Resources / Glossary
Straightforward definitions for the terms, acronyms and programs used across special education, school-based health, compliance and reimbursement.
Program
[HOLD — needs Navis wording. Outreach, coordination and referral activities that support access to Medi-Cal services and may be claimable through administrative programs.]
Program
[HOLD — needs Navis wording: what the Annual Service Plan covers, who submits it and when.]
Industry/Federal
Services that help a student and family access needed medical, social, educational and other services, including assessing needs, developing a plan, coordinating referrals and reviewing progress.
California
The state agency that oversees public education in California, including special education requirements, reporting and plan implementation.
Industry/Federal
The codified rules published by federal agencies. Medicaid and special education requirements that schools follow are set out in the CFR.
Product
A Navis Group solution supporting IEP development, service documentation, progress monitoring, plan implementation and IDEA compliance.
Industry/Federal
The obligation under IDEA for education agencies to identify, locate and evaluate all children with disabilities who may need special education services, including children who are homeschooled or in private schools.
Industry/Federal
A request for payment submitted to a payer for a service that has been delivered and documented.
Industry/Federal
A payer’s decision not to pay a submitted claim. Denials can result from eligibility, documentation, coding or timeliness issues, and may be corrected and resubmitted.
Industry/Federal
The federal agency that oversees Medicaid and, through it, the school-based programs states administer. (SRC)
California
In California, county offices provide support and services to local school districts, including special education programs, financial oversight and professional development. (SRC)
Industry/Federal
Meeting the requirements that apply to a program — documentation, timelines, eligibility, privacy and reporting — and being able to demonstrate that they were met.
Industry/Federal
A service a payer will reimburse when it is delivered by a qualified provider, is medically necessary and is documented as required.
California
An annual report LEAs complete and submit to DHCS to reconcile the costs of services provided against reimbursements received. (SRC)
California
A statewide effort to address the mental health needs of students, including a multi-payer fee schedule that allows LEAs to bill for mental health and substance use services delivered at or near a school site. (SRC — confirm official program name)
California
The state agency that administers Medi-Cal and oversees California’s school-based Medicaid programs on behalf of CMS. (SRC)
Program
[HOLD — needs Navis wording: which service types qualify as direct medical services within LEA BOP, and how they differ from administrative activities.]
Industry/Federal
A digital record of a person’s health information. In schools, an EHR holds student health documentation, service records and related information in one system. (SRC)
Industry/Federal
The Medicaid benefit for people under 21, known in California as Medi-Cal for Kids & Teens, covering screenings, check-ups and treatment for physical, mental and dental health. (SRC)
Industry/Federal
The standard under IDEA requiring that eligible students with disabilities receive special education and related services at no cost to families, designed to meet their individual needs.
Industry/Federal
The federal law protecting the privacy of student education records. It gives parents the right to access records, request corrections and control the disclosure of personally identifiable information. (SRC)
Product
A Navis Group solution supporting school-based health documentation, Medicaid claiming and care coordination.
Industry/Federal
The federal law establishing national standards for protecting individually identifiable health information. Whether HIPAA or FERPA applies to a student health record depends on who maintains it and why. (SRC)
Industry/Federal
The federal law governing special education. It establishes the right to a free appropriate public education, the IEP process, procedural safeguards and the least restrictive environment requirement. (SRC)
Industry/Federal
A written plan for a student who qualifies for special education under IDEA, setting goals, describing the services the student will receive and recording how progress will be measured. (SRC)
Industry/Federal
The equivalent of an IEP for children from birth to age three, focused on the child and family together. (SRC)
California
A school district, county office of education, charter school or community college district. LEA is the term used across school-based Medicaid programs. (SRC)
California/Program
The California program through which LEAs bill Medi-Cal for specific direct medical services delivered by qualified practitioners. (SRC)
Industry/Federal
The IDEA requirement that students with disabilities be educated alongside peers without disabilities to the greatest extent appropriate for their needs.
Program
[HOLD — needs Navis wording: how MAC relates to SMAA in California and what activities are claimable.]
California
California’s Medicaid program. School-based Medi-Cal programs allow LEAs to receive reimbursement for eligible health services delivered to students.
Industry/Federal
The joint federal and state programme providing health coverage to eligible low-income people, including children. Each state administers its own version — in California, Medi-Cal.
Industry/Federal
The standard that a service must meet to be reimbursable: appropriate to the person’s condition, consistent with accepted practice and required for their care.
Industry/Federal
A framework for organising academic, behavioural and social-emotional supports in tiers of increasing intensity based on student need.
California
A private, nonsectarian organisation or individual certified to provide related services to students with special education needs. (SRC)
California
A private, nonsectarian school certified by the state of California to provide special education services to students based on their IEP. (SRC)
Industry/Federal
A related service supporting a student’s ability to participate in school activities, addressing fine motor skills, sensory processing, self-care and access to the learning environment.
Industry/Federal
Written permission from a parent or guardian, required under IDEA before evaluation or initial provision of special education services, and under FERPA before certain disclosures.
Industry/Federal
Information about a person’s health status, care or payment for care that can be linked to that individual. (SRC)
California
[HOLD — needs Navis wording: what CDE Plan Implementation reporting requires and who submits it.]
Product
A Navis Group solution supporting California school-based Medi-Cal reimbursement, documentation, compliance and revenue cycle processes.
Industry/Federal
The end-to-end process of capturing, submitting and reconciling claims for services delivered, from eligibility through payment.
Program
A federally approved statistical sampling method that estimates how staff time is distributed across activities — educational, direct medical and administrative — used for both LEA BOP and SMAA. (SRC — source documents say ‘Sampling’; confirm preferred term)
Industry/Federal
Health services delivered to students in a school setting, which may include nursing, behavioural health, therapy and related services.
California
The set of California programs through which LEAs receive Medi-Cal reimbursement for eligible services delivered to students.
Industry/Federal
The part of the Rehabilitation Act prohibiting disability discrimination in programs receiving federal funding. A 504 plan provides accommodations for a student who does not qualify under IDEA.
Program
The record of a service that was delivered — who provided it, to whom, when, for how long and under what authorisation — supporting both compliance and reimbursement.
Industry/Federal
A related service addressing communication, language, articulation, fluency, voice and swallowing needs that affect a student’s access to education.
Industry/Federal
Specially designed instruction and related services provided at no cost to meet the individual needs of a student with a disability under IDEA.
Industry/Federal
The record of a student’s health information held by a school, which may be governed by FERPA or HIPAA depending on who maintains it and why.
Program
[HOLD — needs Navis wording: how third-party billing operates for LEAs and how it relates to other health coverage.]
Program
[HOLD — needs Navis wording, and confirmation of how this differs from RMTS, which is itself a time survey method.]
Tell us what you’re trying to understand and we’ll point you in the right direction — or add it to the glossary.
