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MSB VT Community Email | August 10, 2012  


2012 - 2013 Fall Start-up Checklist


It's that time of year again! This email is a reminder of those items that MSB requires in order to make the Medicaid School-Based Health Services Program successful this school year! 


This email contains information on the following:

  • District Contact Information (Due: September 10th)
  • Special Education Roster (Due: September 10th)
  • Release of Information
  • Provider Certification Agreement and Licensing
  • Out of District Provider Agreement
  • Individual Education Plan
  • Unscheduled School Days
  • Grant Awards
  • Register for On-Site Trainings
  • Facebook & Twitter  

District Contact Information (Due: September 10th)

All districts need to update/add their contact information for the following roles:

  • Special Education Director
  • Special Education Secretary
  • Superintendent
  • Business Manager
  • Payroll Contact Person
This information can be updated by completing our district information form. Please fax this form to 603-692-0857 or email to  Kelly Bilodeau.

Special Education Roster (Due: September 10th)

Please provide an updated Special Education Roster to include Last Name, First Name, DOB, Gender, Case Manager and current physician. Please submit your roster by 9/10/12.  For Adori clients - please have your student information updated in Adori by 9/10/12.


Release of Information

Please provide copies of all Release of Information for new students and Release of Information for 18-year-old students who become their own guardian. Click on the links to download forms  ROI and Age 18 ROI.


Provider Certification Agreement

All new staff who will be providing Medicaid billable services at a professional rate (Speech, OT, PT, Nursing, Counseling, etc.) must submit a Provider Certification Agreement and a copy of their current license.  Also, any staff whose license has expired must submit a copy of their current license as well.  Provider Certification agreements and licensing are not required for those billing as paraprofessionals.  Click to download the Provider Certification form.


Out-of-District Provider Certification Agreement

Please provide Out-of-District Provider Certification Agreements for students attending out-of-district programs. Click to download the OOD form.


Essential Early Education IEP (EEE IEP)

Vermont DOE has implemented a new Essential Early Education IEP - for ages 3 through 5 (EEE IEP).  This will be available in  Adori (MSB's Special Education IEP Management) in the very near future.


Individual Education Plan (IEP)

Please forward any new and updated IEPs along with applicable amendment forms.  If you are an Adori client, we have the ability to access the IEPs directly from the software. If we see that an IEP has been amended, we will request the appropriate amendment form.


Unscheduled School Days

This form must be submitted at the end of each billing period. Click to download the form. 


Grant Awards

The next Grant Award is scheduled for mid-October.  This will include all claims paid with RA dates July to September.  Please submit all documentation logs including Extended School Year (summer services) as soon as possible.  


On-site Training

MSB provides regional and webinar trainings to our community. Regional and webinar trainings work on a first come first serve basis and are free to attendees.  Please contact Jen Surina to schedule on-site training for your district.  Districts will be scheduled based on availability of MSB staff on a first-come, first-serve basis.  MSB will make every effort to accommodate your request for on-site training.


Topics for On-Site Training typically include:

  • Adori Case Manager, Team Leader and Service Provider training
  • Service documentation log training and forms training for school-based Medicaid
  • Director Meeting for School-Based Health Services Program
  • Adori User workgroups

Facebook & Twitter

MSB utilizes many sources to connect to users within the MSB Community. If you are a fan of Facebook or Twitter and would like to connect to this network for updates on events, regulations, etc.


 Like us on Facebook Follow us on Twitter 


MSB is looking forward to a fantastic fall startup this year, and we look forward to working with you in 2012-2013!