WCH: School Nursing: Medicaid Reimbursement for School Nursing Services

Local Education Agencies (LEAs) may bill Medicaid for cost reimbursement when providing qualifying nursing services to students in schools who are Medicaid beneficiaries. Policy language includes medically necessary evaluations and treatments provided to a NC Medicaid-eligible beneficiary when the service is documented on an Individual Education Program (IEP), Individual Family Service Plan, Individual Healthcare Plan (IHP), Behavior Intervention plan, or 504 plan. Nursing services are covered when they are directly related to a written nursing plan of care (POC), based on an order from a licensed provider and included on a student’s IHP. Related resources are available below.

• An Overview for NC Medicaid Reimbursable School Nursing Services (PDF, 649 KB) - This presentation provides an overview of the requirements as described in the related Medicaid Policy 10c, an introduction to the documents and documentation that must exist and be retained for possible verification or audit, and suggestions for how to be a part of the local billing process.
• NC Plan of Care/Individualized Healthcare Plan Template (DOCX, 23 KB)
• Medication Administration Record Template (DOC, 121 KB)
• Progress Note Template (DOC, 55 KB)
• Medicaid and Health Choice Clinical Coverage Policy 10C
• NCDPI Medicaid Reimbursement for Related Services

Last Modified: 2-15-2022