The Kentucky Finance and Administration Cabinet has determined Medicaid managed care organizations’ (MCO) contracts do legally cover services to students provided by school nurses at health clinics operated by local health departments, according to the Kentucky School Boards Association (KSBA) in Frankfort.
In a Jan. 3 letter from Robin Kinney, executive director of the Finance and Administration Agency’s Office of Administrative Services, the agency denied Kentucky Spirit’s appeal of an August 2012 decision by the Cabinet for Families and Children (CFC).
In that decision, the CFC determined school-based health services are a “historical” service of local health departments, which may continue to bill managed care contractors for reimbursement.
Kentucky Spirit asked the finance cabinet to overrule CFC.
Kentucky Spirit also appealed the CFC determination that, even if such services were covered by its contract with the state when provided in a school building, nurses could not bill for such services.
The Finance Cabinet ruling states that it found “that school-based nurses operate under the rules approved by the commissioner of the Department for Public Health and by the medical director of the local health department.”
“These nurses themselves do not bill for preventive or remedial Medicaid services, but rather the local health departments bill for nursing services, regardless of the location. These services have been historically provided by the local health departments through nurses in the schools and are covered by the Department of Medicaid Services as supported by language in the State Plan Attachments that specifies which practitioners may provide services billed through public health department clinics,” the Jan. 3 letter read. The Kentucky Spirit appeal point was thus denied.
While this resolves the administrative appeal process, Kentucky Spirit has sued the state, seeking to be released from its managed care contract over a claim of being provided with faulty data.
The lawsuit is pending in Fayette Circuit Court.
As earlier reported, schools across the state have been in danger of losing their health clinics due to Medicaid non-payment, creating financial hardships on their agencies.
You can reach Reina Parker Cunningham at firstname.lastname@example.org or by phone at 606-248-1010, ext. 205.