Overview of School Based Medicaid Who needs this information Special Education Directors Teachers Related Service Providers School Nurses Medicaid Billing Staff Training Documents Behavioral Intervention Professional ID: 1043835
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1. What will be presented: Overview of School Based MedicaidWho needs this information: Special Education Directors, Teachers, Related Service Providers, School Nurses, Medicaid Billing StaffTraining Documents: Behavioral Intervention Professional Behavioral Intervention ParaprofessionalBehavioral Intervention Consultation
2. School Based Medicaid Overview
3. History of IDEA and MedicaidEducation of All Handicapped Children Act of 1975 - Now known as the Individual with Disabilities Education Act (IDEA)Ensure children with disabilities receive a free, appropriate public education in the least restrictive environment based on individual needs and individualized education programs.
4. History of IDEA and MedicaidThe Medicare Catastrophic Coverage Act of 1988 (MCCA) and the Omnibus Budget Reconciliation Act of 1989 (OBRA ’89)Allow Medicaid to pay for health related services, including screening activities and related services based on a child’s Individualized Education Plan (IEP) if the child is Medicaid eligible and if the service is covered in the state Medicaid plan.
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6. Role of Health and Welfare
7. Role of Local Education Agency (School Districts)
8. Education and Medicaid
9. Medicaid School Based ServicesProvided by:School districtsCharter schoolsInfant toddler programsServices provided must be considered medically necessary for the student to participate in an educational program.http://www.healthandwelfare.idaho.gov/Medical/Medicaid/SchoolBasedServices/tabid/1587/Default.aspx
10. IDAPA 16.03.09.11.14It is a reasonable calculated service to prevent, diagnose, or treat conditions in the participant that endanger life, cause pain, or cause functional significant deformity or malfunction; and There is no other equally effective course of treatment available or suitable for the participant requesting the service which is more conservative or substantially less costly.Medicaid services must be of a quality that meets professionally-recognized standards of health care and must be substantiated by records including evidence of such medical necessity and quality. Those records must be made available to the Department upon request.Must Be Medically Necessary
11. Services not covered by School-Based ServicesVocational ServicesEducational ServicesRecreational ServicesIDAPA 16.03.09
12. NODevelopmental TherapyBeginning in July 1, 2013
13. Who Qualifies for Developmental Disabilities ServicesStudent’s who have an IQ of 70 or below on a Standardized IQ test; and Student has an educational disability; andLimitations in 3 of 7 life areasLife Areas include:self care,receptive and expressive language,learning,mobility,self-direction,capacity for independent living, oreconomic self-sufficiency;IDAPA 16.03.10
14. How Did We Get Here?
15. Legislative ProcessPUBLIC HEARING SCHEDULE: Public hearings concerning this rulemaking will be held as follows:Date: September 19, 2012Time: 6:00 p.m. (MDT Time)Place: 1720 Westgate Dr. Suite ABoise, Idaho 83704Date: September 19, 2012Time: 6:00 p.m. (PDT Time)Place: 2195 Ironwood CourtCoeur d’Alene, Idaho 83814Date: September 19, 2012Time: 6:00 p.m. (MDT Time)Place: 421 Memorial DrivePocatello, Idaho 83201If you are unable to attend a public hearing in any of the physical locations listed above, you can join the Boise publichearing from anywhere in the state via teleconference.Teleconference number: 1-1-888-706-6468Participant Code: 526505
16. School-based Medicaid Services:Beginning in July 1, 2013, schools can bill Medicaid for the following services provided to Medicaid-eligible students who meet specific criteria:
17. SB Medicaid Services that may be used on a daily basis:Behavior Intervention/Consultation (BI/BC)Psychosocial Rehabilitation (PSR)Personal Care Services (PCS)
18. Behavior InterventionConsistent, assertive and continuous intervention Instruct in replacement behaviorsIntervene and prevent maladaptive behaviorsInstruct in tools and strategiesIDAPA 16.03.09.852
19. Behavior Consultation Consult with LEA service providersPerform advanced assessment (FBA)Write BIPCoordinate implementation of BIPOngoing trainingIDAPA 16.03.09.852
20. Student Eligibility for BI/BCMeet criteria for a developmental disability per Idaho Code and IDAPA, Must exhibit maladaptive behaviors that include but are not limited to frequent disruptive behaviors, aggression, self-injury, criminal or dangerous behavior, and These maladaptive behaviors impede the student’s learning or that of others. IDAPA 16.03.10 section 501 , Idaho Code 66-402(5), and IDAPA 16.03.09.851
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22. Provider QualificationsProfessionalCredentialed Special Ed TeacherSpecial Ed ConsultantIBI ProfessionalIDAPA 16.03.09.12.04
23. Provider Qualifications Para-professionalMust be at least eighteen (18) years of age;Demonstrate the knowledge and skills needed and meet SDE standards for Paraprofessionals,Must meet the paraprofessional requirements under the Elementary and Secondary Education Act of 1965, as amended, Title 1, Part A, Section 1119. Must be under the supervision of a behavior intervention professional or behavior consultant.IDAPA 16.03.09.12.04
24. Provider QualificationsBehavior ConsultantMaster’s or Doctoral degree with 1500 hours relevant coursework; andExceptional Child Certificate, orEC/EC Sped Blended Certificate, orSpecial Education Consulting Teacher, orPupil Personnel Certificate (excluding RN or audiologist), orOccupational Therapist, orTherapeutic Consultation Professional as defined in rule.IDAPA 16.03.09.12.04
25. Psychosocial RehabilitationIndividual and group skill training interventionGoal is to restore individual to optimal independent functioningAid in the development of more socially appropriate behaviors and prevent a student from requiring a more restrictive living situationhttp://www.211.idaho.gov/elibrary/PsychosocialRehab.html
26. Student Eligibility for Psychosocial RehabilitationStudents must meet Idaho State Department of Education eligibility criteria for Emotional DisturbanceStudents must meet eligibility found in IDAPA 16.03.10 Section 112 ORIDAPA 16.03.10 Section 112
27. Provider QualificationsPsychosocial RehabilitationLicensed physician, licensed practitioner of the healing arts, or licensed psychiatrist; Licensed master’s level psychiatric nurse; Licensed psychologist; Licensed clinical professional counselor or professional counselor; Licensed marriage and family therapist or associate marriage and family therapist; Licensed masters social worker, licensed clinical social worker, or licensed social worker; Psychologist extender registered with the Bureau of Occupational Licenses; Licensed professional or registered nurse (RN); Psychosocial rehabilitation specialist as defined in IDAPA 16.03.10, “Medicaid Enhanced Plan Licensed occupational therapist; Certified school psychologist; or Certified school social worker.
28. Personal Care Services (PCS)Provision of medically oriented tasks having to do with the student’s physical or functional requirementsDoes not address academic needs, but daily living needs such as: grooming, toileting, eating, mobility, dressing, use of adaptive devices, transferring and medication assistance
29. Student Eligibility PCSStudent must be on an IEPStudent’s needs must be assessed utilizing the PCS School-based Children’s AssessmentAssessment must find that the student requires PCS due to a medical condition that impairs physical or functional abilities
30. Provider QualificationsPCS Registered Nurse or Licensed Professional Nurse (RN), Licensed Practical Nurse (LPN), Personal Assistant. A person who meets the standards of Section 39-5603, Idaho Code, and receives training to ensure the quality of services. IDAPA 23.01.01
31. Specific documentation is required for all Medicaid Billable Services.Be sure that staff are familiar with the document requirements for each of the billable services.Medicaid Documentation
32. Use Correct Billing CodesBill Correct Units Have Documentation to back up what is billedKeep records for 6 yearsMedicaid Billing
33. Don’t forget…Districts must be enrolled as a Medicaid provider to be reimbursed for school based Medicaid services.Each service must be specifically identified on the IEP.Services cannot be educational.Services must be medically necessary for the student to access their educational program.IDAPA 16.03.09
34. www.idahotc.com Training CalendarOnline RegistrationWebinarsLearning Communities
35. Department of Health and Welfare Website
36. MedicAide
37. Contact Information:Shannon DunstanEarly Childhood & Interagency CoordinatorIdaho State Department of Education Division of Student Achievement and School ImprovementDivision of Special Education(208) 332-6908sdunstan@sde.idaho.gov
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