Executive Summary

The Third Party Billing program commenced in the spring of 1992 as a collaborative effort between Baltimore County Public Schools (BCPS) and the Baltimore County Department of Health (BCDH). The Third Party Billing program is a systemwide effort of BCPS designed to recover health care costs from Medicaid for health care services rendered to BCPS students.  Funds recovered from the Third Party Billing program supplement existing program budgets by funding staff positions and supplies and equipment for several programs designed to enhance special education and health-related services.

The Office of Third Party Billing provides annual school-based training sessions to all service providers, offers incentive programs for schools designed to maximize the recovery of funds, conducts self-monitoring of the program to minimize audit findings, coordinates state monitoring visits conducted by the state health department and the Maryland State Department of Education (MSDE), coordinates visits by external Medicaid auditors, and works collaboratively with other local education agencies and MSDE on statewide issues that impact the Third Party Billing program.

Since 2000, the Medicaid program has undergone changes at the federal and state levels. In several instances, revenue has decreased due to a wide variety of federal and state changes. At the state level, the billing rates have been decreased by approximately 50 percent for services. MSDE and Maryland Department of Health (MDOH) unilaterally decreased the billing rates in 2006 after the Office of the Inspector General’s audit of the state of Maryland.

At the federal level, the Center for Medicare and Medicaid Services (CMS) proposed two rules in 2007 that were designed to eliminate case management and transportation billing. In June 2009, CMS reversed the rules allowing school districts to continue to bill Medicaid for these services.

In 2009, the Office of Third Party Billing assumed the responsibilities for the Out-of-County Living Arrangements (OCLA) program. The OCLA program is designed to bring reimbursement for students who are placed into foster care in BCPS, but their parents reside in another district. In those instances, the school district where the parent resides is responsible for the cost of tuition.

The Office of Third Party Billing will continue to work with schools and offices in order to determine ways to sustain and enhance these revenue sources.