Compliance with Family Educational Rights and Privacy Act (FERPA) requirement for Parental Consent (Medicaid Certified School Match Program).

ALL PRINCIPALS:

• M-DCPS is enrolled as a Medicaid provider in the Medicaid Certified School Match Program and is able to bill Medicaid and receive reimbursement for health-related services provided to Special Education (SPED) students covered under the Individuals with Disabilities Education Act (IDEA).

• Pursuant to the attached memorandum from the Florida Department of Education, M-DCPS should secure written parental consent that complies with the Family Educational Rights and Privacy Act (FERPA).

• The “Medicaid Certified School Match Program (MCSMP) Parental Consent” form has been designed to comply with FERPA requirements by informing the parent/guardian of the following:  1) what information will be shared about the student (e.g., student name, Medicaid #, etc.); 2) who we are sharing the information with (e.g., Medicaid’s fiscal agent); and 3) what the purpose is (e.g., to determine Medicaid eligibility status and billing).

• Attached please find copies of all three versions of the “Medicaid Certified School Match Program Parental Consent” form FM-7032 E,H,S (i.e., English, Haitian Creole and Spanish) which are also available online through the Records and Forms Management website.

• For regular education students, who have been referred for a psycho-educational evaluation during a Child Study Team (CST)/School Support Team (SST) meeting, the “MCSMP Parental Consent” form must be provided and explained to the parent/guardian by the principal’s designee, thus securing written parental consent.

• For SPED students, the “MCSMP Parental Consent” form will be provided and explained to the parent/guardian by the principal’s designee at an Individual Educational Plan (IEP) meeting (e.g., annual or interim IEP review), or at another convenient venue when the school staff and the parent/guardian are meeting regarding the student with a disability, thus securing written parental consent.

• In addition to the “MCSMP Parental Consent” form, a field has been added to the “PF8 Parent Information” screen in the Integrated Student Information System (ISIS) for data input at each school site by the principal’s designee.

• If the parent/guardian checked “Yes” on the “MCSMP Parental Consent” form, then data input on the ISIS PF8 screen should be indicated as “Y” on the Medicaid Parental Consent field for each student.

• If the parent/guardian checked “No” on the “MCSMP Parental Consent” form, then data input on the ISIS PF8 screen should be indicated as “N” on the Medicaid Parental Consent field for each student.

• The original signed “MCSMP Parental Consent” form must be placed in the student’s cumulative record.

• A copy of the signed “MCSMP Parental Consent” form must be provided to the parent/guardian.

• A copy of the signed “MCSMP Parental Consent” form must be mailed to the Regional Center’s SPED Instructional Supervisor.

• A copy of the signed “MCSMP Parental Consent” form must be mailed to:  Location #9602 – Annex Rm. 407M M-DCPS Medicaid Reimbursement Programs.