Q1 2025 Medicaid Manual Update

I’m not sure if I’m the only one who hoped for a rate increase with this manual update, I guess Georgia Medicaid had other plans. This quarter’s manual focused on school-based services, identifying IEP requirements and referencing homeschooled members.

Medicaid Cover Page

• Added IEP requirement for school-based services (Section 804.12 & Appendix D)

• The most recent Individualized Education Plan (IEP) should be included for members who attend public school.

• If the member is enrolled in school, the name of the school/homeschool and schedule must be included.

• The submission of an IEP is optional unless school-based services are requested.

In 2024 Medicaid began approving authorizations for school-based services more than ever before. This is great news for our learners who require more significant support when transitioning from a full-time, intensive behavioral program, to less a restrictive school setting. Naturally, greater clarification is needed to ensure that Medicaid members are receiving what they require, while ensuring that learners receive the free, public education of which they are legally entitled.

At Aurora Behavior Services, we make coordination with our clients' academic teams a priority from the moment we begin onboarding. This includes receiving and reviewing the client's IEP, and communicating with their academic team to ensure coordination of treatment plan goals and the behavior intervention plan. If this is not something your agency incorporates in initial and ongoing assessment, it is more important now than ever.

This manual update is an opportunity for ABA providers across the state to evaluate their role in a comprehensive treatment model, to include teachers, school-based and private SLPs, OTs, PTs, and other specialists.

How will you and your clinical team adjust to the new requirements outlined in the Medicaid Autism Providers Manual?