Medical-surgical questions with correct answers you will never miss in every Exam 100%

Don't panic because of examination, all you have to do is go through this document. The document entails of most frequently asked question in every exam with well explained answer. Trust me if you do so A will be your only grade. Q. Who is responsible for setting Medicaid policy and reimbursement rates for the Preschool/School Supportive Health Services Program (SSHSP)? The responsibility for setting Medicaid policy and reimbursement rates for the SSHSP resides with the DOH Office of Health Insurance Programs (OHIP). OHIP has restructured the Preschool/School Supportive Health Services Program to meet all applicable federal, state and Medicaid regulations, to ensure that future claims are in compliance with all applicable requirements. [June 11, 2010] Q. What is a State Plan Amendment and how does it impact the SSHSP? A State Plan Amendment (SPA) is a comprehensive written statement prepared by a State and submitted to CMS describing the nature and scope of Medicaid coverage and reimbursement and giving assurance that both will be administered in conformity with the specific requirements of Title XIX of the Social Security Act, the regulations in 42CFR Section 430.10 and other applicable official issuances of the New York State Department of Health. CMS determines whether the SPA can be approved to serve as a basis for federal financial participation in the State Medicaid program. The SPA submitted to CMS defines the services, providers and their qualifications, and reimbursement methodology for the SSHSP. DOH has worked closely with the NYS Department of Education to develop a SPA that meets the federal requirements applicable to the SSHSP. [June 11, 2010] Q. What is the current status of the State Plan Amendment? The SSHSP SPA was approved by CMS on April 26, 2010, effective September 1, 2009. For additional information, see State Plan Amendment #09-61. [June 11, 2010] Q. When will billing for Medicaid-covered preschool/school supportive health services resume? School districts, counties and §4201 schools will be able to begin billing for the SSHSP services described in SPA #09-61 once the necessary system changes are in place. The target date is July 1, 2010. [June 11, 2010] Q. Will school districts, counties, and §4201 schools be able to bill retroactively? Yes. Medicaid billing will be retroactive for services provided on or after September 1, 2009 and prior to July 1, 2009, as long as those services meet the Medicaid requirements as described in SPA #09-61 and there is proper documentation to support the claims. [June 11, 2010] Q. Can school districts, counties and §4201 schools bill retroactively for services provided from July 1, 2009 through August 31, 2009? No. The Medicaid program does not have federal approval to pay claims for services provided during this time period. Therefore, school districts, counties, and §4201 schools may not bill for services provided from July 1, 2009 through August 31, 2009. [June 11, 2010] Compliance Agreements Q. What is the difference between the Compliance Agreement and the Compliance Program for the SSHSP? There is a Compliance Agreement between NYS and CMS. This is the agreement between the federal and state government to ensure compliance with Medicaid requirements. There is also a Compliance Program required by Social Services Law (SSL) Section 363-d, which is administered by the NYS Office of the Medicaid Inspector General (OMIG). The SSL-required Compliance Program mandates that all Medicaid providers claiming over $500,000/year implement a compliance program. [June 11, 2010] Q. What are the conditions of the NYS Compliance Agreement with CMS? The NYS Compliance Agreement with CMS is the legal arrangement that New York State has with the federal Centers for Medicare and Medicaid Services (CMS) to prevent fraud, abuse, and false billing to Medicaid in the SSHSP. The terms and conditions address: Appointment of Compliance Officer and Compliance Committee Audit Requirements Independent Audits Annual Written Reports Written Policies to Ensure Compliance Training Confidential Disclosure State Plan Amendment and Revisions to Reimbursement Methodology Implementation Plan Certifications [June 11, 2010] Q. What is the purpose of the Mandatory Compliance Law? The Mandatory Compliance Law, Chapter 442 of the Laws of 2006, established the NYS Office of the Medicaid Inspector General (OMIG) and created SSL §363-d, which requires Medicaid providers develop, adopt and implement effective compliance programs aimed at detecting fraud, waste, and abuse in the Medicaid program. The purpose is to ensure that providers establish systemic checks and balances to detect and prevent inaccurate billing and inappropriate practices in the Medicaid program. [June 11, 2010] Q. Who must have an OMIG compliance program? The Mandatory Compliance Law applies to Medicaid providers operating as clinics under the Public Health Law, clinics operating under Mental Hygiene Law, and those providers who order, provide, bill or claim $500,000 or more from Medicaid in a 12month period. The $500,000 threshold applies if a provider receives the reimbursement directly or indirectly from Medicaid funds. If the provider meets either the statutory provisions or monetary thresholds, there are no exemptions. The law is applicable to providers of preschool and school supportive health services. [June 11, 2010] Note: The response to Question #11 was revised December 10, 2012. Deletions are struck through and additions are underlined. Q. How can an OMIG compliance program be developed for multiple school districts providing school supportive health services? This response is under development. School districts providing SSHSP services can collaborate on the development of a compliance program. Each school district must then tailor the program for its own use to meet regulations at Title 18 NYCRR (Social Services) – Part 521. For information on the OMIG compliance program, refer to the Compliance link on the OMIG website at: Q. What must an OMIG compliance program contain? OMIG compliance programs apply to Medicaid billing and payments. The minimum requirements may be found in 18 NYCRR §521.3 (c) and include: Written policies and procedures that describe compliance expectations; Designation of an employee vested with the responsibility for the day-to-day operation of the compliance program (compliance officer); Training and education for affected employees and persons associated with the provider; Establishment of communication lines to the compliance officer for anonymous/confidential disclosure; Disciplinary policies to encourage good faith participation in the compliance program by all affected individuals; Creation of a system for routine identification of compliance risk areas specific to the provider type; Creation of systems for responding to compliance issues as they are raised; and, A policy barring intimidation or retaliation for participating in the compliance program. For additional information on compliance programs, consult the OMIG website at [June 11, 2010] General Requirements – IDEA and SSHSP Q. What is the Individuals with Disabilities Education Act (IDEA)? In 1975, Congress passed Public Law 94-142 (Education of All Handicapped Children Act), which was the first major law to ensure a public education for children with disabilities, ages five to 21. The intent was to provide each student with a disability a free appropriate public education (FAPE). The Act has been reauthorized several times since, includes children ages three to five years, and is now codified as the Individuals with Disabilities Education Act (IDEA) (PL 108-446). States are required to establish and implement policies that assure a FAPE to all children with disabilities. [June 11, 2010] Q. How does Medicaid relate to education for children with disabilities? A 1988 amendment to the Social Security Act provided statutory authority for SSHSP, also known as Medicaid in Education, by allowing Medicaid coverage of medically necessary services included in the Individualized Education Programs (IEPs) of students with disabilities. The purpose of SSHSP is to assist school districts, §4201 schools and counties in obtaining Medicaid reimbursement for certain diagnostic and health support services provided to students with disabilities. The SSHSP applies to students with Medicaid coverage from age three years up to their twenty-first birthday. [June 11, 2010] Q. What is an Individualized Education Program (IEP)? An IEP is a written statement for a student with a disability that is developed, reviewed and revised by a Committee on Special Education (CSE), Subcommittee on Special Education or Committee on Preschool Special Education (CPSE). The IEP is the tool that ensures a student with a disability has access to the general education curriculum and is provided the appropriate learning opportunities, accommodations, adaptations, specialized services and supports needed for the student to progress towards achieving the learning standards and to meet his or her unique needs related to the disability. Each student with a disability must have an IEP in effect by the beginning of each school year. Federal and State laws and regulations specify the information that must be documented in each student’s IEP. In New York State (NYS), IEPs developed for the 2011-12 school year and thereafter, must be on a form prescribed by the Commissioner of Education. [June 11, 2010] Note: The response to Question #16 was revised November 24, 2014. Deletions are struck through and additions are underlined. Q. What are the requirements for Medicaid reimbursement of services under SSHSP? In order for children to receive Medicaid reimbursable services under SSHSP/PSSHSP, they must be Medicaid eligible, be between the ages of three and 21 years, have been determined to have a disability through the IEP process and have an IEP. In addition, to qualify for reimbursement under New York State Medicaid, SSHSP services must be: Medically necessary and included in a Medicaid covered category (speech therapy, physical therapy, etc.) in accordance with State Plan amendment 0961; Ordered by a NYS Medicaid enrolled* practitioner acting within his or her scope of practice; Included in the student’s Individualized Education Program (IEP); Provided by qualified professionals under contract with or employed by a school district; a §4201 school; an approved pre-school; a county in the State or the City of New York; Furnished in accordance with all requirements of the State Medicaid Program and other pertinent state and federal laws and regulations, including those for provider qualifications, comparability of services, and the amount, duration and scope provisions; and, Included in the State’s Medicaid plan and/or available under Early Periodic Screening, Diagnosis and Treatment (EPSDT). [November 24, 2014] * Please note that referrals for psychological evaluations and counseling services may be made by an appropriate school official or other voluntary health or social agency. School officials are not allowed nor required to enroll as NYS Medicaid providers. Q. What is a §4201 school? §4201 State-Supported Schools are institutions for the instruction of the deaf, blind, physically, or multiply disabled under §4201 of the New York State Education Law. There are two State Operated and Supported (4201) Schools and 11 StateSupported (4201) Schools in New York State that offer services to children with disabilities ages three through twenty-one years: Cleary School for the Deaf Henry Viscardi School Lavelle School for the Blind Lexington School for the Deaf Mill Neck Manor School for the Deaf New York Institute for Special Education New York School for the Deaf Rochester School for the Deaf St. Francis de Sales School for the Deaf St. Joseph’s School for the Deaf St. Mary’s School for the Deaf [June 11, 2010] Medicaid Covered Services and Provider Qualifications Under SSHSP Q. What Medicaid services are covered under SSHSP? The ten covered services are: Physical therapy services Occupational therapy services Speech therapy services Psychological evaluations Psychological counseling Skilled nursing services Medical evaluations Medical specialist evaluations Audiological evaluations Special transportation services [June 11, 2010] Note: The response to Question #19 was revised November 24, 2014. Deletions are struck through and additions are underlined. Q. What are the requ