Medicaid
New Mexico schools provide a variety of health-related services to students. IDEA and Section 504 require schools to accommodate students who have a disability and are in need of educational and other related services. The expense of these services is managed by the school districts through a combination of federal, state, and local funds. The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) initiative gave states the authority to reimburse schools for the expenses incurred for health services (including screening activities) provided to Medicaid eligible children as part of their IEP or IFSP.
Southwest Regional Education Cooperative coordinates the use of Medicaid reimbursement funds to improve health related services for all students in our member districts by maximizing Medicaid reimbursement for school-based services provided to eligible students in compliance with IDEA. We work closely with individual school districts and charter schools to support clinician training and billing for these services. We bill Medicaid for both service fees and administrative claims to maximize our schools’ reimbursement funds.
For questions pertaining to our services or the billing of them, please contact our Medicaid staff.
Billing
The Southwest REC provides data entry and processing of Medicaid billing for Region 10 (Animas, Cobre, Deming, Hatch Valley, Lordsburg, Reserve, Silver, and Truth or Consequences) and over 40 charter schools across the state. This service encompasses direct service logs and administrative time studies.
Direct Service Logs
Direct service logs cover the billing of ancillary services such as occupational therapy, physical therapy, speech therapy, counseling, transportation, and nursing services as directed by the student’s IEP. To help expedite these billings, each member district is required to:
- Submit completed IEP Medicaid consent forms in addition to the participant’s IEP;
- Submit service logs electronically through SIVIC in accordance with deadlines; and
- Ensure provider licenses are up to date and current copies are furnished to the SWREC.
Random Moment Time Studies
Random moment time studies are given to calculate the amount of time spent administrating school-based health services. This is a completely separate accounting from clinical time sheets but includes the number of hours personnel are involved in documentation and paperwork for student services. Time studies are given quarterly to participating schools. Please take the few moments necessary to complete and return them; they do affect the amount of money your district receives as well as the salaries of some of your related personnel.
Quarterly Medicaid Administrative Claims
Quarterly Medicaid Administrative Claiming (MAC) is the accurate reporting of financial information for MSBS that is essential for ensuring that your district/charter receives all federal reimbursement that you are entitled to for services provided to Medicaid-enrolled SPED students.
Participant List
Districts submit a list of eligible providers to participate in the Random Moment Time Study (RMTS) each quarter, based on provided guidelines. The Participant List is used to sample individuals who will participate in the RMTS each quarter.
Cost Report
The purpose of the annual Fee for Service (FFS) Cost Report is to ensure districts/RECs that participate in the FFS Medicaid billing program receive the appropriate level of Medicaid reimbursement for the provision of Medicaid eligible direct medical services. The FFS Cost Report serves to reconcile the district’s/REC’s ongoing (interim) FFS payments received throughout the year and compares it to the district’s/REC’s allowable costs for providing these services during the same period. If a district’s/REC’s interim FFS payments are less than the allowable costs calculated via the FFS Cost Report, the district/REC will receive this settlement amount. Likewise, if a district’s/REC’s interim FFS payments are more than the allowable costs calculated, the district/REC will pay the settlement amount.
- Provider Credentialing – SWREC contact is Amber Rivera
- National Provider Identifier (NPI)
- NM State Regulation and Licensing Boards
- NM PED Licensing Bureau
- Medicaid School-Based Services Provider Type Information
For information on allowable expenses and supplanting rules, please review the following documents.
Medicaid Staff
Send message
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Cabrera TinaTina Cabrera Medicaid Clerk Send message »Tina started working every summer at a meat company in New Jersey where her siblings and Tina would spend our summers with their grandparents. She began an early education degree at NMSU but was unable to finish. She still has the passion for teaching young children. Before coming to join the SWREC family, Tina worked for Luna County as a court security officer. She enjoyed working with the public at the old courthouse, and the coworkers there became family. She has been with her lovely wife 21 years, and she is Tina's rock. They have a four-year-old they are truly blessed to have in their lives. Although technically a grandchild, the baby calls Tina's wife mommy, and Tina is Nini. She is their world! Tina joined the SWREC team June 2024 and loves the chance this new job allows her to spend more time with her baby. She is a welcome addition to the SWREC family.
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Camacho KristinaKristina Camacho Medicaid Clerk Send message »
Kristina Camacho was born and raised in Deming, New Mexico. She started with SWREC in 2018. She is a medicaid clerk for the organization. She hopes to pursue a degree in graphic design. Kristina is married with four boys, three of them grown and the last one in high school. In her free time, she plays women's slow pitch softball. She loves to hang out with her husband and boys while hunting and fishing, or just playing softball!
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Gonzales CrystalCrystal Gonzales Medicaid Financial Coordinator Send message »
Crystal Gonzales, a proud Deming native, joined the Southwest Regional Education Cooperative team in February 2023 as our Medicaid financial coordinator. She comes to us after working for the Deming Public School District for over 21 years. Crystal served in various positions during her tenure with DPS, including her most distinguished positions as administrative assistant for the Transportation Department and lastly as the lead equity liaison for the Equity Department. During her time in the Transportation Department, she obtained her bachelor's degree in business from Western New Mexico University. In her downtime, she enjoys time spent with her family and friends.
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Rivera AmberAmber Rivera Medicaid Specialist Send message »
Amber Rivera
Medicaid Specialist
Southwest Regional Education CooperativeAmber Rivera is a Medicaid Specialist with the Southwest Regional Education Cooperative, where she provides billing support and guidance for the Medicaid School-Based Services Program. She works closely with over 50 school districts and charter schools across New Mexico, helping them navigate the ins and outs of Medicaid billing with confidence and clarity.
Before joining the team, Amber spent nine years at Mimbres Memorial Hospital as an ER Registration and Admissions Clerk, gaining valuable experience in healthcare administration and patient services.
When she's not helping schools stay on track with billing, Amber enjoys spending quality time with her husband, kids, and grandbaby. Family means everything to her, and she brings that same warmth and care to her work every day.
Resource Links
For more information about school-based healthcare and Medicaid reimbursements, see the corresponding resources below:
Important Dates
Workshop PowerPoints
