In recent years, school districts have requested waivers from DHHS to allow districts to seek Medicaid reimbursement for services provided by Board Certified Behavior Analysts (BCBAs) to qualify as Mental Health services.
MSB received clarifying information dated March 3, 2015 further narrowing the function of a BCBA with regard to his/her ability to meet the definition of a Licensed Practitioner of the Healing Arts (LPHA). The state approved several BCBAs for their own provision of Mental Health services but denied the request for BCBAs to function as LPHAs for purposes of providing weekly consultation to those providing Rehabilitative Assistance. The state explained its position as follows:
He-M 1301.02(j) provides a “‘Licensed practitioner of the healing arts’ means any person licensed or certified under state law to provide a medical, psychological, or other service the goal of which is improvement or maintenance of a person’s physical or emotional functioning.” He-M 1301.08(d) provides that no federal requirement may be waived. 42 CFR §440.60(a) defines medical care or other remedial care as that provided by a licensed practitioner within the scope of practice as defined under State law. As a BCBA certification is not pursuant to state law, the request for [BCBAs] to function as licensed practitioners of the healing arts must be denied.
Each district must request and be granted their own waiver in order to submit Medicaid claims for services delivered by a provider who does not specifically meet the Medicaid to Schools Program qualification.
MSB can no longer process claims for Medicaid reimbursement when a BCBA signs as a LPHA providing weekly consultation to paraprofessionals. For purposes of Medicaid reimbursement, we recommend your district act as quickly as possible to identify a properly qualified LPHA, as required under state and federal regulations, who can assume responsibility going forward for weekly consultations to anyone providing Rehabilitative Assistance who has been providing services under the direction of a BCBA.
If you have any questions regarding this change in the state’s waiver approval process or its effect on Medicaid reimbursement, please contact your Program Specialist.