83, Eff. 1/1/04; AMD, 2008 MAR p. 2673, Eff. 12/25/08; AMD, 2013 MAR p. 1111, Eff. 7/1/13.