Medicaid





October 28, 2013 //**(Updated September 8, 2014)**//

Memo: To Special Education Staff, School Nurses, Transportation, Counselors, and School Administrators Re: Timberline Services and Medicaid

__There are 5 categories that are Medicaid billable.__
 * 1) ** Health ** – Students who have a diagnosis which supports their need for additional paraprofessional support for health services.
 * 2) ** Behavior ** – Students who have a diagnosis, behavior intervention plan, and need for additional paraprofessional support for behavioral success. (Remember, “behavior” means a myriad of things, not just explosive, avoidant, or attention seeking behavior.)
 * 3) ** Transportation **
 * 4) We can bill trip **mileage** for students with a **daytime service** who need special transportation. The driver must initial this log.
 * 5) We can bill for an **attendant**, even if they do **not have day time services**. This can be any district personnel.
 * 6) ** Nursing Services ** – Time to update health plans, administer medication, etc. are billable nursing minutes. If the school nurse spends 1 hour each fall updating the Health Care Plan, this can be billed.
 * 7) ** Counseling ** – A school **guidance counselor** who provides social skills instruction in a small group setting or 1-on-1 is providing a billable service. The student does NOT have to have a BIP. (This should be noted on Page F with the “GC” code.) Medicaid will not look specifically for the GC code, but will look at the narrative for indication of social skills instruction by the school counselor.

__Things to Know:__
 * Electronic copies of all of the forms are linked above for downloading.
 * **All** log sheets, for any of the categories above, should be sent to building nurses and School Psychologists by** 8th of each month ** for the prior month. This should include:
 * The **Perry Monthly Medicaid Checklist**
 * The **Timberline Coversheet for Medicaid Billing**
 * The **Signature Cover Sheet for Medicaid Billing**
 * Log Sheets for the month
 * Weekly Summary Sheets (**//Behavior// //Only//**)
 * Medicaid packets should then be sent to [Sp Ed Director] at [Location] by the ** 14th of each month **.
 * Medicaid related paperwork is all filed at the School Administrative Center. Original paperwork will be housed for two years, and then it will be scanned and saved.

__Timberline Services:__
 * [Timberline] will be coming each month after the due date of the 14th, to get all of the paperwork.
 * Timberline will provide a quarterly review, to ensure we are getting as much benefit as possible. Information that they will review:
 * IEP pages B, F, and G
 * Health Care Plans
 * Current BIP
 * Diagnosis is on file – This can be a variety of items, as long as it is proof that a health care professional has diagnosed the child. Health care professionals include Nurse Practitioners, Physicians, Psychologists and Social Workers not working with the school setting, Psychiatrists, etc. Licensed Practical Nurses (LPN) and Registered Nurses (RN) may not diagnose. **If we do not have diagnosis documentation on file, and know the child’s health care provider, Timberline has a form letter that they can send to the provider to confirm diagnosis. This is part of the service that they provide.**
 * Monthly paperwork packets for each student.

__Nurse’s Responsibilities:__
 * Review and sign monthly paperwork and send it to [Sp Ed Director] by the 14th of each month.
 * Health Care Plans
 * Each child with a diagnosis should have a health care plan on file. This could be very general, just giving an overview of the diagnosis and implications.
 * For each Health Care Plan, the special education teachers and I need to know a minimum number of minutes that you need each year to update the plan. (This is billable, and can be billed as they’re updated, or annually when they’re reviewed for the upcoming year.) Page F will have the code “NS” for Nursing Services for these minutes.
 * The Health Care Plan that is in place and on file in your office at the time of the IEP, should be emailed to the Special Education Teacher so that they can **upload it to Associated Files.**
 * A note should be made that the attached Health Care Plan is current at the time of the IEP, and any updates during the school year can be found in the Nurse’s Office. This is a common practice in many districts, and ensures that if child moves, the new school has some idea of their diagnosis and health care needs.
 * We will slowly make these changes as IEPs occur.
 * Teachers: You need to inform the nurses at least a week in advance of IEP meetings so that they can complete updates to Health Care Plans.

__Teacher’s Responsibilities - Health Services:__
 * A note should be made in the IEP on Page F that the Individual Health Care Plan is attached to Associated Files, and is current at the time of the IEP. Note that any updates that may be made to the IHP later in the school year will be can be found on the most current IHP filed in the Nurse’s Office. (This is a common practice in many districts, and ensures that if child moves, the new school has some idea of their diagnosis and health care needs.)
 * Please inform the nurses at least a week in advance of IEP meetings so that they can complete updates to Health Care Plans.

**//Here is what the procedure manual says about Medicaid.//**
Reimbursable services must be **described** in the IEP in two locations:

In Section B under “Other information essential for the IEP development” place documentation describing the necessity of the service (See the 5 categories listed above).

In Section F, the exact time and frequency of the service must be documented. Services may be documented in daily, weekly, or monthly increments. For services that are required but provided on an irregular basis or, only in the event of specific health criteria, it is acceptable to note “per physician’s orders” or “per IHP/IEP.”

[|Medicaid: Iowa Department of Education]


 * Completing an IEP that meets Requirements for Medicaid Reimbursement **



The IEP form **above** has captions which match the descriptions **below.** 2. The team listing should include a health care professional for the appropriate Medicaid covered service for which reimbursement will be claimed. For example, if there are Physical Therapy services in the IEP, then a Physical Therapist should be listed on the team. || 4. If the student has health services provided by LEA staff, Medicaid requires a formal plan of care (health plan) designed by a health care professional and carried out by staff. || 7. If support or related services are being provided to the student, this line should be checked “Y” for Yes. This is the indication of health professional services, such as a Physical Therapist or School Nurse, by the AEA or the LEA. 8. As each service is checked with a “Y” for Yes a text box is added below. A description of how the service is provided to the student is entered into the text box.
 * **IEP Form ** || Print out the IEP form that shows where to document each step below. [|IEP with Medicaid Captions] ||
 * **Page A ** || 1. The duration dates of the IEP will be the range of dates when the services are allowed reimbursement from Medicaid by either the AEA or the LEA
 * **Page B PFAAFP ** || 3. If the student has behavior services provided by LEA staff, Medicaid requires there be a Behavior Intervention Plan (BIP) that addresses the interventions.
 * **Goal Page ** || 5. For those AEA services that are discipline specific, there should be a related goal that outlines their services. For example, there would be a speech or language goal if the AEA Speech Language Pathologist is claiming Medicaid reimbursement for their services ||
 * **Page F – Special Education Services ** || 6. If supplementary aids and services are being provided to the student, this line should be checked “Y” for Yes. This is the indication of health or behavior paraprofessional services by the LEA.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">In some cases, one staff member may provide both educational and health/behavior related services. These should be entered in two separate text boxes. One text box for the education related services, such as extra time for class assignments, and one text box for the health/behavior related services, such as assistance with personal hygiene or to monitor his/her safety.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">If the service is an AEA or LEA professional service (whether direct or consultative), the description should reflect the discipline related service.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">For most services, the option of “Service - no LRE minutes” should be selected from the drop-down box for this section. “Service - no LRE minutes” is used be for any service, support or activity that is provided in a general education setting.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">LRE minutes would be entered on the IEP for those services that are provided in a pull-out situation where the student is removed from a general education setting

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">9. Enter all possible staff positions that will be providing the service. For example, if health paraprofessional services are being provided the entry should be “Teacher and trained staff”. For discipline specific services, such as Physical Therapy, the entry should reflect the appropriate discipline, Physical Therapist. The Web IEP also requires the name of the service provider be entered. This name will not appear when the IEP is printed. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">10. A time and frequency entry is required for Medicaid reimbursement and should reflect the amount of time staff will be providing this service. For those services with varying frequencies, it would be acceptable to lengthen the range, such as entering 200 minutes monthly instead of 10 minutes daily (10 minutes X 20 school days in a month equals 200 minutes a month), in order to blend the various times into an average amount of time. This entry will be the maximum amount of time allowed for reimbursement from Medicaid. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">11. If a student receives special transportation service, it would be noted in this section of the IEP. Medicaid will only reimburse the transportation cost on an IEP for trips to and from a Medicaid provider for a medical service. ||



Info from 2013 - below More Medicaid Information can be found here...

Memo: To Special Education Staff, School Nurses, Transportation, Counselors, and School Administrators Re: Timberline Services and Medicaid I met with our Timberline Service Providers yesterday to review the services that they offer and how we can streamline our practices to get the most benefit possible out of their service and from Medicaid. __There are 5 categories that are Medicaid billable.__ __Here are some points, which may be changes, which I want everyone to know about:__
 * 1) ** Health ** – Students who have a diagnosis which supports their need for additional paraprofessional support for health services.
 * 2) ** Behavior ** – Students who have a diagnosis, behavior intervention plan, and need for additional paraprofessional support for behavioral success. (Remember, “behavior” means a myriad of things, not just explosive, avoidant, or attention seeking behavior.)
 * 3) ** Transportation **
 * 4) We can bill trip **mileage** for students with a **daytime service** who need special transportation. The driver must initial this log.
 * 5) We can bill for an **attendant**, even if they do **not have day time services**. This can be any district personnel.
 * 6) ** Nursing Services ** – Time to update health plans, administer medication, etc. are billable nursing minutes. If the school nurse spends 1 hour each fall updating the Health Care Plan, this can be billed.
 * 7) ** Counseling ** – A school **guidance counselor** who provides social skills instruction in a small group setting or 1-on-1 is providing a billable service. The student does NOT have to have a BIP. (This should be noted on Page F with the “GC” code.) Medicaid will not look specifically for the GC code, but will look at the narrative for indication of social skills instruction by the school counselor.
 * Timberline will be sending me electronic copies of all of the forms, and I will upload them to the wiki for everyone’s use. (www.kellyschloss.wikispaces.com)
 * We will begin housing the Medicaid related paperwork at the School Administrative Center. Any old paperwork that you have, should be sent to me at the SAC. Original paperwork will be housed for two years, and then it will be scanned and saved.
 * **All** log sheets, for any of the categories above, should be sent to me, Kelly, at SAC by the **8th** of each month for the prior month. This should include:
 * the signatures cover sheets (make sure that subs are signing),
 * daily logs
 * and weekly behavior summary sheets.

__Things to know about Timberline services:__ __Changes to Nurse’s Responsibilities:__ Thank you!
 * They have support for us! John or Chris will be coming each month after the due date of the 8th, to get all of the paperwork, and will then go to the school psychologists and nurses for signatures.
 * They will provide a quarterly review, to ensure we are getting as much benefit as possible. Information that they will review:
 * IEP pages B, F, and G
 * Health Care Plans
 * Current BIP
 * Diagnosis is on file – This can be a variety of items, as long as it is proof that a health care professional has diagnosed the child. Health care professionals include Nurse Practitioners, Physicians, Psychologists and Social Workers not working with the school setting, Psychiatrists, etc. Licensed Practical Nurses (LPN) and Registered Nurses (RN) may not diagnose. **//If we do not have diagnosis documentation on file, and know the child’s health care provider, Timberline has a form letter that they can send to the provider to confirm diagnosis. This is part of the service that they provide.//**
 * Log sheets – including signature sheets and weekly behavior summary sheets.
 * You no longer need to collect and maintain Medicaid records. Everyone should be sending them to me at the SAC.
 * Timberline will be here monthly and will bring the relevant sheets to nurses and school psychologists for signing.
 * Health Care Plans
 * Each child with a diagnosis should have a health care plan on file. This could be very general, just giving an overview of the diagnosis and implications.
 * For each Health Care Plan, the special education teachers and I need to know a minimum number of minutes that you need each year to update the plan. (This is billable, and can be billed as they’re updated, or annually when they’re reviewed for the upcoming year.) Page F will have the code “NS” for Nursing Services for these minutes.
 * The Health Care Plan in place at the time of the IEP will be either be pasted on Page I or will be uploaded to additional documents. A note should be made that the attached Health Care Plan is current at the time of the IEP, and any updates during the school year can be found in the Nurse’s Office. This is a common practice in many districts, and ensures that if child moves, the new school has some idea of their diagnosis and health care needs.
 * We will slowly make these changes as IEPs occur.
 * Teachers: You need to inform the nurses at least a week in advance of IEP meetings so that they can complete updates to Health Care Plans.

Kelly Schloss Director of Learning Supports

CC: Dann, Jon, & Chris at Timberline CC: Lynn Ubbe, Superintendent CC: Kent Bultman, Business Manager