CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

Authorization and Orders for Medicaid to Schools

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This bulletin governs the authorization and order requirements for qualifying medical services delivered in school settings and billed to New Hampshire Medicaid. It affects schools and providers submitting Medicaid claims for school years 2020-2021 and 2021-2022.

Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyAuthorization and Orders for Medicaid to Schools

Policy CodePolicy N/A

Change TypeOperational update

Effective DateN/A

Next Review DateN/A

Key ActionObtain medical orders for services in the child's IEP, 504 plan, or Health Care plan before billing.

SourceLink

POLICY UPDATE CHANGES

The bulletin supersedes all previously published guidance on authorization and orders for Medicaid to Schools.

For school year 2021-2022, orders must include the medical condition, the specific service needed, and an authorized practitioner signature and date.

1 yearMaximum order date span

Before billingOrder timing

2020-2021School year requiring date-of-service coverage

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CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

Authorization and Orders for Medicaid to Schools

Customize your policy alerts

Sign up for all New Hampshire Department of Health and Human Services policy alerts

Know when New Hampshire Department of Health and Human Services releases new policies or updates existing guidance.

Monitor payer policy activity

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Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyAuthorization and Orders for Medicaid to Schools

Policy CodePolicy N/A

Change TypeOperational update

Effective DateN/A

Next Review DateN/A

Key ActionObtain medical orders for services in the child's IEP, 504 plan, or Health Care plan before billing.

SourceLink

POLICY UPDATE CHANGES

The bulletin supersedes all previously published guidance on authorization and orders for Medicaid to Schools.

For school year 2021-2022, orders must include the medical condition, the specific service needed, and an authorized practitioner signature and date.

1 yearMaximum order date span

Before billingOrder timing

2020-2021School year requiring date-of-service coverage

Medicaid Billing Requirements

Medicaid billing requirements for school-based medical services

A school-based medical service may be billed to Medicaid when all applicable requirements are satisfied.

ALL of the following

The IEP team recommends the health-related service in an IEP, 504 plan, or Health Care plan.
A medical order is obtained for the medical service included in the child's plan.
The order encompasses the date of service and is in place before services are billed.
The order has a date span of no more than one year. If no date span is stated, or the date span extends beyond one year, the order is effective for one year from the date of signature; the date span or signature date must appear on the order.
For claims submitted for school year 2021-2022, the order includes a description of the medical condition, describes the actual service needed, and is signed and dated by a physician, advanced practice registered nurse, physician assistant, or other licensed practitioner authorized to order services.

Order Validity and Billing Timing

Maximum order date span

Maximum date spanNo more than one year

Longer spanIf the stated date span extends beyond one year, the order is effective for one year from the date of signature

Required locationThe date span or date of signature must appear on the order itself

Order timing

Billing prerequisiteThe order must be in place before services are billed

Date-of-service coverageThe order must encompass the date of service for the service to be billed to Medicaid

Applicable school year

Orders and School-Based Service Billing

Documentation Required

Plan Recommendation and Medical Order Required

The IEP team must recommend health-related services in an IEP, 504 plan, or Health Care plan. Medical orders are required for medical services included in the child’s plan before those services are billed to Medicaid.

Billing Rule

2020–2021 Order Timing and Coverage

For claims submitted for school year 2020–2021, the order must encompass the date of service and must be in place before the school bills Medicaid.

The order must cover the applicable date of service.
Do not submit the claim until the order is in place.

Key Terms

Medical order

DefinitionA written order for a medical service included in the child's IEP, 504 plan, or Health Care plan

Date-of-service coverageThe order must cover the date of service

Pre-billing requirementThe order must be in place before services are billed

Validity periodThe order may have a date span of no more than one year; if no valid span is stated, it is valid for one year from the signature date

Actual service needed

DefinitionThe specific medical service required

Example

Documentation Required

2021–2022 Order Content Requirements

For claims submitted for school year 2021–2022, orders must meet the Section I requirements and include the information needed to establish medical necessity and the service to be delivered.

Include a description of the medical condition.
Describe the actual service needed, such as occupational therapy or skilled nursing.
Have the ordering practitioner’s signature and date.
Include the applicable date span, or the date of signature when no date span is stated.
Ensure the order covers the date of service and is in place before billing.

Billing Rule

Apply Order Effective Dates

Apply the order’s effective dates when submitting claims. A claim may be submitted on or after the order’s signature date; the covered service dates depend on whether the order states a date span.

With a stated date span, follow the order’s authorized span and submit claims on or after the signature date.
Without a date span, the order covers dates of service on or after the signature date and remains valid for one year from that date.
Example: an order signed August 10, 2020 without a date span is valid through August 10, 2021, and claims may be submitted on or after August 10, 2020 for services on or after that date.