Section 16.03.09.856 - SCHOOL-BASED SERVICE: PROVIDER REIMBURSEMENTPayment for health-related services provided by school districts and charter schools must be in accordance with rates established by the Department.
01.Payment in Full. Providers of services must accept as payment in full the school district or charter school payment for such services and must not bill Medicaid or Medicaid participants for any portion of any charges.02.Third Party. For requirements regarding third party billing, see Section 215 of these rules.03.Recoupment of Federal Share. Failure to provide services for which reimbursement has been received or to comply with these rules will be cause for recoupment of the Federal share of payments for services, sanctions, or both.04.Matching Funds. Federal funds cannot be used as the State's portion of match for Medicaid service reimbursement. School districts and charter schools must, for their own internal record keeping, calculate and document the non-federal funds (maintenance of effort assurance) that have been designated as their certified match. This documentation needs to include the source of all funds that have been submitted to the State and the original source of those dollars. The appropriate matching funds will be handled in the following manner: a. Schools will estimate the amount needed to meet match requirements based on their anticipated monthly billings.b. School districts and charter schools will send the Department the matching funds, either by check or automated clearing house (ACH) electronic funds transfers.c. The Department will hold matching funds in an interest bearing trust account. The average daily balance during a month must exceed one hundred dollars ($100) in order to receive interest for that month.d. The payments to the districts will include both the federal and non-federal share (matching funds).e. Matching fund payments must be received and posted in advance of the weekly Medicaid payment cycle.f. If sufficient matching funds are not received in advance, all Medicaid payments to the school district will be suspended and the school district will be notified of the shortage. Once sufficient matching funds are received, suspended payments will be processed and reimbursement will be made during the next payment cycle.g. The Department will provide the school districts a monthly statement that will show the matching amounts received, interest earned, total claims paid, the matching funds used for the paid claims, and the balance of their funds in the trust account.h. The school districts will estimate the amount of their next billing and the amount of matching funds needed to pay the Department.i. The estimated match requirement may be adjusted up or down based on the remaining balance held in the trust account.Idaho Admin. Code r. 16.03.09.856