Mission of MIPS and NEBMAC
To provide the students of Nebraska with opportunities to maximize Medicaid reimbursement for the purpose of enhancing the student's health and promoting academic success.
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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 IEP or IFSP.
Note: An IEP is an education document for children ages 3 to 22. It focuses on special education and related services in schools. An IFSP is broader. It is used for children from infancy through age 2, involves the family more, and may include professionals from several disciplines in planning for the child.
Nebraska MIPS
The eight services currently covered are: Occupational Therapy, Physical Therapy and Speech-Language Therapy, Nursing, Mental Health, Personal Care, Vision, and Transportation.
All services must be provided in accordance with all regulations and statutes governing the provision of these in force at the time each discipline (therapy) is provided.
School districts can access the Nebraska Department of Education's portal for information regarding Medicaid eligible students by clicking here.
Medicaid Administrative Claiming (MAC)Title XIX of the Social Security Act authorizes federal grants to states for a portion of expenditures for medical assistance under each state's approved Medicaid State Plan and for expenditures necessary for the administration of the State Plan.
The school setting provides a unique opportunity to enroll eligible children in Medicaid and to assist children who are already enrolled in Medicaid to access the benefits available to them. Medicaid offers reimbursement for the costs of administrative activities such as outreach which support the Medicaid program.
Nebraska Education-Based Medicaid Administrative Claiming (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 November of 2013. The purpose of the Nebraska Education-Based Medicaid Administrative Claiming Guide is to inform schools and other interested parties on the appropriate methods for claiming reimbursement for the costs of Medicaid administrative activities performed in the school setting.
Any public school district or Educational Service Unit (ESU) may participate in Medicaid administrative claiming (NEBMAC). School districts and ESU's receiving payment for Medicaid administrative activities being performed in the school setting 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 the proper and efficient administration of 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.
The NEBMAC Guide can be found in the Resources section on this page.
Payment Methodology
RMTS, Interim Payment & Settlement Process:
To determine the proportion of claims for administrative activities and direct service activities, DHHS utilizes a statewide Random Moment Time Study (RMTS) time study methodology. On a quarterly basis, each school district compiles a list of staff members who perform program-related administrative or direct service activities that support the NEBMAC and MIPS programs and then reports them in the appropriate category. Each category of staff will fall into one of two mutually exclusive cost pools, i.e., no staff should be included in both pools.
- Cost Pool 1 is made up of direct service/therapy personnel and is the same listing of providers in the State plan.
- Cost Pool 2 is made up of staff involved in administrative activities rather than direct service activities.
Using a statistically valid random sampling technique, the sample is selected for each statewide cost pool. At the end of the quarter, the RMTS results are compiled by activity code, and the results of Code 4b: “Direct Medical Services, Covered as IDEA/IEP Services" are used as one component of the quarterly Cost Report calculation which determines the quarterly interim payments.
The quarterly interim settlements for services will be based on the quarterly RMTS and use of the interim cost reports compiled on a quarterly basis. School districts will submit costs on a quarterly cost report to report their provider costs for those staff included in Cost Pool 1, along with other direct costs related to the direct service personal and delivery of medical services. The Cost Report then calculates the amount of reimbursement that each school district is eligible to receive as an interim payment.
On an annual basis, a Cost Settlement process must be completed by each school district. Each school district completes an annual Cost Report which compares their total Medicaid-allowable costs from the year to each school district's Medicaid interim payments delivered during the quarterly reporting periods, to determine the final cost reconciliation and settlement. If a provider's interim payments exceed the actual, certified costs for Medicaid services provided in schools to Medicaid clients, the provider will remit the federal share of the overpayment at the time the Annual Settlement Cost Report is submitted. If the actual, certified costs of a LEA provider exceed total interim payments, the Nebraska DHHS will pay the federal share of the difference to the provider.
Resources
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.