Common use of School-Based Services Clause in Contracts

School-Based Services. The State uses the School-Based Health Services Program to obtain Medicaid reimbursement for medical services provided by schools to eligible students. To be eligible, the students must be enrolled in Medicaid, receiving special education services, and receiving Medicaid-billable services. School districts can claim reimbursement under the Program only for those students on an individualized education program (“IEP”) and not for students on 504 plans. A release of protected health information for each eligible student is required before any claims can be processed. The parent or guardian has the right to refuse to give consent to such a release. In such case, the school district cannot claim Medicaid reimbursement for any services provided to that student. Additionally, a Vermont Medicaid enrolled physician or a nurse practitioner must sign a physician authorization form, establishing that the IEP services are medically necessary. Federal Individuals with Disabilities Education Improvement Act (“IDEA”) statutes and regulations govern the process for assessing needs and developing the IEP. Separate Agency of Education (AOE) due process and appeals procedures apply when there is a disagreement concerning the services included in the IEP. Parents of a child receiving special education services who disagree with decisions made by the school regarding a child’s identification, eligibility, evaluation, IEP or placement have three options available under the AOE procedures for resolving disputes with the school: mediation, a due process hearing and/or an administrative complaint. The Agency of Education due process and appeals procedures also apply to Global Commitment services authorized under Part C of IDEA. DVHA will ensure that coverage policies for outpatient drugs as defined in section 1927(k)(2) of the Social Security Act (SSA), meets the standards for such coverage imposed by section 1927 of the SSA. DVHA will: • Collect drug utilization data that is necessary for States to bill manufacturers for rebates in accordance with section 1927(b)(1)(A) of the SSA Act no later than 45 calendar days after the end of each quarterly rebate period. Such utilization information must include, at a minimum, information on the total number of units of each dosage form, strength, and package size by National Drug Code of each covered outpatient drug dispensed or covered by the MCO, PIHP, or PAHP, including procedures to exclude utilization data for covered outpatient drugs that are subject to discounts under the 340B drug pricing program. • Operate a drug utilization review program that complies with the requirements described in section 1927(g) of the SSA Act and 42 CFR part 456, subpart K. • Provide a detailed description of its drug utilization review program activities to AHS on anannual basis. • Conduct a prior authorization program that complies with the requirements of section 1927(d)(5) of the SSA Act.

School-Based Services. The State uses the School-Based Health Services Program to obtain Medicaid reimbursement for medical services provided by schools to eligible students. To be eligible, the students must be enrolled in Medicaid, receiving special education services, and receiving Medicaid-billable services. School districts can claim reimbursement under the Program only for those students on an individualized education program (“IEP”) and not for students on 504 plans. A release of protected health information for each eligible student is required before any claims can be processed. The parent or guardian has the right to refuse to give consent to such a release. In such case, the school district cannot claim Medicaid reimbursement for any services provided to that student. Additionally, a Vermont Medicaid enrolled physician or a nurse practitioner must sign a physician authorization form, establishing that the IEP services are medically necessary. Federal Individuals with Disabilities Education Improvement Act (“IDEA”) statutes and regulations govern the process for assessing needs and developing the IEP. Separate Agency of Education (AOE) due process and appeals procedures apply when there is a disagreement concerning the services included in the IEP. Parents of a child receiving special education services who disagree with decisions made by the school regarding a child’s identification, eligibility, evaluation, IEP or placement have three options available under the AOE procedures for resolving disputes with the school: mediation, a due process hearing and/or an administrative complaint. The Agency of Education due process and appeals procedures also apply to Global Commitment services authorized under Part C of IDEA. DVHA will ensure that coverage policies for outpatient drugs as defined in section 1927(k)(2) of the Social Security Act (SSA), meets the standards for such coverage imposed by section 1927 of the SSAAct. DVHA will: • Collect drug utilization data that is necessary for States to bill manufacturers for rebates in accordance with section 1927(b)(1)(A) of the SSA Act no later than 45 calendar days after the end of each quarterly rebate period. Such utilization information must include, at a minimum, information on the total number of units of each dosage form, strength, and package size by National Drug Code of each covered outpatient drug dispensed or covered by the MCO, PIHP, or PAHP, including procedures to exclude utilization data for covered outpatient drugs that are subject to discounts under the 340B drug pricing program. • Operate a drug utilization review program that complies with the requirements described in section insection 1927(g) of the SSA Act and 42 CFR part 456, subpart K. • Provide a detailed description of its drug utilization review program activities to AHS on anannual an annual basis. • Conduct a prior authorization program that complies with the requirements of section 1927(d)(5) of the SSA Act.

School-Based Services. The State uses the School-Based Health Services Program to obtain Medicaid reimbursement for medical services provided by schools to eligible students. To be eligible, the students must be enrolled in Medicaid, receiving special education services, and receiving Medicaid-billable services. School districts can claim reimbursement under the Program only for those students on an individualized education program (“IEP”) and not for students on 504 plans. A release of protected health information for each eligible student is required before any claims can be processed. The parent or guardian has the right to refuse to give consent to such a release. In such case, the school district cannot claim Medicaid reimbursement for any services provided to that student. Additionally, a Vermont Medicaid enrolled physician or a nurse practitioner must sign a physician authorization form, establishing that the IEP services are medically necessary. Federal Individuals with Disabilities Education Improvement Act (“IDEA”) statutes and regulations govern the process for assessing needs and developing the IEP. Separate Agency of Education (AOE) due process and appeals procedures apply when there is a disagreement concerning the services included in the IEP. Parents of a child receiving special education services who disagree with decisions made by the school regarding a child’s identification, eligibility, evaluation, IEP or placement have three options available under the AOE procedures for resolving disputes with the school: mediation, a due process hearing and/or an administrative complaint. The Agency of Education due process and appeals procedures also apply to Global Commitment services authorized under Part C of IDEA. DVHA will ensure that coverage policies for outpatient drugs as defined in section 1927(k)(2) of the Social Security Act (SSA), meets the standards for such coverage imposed by section 1927 of the SSAAct. DVHA will: • Collect drug utilization data that is necessary for States to bill manufacturers for rebates in accordance with section 1927(b)(1)(A) of the SSA Act no later than 45 calendar days after the end of each quarterly rebate period. Such utilization information must include, at a minimum, information on the total number of units of each dosage form, strength, and package size by National Drug Code of each covered outpatient drug dispensed or covered by the MCO, PIHP, or PAHP, including procedures to exclude utilization data for covered outpatient drugs that are subject to discounts under the 340B drug pricing program. • Operate a drug utilization review program that complies with the requirements described in section 1927(g) of the SSA Act and 42 CFR part 456, subpart K. • Provide a detailed description of its drug utilization review program activities to AHS on anannual an annual basis. • Conduct a prior authorization program that complies with the requirements of section 1927(d)(5) of the SSA Act.

School-Based Services. The State uses the School-Based Health Services Program to obtain Medicaid reimbursement for medical services provided by schools to eligible students. To be eligible, the students must be enrolled in Medicaid, receiving special education services, and receiving Medicaid-billable services. School districts can claim reimbursement under the Program only for those students on an individualized education program (“IEP”) and not for students on 504 plans. A release of protected health information for each eligible student is required before any claims can be processed. The parent or guardian has the right to refuse to give consent to such a release. In such case, the school district cannot claim Medicaid reimbursement for any services provided to that student. Additionally, a Vermont Medicaid enrolled physician or a nurse practitioner must sign a physician authorization form, establishing that the IEP services are medically necessary. Federal Individuals with Disabilities Education Improvement Act (“IDEA”) statutes and regulations govern the process for assessing needs and developing the IEP. Separate Agency of Education (AOE) due process and appeals procedures apply when there is a disagreement concerning the services included in the IEP. Parents of a child receiving special education services who disagree with decisions made by the school regarding a child’s identification, eligibility, evaluation, IEP or placement have three options available under the AOE procedures for resolving disputes with the school: mediation, a due process hearing and/or an administrative complaint. The Agency of Education due process and appeals procedures also apply to Global Commitment services authorized under Part C of IDEA. DVHA will ensure that coverage policies for outpatient drugs as defined in section 1927(k)(2) of the Social Security Act (SSA), meets the standards for such coverage imposed by section 1927 of the SSAAct. DVHA will: • Collect drug utilization data that is necessary for States to bill manufacturers for rebates in accordance with section 1927(b)(1)(A) of the SSA Act no later than 45 calendar days after the end of each quarterly rebate period. Such utilization information must include, at a minimum, information on the total number of units of each dosage form, strength, and package size by National Drug Code of each covered outpatient drug dispensed or covered by the MCO, PIHP, or PAHP, including procedures to exclude utilization data for covered outpatient drugs that are subject to discounts under the 340B drug pricing program. • Operate a drug utilization review program that complies with the requirements described in section 1927(g) of the SSA Act and 42 CFR part 456, subpart K. • Provide a detailed description of its drug utilization review program activities to AHS on anannual an annual basis. • Conduct a prior authorization program that complies with the requirements of section 1927(d)(5) of the SSA Act.