Medicaid School-Based Claiming Resources

Clarification of Medicaid Coverage of Services to Children with Autism

The Centers for Medicare & Medicaid Services (CMS) released an informational bulletin with respect to services available under the Medicaid program to children with autism spectrum disorder (ASD). The bulletin provides information on approaches available under the federal Medicaid program for providing services to eligible individuals with ASD.

Information about IDEA Part B Final Regulations Related to Parental Consent to Access Public Benefits


Other Useful Resources

  • Cost Reporting Guide—Any Arizona PEA may participate in the DSC program. PEA participation in this program is voluntary. If school districts/charters wish to participate in the MAC program, they are required to also participate in the Direct Service Claiming program. School districts/charters cannot participate solely in MAC. Each PEA is required to: be enrolled as an Arizona Medicaid provider, complete a participation agreement with the state-approved third-party administrator (PCG), participate in the Random Moment Time Study (RMTS) process, and submit an annual Cost Report. This guide provides an overview of these requirements.
  • Guidance for Clinical Note Documentation— The information contained in this document is meant to provide guidance on the core elements to include when documenting medical services provided to a student. For purposes of this guidance, the term clinical notes  refers to “those notes written by the qualified medical provider to document what medical services were provided to the student on a particular day.” Clinical notes not only help the medical provider write a student’s progress report but also substantiate that the billed service occurred on the designated date.
  • Guidance for Health Aide Documentation—This document was created through the collaborative efforts of AHCCCS, ADE, local education agency special education directors, and MAXIMUS (a former third-party administrator for the Medicaid School-Based Claiming program). The information contained in this document provides guidance on the documentation needed by both the qualified health care professional and the health aide for billable services provided by the health aide to Medicaid-eligible students. The information for this document reflects what is in the Arizona State Plan Amendment and the AHCCCS Medical Policy Manual.
  • Qualified Medical Provider Table
  • Medical Record Keeping Memo
  • Medicaid School-Based Claiming Program Handbook—This handbook provides the information necessary to successfully participate in the MSBC program.
  • Time Study Implementation Guide—The purpose of the Medicaid School-Based Claiming Time Study Implementation Guide is to inform the third-party administrator (Public Consulting Group or PCG) and school districts/charters of the appropriate methods for claiming federal reimbursement for the cost of Medicaid direct services and administrative activities performed in the school setting. This guide replaced the prior approved MAC Time Study Guide beginning July 1, 2011.Particularly, the guide will:
      • Help schools and school districts prepare appropriate claims for both direct medical services and administrative costs under the Medicaid program;
      • Ensure that the Medicaid program pays only for appropriate school-based services and activities and that such activities are carried out effectively and efficiently;
      • Protect the fiscal integrity of the Medicaid program by clearly articulating the requirements for school-based claiming;
      • Help ensure consistency in the application of federal administrative claiming requirements across school districts;
      • Assist the third-party administrator in implementing operational and oversight functions;
      • Provide technical assistance for the intended audience.


Frequently Asked Questions Resources Memos and Communications Links