School Based Admin Claiming Local Edu Agencies ( C5988 )

2026-11-03

The Centers for Medicare and Medicaid Services ( CMS ) approved a state plan amendment that allows the Department to reimburse Local Education Agencies ( LEAs ) approximately 70 % of their costs for the provision of Medicaid covered services to Medicaid recipients in accordance with an Individualized Education Plan ( IEP ), an Individual Family Service Plan ( IFSP ) or are otherwise medically necessary . This amendment constitutes an expansion of services provided by LEAs . SCOPE OF WORK ; 1 . Ensure that a statewide , toll - free telephone system is installed with sufficient staff and lines to handle the daily call volume . The toll - free telephone system will include internal monitoring processes to monitor its call center and automated answering system for accuracy , sufficiency , and customer service . Hours of operation for the telephone system will be Monday through Friday ( M - F ), 8 : 00 AM – 6 : 00 PM EST / DST . 2 . Establish a grievance system that allows the LEAs to make an inquiry or complaint directly to the Vendor . If LEA does not accept the Vendor ' s findings or response , the system must provide for an appeal to the Department . The Vendor is to resolve any grievance within thirty ( 30 ) days of its filing . An LEA may appeal the denial of a claim for reimbursement or recoupment of an overpayment by the Department or Vendor , LLC in accordance with 907 KAR 1 : 563 3 . Include internal monitoring processes to verify the accuracy of all training materials , including periodic review and updating , as needed . Access ( geographical and individual LEA access ) to training programs established by Vendor in support of the School - Based Health Services Program is expected to be monitored for LEA attendance , understanding of materials / information , customer satisfaction , and to assist in identifying ongoing technical assistance needs . Vendor is expected to have quality monitoring in place to ensure the training modules developed encourage coordination of Early Periodic Screening , Diagnosis , and Treatment ( EPSDT )- related services with other EPSDT providers / contractors , as identified by the Department .

Kentucky

2026-05-08