§ 40-8-18. Local education agencies as EPSDT providers.
(a) It is the intent of this section to provide reimbursement for early and periodic screening,
diagnosis, and treatment (EPSDT) services through local education agencies for children
who are eligible for medical assistance. A local education agency's participation
as an EPSDT provider is voluntary. Further, it is the intent that collaboration among
the department of human services (DHS), the department of elementary and secondary
education, and local education agencies (LEAs) will result in state and local funds
being used to maximize federal funding for such EPSDT services.
(b) The services available to eligible children under Title XIX of the Social Security
Act, 42 U.S.C. § 1396 et seq., for early and periodic screening, diagnosis, and treatment (EPSDT) may be
provided by local education agencies.
(c)(1) Voluntary participation as an EPSDT provider shall require the local education agency
to provide the state match to obtain federal financial participation for EPSDT services
and associated administrative costs by certifying to the department of human services
that sufficient qualifying local funds (local certified match) have been expended
for the services and administrative costs; provided, however, that a local education
agency shall not be required to provide the local certified match for those EPSDT
services for which the department of human services, or another state agency, agrees
to provide the state match to obtain federal financial participation for EPSDT services.
(2) The local certified match shall be established in the local education agency pursuant
to federal Title XIX provisions. Failure of the local education agency to provide
the local match shall result in the penalties described in subsection (f).
(3) The department of human services shall pay the local education agency from the federal
matching funds for EPSDT services pursuant to fee schedules established by rules and
regulations of the department of human services, and for associated administrative
costs pursuant to administrative cost reimbursement methodologies to be approved by
the federal government, upon certification of the local match by the local education
agency in accordance with federal Title XIX provisions. Payments made to the local
education agency pursuant to this section shall be used solely for educational purposes
and shall not be made available to local communities for purposes other than education.
The local fiscal effort to support education referred to in subsection (d) shall not
be reduced in response to the availability of these federal financial participation
funds to the local education agency. These federal financial participation funds must
supplement, not supplant, local maintained fiscal effort to support education.
(4) For the purposes of this subsection, the term "local education agency� shall include
any city, town, state, or regional school district or the school for the deaf or the
William M. Davies, Jr. career and technical high school, the Metropolitan Career and
Technical Center, any public charter school established pursuant to chapter 77 of title 16, any educational collaborative established pursuant to chapter 3.1 of title 16, or the department of children, youth and families (DCYF).
(d)(1) Each community shall maintain local fiscal effort for education. For the purpose of
this subsection, to "maintain local fiscal effort� means each community shall contribute
local funds to its school committee in an amount not less than its local contribution
for schools in the previous fiscal year.
(2) Further, state support for education shall not be reduced from the prior fiscal year
in response to local community participation in the EPSDT program.
(e) The department of human services and the department of elementary and secondary education
shall effect the interagency transfers necessary to comply with the provisions of
this section. The department of elementary and secondary education and the department
of human services are authorized to promulgate any and all regulations necessary to
implement this section. All local school agencies becoming EPSDT providers shall be
required to comply with all provisions of Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., relative to responsibilities of a Medicaid provider.
(f) Failure of the local education agency to establish a local certified match under this
law sufficient to support its claims for reimbursement of EPSDT services and associated
administrative costs will result in the withholding of state funds due that community
in accordance with § 16-7-31 in an amount equal to the federal financial participation funds denied by the federal
government as a result thereof. The withheld funds will be transferred to the department
of human services.
(g) The department of human services, with the aid of the department of education, shall
determine which healthcare-related services are eligible for federal Medicaid reimbursement
for health-related services provided by local education agencies to children eligible
for early periodic screening, diagnosis, and treatment. The department of human services,
with the assistance of the department of administration, shall also develop the following
resources in furtherance of the goal of recouping the maximum amount of administrative
costs associated with the services:
(1) A time-study training manual that outlines how to complete a time study by school
personnel to enhance recovery of administrative costs; and
(2) A claiming manual that outlines the financial information and claim submission requirements
that are needed to complete the claim.
(h) Services provided by school social workers and certified school psychologists who
are certified by the department of elementary and secondary education shall be included
as healthcare-related services eligible for federal Medicaid reimbursement pursuant
to this section. These school social workers and certified school psychologists shall
be eligible to participate in time studies as local education agency employees and
contractors.
(i) The general assembly encourages the executive office of health and human services
and the department of elementary and secondary education to collaborate and pursue
pathways to expand opportunities for local education agencies to bill and obtain federal
Medicaid reimbursement for eligible services delivered in schools.