Executive Deputy Commissioner

1

/ STATE OF NEW YORK
DEPARTMENT OF HEALTH
584 DELAWARE AVENUE, BUFFALO, NEW YORK 14202
Antonia C. Novello, M.D., M.P.H., Dr.P.H. / Dennis P. Whalen
Commissioner /

Executive Deputy Commissioner

Mr. Thomas J. Markle

Superintendent of Schools

LancasterCentralSchool District

177 Central Avenue

Lancaster, New York 14086

Re:LancasterCentralSchool District

Audit #05-1253

MMIS #01365131

School Supportive Health Services Program

Dear Mr. Markle:

This letter contains a summary of findings for our recently completed review of sample billings by LancasterCentralSchool District to the School Supportive Health Services Program (SSHSP). As you know, the SSHSP assists school districts in obtaining Federal Medicaid funds for certain diagnostic and health related services that traditionally have been funded exclusively through educational resources.

The purpose of this review was to determine whether LancasterCentralSchool District was following the State Education Department program requirements governing the New York State Medicaid Program and was able to provide the appropriate documentation to support its claims. We reviewed 50 claims representing $17,590.81 in services billed from November 19, 2003 through November 18, 2004. Each type of service billed by LancasterCentralSchool District was included in our sample claims.

LancasterCentralSchool District’s Medicaid claims were generally supported by adequate documentation. However, the following two instances of insufficiently documented claims totaling $446.00 must be voided.

SCHEDULE OF PAYMENTS TO BE VOIDED
SAMPLE / CLAIM
CLAIM / REFERENCE / DATE OF / RATE / AMOUNT
NUMBER / NUMBER / SERVICE / CODE / PAID
25 / 2041312557293116 / 02/01/03 / 5329 / $223.00
26 / 2041312557294312 / 01/01/04 / 5329 / 223.00
Total Claims to be Voided / $446.00

DETAILED FINDINGS – CLAIMS TO BE VOIDED

Insufficiently Documented Claims

In 2 sample claims, there was insufficient documentation to support $446.00 in Medicaid payments made to the school district, as follows:

• For Claim #25, a transfer student received psychological counseling services prior to development of the IEP. The IEP was not obtained from the prior school district.

State Education Department Letter, January 2002

Students Transitioning from Preschool to School Age – Page 3

• For Claim #26, a student received one psychological counseling service, although two were billed during January, 2004. Two services are required for billing.

State Education Department Medicaid Claiming/Billing Handbook

(UPDATE #5) – Page 28

The overpayment for Insufficiently Documented Claims totals $446.00.

CORRECTIVE ACTION

We also noted the following procedural issues which do not require any payments to be voided, but which do require corrective action by LancasterCentralSchool District.

• While a provider agreement was available, Statement of Reassignment must also be on file for the CantilicianCenter for Learning, Autistic Services, Inc., Western New York Physical & Occupational Therapy Group, and Carrier Coach, Inc., who provide contracted services to the school district. This statement is required of any agency/provider who is not an employee of the school district or BOCES.

State Education Department Medicaid Claiming/Billing Handbook

(UPDATE #5) – Page 6 and Appendix C-3

These issues were presented to school district staff at our exit conference held on February 24, 2005. At that time, they were instructed you to void $446.00 in payments according to the above schedule and notify us when this was done. At the exit conference, we were informed that the school district will obtain a Statement of Reassignment for all providers contracting with the school district for SSHS.

If you have any questions related to this review, please contact Ms. Deborah Acanfora at (716) 847-5090.

Thank you for the cooperation and courtesy extended to our staff during this review.

Sincerely,

George E. Meeks, Director

Buffalo Medicaid Audit Office

Western Region

Office of Medicaid Management

GEM:kla

cc:Robert Scalise, SED

Suzanne M. Jacobs

Asst. Superintendent for Curriculum,

Instruction, Pupil Services