Date and Time: Tuesday, January 28, 2025, 6:30-7:30 p.m.
Presenters(s): Karen Hefler, OT, OTR, FAOTA, Jan Hollenbeck, OT, OTD, OTR, FAOTA
Location: Zoom - to be sent out day before the event
Title: The School-Based Medicaid Program (SBMP)-Overview and Updates
Learning Objectives:
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Identify considerations for determining medical necessity
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List key resources to understand the requirements of SBMP
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Identify systems-level supports needed for effective SBMP implementation and strategies useful in advocating for supports
Bio/Focus: The MassHealth School-Based Medicaid Program (SBMP) is a reimbursement mechanism to offset local education agency (LEA) costs for providing certain health care services and administrative activities in a school setting. Congress granted access to Medicaid reimbursement in 1988 due to shortages in IDEA funding (Holahan, 2019). The SBMP allows participating LEAs to seek cost-based reimbursement for providing medically necessary Medicaid services (direct service) to eligible MassHealth-enrolled children who have parental consent. This session will provide an overview of the SBMP process and resources. Participants will then have the opportunity to problem-solve challenges in determining medical necessity and are encouraged to come prepared to share and discuss student examples.
Karen Hefler, OT, OTR, FAOTA, is the Owner/Director of Rehabilitation Therapy Associates, LLC, a pediatric occupational therapy private practice that she founded in 1985. Her company primarily contracts with schools and provides assessment services, occupational therapy services and consultation, in-service training, and program development. As a practitioner, Karen has fostered the OT/OTA partnership in her private practice and has facilitated Level 1 and Level 2 Fieldwork programming for OT and OTA students in the public schools. Karen has done presentations for a number of facilities and agencies, including: early intervention programs, hospitals, public schools, private schools, residential programs, college programs, and professional associations. She was the Chairperson for the MAOT School System Special Interest Group for three years, participated in the revision of the Guidelines for Provision of Occupational Therapy in Massachusetts Schools, and is a member of the AOTA School-Based Community of Practice. Karen is the Past President of MAOT and the current SIG Coordinator for MAOT.
Jan Hollenbeck, OT, OTD, OTR, FAOTA, is the former Coordinator of Related Services, Secondary Transition Services, Assistive Technology, and Section 504 for Medford Public Schools. She is co-founder of the Partnership for Advancement of School Service-Providers (PASS), providing professional development and consultation to inform and empower related service providers and others to support and facilitate the success of children in educational settings. Dr. Hollenbeck is a state and national presenter and has authored several chapters and articles on the role of OT in public schools. She is the MAOT Liaison to MA DESE and the first author of the Guidelines for Provision of Occupational Therapy in Massachusetts Schools. She is currently Co-Facilitator of the AOTA State Leaders in School Practice CoP and served a 3-year term on the AOTA Early Intervention and Schools Special Interest Section Committee.
References:
- Holahan, L., (2019). Best Practice in Medicaid Cost Recovery. In G. Frolek Clark, Joyce E. Rioux, & B. E. Chandler (Eds.), Best practices for occupational therapy in schools, 2nd Edition, Bethesda, MD: AOTA Press, 978-1-56900-411-1, Ebook ISBN: 978-1-56900-591-0.
- MassHealth School-Based Medicaid Program Direct-Service Claiming (DSC) Program Guide, https://www.mass.gov/info-details/school-based-medicaid-program-sbmp-resource-center, Revised August 2020
- School-Based Medicaid Program (SBMP) Resource Center, https://www.mass.gov/info-details/school-based-medicaid-program-sbmp-resource-center
- Top 5 Things Providers Need to Know for the 2020-2021 School Year, MassHealth School-Based Medicaid Program, https://www.mass.gov/info-details/school-based-medicaid-program-sbmp-resource-center, 12/1/20
Registration will be closed at 4 p.m. the day before the event. Please register by Monday, January 27, 2025.
Please keep this copy for your own records and keep with your certificate. MAOT is not responsible for maintaining records for contact hours.