“The Medicaid reimbursement process has become increasingly cumbersome,” the spokeswoman, Barbara Morgan, said.
Ms. Morgan said a city analysis found that the Education Department did not have proper documentation for all but 9,000 students during the 2007-8 and 2008-9 school years, a period covered retroactively by the new rules. The analysis shows, however, that even for those students, almost 20 percent of the $10 million in claims filed were rejected for not meeting the new criteria.
In September, for the first time since 1988, when Congress allowed school districts to file for Medicaid reimbursements, the city put a manager in charge of handling the claims exclusively, one of several recent changes intended to improve collections.
“We aggressively pursue reimbursements,” Ms. Morgan said, “and are working towards a long-term, streamlined solution that will allow us to receive money available to our students.”
The new rules are part of a settlement in which New York City agreed to repay the federal government $100 million — and the state $332 million — after a 2005 audit unearthed myriad irregularities in its claims. They require school districts to file claims much as medical clinics do. For example, doctor’s orders must accompany individual claims, and districts must use specific codes for the types of services they provide. In addition, therapists are now required to hold higher levels of certification — levels which half of New York City’s speech teachers lack — and districts must provide annual training, and hire compliance officers.