HCPF:School Health Services Program

Colorado.gov

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School Health Services Program

The Program Process

First, the district or BOCES must conduct a health needs assessment.

Many children in Colorado do not have health insurance or do not have enough health insurance to meet their needs. The district or BOCES must find out what health care services those children need.

Second, the district or BOCES must seek community input.

The district or BOCES must let the people in their community know that it plans to have a School Health Services Program. People from the local community are invited to help decide which health services will be delivered for the public school children.

Third, the district or BOCES writes a plan.

Using the information from the health assessment and from the local community, the district or BOCES writes a plan that describes the health services that the district wants to provide for its students. This document is called the Local Services Plan (LSP).

Fourth, the district or BOCES submits the LSP to the state for approval.

The LSP is sent to the Colorado Department of Education (CDE) and the Department of Health Care Policy & Financing (HCPF) (the Department). Both of these state departments are responsible for operating the School Health Services Program.
The LSP is reviewed to see that the plan follows the law that says all of the money that the district or BOCES receives must be spent for children's health care services. The review also looks to see how the community decisions were used to create the plan and to be sure that only new or expanded services are being provided with the School Health Services funds.

Fifth, the district or BOCES receives a contract to obtain the funds.

Some health services are already being delivered for children in public schools. And some of these services are for children on the Medicaid program. The Department of Health Care Policy & Financing (HCPF) is the agency in the state that operates the Medicaid program. When a district or BOCES has an approved Local Services Plan, the Department HCPF makes a contract to fund the LSP with dollars that are reimbursed to districts for the health services that they provide for Medicaid children.

In order to obtain the reimbursed dollars for each service, the district submits a Medicaid insurance claim to the Department. The district must first obtain permission from the parent or guardian of the Medicaid child to bill Medicaid on behalf of the child. Then the claim can be submitted. The insurance claim shows that a service was delivered, who received the service, what the service was and how much it cost the district or BOCES to provide the service. The district or BOCES certifies that they paid for the service. Then the Department reimburses the federal share of the cost of the service back to the district or BOCES.

In other words, when a contracted district or BOCES provides a health service for a Medicaid child, they submit a claim to obtain reimbursement for part (the federal share) of their costs and then they use the reimbursement money to buy new or expanded health services identified in their Local Services Plan. Right now, the federal share is 50% of the total cost. Although simplified, the following example shows the basic idea of the funding formula:

A district or BOCES spends $10.00 to provide a service. They submit a claim for the federal share of what they spent. The federal Medicaid program reimburses 50%, or $5.00.

Sixth, reimbursed Medicaid dollars fund the health services identified in the LSP.

The reimbursed money is used to pay for the health services that the district or BOCES identified in their LSP. The health services provided through the LSP are the new or expanded services and cannot be claimed as a Medicaid service. The Medicaid service is only the service already being provided by the district or BOCES by a Medicaid qualified provider for a Medicaid enrolled child. Reimbursable services for the Medicaid enrolled child must also be prescribed in the child's Individualized Education Program (IEP) document. All of the reimbursed dollars that are received during the contract period are spent on services for children according to the LSP written with community input.

Reference Material