School Health
The Medical Assistance Division School Health Office is Responsible for the Management of all Medicaid School Health Programs in New Mexico. These Include:
- The MSBS Program, a multimillion dollar Medicaid program for children and youth under 21 years of age who have special education and health care needs and are eligible to receive services as part of an IEP/IFSP in accordance with the IDEA;
- The SBHC/Managed Care Organization (MCO) Project, which provides quality, inclusive health services to youth by linking SBHC programs across New Mexico with the state's four Medicaid MCOs and Statewide Entity (SE) for behavioral health services; and
- Multiple interagency initiatives requiring collaboration between HSD, DOH, CYFD, and PED on matters relating to health and health-related services provided in the school setting.
Medicaid School-Based Services Program
Under the auspices of the MSBS Program, New Mexico schools offer key health and health-related services that are designed to integrate and maintain active learning for Medicaid-eligible children with disabilities and special health care needs who receive services under the IDEA through an IEP/IFSP. Examples of such services include:
- Physical, occupational, audiological and speech therapies;
- Mental health services;
- Social services;
- Nutritional assessments and counseling;
- Transportation;
- Case management; and
- Nursing services
In addition, school districts are able to bill and be reimbursed for certain Medicaid-related administrative activities, such as conducting Medicaid-related outreach; facilitating Medicaid eligibility determinations; coordinating transportation to Medicaid-covered services; making referrals; coordinating and monitoring Medicaid services; and engaging in medical service program planning, policy development and interagency coordination.
School districts are able to use the money paid to them under the MSBS program to pay for health and health-related services benefiting all students, not just those who are Medicaid- or IDEA-eligible.
MSBS Program Guide:
- New Mexico Medicaid Guide for School-Based Services
- Appendix A: Governmental Services Agreement
- GSA Amendment
- Appendix B1: Provider Participation Application - Group
- Appendix B2: Provider Participation Application - Individual
- Appendix C: MSBS Program Regulations
- Appendix D: Covered Services, Procedure Codes & Rates
- Appendix E: Medicaid General Provider Policy
- Appendix F: MSBS Quality Assurance Checklist
- Appendix G: MSBS Provider Licensure & Supervision Requirements
- Appendix H: MSBS Procedure for Coordinating Care With A Recipient's Primary Care Provider
- Appendix H: MSBS PCP Procedure Worksheet
- Appendix I: NM MAC Program
- Appendix J: Administrative Claiming Activity Codes
- Appendix K: Job Codes & Descriptions for Time Study Employees
- Appendix L: Fairbanks MAC Program
- Appendix M: Administrative Claim Form
- Appendix N: Instructions for Completing the Administrative Claim Form
- Appendix O: School Health Office Contact Information; MCO Contact Information
- Appendix P: Acronym Dictionary
- Appendix Q: Annual Expenditure Report
- Appendix R: Medicaid Site Review Tool
- Appendix S: Spending MSBS Reimbursements/Supplanting vs. Supplementing
Resources for MSBS Related Services:
Resources for MSBS Nursing Services:
- Instructions for Completing Nursing Direct Services Billing Form
- Nursing Direct Services Billing Form
- Instructions for Completing Nursing Services Weekly Medication Administration Billing Form
- Nursing Services Weekly Medication Administration Billing Form
- Instructions for Completing Nursing Direct Services Billing Form
- Nursing Direct Services Billing Form
- Instructions for Completing Nursing Services Weekly Medication Administration Billing Form
- Nursing Services Weekly Medication Administration Billing Form
Resources for MSBS Behavorial Health Services:
School-Based Health Center (SBHC)/ Managed Care Organization (MCO) Project
SBHCs are partnerships created by schools and community health organizations to provide onsite primary, preventive and behavioral health services to students while reducing lost school time, removing barriers to care, promoting family involvement and advancing the health and educational success of school-age children and adolescents. SBHCs play an important role in increasing access to primary and behavioral health services among vulnerable, hard-to-reach or at-risk children and adolescents who may not have access to services outside of the school setting, particularly in rural and other medically underserved areas of New Mexico.
The SBHC/MCO Project, which was funded originally by a four-year, $500,000 grant to HSD by the Centers for Health Care Strategies (CHCS) via a separate grant to CHCS by the Robert Wood Johnson Foundation, has been institutionalized as part of the Medicaid managed care program. The project links several SBHC programs in urban, rural and frontier parts of New Mexico with the Medicaid MCOs and the Statewide Entity (SE) for behavioral health services. The goals of the project are to explore best practices for collaboration; increase access to care for underserved children and adolescents; strengthen the provision of comprehensive and preventive care; promote the integration of systems, particularly for primary and behavioral health; and improve the overall health of students served in SBHCs.
The project has allowed for the development and implementation of several best practice clinical guidelines to guide SBHCs in providing EPSDT health screens; identifying and managing asthma, depression and obesity/type-2 diabetes; communicating with primary care providers; and working with the MCOs and the SE for behavioral health services to coordinate and manage recipient care.
SBHC/MCO Project Clinical Guidelines:
- Conducting EPSDT Screens
- Identification and Management of Asthma
- Identification and Management of Depression
- Guidelines for Coordinating and Managing Recipient Care
- Guidelines for Communication Among SBHCs, MCOs, PCPs and Parents/Legal Guardians
- Guidelines for identifying and managing obesity/type-2 diabetes
SBHC/MCO Project Resources:
- SBHC Process for Becoming a Credentialed Medicaid Provider
- SBHC SOS, revised 10/11
- SBHC Encounter Form SY revised 10/11
- SBHC Profile Worksheet
- SBHC Medicaid Site Readiness Review Checklist
- SBHC Medicaid Documentation Checklist
- SBHC Medicaid Site Readiness Review Checklist (for Recredentialing Visits)
- Annual Wellness Exam EPSDT Envision, 2010