Sample Special Education Medicaid Initiative (SEMI) Action Plan

In accordance with N.J.A.C. 6A:23A-5.3(f) and (g), failure to maximize SEMI, each district that has less than 90 percent participation of SEMI eligible students in the prebudget year or has failed to comply
set forth in N.J.A.C. 6A:23A-5.3(e) shall submit a SEMI action plan to the Executive County Superintendent for review and approval as part of the district’s proposed budget submission. Districts shoul
relate to their specific areas of weakness and then specify activities to be implemented to improve and maximize SEMI participation.

County: District:

Sample Corrective Action Plan Table (Table spans columns A through F and rows 6 through 14. Cells in columns B through F are intentionally blank so that the user can input relevant information).

SEMI Action Plan Components District Activities for Compliance Person(s) Responsible Projected Timelines

SEMI Action Plan Template revised Dec. 2017 Page 1

 Sample Special Education Medicaid Initiative (SEMI) Action Plan
In accordance with N.J.A.C. 6A:23A-5.3(f) and (g), failure to maximize SEMI, each district that has less than 90 percent participation of SEMI eligible students in the prebudget year or has failed to comply
set forth in N.J.A.C. 6A:23A-5.3(e) shall submit a SEMI action plan to the Executive County Superintendent for review and approval as part of the district’s proposed budget submission. Districts shoul
relate to their specific areas of weakness and then specify activities to be implemented to improve and maximize SEMI participation.

County: District:

Sample Corrective Action Plan Table (Table spans columns A through F and rows 6 through 14. Cells in columns B through F are intentionally blank so that the user can input relevant information).

SEMI Action Plan Components District Activities for Compliance Person(s) Responsible Projected Timelines
Parental Consent Forms: Procedures for obtaining parental
consent forms, such as those delineated in the Parental
Consent Best Practices document available on the EdPlan™
website. This includes procedures to document how annual
notification for parental consent is disseminated to parents in
order to maintain consent.

SEMI Action Plan Template revised Dec. 2017 Page 2

 Sample Special Education Medicaid Initiative (SEMI) Action Plan
In accordance with N.J.A.C. 6A:23A-5.3(f) and (g), failure to maximize SEMI, each district that has less than 90 percent participation of SEMI eligible students in the prebudget year or has failed to comply
set forth in N.J.A.C. 6A:23A-5.3(e) shall submit a SEMI action plan to the Executive County Superintendent for review and approval as part of the district’s proposed budget submission. Districts shoul
relate to their specific areas of weakness and then specify activities to be implemented to improve and maximize SEMI participation.

County: District:

Sample Corrective Action Plan Table (Table spans columns A through F and rows 6 through 14. Cells in columns B through F are intentionally blank so that the user can input relevant information).

SEMI Action Plan Components District Activities for Compliance Person(s) Responsible Projected Timelines
Establishing Benchmarks for Maximum SEMI
Participation: Establish a benchmark of x percent for the
current school year or for the first year that the district does
not have an approved waiver pursuant to the provisions of
N.J.A.C. 6A:23A-5.3(b), whichever is applicable, for obtaining
maximum participation of all SEMI eligible students by the
start of the subsequent school year.

The benchmarks for the current school year or for the first
year that the district does not have an approved waiver
pursuant to (b) above, whichever is applicable, for achieving
maximum participation shall close, at a minimum, the gap
between current participation and maximum participation by
50 percent by the beginning of the subsequent school year;
and

The benchmarks shall be based on the percentage of

parental consent forms collected from eligible students. The
number of parental consent forms shall reflect one parental
consent form or one document noting parental refusal for
each eligible student.

SEMI Action Plan Template revised Dec. 2017 Page 3

 Sample Special Education Medicaid Initiative (SEMI) Action Plan
In accordance with N.J.A.C. 6A:23A-5.3(f) and (g), failure to maximize SEMI, each district that has less than 90 percent participation of SEMI eligible students in the prebudget year or has failed to comply
set forth in N.J.A.C. 6A:23A-5.3(e) shall submit a SEMI action plan to the Executive County Superintendent for review and approval as part of the district’s proposed budget submission. Districts shoul
relate to their specific areas of weakness and then specify activities to be implemented to improve and maximize SEMI participation.

County: District:

Sample Corrective Action Plan Table (Table spans columns A through F and rows 6 through 14. Cells in columns B through F are intentionally blank so that the user can input relevant information).

SEMI Action Plan Components District Activities for Compliance Person(s) Responsible Projected Timelines
Documenting IEP Meetings: Procedures to ensure that all
SEMI eligible IEP meetings are documented in the third-party
administrator’s system. Evaluation Services/IEP meetings
are only claimable if a Medicaid qualified practitioner is
present and it is documented that a health-related service is
discussed.

Documenting SEMI Eligible Health-Related Services:

Procedures to ensure that all SEMI eligible health-related
services, including those provided by entities where the
district has placed SEMI eligible students, are documented in
the third-party administrator’s system.

Validation of IEP on File: Procedures to ensure that a valid

IEP is on file and the correct IEP date is documented in the
third-party administrator’s system for each SEMI eligible
student for whom parental consent has been obtained.

Validation of Service Provider Qualifications: Procedures

to ensure that service providers used by the district and
entities where the district has placed SEMI eligible students
have valid licenses and certifications and that these SEMI
provider qualifications are documented in the third-party
administrator’s system.

SEMI Action Plan Template revised Dec. 2017 Page 4

 Sample Special Education Medicaid Initiative (SEMI) Action Plan
In accordance with N.J.A.C. 6A:23A-5.3(f) and (g), failure to maximize SEMI, each district that has less than 90 percent participation of SEMI eligible students in the prebudget year or has failed to comply
set forth in N.J.A.C. 6A:23A-5.3(e) shall submit a SEMI action plan to the Executive County Superintendent for review and approval as part of the district’s proposed budget submission. Districts shoul
relate to their specific areas of weakness and then specify activities to be implemented to improve and maximize SEMI participation.

County: District:

Sample Corrective Action Plan Table (Table spans columns A through F and rows 6 through 14. Cells in columns B through F are intentionally blank so that the user can input relevant information).

SEMI Action Plan Components District Activities for Compliance Person(s) Responsible Projected Timelines
Participation in SEMI Training Opportunities: Procedures
to ensure that staff participate in relevant training
opportunities provided by the third-party administrator,
including, but not limited to, regional meetings and online
training.

Timely Certification of Quarterly Staff Pool List:

Procedures to ensure that the quarterly staff pool list is
certified under the time frames required in the
implementation of cost settlement via the third-party
administrator's system.
End of Worksheet

SEMI Action Plan Template revised Dec. 2017 Page 5

he prebudget year or has failed to comply with all program requirements
posed budget submission. Districts should determine which items below

Date:

Date
Documentation of Completion/Implementation
Completed

SEMI Action Plan Template revised Dec. 2017 Page 6

he prebudget year or has failed to comply with all program requirements
posed budget submission. Districts should determine which items below

Date:

Date
Documentation of Completion/Implementation
Completed

SEMI Action Plan Template revised Dec. 2017 Page 7

he prebudget year or has failed to comply with all program requirements
posed budget submission. Districts should determine which items below

Date:

Date
Documentation of Completion/Implementation
Completed

SEMI Action Plan Template revised Dec. 2017 Page 8

he prebudget year or has failed to comply with all program requirements
posed budget submission. Districts should determine which items below

Date:

Date
Documentation of Completion/Implementation
Completed

SEMI Action Plan Template revised Dec. 2017 Page 9

he prebudget year or has failed to comply with all program requirements
posed budget submission. Districts should determine which items below

Date:

Date
Documentation of Completion/Implementation
Completed

SEMI Action Plan Template revised Dec. 2017 Page 10