Bristol Virginia Public Schools oppose the proposed changes by the Department of Medical Assistance Services (DMAS) to the Virginia school-based Medicaid reimbursement program.  Specifically, the proposed changes that would require a physician's signature for each Plan of Care for nursing and personal care services which could force school divisions to discontinue billing for these services.  At best, these changes would create a significate amount of additional work and cost for local school divisions.  The requirement for a physician's signature for each Plan of Care may be difficult to obtain, and will likely result in a decrease in reimbursement for theses services.  In addition, complications of billing for nursing and personal care services could impact school divisions' transportation reimbursement, since billing for transportation depends on other billable services.

A decrease in Medicaid reimbursement dollars and an additional cost to school divisions for participating in the Medicaid reimbursement program is of great concern.  As the number of student with disabilities increased (by 24% in Virginia in the past four years), so did the complexities of students' needs.  Consequently, federal, state, and local education funding fails to keep pace with the cost of providing special education, causing school divisions to rely more and more on Medicaid reimbursement to off-set the increasing costs of specialized instruction and related services.

We urge you to reconsider these proposed changes and allow the current school-based Medicaid reimbursement program requirements to remain in place.