Opportunity for Kepro Review of IEP Documentation for School-Health Related Services under MaineCare Sections 28 and 65  

Opportunity for Kepro Review of IEP Documentation for School-Health Related Services under MaineCare Sections 28 and 65  

The Office of MaineCare Services (OMS) and the Maine Department of Education  (MDOE) are pleased to announce that, effective September 1, 2021, Kepro will be able to review MaineCare members’ Individualized Education Program (IEP) documentation at the time providers submit a Prior Authorization (PA) request for services, pursuant to the MaineCare Benefits Manual (MBM). This review will help providers ensure that there is alignment between the member’s IEP and the services being requested, prior to delivery of the services. 

Providers may voluntarily take advantage of this opportunity for review from September 1, 2021 through December 31, 2021; beginning in January 2022, the current plan is for Kepro to conduct this IEP review as a regular, mandatory component of their general prior authorization request process.  

As a reminder, as communicated in recent joint guidance from the Maine Department of Health and Human Services (MDHHS) and MDOE, Section 1903(c) of the federal Social Security Act permits Medicaid payments for medical services provided to children under the Individuals with Disabilities Education Act (IDEA) through a child’s IEP. Documentation that health-related services are being provided as part of a member’s IEP is required under federal law to ensure the services are Medicaid reimbursable. 

During this voluntary “soft launch” period, providers who take advantage of Kepro’s new review process will be asked to indicate if the requested service is being provided pursuant to IDEA regulations. If the answer is yes, the provider will be asked if they would like to have the IEP reviewed for compliance with OMS/MDOE guidance. If so, providers will then be able to submit the IEP cover page, along with Sections 6 and 7 of a member’s IEP.  

Kepro will review the submitted IEP documents to ensure services are documented in accordance with the DHHS/MDOE joint guidance. Providers will be notified if documentation is not in compliance; they will then have the opportunity to correct and update the member’s IEP. Service authorizations will be placed on hold until providers upload the updated IEP. The Kepro IEP review process will help providers ensure their documents are aligned with IDEA and federal requirements prior to the provision of services. As reminder, IEP services must be a determination of the IEP team and cannot be altered or added solely for the purpose of MaineCare authorization of payment. 

Whether or not providers participate in this voluntary review process starting in September, federal law requires that providers keep IEP documents on file that are aligned with services provided. All providers will be required to submit IEP documents via the Atrezzo portal once the final process becomes mandatory in January 2022. 

Additional information regarding the provision of MaineCare-covered services in schools is available on the MaineCare in Education website.  Providers will also find a recording of the joint OMS/MDOE presentation from June 2, 2021. To access the recording, please use Passcode:  %r^KpD51. 

For technical assistance with the IEP process, please contact Colette.Sullivan@maine.gov or Roberta.Lucas@maine.gov.

For technical assistance regarding the billing and processing of MaineCare claims, please email MaineCareinEducation.DHHS@maine.gov or Rebecca.A.Maranda@maine.gov.