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Medical vs. Educational Standard of Care

Updated: Feb 12

One statement that is often made by district's is that they don't provide a medical standard of intervention but rather an "educational standard". Yet, the same school collects consent forms from parents seeking to obtain reimbursement for covered services from Medicaid. Here's what you need to know:


District's who so solicit for Medicaid reimbursement are holding themselves out as Medicaid providers. They, like any hospital or clinic or practice which accepts Medicaid, are held to the same standard:


"The medically necessary services must be of a quality that meets professionally recognized standards of health care, and must be substantiated by records including evidence of such medical necessity and quality” (130 CMR 450.204(1)(B)).


Thus, even if the district wanted to leverage IDEA's perhaps lower standard of "progress commensurate with individual potential" as a Medicaid provider, the district is still required to provide a medical standard of care. To do any less would open them to a potential claim of Medicaid fraud.


Remember, gaslighting only works when you don't know your rights. Here's reference material to help you learn about how this process works including examples of services typically seen in an IEP:

https://www.mass.gov/…/sbmp-direct-service-claimin…/download


And, if you want to see a sample of activities that get billed back check out this link. You may find that things you've been told couldn't be provided by a district via an IEP (e.g. SLP services for auditory processing disorder) are indeed being billed back to the state in some instances.

https://www.mass.gov/…/sbmp-billable-procedure-cod…/download

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Advocate Tip of the Day℠, Empowering Advocacy℠, Advocacy Tip of the Day℠, The IEP Clinic℠, Vulnerable Alone -  Formidable Together℠, are all service marks. Cynthia Moore is not a lawyer, does not give legal advice, and does not practice law. © 2018 

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