We provide Nebraska students with opportunities to improve their health and achieve academic success.
Medicaid in Public Schools (MIPS)
Public schools may receive Medicaid funds for some health services provided to students at school.
The services must be medically necessary, the student must be eligible for Medicaid, and special education and services must be included in their Individual Education Plan (IEP) or Individualized Family Service Plan (IFSP).
The following services are currently covered under Nebraska MIPS. All services must be provided in accordance with all relevant rules and regulations in force on the date of service:
School Based Services Initiatives
In October 2017, CMS launched a School-Based Service Affinity group. Nebraska was one of eight states chosen to be a part of this group.
The group was started to work on initiatives specific to schools in each state. To meet one of this group's goals, they conducted a survey to analyze how schools access mental and behavioral health care in the schools and the extent to which they use their community partners. The survey's findings are in the report below.
Nebraska CMS School Health Affinity Group Report of School Survey
Medicaid Administrative Claiming (MAC)
The school setting provides a unique opportunity to enroll eligible children in Medicaid and to assist children who are already enrolled in Medicaid access the benefits available to them.
Medicaid offers reimbursement for the costs of administrative activities that support the Medicaid program. This reimbursement is allowed under Title XIX of the Social Security Act.
MAC in Nebraska (NEBMAC)
Guidance for the NEBMAC program can be found in the Nebraska Education-Based Medicaid Administrative Claiming Guide. This guide was approved by Centers for Medicare and Medicaid Services in January 2018. The guide includes information for schools and other interested parties on the appropriate methods for claiming reimbursement for Medicaid administrative activities performed in the school setting.
Any public school district or Educational Service Unit (ESU) may participate in NEBMAC. School districts and ESUs receiving payment for Medicaid administrative activities are acting as agents for the Nebraska Department of Health and Human Services. Such activities may be paid under Medicaid only if they are necessary for administering the Nebraska Medicaid program. Both ESU's and public school districts may claim related costs as long as the costs are allowable according to the NEBMAC Guide.
Random Moment Time Study, Interim Payment, & Settlement Process:
To determine the proportion of claims for administrative activities and direct service activities, DHHS uses a statewide Random Moment Time Study (RMTS) methodology. On a quarterly basis, each school district compiles a list of staff members who perform program-related activities that support the NEBMAC and MIPS programs and then reports them in the appropriate category. All staff will fall into one of two mutually exclusive cost pools.
A random sample is selected for each statewide cost pool. At the end of the quarter, the RMTS results are compiled by activity code. The results of Code 4b, “Direct Medical Services, Covered as IDEA/IEP Services," are used as one part of the quarterly cost report calculation, which will be the direct service payment to the school.
School districts will submit a quarterly cost report to report their provider costs for staff in Cost Pool 1, along with other costs related to the direct service personal and delivery of medical services. The cost report then calculates the amount each school district is eligible to receive as reimbursement.
On an annual basis, school districts must complete a cost settlement process. Each school district completes an annual cost report which compares their total Medicaid-allowable costs to each school district's Medicaid interim payments, to determine the school's final costs. If a provider received more in interim payments than the actual costs for Medicaid services provided in schools, the provider will pay back the federal share of the overpayment when the Annual Settlement cost report is submitted. If the actual costs of a provider exceed total interim payments, DHHS will pay the federal share of the difference to the provider.
Please note, Fairbanks was the former School-Based Services vendor for Nebraska Medicaid starting with the 2017-2018 school year through the 2021-2022 school year. Public Consulting Group is Nebraska Medicaid's current School-Based Services vendor starting with the 2022-2023 school year.
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