Finding 1124386 (2024-003)

2024-003 – Medical Assistance (Medicaid School Based Services) Criteria: For an agency to bill Wisconsin Medicaid for School Based Services (SBS), an IEP, and Consent to Bill Wisconsin Medicaid for Medically Related Special Education and Related Services (DPI Form M-5) must be current, signed, and dated by the parent or guardian of a student with an IEP before claims can be submitted.The School District must obtain parental consent before the District accesses Wisconsin Medicaid for the first time. Condition: There were two students tested that did not have signed consent to bill forms on file. The District received reimbursements for services provided to these two students from Medicaid SBS. Without the signed consent to bill forms, theses services are not eligible for reimbursement. Cause: The District had a transition in staffing and the process step to verify signed consent to bill forms was missed. Effect: A reimbursement request was made for services that were not eligible to be reimbursed and did not comply with Medicaid SBS requirements. Auditor’s Recommendation: Establish controls to verify all student services billed to Medicaid SBS have a signed consent to bill on file. Grantee Response: The District will review Medicaid SBS consent to bill forms and verify signed copies are on file going forward.