The Belen and Los Lunas school districts are taking a stand for children in Valencia County.

The Valencia County school districts are two of 30-some districts statewide that have been battling for two years with the State Human Services Department regarding non-reimbursement of administrative claims for Medicaid In Schools.

The latest battle puts the school districts’ status as Medicaid providers on the line if they do not sign joint powers agreements proposed by the state. The schools have until Sept. 13 to sign the state’s version of the joint powers agreement or else they will lose their ability to file Medicaid claims.

The human services department presented a joint powers agreement to the districts the first of July. In response, the coalition of school districts made suggestions for changes, in the form of its own joint powers agreement.

Mike Ogas, assistant superintendent for special services for the Los Lunas Schools, said the new document is written the way it always has been, “in the best interest of children.”

The human services department responded by taking the districts’ recommendations and modifying their version of the document, but the state agency’s stand on administrative services reimbursement was not changed. This document was mailed to the school district on Friday.

“One area we did respond to was stating that the schools must spend Medicaid money on health care services. There was a big concern of the health care advocates about this clause,” said Eric Wolfe, program manager for children services in the human resources department’s benefits bureau.

But the area of contention is whether the districts will be reimbursed for their administrative costs. The state has said no, while the school districts have said, by federal law, they are supposed to receive the funding.

“Because of the complexity of billing for administrative services, there has been considerable disagreement between the schools and Medicaid. As a result, our director, Robert Maruca, has determined that both the schools and Medicaid are spending far too much energy on this administrative issue,” Wolfe said. “This conflict has not serviced the children well.”

Therefore, the human services department decided to eliminate billing for administrative services. Instead, it added several new provider types that schools may bill within the direct-services category.

“We fund medically necessary services for children who qualify for Medicaid,” said Wolfe.

These services include nurses performing medical tasks related to the qualified students’ Individual Education Plans, such as feeding children with tubes, managing seizures and injection of medication. It also provides for behavior health services from licensed marriage and family therapist, licensed professional clinical councilors and psychiatric nurses.

“I don’t think the state understands the costs required to provide the services in a school environment,” said Peggy Gutjahr, director of health services for Belen. “It’s different than an outside provider, like a doctor’s office. It takes a lot more time to coordinate the services to make them work well for the students.”

Los Lunas officials agree. “Therapists go to meetings that aren’t directly related to servicing children, but, without those processes, we wouldn’t be able to serve children. Indirectly, that part is invaluable to the children,” Ogas said.

Regarding the removal of payment for administrative services, Ogas said, “If we were to comply, we would end up having to reduce health and health-related services to children in our district.”

Ogas said that the elimination of this money means an estimated $5 million to $7 million a year loss in revenue to New Mexico school districts.

“The human services department also wants to eliminate the State Department of Education as a joint partner in the agreement. We disagreed about that. They were, in the beginning, a very viable partner in making this collaboration work so education could benefit from health services,” Ogas said.

The original intent of Medicaid In Schools was for districts to improve health and health-related services to qualified students.

School districts generate funds in two ways — direct services and administrative claims.

Direct services are those that are provided to eligible children, as prescribed by their Individual Education Plans. The district gets a fee for this service. In the battle over the joint powers agreement, these funds are not in danger of being lost, except if the districts lose their provider status.

Both Valencia County school district administrators say the federal funds have been invaluable. The districts have been able to add nurses, psychologists and social workers.

“New Mexico has added hundreds of positions in behavioral and health-related services in the schools because of the funds,” Ogas said.

Because of the disagreement with the state, it’s likely many of the services will be cut.

“Some districts have to make tough decisions. We have stayed solvent by moving positions to other areas of the budget,” Ogas said.

The battle started a few years ago when districts across the state and the human services department differed on their interpretation of what services were allowed on claims.

“It started when administrative claims for many districts, not just Los Lunas, were denied,” Ogas said.

Administrative claims are submitted by therapists, who report what they’re doing throughout the day. Every 15 minutes, they record the specific tasks they are performing.

The human services department continually asked the district to change its claims to comply with its interpretation of what was acceptable.

“We weren’t there, so we trust what they’re doing. We shouldn’t be changing the intentions of what they are claiming,” Ogas said.

The battle has cost the Valencia County school districts several hundred thousand dollars. Los Lunas alone has lost close to $250,000.

“We’re not alone. Across the state, roughly $6 million has been lost,” Ogas said.

Attorneys for school districts may be seeking injunctions against the human services department. Los Lunas is also looking at legal avenues until the debate is resolved. The district hopes to allow funds to continue until a resolution is found.

The coalition of districts has already been to mediation with the state agency to resolve the billing questions.

The coalition of districts has filed a lawsuit against the human service department, but it has not been heard at the district level in Santa Fe.

Both the Legislative Finance Committee and the Education Study Committee have heard about the situation and encouraged the human services department to pay for Medicaid in the schools.

“Now, we wait to see what the response is,” Ogas said of the state’s reaction to the districts’ version of the joint powers agreement. “I’m concerned because it doesn’t seem like they want to bend in their position. It’s beyond our comprehension.”

“My biggest concern is: how do we make this work,” said Gutjahr, who is the co-chair of the state-wide Medicaid Advisory Council. “Medicaid in the schools works well in other states. It is a wonderful opportunity to provide services to children who might not get them elsewhere. It is a shame we in New Mexico can’t work together.”

What’s your Reaction?
+1
0
+1
0
+1
0
+1
0
+1
0
+1
0
Jennifer Harmon