Story by Dan Hust
SULLIVAN COUNTY — Red tape at the state and federal levels has cost Sullivan County around $150,000-$210,000 in its Preschool Special Education Program.
The program, which offers educational and transportation services to children identified as delayed in their development, currently costs the county approximately $4.5 million a year, with the NYS Education Dept. reimbursing the county for 59.5 percent, or about $2.7 million.
In 2007, New York stopped counties from billing it for pre-school Medicaid reimbursement after a lawsuit compelled the state to launch an investigation into millions of dollars of fraudulent provider bills across the state.
“As a result, the settlement agreement reached required a massive overhaul to the Medicaid billing component of the Preschool Special Education Program,” recalled Sullivan County Public Health Director Carol Ryan.
In 2010, the state lifted that moratorium, but the new billing rules took so long to implement and were so complex that billing did not recommence.
The necessary retraining, said Ryan, wasn’t even offered by the state to Sullivan County personnel until 2011.
“The documentation was onerous and, as an example, required signed parental consent to release documentation which would allow Medicaid billing,” Ryan remarked. “Without the consent, Medicaid could not be billed.”
The next delay arrived courtesy of the federal government, which also decided to revise the rules about parental consent documentation.
“Neither the state nor federal government has made the revised parental consent form available to the counties,” Ryan said in June. “As a result, billing Medicaid for eligible Pre-K services was frozen effective March 1, 2013.”
That second moratorium was lifted just this past week.
The county has begun billing Medicaid again, said Ryan, but it can only back-bill the past two years (to 2011).
That means that the Medicaid reimbursement the county is owed from between 2007 and 2010 – around $150,000-$210,000, said Ryan – won’t be forthcoming. Ever.
“Comparable to previous years that Sullivan County was able to bill Medicaid for Preschool Special Education services, the amount would be between $50,000 and $70,000 per year,” she confirmed. “Although Medicaid reimbursement for these years is not possible, all those services have been or will be billed to the state for 59.5 percent reimbursement.”
Ryan, who retires at the end of this month, said her staff have complied with all the state mandates and are ready to begin this new process, as well.
“The Pre-K Program has purchased a Medicaid billing program that will complete necessary system and documentation checks to ensure all regulatory documentation is in place before billing,” she explained.