Medicaid School-Based Services 

New Mexico schools provide a variety of health-related services to support student success. Under IDEA and Section 504, schools are required to provide accommodations and related services to eligible students with disabilities. Funding for these services is supported through a combination of federal, state, and local resources. 

Through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) initiative, schools may receive Medicaid reimbursement for eligible health-related services provided to Medicaid-enrolled students as part of an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP). 

The Southwest Regional Education Cooperative (SWREC) coordinates Medicaid reimbursement services to help member districts maximize funding for school-based services while maintaining compliance with IDEA and Medicaid requirements. We work closely with school districts and charter schools to support clinician training, service documentation, and Medicaid billing for both direct services and administrative claims. 

For questions regarding Medicaid services or billing support, please contact our Medicaid staff. 

Billing

SWREC provides Medicaid billing support and data processing services for Region 10 districts — including Animas, Cobre, Deming, Hatch Valley, Lordsburg, Reserve, Silver, and Truth or Consequences — as well as more than 40 charter schools across New Mexico. 

Our services include support for direct service billing, administrative claiming, random moment time studies, and annual cost reporting. 

Direct Service Logs

 Direct service logs support Medicaid billing for related services provided to eligible students, including:

  • Occupational therapy
  • Physical therapy
  • Speech therapy
  • Counseling services
  • Nursing services

To ensure timely and accurate billing, member districts are required to:

  • Submit completed Medicaid consent forms along with the student’s IEP;
  • Enter service logs electronically through SIVIC in accordance with established deadlines; and
  • Maintain current provider licenses and submit updated copies to SWREC.

Random Moment Time Studies (RMTS)

Random Moment Time Studies (RMTS) are conducted quarterly to determine the amount of time staff spend supporting Medicaid administrative activities related to school-based services. 

RMTS is separate from direct clinical service documentation and focuses on administrative duties such as coordination, documentation, and related student service activities. Participation is essential, as RMTS results directly impact the level of Medicaid reimbursement districts receive. 

Quarterly Medicaid Administrative Claims

Quarterly Medicaid Administrative Claiming (MAC) ensures accurate reporting of financial information related to Medicaid School-Based Services (MSBS). 

Accurate MAC reporting helps districts and charter schools receive the full federal reimbursement available for services provided to Medicaid-enrolled special education students. 

Participant List

Each quarter, districts submit a list of eligible staff who may participate in the Random Moment Time Study (RMTS), based on state guidelines. 

The Participant List is used to randomly select staff members for quarterly RMTS participation and to help ensure appropriate staff costs are included in the Medicaid Administrative Claiming (MAC) process. Accurate participant lists are essential to maintaining compliance and maximizing eligible Medicaid reimbursement. 

Annual Cost Report

The annual Fee-for-Service (FFS) Cost Report ensures districts and RECs participating in the Medicaid billing program receive the appropriate level of reimbursement for eligible direct medical services. 

The Cost Report compares interim Medicaid payments received throughout the year against the actual allowable costs of providing services. This reconciliation process determines whether a district or REC will receive additional reimbursement or repay overpaid funds. 

For information on allowable expenses and supplanting rules, please review the following documents.