Medicaid Claim
A formal request submitted to Medicaid for reimbursement of health-related servicesRelated Services Support services (such as speech therapy, occupational therapy, or transportation) that are required to assist a child with a disability in benefiting from their educational program. provided to eligible individuals.
Medicaid Compliance
The adherence to federal and state regulations governing the proper documentation, billing, and use of Medicaid funds for reimbursable services.
Medicaid Reimbursement
The process of receiving payment from Medicaid for services provided to eligible students as part of a school-based program.
Medicaid-Eligible Students
Students who meet specific income and eligibility criteria, making them qualified to receive health-related servicesRelated Services Support services (such as speech therapy, occupational therapy, or transportation) that are required to assist a child with a disability in benefiting from their educational program. reimbursed by Medicaid.
Modifications
Changes made to the curriculum or assessments to meet the needs of a student with disabilities, potentially altering what is taught or how success is measured.
Multidisciplinary Evaluation Team (MET)
A team that evaluates a student to determine whether they have a disability and what services they may require.
National Provider Identifier (NPI)
A unique 10-digit identification number assigned to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS) to streamline billing and improve healthcare data management.
Present Levels of Academic Achievement and Functional Performance (PLAAFP)
A section of the IEP that describes the student’s current academic and functional performance, providing a baseline for setting goals.
Prior Written Notice (PWN)
A formal notice that schools must provide to parents when proposing or refusing to initiate or change the identification, evaluation, or placement of a child.
Random Moment Time Study (RMTS)
A federally approved method used to determine the amount of time school staff spends on Medicaid-eligible activities, supporting accurate billing and cost allocation.
