State Medicaid Director Letter on Medicaid Payment for Services Provided without Charge (Free Care)

Centers for Medicare & Medicaid Services (CMS) issued this guidance in December 2014 to remove any ambiguity about Medicaid payment being allowed for covered services for Medicaid-eligible students when delivered by Medicaid-qualified providers -- even if those services are "free care," meaning available without charge to the community at large. This guidance paved the way for expanding school Medicaid.

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CMS Letter to State Medicaid Directors - Dec. 15, 2014

Joint Guidance on the Application of FERPA and HIPAA to Student Health Records

December 30, 2019

The U.S. Department of Education and the Office for Civil Rights at the U.S. Department of Health and Human Services released updated joint guidance addressing the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to records maintained on students.

The guidance, which was first issued in November 2008 and last updated in December 2019, clarifies for school administrators, healthcare professionals, families and others how FERPA and HIPAA apply to education and health records maintained about students. The revised guidance includes additional frequently asked questions and answers addressing when a student’s health information can be shared without the written consent of the parent or eligible student under FERPA, or without written authorization under the HIPAA Privacy Rule.

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Joint Guidance on the Application of FERPA and HIPAA to Student Health Records

Health Insurance Portability and Accountability Act (HIPAA) Regulations

To reduce paperwork and streamline business processes across the health care system, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and subsequent legislation set national standards for electronic transactions, code sets, unique identifiers and operating rules. This regulation text was published in 2013 by the U.S. Department of Health and Human Services Office for Civil Rights.

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HIPAA Administrative Simplification - Regulation Text

EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents

The Medicaid program’s benefit for children and adolescents, known as Early and Periodic Screening, Diagnostic and Treatment services, or EPSDT, provides a comprehensive array of prevention, diagnostic and treatment services for low-income infants, children and adolescents under age 21, as specified in Section 1905(r) of the Social Security Act (the Act).

EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents, issued by Centers for Medicare & Medicaid Services (CMS), provides guidance for the requirements for the EPSDT periodic and interperiodic screens, services, medical necessity, experimental treatments and other topics.

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EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents