Personal Care Services

Personal Care Services School-Based Medicaid Expansion Information

Personal Care Services Guide from the UMASS and MassHealth

***Important Information to bill Personal Care Services: Personal Care Service providers must be listed on the RMTS (Random Moment Time Study). If you are considering billing personal care services, please connect with NEMB prior to review the requirements.

***Most Important! All Personal Care services must be authorized by a physician, physician assistant or nurse practitioner and pursuant to a care plan. Services for Personal Care will not be billed if NEMB does not receive a copy of the Doctor’s Order/ Service Authorization authorizing personal care services and a copy of the Care Plan. Additionally, if the personal care services are written on the IEP please provide the grid page or additional information page (wherever the service is listed) to NEMB. Please obtain these and provide them to your district’s Medicaid contact to be sent to NEMB via the ShareFile/secure portal. For questions on this please call NEMB directly at 508-297-2068 ex.226.

  • Description: Use this PowerPoint as your guide for the requirements to complete billing under the Expansion program. Please read the entire presentation and pay extra attention to the following slides:
    • To determine if services provided meet the definition of Medicaid Medical Necessity and Covered vs. Non-Covered Services: Slides 15, 20-22, 30-34
    • ADLs and IADLs: Slides 16-18
    • What is included in Care plans & Service Authorization: Slides 35-37
      • *** Review the required items for a written care plan on page 36. Reminder Care Plans and Service Authorizations for Personal Care Services only must be sent to NEMB via the ShareFile/Secure Portal for billing to be processed.
    • What should be included in the Activity/Procedure Note on Service Documentation: Slide 41
    • Rule of Eights: To be billed skilled nursing services must occur for at least 8 minutes total to be counted as a billing unit. Always bill with the Start and End time of the visits and NEMB will calculate the time and units for billing. Please also review examples of how to bill for ADLs. Slide 53 & 54
    • ICD-10 Diagnosis Codes: Slide 55-56

Nurse Service Authorization and Service Authorization Guide

  • Description: See the Service Authorization Guide for all the required elements of Service Authorization. A doctor’s order can be used if it contains all the listed elements. If the doctor’s order does not contain all the elements for a billable student, please have the doctor adjust the order or have Personal Care Service Authorization form completed fully.


Service Documentation Paper Billing Form

  • In-District Service Documentation Billing Form
    • Description: The In-District Service Documentation form can be used to document Medicaid Medically Necessity nursing services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Aspen, Frontline (ESPED), SNAP, or other software. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
  • Out-of-District Day & Residential Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document Medicaid Medically Necessity nursing services that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.


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