Quality Assurance

​​​SBS providers are responsible for implementing a quality assurance program. The purposes of the quality assurance program are to establish and maintain a process for monitoring and evaluating the quality and documentation of covered services, and the impact of Medicaid enrollment on the school environment.

The quality assurance program will reflect an overall approach to ensure and review the qualifications of personnel, medical necessity of services, accuracy of billing, and appropriateness, intensity, level and outcomes of services provided to individuals. The Michigan Department of Education will conduct ongoing certification of school based services providers to assure compliance with enrollment criteria and quality assurance standards. The Department of Education certification requirements are accepted by the Medical Services Administration. An acceptable provider program addresses each of the following quality assurance standards:

  • Covered services are medically necessary, as determined and documented through appropriate and objective testing, evaluation and diagnosis
  • The IEP, IFSP or care plan identifies which covered services are to be provided and the service frequency, duration, goals and objectives
  • A monitoring program exists to ensure that services are appropriate, effective and delivered in a cost effective manner consistent with the reduction of physical or mental disabilities and assisting the student to benefit from special education
  • Staff qualifications meet current license, certification and program requirements
  • When appropriate, collaboration exists to develop plans of care with other providers, including those from local Public Health and Family Independence Agencies, EPSDT (Early Periodic Screening and Diagnostic Testing) providers, Community Mental Health Service Providers, the student's physician and managed care providers and from Qualified Health Plans
  • Parent, guardian, student or surrogate participation exists, outside of the IEP or IFSP committee process, in evaluating the impact of the SBS program on the educational setting, service quality and outcomes.  â€‹