Medicaid Reimbursement Program

FCPS can bill Medicaid for services provided to Medicaid- and FAMIS-eligible disabled students.

The FCPS Medicaid reimbursement program is committed to supplementing and enhancing mandated special education programs with funds from the Virginia Medicaid and Schools Reimbursement Program.

This program is a way for local school divisions to access federal funds for health-related services being provided to Medicaid- and FAMIS-eligible students receiving special education services.

The Individuals with Disabilities Education Act (IDEA) provides that children with disabilities be provided with a free appropriate public education. The special education and related services received by the child must be identified as the result of a comprehensive evaluation and described in an individual education plan (IEP). These services are provided free of charge to disabled, eligible students.

This program is operational in more than 120 Fairfax County schools, supporting students receiving services in all autism, mild retardation, moderate retardation, noncategorical, physically disabled, preschool, and severely disabled programs. The revenue generated from this program will be used to enhance the mandated special education programs.

Covered Services

Administrative Claiming

Audiology

  • Audiology assessments
  • Audiology therapy

Occupational Therapy

  • Occupational therapy assessments
  • Occupational therapy individual sessions
  • Occupational therapy group sessions

Physical Therapy

  • Physical therapy assessments
  • Physical therapy individual sessions
  • Physical therapy group sessions

Psychological Services

  • Psychological assessments
  • Counseling services

Speech Therapy

  • Speech therapy assessments
  • Speech therapy individual sessions
  • Speech therapy group sessions

Transportation (Special Education)

Information on Parental Consent

If your child is now or later becomes eligible for Medicaid or FAMIS and is evaluated for, receives, or is considered for, covered services written in the IEP, the federal government can reimburse FCPS for those services. Your consent is needed in order to allow our district to receive funding to enhance FCPS special education programs.

FCPS can seek reimbursement for services outlined in the IEP which may include: evaluation and testing services requested by the IEP team along with physical therapy, occupational therapy, speech-language, psychological, audiology, and skilled nursing services.

The Federal Medicaid-FAMIS program encourages states to pursue funds from their Medicaid-FAMIS program to help pay for services that are delivered in the schools. For many children, schools are the primary point of entry to receiving needed health and social services. Section 1903 (c) of the Social Security Act was amended to allow Medicaid-FAMIS coverage of health-related services provided to children under IDEA.

FCPS uses the funds our district receives to enhance programs for students with special needs by providing more resources for staff, equipment, and supplies.

FCPS is required by the Family Educational Rights and Privacy Act (FERPA) to obtain parent consent before disclosing information about a student with a disability. This includes providing information to the Medicaid agency.

Parental consent is only required one time. Consent is valid while your child is enrolled in FCPS, until your child no longer receives billable services per the IEP, or until you revoke consent.

Parent consent is voluntary and can be revoked at any time. If you grant consent and revoke it at a later time, the revocation will not be retroactive and the services performed during the time your consent was in place will still be billed to the Medicaid agency. Please contact the Medicaid office at 571-423-4098 if you want to change your consent decision.

Your child’s educational program is based on his or her educational needs as defined by the IEP. Your consent decision will in no way impact his or her services regardless of the Medicaid-FAMIS consent status. However, denial of consent affects the district’s ability to access funds that benefit the education of students with disabilities.

FCPS can only bill for services if a child is identified as receiving Medicaid-FAMIS benefits. Losing Medicaid-FAMIS benefits will not impact the services your child receives.

Special education services are provided to students with disabilities at no cost to the parent, guardian, or adult student. Your child is entitled to a free and appropriate public education (FAPE) under IDEA. You will not suffer any financial loss as a result of consenting to the billing for Medicaid-FAMIS services.

Services received outside the school setting will not be affected. Medicaid-FAMIS services received from an outside practitioner are authorized separately from services provided in the school setting. If you feel that your outside services are being impacted, you are encouraged to contact the Medicaid office at 571-423-4098. The Medicaid office will follow-up with the state’s Medicaid agency.

FCPS will not bill your private insurance for IEP related services. It is important for you to know that signing the consent form does not reduce your private insurance benefits nor other Medicaid-FAMIS services that you or your family receive.

School billing does not count towards the maximum amount of sessions you are allowed for private services. When schools seek reimbursement, these sessions will not impact the maximum amount of sessions allowed when receiving private services.

If your private service provider tells you not to sign the consent because your private services will not be reimbursed if the school seeks reimbursement, please have them contact the Medicaid agency at 804-225-3231 for clarity. Billing for school services will not impact the billing of private services.

School billing does not have an impact on services received under the Medicaid waiver program. Being enrolled in the school billing program and the Medicaid waiver program will not impact services received under the Medicaid waiver program.

Your Medicaid-FAMIS information is protected. We understand that your medical and health information is personal. Protecting your health information is important. FCPS follows strict federal and state laws that require us to maintain the confidentiality of your health information.

The only information that is shared with the Medicaid agency to access this funding is your child’s last name, first name, date of birth, Medicaid-FAMIS ID number, date of service, service being provided, diagnosis information, and any supporting documentation.

In order to process claims for reimbursement of Medicaid-FAMIS covered services outlined in the IEP, information about your child’s participation in services may be provided to participating physicians, other health care providers, the Medicaid agency, any Medicaid agency billing agents, and any FCPS billing agents.

You have the right to revoke your consent at any time. To revoke consent you should contact the FCPS Medicaid office at 571-423-4098 to request that your consent be revoked.

Contact the FCPS Medicaid office at 571-423-4098 if you have additional questions or concerns.