minnesota third party reimbursement (tpr) statewide spring forum …€¦ · · 2016-04-22third...

MINNESOTA THIRD PARTY REIMBURSEMENT (TPR) Statewide Spring Forum Wednesday, April 20, 2016 Minnesota Department of Education, Conference Center B, 1500 West Hwy 36, Roseville, MN 55113

PURPOSE

The purpose of this Forum is to clarify steps for school districts to take to successfully access revenue and to share strategies for efficient and effective billing. We welcome educators involved in bringing revenue into school districts by billing Minnesota Health Care Programs (MHCP) for Individualized Educational Program (IEP) health related services provided to students with disabilities.

LEARNING OBJECTIVES

At the conclusion of the meeting, participants will be able to:

• Highlight the year’s TPR changes, realize the challenges and recognize the progress: excluded provider monthly checks, service modifiers, provider reenrollment, ICD-10-CM codes, personal care assistant (PCA) modifications, and progress on mental health services contracts.

• Focus on fiscal issues:

o According to Minnesota Department of Education (MDE) Fiscal Services, for EDRS reporting, name three variables that can affect health services reimbursement rates.

o According to MDE Compliance and Assistance Fiscal Monitoring, list two modifications to improve local programs.

o According to Minnesota Department of Human Services (DHS), state two must-dos to avoid overpayments for IEP health related services.

• Assess the local program according to the implementation criteria for PCA services.

• Review, for each IEP health related services, how the ICD-10-CM codes are derived from the assessment and evaluation reports.

• Measure school district third party billing efforts against statewide data on billed amounts by size of district and number of the nine possible components billed.

MINNESOTA THIRD PARTY REIMBURSEMENT (TPR) Statewide Spring Forum Wednesday, April 20, 2016 Minnesota Department of Education, Conference Center B, 1500 West Hwy 36, Roseville, MN 55113

FLEXIBLE AGENDA All sessions are in CC 15-16. All sessions broadcast via Mediasite

8:30 a.m.: Check in, Networking, Coffee and Breakfast Treats - Department of Human Services (DHS)

9:00 a.m.: Welcome to all on-site and on Mediasite – Thanks, Doug Gray Robyn Widley, Director, Division of Special Education; Tom Delaney, Supervisor, Interagency Partnerships Team; MDE Diogo Reis, Manager, Benefit Policy for Health Care Administration (HCA), DHS

9:10 a.m.: “It’s a new day, one day at a time.” Forum Facilitator - Julie Stoneking, Billing Coordinator, Albert Lea Area Schools

TPR – Year in Review: Change and Challenges - Tom Delaney, MDE TPR State Report and Trends MDE TPR SharePoint – Access, Navigating, Suggestions - Ruth Ellen Luehr, MDE

DHS – Progress and Serving Children Better - Jenny Roth, IEP Services Coordinator; Jill Johnson, CTSS

10:00 a.m.: B R E A K See PACER Resources - Linda Goldman Cherwitz, Family Health Advocate

10:15 a.m.: Focus on Fiscal – 1 Fiscal Services – EDRS, PARS, UFARS - Michael Brooks, Steve Collins, MDE

11:15 a.m.: Consent Review - Prior Notice and Parent Consent Tom Delaney, MDE

11:30 a.m.: L U N C H – thanks to DHS - and Conversations Job-Alike conversations: Use of TPR Revenue Visit PACER Resources

12:15 p.m.: Focus on Fiscal – 2 Fiscal Monitoring – Expectations, Findings, Recommendations - Laura Waldoch, Compliance and Assistance, MDE

Minnesota Health Care Programs (MHCP) Reimbursement Rates – Review and Adjust - Jesusa Williams, DHS

S T R E T C H I N P L A C E B R E A K 1:15 p.m.: Personal Care Assistance (PCA) - Start to Finish

SNEAK PEEK: IEP and PCA Plan of Care Side by Side - Tom Delany, MDE; Jenny Roth, DHS; Special Education Directors (NOTE: View PPTon screen – not posted for download.)

2:30 p.m.: ICD-10-CM Codes – Nearly a Year of Experience - Facilitator: Janet Lowe, TPR Statewide Network Chair, Saint Paul Public Schools Panel: (see next page for credentials and contact information) Dan Porter, Minnesota School Social Workers Association Sally Baas, Minnesota School Psychologists Association Tao Yuan Li, Minnesota Speech-Language-Hearing Association Carolyn Zachariason, Occupational Therapist, Minneapolis Public Schools Jennifer Nordstrand, Licensed School Nurse, Saint Paul Public Schools

3:30 p.m.: Closure & Adjourn - Janet Lowe, Chair, TPR Statewide Network Chair

THIRD PARTY REIMBURSEMENT (TPR) Statewide Spring Forum - April 20, 2016 ICD-10-CM Panel Presenters Name School District/Organization Telephone number Email address Janet Lowe, TRP Coordinator St. Paul Public Schools #625 Phone: 651-767-8189 janet.lowe@spp

s.org; Dan Porter M.S.W., L.I.C.S.W., Northeast Metro Intermediate District, Social Work Lead on Special Assignment; MSSWA Board Member, Professional Development Chair

MSSWA (Minnesota School Social Worker’s Association) (http://www.msswa.org)

612-998-3387 [email protected];

Sally Baas, Ed D., Ed. S – School Psychology, Concordia University – St Paul, Associate Professor of Education; MSPA President Elect Legislative Affairs Co-Chair

MSPA (Minnesota School Psychologists Association) (www.mspaonline.net)

(651) 603-6188 [email protected];

Tao Yuan Li, PhD, CCC-SLP Yinghua Academy Speech-Language Pathologist, MSHA Co-Vice President for Educational Issues

MSHA (Minnesota Speech-Language-Hearing Association) (www.msha.net)


Carolyn Zachariason, M.A., OTR/L; Minneapolis Schools Occupational Therapist

Minneapolis Public Schools Voicemail: 612-692-1233

[email protected];

Jennifer Nordstrand, MS, RN, Licensed School Nurse, CPNP, Coordinator -Section 504

Saint Paul Public Schools 651-767-8382

[email protected];

mailto:[email protected]


http://www.msswa.org/



http://www.mspaonline.net/


http://www.msha.net/









THIRD PARTY REIMBURSEMENT (TPR) State Staff DHS TPR Staff - Name Role Telephone Number Email Addresss Jenny M Roth DHS IEP Services Program

Coordinator 651- 431-2622 [email protected];

Jill Johnson Children’s Therapeutic Services and Supports (CTSS) Children’s Mental Health Services


Jesusa Williams Setting rates for reimbursement of professional and paraprofessionals


Jeri Boomgaarden

MN-ITS Trainer 651-431-3242 [email protected];

MDE TPR Staff x x x Tom Delany. Supervisor Interagency Partnerships Team Special Education Division

Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113

Phone: 651-582-8324 [email protected];

RuthEllen Luehr Interagency Education Specialist Special Education Division


Phone: 651-582-8403

[email protected];

MDE TPR Network x x x Sue Benolken Interagency Partnerships Team Special Education Division



Kara Temple Part C Coordinator Early Childhood Team



Mary Hunt Related Service Providers Division of Special Education Special Education Division



Bridgette Ramaley, Supervisor Fiscal Monitoring Compliance and Assistance Division



Laura Waldoch, Fiscal Monitor, Compliance and Assistance Division


Phone: 651)582-8404 [email protected];

Michael Brooks Fiscal Services - TPR

Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113;

[email protected];

Steve Collins Fiscal Services - EDRS


[email protected];

Minnesota Department of Health TPR Network

x x x Erika Yoney School Health Consultant Maternal and Child Health

Minnesota Department of Health 85 East Seventh Place, Suite 400 St. Paul, MN 55101 Mailing Address: P.O. Box 64882 St. Paul, MN 55164-0882

x [email protected];























THIRD PARTY REIMBURSEMENT (TPR) Statewide Network - 2015-16 April 22, 2016

Name School District/Organization Telephone number Email address Janet Lowe, Chair Region 11E – Metro (Large District, School Nursing and Personal Care Assistant Services)

St. Paul Public Schools #625 360 Colborne Street St. Paul, MN 55102

Phone: 651-767-8189 Fax: 651-228-3649

[email protected];

Carolyn Zachariason Region 11 – Metro W (Occupational Therapy Services, Large/Metro Districts)

Minneapolis Public Schools 1250 W. Broadway Ave Minneapolis, MN 55411

Voicemail: 612-692-1233 Fax: 612-668-5446

[email protected];

Michele Vold, MA Claims Processor Regions 1-2 NW (Biller, NW Area)

Bemidji Area Schools 3300 Gillett Dr. NW Bemidji, MN 56601

Phone: 218-333-3119 ext. 222 Fax: 218-333-3175

[email protected];

Mary Spang Region 3 – NE (Licensed School Nursing; Coop)

St. Louis County School District Northland Special Education Coop 1701 N. 9th Ave. Virginia, MN 55792

Phone: 218-749-8130 Fax: 218-749-8133

[email protected];

Julie Neururer Regions 5 & 7 Central (Rural/Small districts)

Little Falls Public Schools 1001 5th Ave SE Little Falls, MN 56345


Martha Ritter Regions 6 & 8 - SW/WC (Intermediates/Coops/Ed Districts)

SW/WC Service Cooperative 306 N. First Street Montevideo, MN 56265

Phone: 320-269-9243 Fax: 320-269-7132

[email protected];

Julie Stoneking Region 9 – SC (Small/Rural Districts)

Albert Lea Area Schools #241 211 W. Richway Drive Albert Lea, MN 56007


Denise Moody Region 10 (Mental Health Services)

Rochester Public Schools #535 615 SW 7th Street Rochester, MN 55902


Dawn Willson Suburban Districts (Licensed School Nursing)

Burnsville-Eagan Public Schools 202 West Burnsville Parkway Eagan, MN 55337


Cynthia Ritter Region 11W- Metro (Metro/Large Districts)

Anoka-Hennepin Schools 2740 Wingfield Ave. North Anoka, MN 55303


Lois Lillie Region 11W- Metro (Occupational Therapy Services)

Intermediate District #287 1820 N. Xenium Lane Plymouth, MN 55441

Phone: 763-550-7171 Fax: 763-550-7300

[email protected];

Rachel Sande Third Party Billing

Owatonna Public Schools 515 West Bridge Street Owatonna, MN 55060

Phone: 507-444-8618 Fax: 507-444-8699

[email protected];

Linda Goldman Cherwitz (Parent Advocate)

PACER Center 8161 Normandale Blvd. Bloomington, MN 55437

























Third-Party Reimbursement for Minnesota School Districts:

Frontline Service to Children and Youth with Significant Health-Related Needs

Tom DelaneySupervisor, Interagency Partnerships

Special Education DivisionMinnesota Department of Education

TPR Statewide Spring Forum - April 20, 2016

School Districts• Since 2000, school districts have been

legislatively mandated to bill private and public insurers for the costs of covered special education services (Minnesota Statute § 125A.21).

2

History• School districts have historically struggled

to receive federal funds for the services they provide to students with disabilities and needs for health care at school, including mental health services.

3

Current Situation• There are 133,678 students with disabilities

being receiving special education services through an individualized family service plan (IFSP) or individual education program (IEP) in Minnesota.

• There are over 8,000 students with disabilities receiving services and supports through a Section 504 Plan.

4

Current Situation - 2• Although it is difficult to establish the total number

of Minnesota students who require health-related services at school, the Minnesota Department of Health has evidence indicating there are 179,000 children and youth with special health care needs birth to age 18 (CYSHCN) in Minnesota (14.3% of the state’s population in that age range), not including

children at increased risk, and that among Minnesota households with children, 22.5% have at least one child with a special health care need.

5

Current Situation - 3• Data collected by the Minnesota Department of

Education through the 2013 Minnesota Student Survey suggests there may be a significant population of students who would benefit from improved access to mental health services at schools.

• For example, 14% to 15% of responding students reported they have physical disabilities, or long-term health problems (such as asthma, cancer, diabetes, epilepsy or something else).

6

Current Situation - 4• In addition, 9% to 13% of responding students

reported they have long-term mental health, behavioral or emotional problems.

• Of responding students in 8th, 9th and 11th grade, 26% to 32% reported feeling very trapped, lonely, sad, blue, depressed or hopeless about the future.

• Of responding students in these same grades, 13% to 15% reported thinking about ending their lives or committing suicide.

7

Current Situation - 5• Aggravating the described incidence of significant

health and mental health needs in the population of students in Minnesota schools is the number of uninsured children and youth in Minnesota. A 2014 report by the State Health Access Data Assistance Center indicates 5.4% of Minnesota children were uninsured in 2012.

• A more recent analysis based on the 2103 American Community Survey indicates this percentage increased to 5.6% in 2013.

8

Current Situation - 6• The Children’s Defense Fund also reported that

nearly 72,000 Minnesota children ages 0-17 (5.6 %) were uninsured in 2013.

• However, a 2013 report by the Children’s Defense

Fund identifies that 495,509 Minnesota children are enrolled in Medicaid.

• Affordable Care Act

9

Impact• Educational research has consistently identified the

important connection between the health of students and their academic achievement.

• The link between student mental health and academic achievement is just as important.

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Impact - 2• Optimizing the provision of health services in

schools, including mental health services, along with improving geographic and economic accessibility of these services for children, youth and families, is a promising strategy for improving academic achievement at schools with historically underserved student populations.

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Impact - 3The potential impact of third-party billing by school districts in communities includes:• Students with disabilities receive higher quality services as

school districts have access to increased funding for providing those services;

• Increased access to health-related services in schools, including mental health services, in geographic areas of the state with limited availability of these services for children, youth and families; and

• Increased access to free and affordable health-related services in schools for children and youth in poverty, and families with limited economic resources for accessing health-related services.

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frontline front•line \’frǝnt-līn\• adjective• relating to, being, or involved in a

front line• first-rate, also first string• the most important and active

position in a job or field of activity

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THIRD PARTY REIMBURSEMENT

Ruth Ellen Luehr,Interagency Education Specialist, MDE


1

Jenny Roth, IEP Services Coordinator(651) 431-2622 [email protected]

Jesusa Williams, IEP Services Rates(651) 431-2538 [email protected]

Jeri Boomgaarden, Provider Relations(651) 431-3242 MN-ITS training [email protected]

Jill Johnson, CTSS (Children’s Mental Health)

(651) 431-2333 [email protected]

Department of Human Services (DHS)MHCP Provider - IEP SERVICES

2





Minnesota Department of Education (MDE)Third Party Reimbursement (TPR)

Special Education – Interagency Partnerships

Tom Delaney (651) [email protected]

Ruth Ellen Luehr (651) [email protected]

3



Third Party Reimbursement (TPR)Components

4

When are IEP services billable?Child: Eligible for special education + MHCP

IEP: Child needs medically necessary servicesAuthorized by IEP teamIEP includes health related services

in ICD-10-CM code-able terms

Provide services: (need physician/APRN/PA orders?) Qualified health providerDocumented by provider/supervisor

5

What IEP health related services are billable?

– CTSS - Mental health services– Nursing services– Occupational therapy services– Physical therapy services– Speech-language-hearing services– Personal care assistance services

– Assistive technology devices– Special transportation– Oral/sign language interpreter services

6

How much money?School Population 1,000 students

14% special education ~20% 200 students

17% health care needs ~25% 50 students

30% free meals (on MHCP?) ~30% 15 students

1 student:Professional’s pay per minute x minutes per day = cost per day

$60/hr = $1/min. x 30 min./day = $30Cost per day x School days per year = cost per year

$30/day x 200 days = $6,000

15 students = $90,000 / year billed to MA for one service

Schools receive ½; match with state spec ed funds $45,000/yr7

Warrants Reports: Payments for 2013 – 14 (FY 2014)

and 2014 – 15 (FY 2015) and settle ups in fall 2015

Services Summaries (by type of service): Sneak Preview 2014 – 15 (FY 2015)

(can still bill during 2015 – 16)

TPR State Report

8

TREND: Payments to Districts by School Year

$0.54

$4.00 $6.08

$11.25

$16.75

$19.73 $20.77

$22.15

$25.42

$34.04

$32.48 $31.90

$33.07

$40.77

$46.75

$-

$10

$20

$30

$40

$502

00

1

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

TREND: Percent of Districts Billing by Service Type

48%

80% 83%

45%

32%

67%

3%

50%

1%0%

50%

100%FY2015

FY2014

FY2006

TREND: Number of Services Billed by School Year

11%

19%

11%

16% 14%13% 14%

1%0%

0%

25%

1 2 3 4 5 6 7 8 9

2006

2013

2015

Number of Billable Services

Perc

en

t o

f D

istr

icts

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TOP Number of Services Billed 2014 – 15 (FY 2015)

District # Services

WILLMAR 8DULUTH 8LITTLE FALLS 8ST PAUL 8WASECA 8MOORHEAD 9

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Districts billing for more services:1 – 3 services: 42% 4 – 7 services: 57%

Warrants issued to 311 districts – 75%

Reimbursement revenue: $46.8 million

Summary 2014 – 15 (FY 2015)

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Access: See MDE Third-Party Billing webpage

Third Party Reimbursement: How to Access SharePointSee the instructions on this sheet to get signed up to access the TPR SharePoint for timely materials for coordinators and staff setting up the TPR system and billing.

MDE website – Create an account, get approval, log in

MDE TPR SharePoint –Access, Navigating, Suggestions

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http://education.state.mn.us/MDE/index.html

http://education.state.mn.us/MDE/SchSup/SpecEdComp/ThirdPartyBill/index.html

http://education.state.mn.us/mdeprod/idcplg?IdcService=GET_FILE&dDocName=050313&RevisionSelectionMethod=latestReleased&Rendition=primary

https://collaboration.education.state.mn.us/_layouts/login.aspx?ReturnUrl=/SpecialEd/3rdparty/default.aspx

TPR SharePoint - Navigating

TPR SharePoint – Navigating 2

Announcements and Calendar

Shared DocumentsPrivate insurers denial listDataSHARE documents

FORUM Resources

ICD-10-CM

16


TPR SharePoint - Navigating

LISTSCalendar

Where to find info on DHS and MDE website

DISCUSSIONS

Suggestions!

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April 2016 Spring Forum

Individualized Education

Programs (IEP)

Health Related Services

MHCP

IEP Updates

Jenny M Roth - DHS

3

Criteria for Providing telemedicine services can be found in the MHCP IEP Services Provider Manual under Covered and Noncovered IEP Health-Related Services and then Criteria for Providing Services via Telemedicine

Links to the Telemedicine Criteria, were added to the Occupational Therapy (OT) Physical Therapy (PT) and the Speech Language Pathology sections of the IEP Provider Manual for easy access to the telemedicine services requirements

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_151385

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_185201#criteria

4

Telemedicine coverage applies to a child or youth who is MA eligible, has an IEP and the service provided is identified in the IEP

MHCP allows payment for a total of three telemedicine visits per week per child or youth

5

To be eligible for reimbursement, the school or school district must self-attest that the telemedicine services provided by the professional provider either employed by or contracted by the school meets all of the conditions of the MHCP telemedicine policy.

A completed Provider Assurance Statement for Telemedicine (DHS-6806) (PDF) must be submitted, approved and in the provider file of each school or school district.

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6806-ENG

Use the same HCPC codes (T1018 – Ux) and modifiers that describe the IEP services as if provided face-to-face

Add the modifier GT to indicate the service was provided via an interactive audio and video telecommunciations systems

Use the Place of Service code that identifies the location of the recipient/child (originating site) when the service was provided

IEP Health Related Service HCPC code Modifiers

Speech evaluation (in person) T1018 – U3 (no modifiers)

Tele-med Speech services T1018 – U3 TM, GT

6

Revalidation

Procedure Codes, Modifiers and Units

Explanation of Benefits

Tidbits of

Information

8

370 revalidation letters were sent to schools DHS received approximately 300 applications Many pending more information – letters sent to schools

Common Errors Applications fees not paid Disclosure of Ownership – Who has to disclose Yes/No questions on signature page

Exemptions One exemption to waive fee was approved Four in review

10

See instructions in the IEP Services Provider Manual -

left hand column, Billing and Authorization Requirements,

then IEP Procedure Codes, Modifiers and Units

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_185202#iep

11

An EOMB is a statement from DHS (or other health plans) reporting the amounts paid, reduced or denied for the services provided.• Provided to parents to inform parents of services

provided to their child

• An EOMB is not a bill

• Services provided in schools do not affect the parental fee for children on TEFRA

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July 2015 = 32 Option 2 & 3

April 2016 = 68 Option 2 = 81% Option 3 = 19%

6 in process, plus Option 3 applications

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Save the date! November 2-4, 2016Place to be confirmed

Clinical, supports, contracting, invoicing, etc.

Interested in presenting or planning committees?

Email [email protected]

IEP - MA

Michael Brooks and Stephen Collins

TPR Statewide Spring Forum, April 20, 2016

Division of School FinanceSFY 2016

Minnesota Statutes, section 125A.21, Subdivision 2 requires school districts to seek reimbursement from insurers and other third parties for the cost of services provided by a district whenever these services are covered by the child’s health insurance. This statute is

based on federal regulations and the Individuals with Disabilities Education Act (IDEA). Districts can enroll as providers with public programs like Medical Assistance (MA) and private plans like Blue Cross and Blue Shield.

THIRD PARTY FUNDING

education.state.mn.us 2

Districts, Charter Schools and Cooperatives have the responsibility to accurately report their data on EDRS for the purpose of state special education aids and information that will be provided to DHS to calculate rates for each district, charter school and cooperative for the IEP-MA Service categories.

Errors in the rates, in a large part, can be traced back to inaccurate information especially in the expenditures and hours or days reported on EDRS.

Data Reporting for Rate Calculations


Independent school districts Special school districts Charter schools Intermediate districts Special education cooperatives Vocational and special education cooperatives Education districts State Academies for the Deaf and Blind School for the Arts Service cooperatives Tribal Schools

Who May Enroll as Providers


A student is eligible for special education. A student is eligible under a public/private health

plan when the covered service is provided. The service is identified on the Individualized

Education Program (IEP)/Individual Family Service Plan (IFSP) as necessary for the student to benefit from special education.

The parent/legal representative has been notified/informed and consents/releases have been obtained.

The service meets the criteria of the plan including medical necessity, staff credentials, physician orders, authorization, documentation, etc.

IEP health-related services are billable when:


The IEP team authorizes all IEP health-related services documented in the Individualized Education Program plan (IEP) or Individualized Family Service Plan (IFSP). Services do not require prior authorization from the MHCP medical review agent.

Orders from a physician, nurse practitioner, or physician assistant are required for nursing service that would require such orders if performed in another setting, such as a hospital, clinic or home. Orders must be obtained annually and can cover a period of up to one year. The orders must be in place at the time the provider bills the service.

All other covered IEP services are ordered by the health care professional within their scope of practice.

IEP health-related services:Authorization and Orders


• Below is a listing of the IEP-MA categories of service:Physical therapyOccupation TherapySpeech Language Therapy and AudiologyNursingMental HealthPersonal Care Interpreter

• Also, Transportation and Assistive Technology/equipment can be billed to DHS

Categories of IEP-MA Services


Minnesota Statutes, section 125A.74, Subdivision 5 protects other special education funding from being reduced by third party revenue. Revenue obtained from a third party source does not reduce any other revenue a district receives for a child. The revenue received from third party sources must be tracked through the Uniform Financial and Reporting System (UFARS) according to Minnesota Statutes, section 125A.76, Subdivision 2. UFARS Finance Code 372: Report expenditures using third party

revenue with this code. UFARS Source Code 071: Report all revenue received from

Minnesota Health Care Programs (MA and MinnesotaCare) in UFARS with Source Dimension Code 071.

UFARS Source Code 072: Report all revenue received from private health plans (Blue Cross, Medica, etc.) in UFARS with Source Dimension Code 072.

Reporting Revenue from Third Party (1)


Minnesota Statutes, section 125A.76, Subdivision 2(8), requires revenue received from public and private health plans to be treated as special education revenue for only the purpose of calculating cross-subsidy. The revenue will be included as special education revenue in annual cross-subsidy reports and excluded when calculating excess cost aid to districts

For auditing purposes, third party revenue is considered ongoing and can be carried over. It is essentially treated as current year revenue, because at the time of an audit the amount of the year-end revenue is unknown.

Reporting Revenue from Third Party (2)


34 Code of Federal Regulations (C.F.R.) 300.154 (g) (2), requires that expenditures from “Federal funds (e.g. Medicaid)”…. used for special instruction or related...”will not be considered “State or local” funds for purposes of the maintenance of effort provision in 300.163 and 300.203.”

Based on this requirement, maintenance of effort (MOE) calculations do not include:

– Funding Source Code ‘i’ Third-party Expenditures Extended School Year.

– Funding Source ‘j’ Third-party Expenditures Regular School Year.

Maintenance of Effort


Assistive technology (equipment) may be purchased with state and local funds and the district will receive third party revenue reimbursement. Pieces of equipment purchased through third party revenue reimbursement, in whole or in part, are the property of the child for whom they are purchased. There is no specific law or rule in Minnesota about ownership of equipment purchased with local or state education funds. Districts are not violating any law or rule by assigning ownership of equipment to the student. For equipment that costs more than $5,000 or the district’s standard, use UFARS Object Code 381

and EDRS Service Code P, for equipment purchased in whole or in part, use UFARS Object Code 381.

Equipment Purchased for Third Party Reimbursement


Use UFARS Object Code 433 and EDRS Service Code H. Supplies/equipment purchased with any combination of funding but with a cost per unit of under $5,000 or the district’s standard, are reported in

UFARS and EDRS as expenditures for supplies. It doesn’t matter if the cost is less or more than $5,000 or

the district’s standard, the equipment still belongs to

the child and is not an asset of the district if the district receives public or private health plan funding for the equipment.

Equipment Less Than $5,000 or the District’s Standard


Minnesota school districts use a variety of delivery models to provide necessary related services for children eligible for special education. In some situations, more than one district may be providing services to a child. When this happens: Only the district that provides a service and pays the

salary or other actual cost of the service can bill a third party for that service. More than one district may bill a third party for health-related services.

Purchased Services and Contracted Services (1)


For example, an independent district provides special transportation for a child to an intermediate district where the child receives occupational therapy (OT), physical therapy (PT), speech, and personal care services. If all the billing criteria are met, the independent district provides and bills for special transportation services. If all the billing criteria are met, the intermediate provides and bills for OT, PT, speech, and personal care services. Each district receives and reports the revenue. Neither district may bill for services provided by another district unless one of the districts has agreed to act on behalf of the other district as a billing agent. However, the billing agent must bill under a specially approved billing agent number using the provider number of the district for whom it is billing.



No formal written agreement is needed for either district to bill a third party for services provided by the district.

If a district acts as a billing agent for another district, the districts will want to have a written agreement outlining responsibilities, including potential charges for providing billing services. The charge for billing agent services, according to federal regulation and Minnesota Rule 9505.0455, may not be based on the amount of money received (e.g., a percentage of the reimbursement). For more, refer to the DHS Provider Manual.



A student’s serving or resident district cannot make

claims to a third party for related services provided under special education by another district, such as an intermediate, cooperative, or education district.

Some districts use billing agents. It is important to remember that the district, not the billing agent, is responsible for the services they bill. Whether the district is billing Minnesota Health Care Programs (MHCP) or another third party, the providing/billing district must make sure the service is identified in the IEP/IFSP, is provided/supervised by qualified staff, and is appropriately documented. They also must make sure the parent/legal representative has been informed and release/consent is obtained.



A cooperative, intermediate, or educational district cannot simply refund third party revenue to its member districts. The cooperative, intermediate, or educational district must document the receipt and expenditure of third party revenue according to the procedures previously described. Simply “refunding” third party revenue to a

member district does not provide the required documentation.

Multiple District Funding


Employees and contracted service providers cannot be paid with federal special education funds (Finance 419, 420 or 422), IEP-MA Funds (Finance 372) or LCTS (Finance 799) AND billed for IEP-MA reimbursement.

Employees and contracted services providers paid with local or state funds are eligible to be billed for IEP-MA reimbursement.

Supervisory Services are not entered separately.

Federal or IEP-MA Funded Staff


The data reported on EDRS includes the time and expenditures for Occupational Therapist and Occupational Therapy Assistants.

EDRS Personnel Type Code 05

UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 151 – Salaries or 394 – Contracts

Occupation Therapy


The data reported on EDRS includes the time and expenditures for the Physical Therapist and Physical Therapy Assistants.



Physical Therapy


The data reported on EDRS includes the time and expenditures for Speech/Language Therapist and Audiologist. Speech/Language Therapy Assistants are not eligible to be billed for IEP-MA reimbursement.

Speech/Language Therapist EDRS Personnel Type Code 07


Speech Language/Hearing Services


Audiologist



Speech Language/Hearing Services (2)


The data reported on EDRS includes the time and expenditures for nursing services. This can include school nurses and other nurses that are authorized by the IEP team.

School Nurse EDRS Personnel Type Code 06


Nursing Services


Licensed Nursing Services



Nursing Services (2)


A number of professionals are reported in this area, including, school psychologist, qualified mental health professionals, mental health practitioners and behavioral aids.

It is important that districts that have contracted for mental health services enter the individuals who are under contract separately on EDRS with the appropriate personnel type code, actual expenditures and hours of services provided.

Districts should not enter lump sums of these services but separate the expenditures by service providers.

Mental Health Services (1)


School Psychologist





Qualified Mental Health Professional





Mental Health Practitioner





Mental Health Behavioral Aid





The Personal Care Assistant (PCA) provide assistance for daily living skills/behaviors and are authorized by the IEP team.

Personal Care Assistants EDRS Personnel Type Code 008 or 053

UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 416– Object Code 161/162 – Salaries or 394 – Contracts

Please see the transportation area for additional information for PCAs that are included in the data provided to DHS for IEIP-MA rates.

Personal Care Assistant Services


Interpreters are authorized to be billed to DHS for IEP-MA when the student is receiving a medical service in the categories above and need to the interpreter to understand and/or respond to the therapies. Interpreters are not covered for PCA services or transportation

Interpreters (Foreign Language) EDRS Personnel Type Code 26

UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 416– Object Code 163 – Salaries or 394 – Contracts for

students, Object 305 for parents and other adults.

Interpreters (1)


Interpreters (Deaf)


UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 164 – Salaries or 394 – Contracts for

students, Object 305 for parents and other adults.

Interpreters (2)


Cooperatives will bill DHS for the IEP related services that the Cooperative provides to the MA eligible students and the Cooperative is reimbursed with their own NPI number.

Districts submit the IEP claims to DHS and they are reimbursed the federal portion of those claims using the district’s NPI number. If the Cooperative provides the services to the district, the expenditures should be reported by the district as purchased services and the district should bill for those services to DHS.

Cooperative Entities Data Reporting to MDE and Billing of IEP Services to DHS


After the fiscal year has ended, the Division of School Finance posts a report of the data that will be provided to DHS for the calculation of IEP-MA rates.

Districts should verify that the information is accurate. If the district is invoicing DHS for an IEP-MA service, then the report should show FTE and Expenditures for that service.

If no data is reported on EDRS for Health Related Service category, e.g. nursing service, then DHS will calculate the rate to ZERO.

Verification of IEP-MA EDRS Data (1)


The “Special Education Salary and FTE Information for

Medial Assistance” report may be found at:

MDE website (www.education.state.mn.us)

Select: Data Center > Data Reports and Analytics > Under School Finance Reports select Minnesota Funding Reports (MFR)



http://www.education.state.mn.us/

From the ‘drop down’ menu select:

District: Select your District Name View Reports: “All Reports”

Category: “Special Education”

Year: The fiscal year you are seeking to review

Report: “Special Education Medical Assistance Reports on Salaries, Contracted Services and FTE”



Report: “Special Education Salary and FTE

Information for Medial Assistance”


Minnesota Statutes, section 125A.21, Subdivision 3 gives broad general guidelines for district use of third party revenue (revenue received from medical assistance/insurance companies). Districts may:

1. Retain a sufficient amount of third party revenue to pay for the cost of obtaining the revenue, e.g. billing agent or district staff that bill third parties.

2. Secure or provide training and technical assistance to obtain third party revenue or increase the amount of their third party revenue.

3. Reallocate third party revenue for the “benefit of students with

IEPs/IFSPs served by the district.”

District Use of Third Party Revenue (1)


Some things for which districts have earmarked third party revenue include:1. Additional support staff to perform clerical due process

functions, thus freeing up teacher time for special education.2. Additional professional staff to reduce class/caseloads in

special education.3. Equipment such as computers for special education.4. Helping professional staff with training costs related to

special education.5. Helping professional staff with license fees/membership dues

for special education.6. Maintaining current special education staff salaries.7. Purchasing items requested by students or families to

enhance the student’s ability to benefit from special education.



If third-party revenue is used for the cost of items above, those costs may never be reported in EDRS. If third-party revenue is used for the cost of item 3 above, those costs may be eligible to report in EDRS if the costs meet the criteria for Funding Source Code A.

While third-party revenue may be used for the items, some, not all of the items above are eligible to be entered on EDRS for state aid.



Each fall the Minnesota Department of Human Services (DHS) invoices districts, charter schools and cooperatives for the prior fiscal year’s administrative

costs for IEP-MA services (Minnesota Statutes, section 256B.77, Subdivision 2). Districts cannot establish a payable for these costs as the districts portion of IEP-MA payment is not known as it is based upon the total payments made to districts and the costs of the administration of IEP-MA services. Therefore, the districts should pay this fee out of current year receipts of IEP-MA funds.

DHS Administrative Fees


Districts may bill DHS for IEP-MA reimbursement for transportation to and from school on the days that the student receives a medical services as listed above, if the student requires special transportation.

The requirements for a student to be eligible for special transportation for IEP-MA is different from the requirements for the expenditure to be eligible for state special education aids. Districts should check the DHS IEP Reference Guide for guidance as to when the transportation is eligible for IEP-MA billing

Transportation (1)


MDE calculates a “trip rate” using the data submitted

by districts through MARSS and UFARS to calculate the average cost of special education transportation.

A “trip rate” is the average cost of transporting a

student to and from school.

Nursing and PCA as well as administrative costs are not included in the trip rate.

Transportation (2)


District that have nursing and PCA services provided while transporting the student would bill DHS for IEP-MA separately for those services over and above the “trip costs”.

Districts have to enter the nursing and PCA services provided while a student receives special transportation in billing.

Districts receive special transportation revenue as the data entered on EDRS is only used by DHS to calculate the IEP-MA rates.

Transportation (3)


Special Transportation Nursing Services


UFARS ExpendituresFinance Dimension 723Program/Disability Code 760Object Code 155

Transportation (4)


Special Transportation Personal Care Assistants


UFARS ExpendituresFinance Dimension 723Program/Disability Code 760Object Code 161

Special Transportation (5)


Please direct all questions regarding IEP-MA data and EDRS entries to:

Michael Brooks651-582-8240

[email protected]

Stephen Collins651-582-8467

[email protected]

Questions


Prior Information and Parental Consent for Sharing Data

and Billing Medical Assistance

Tom DelaneySupervisor, Interagency Partnerships


*Commissioner’s Priorities: Scope

• Ensure the rights of students with disabilities and their parents;

• Consolidate special education paperwork.– Effectiveness (i.e. meets standards)– Efficiency– Consistency

2

*Opportunities for Improvement

• Revision of the Minnesota Health Care Providers enrollment form (2013); and

• Issuance of revised federal regulations for data sharing and consent for billing public health insurance (2013).

3

*Revised Policies• Effective July 1, 2013;

• Prior Information: Specific information must be provided to parents before legitimately procuring their consent to share data and bill public health insurance (e.g. Medical Assistance); and

• Consent: Required elements, documentation and duration of parental consent.

4

*Prior Information• All of the following requirements must be met

before procuring consent and accessing Medical Assistance:

• Text in Due Process & Procedural Safeguards;

• Provided at least annually; and

• Explain all of the protections available to parents under Part B of the IDEA, as described in 34 CFR §300.154(d)(2)(v).

MDE Procedural Safeguards Notice – link to form, translated

5

http://education.state.mn.us/MDE/SchSup/ComplAssist/ProcSafe/index.html

*Prior Information: Recommended Text

WRITTEN ANNUAL NOTICE RELATING TO THIRD PARTY BILLING FOR IEP HEALTH-RELATED SERVICES

• Before billing Medical Assistance or MinnesotaCare for health related services the first time, and each year, the district must inform you each year in writing that:

MDE Consent form for Third Party Billing Health-Related Services -Parts B and C combined, translated

6

http://education.state.mn.us/MDE/SchSup/SpecEdComp/ThirdPartyBill/index.html

Prior Information: Recommended Text

• The district will share data related to your child and health related services on your child’s IEP with the Minnesota Department of

Human Services to determine– if your child is covered by Medical Assistance or

MinnesotaCare; and

– whether those services may be billed to Medical Assistance or MinnesotaCare.

7

Prior Information: Recommended Text - 2

• Before billing Medical Assistance or MinnesotaCare for health related services the first time, the district must obtain your consent, including specifying (cont.):

– the personally identifiable information that may be disclosed (e.g. records or information about the services that may be provided); and

8


• Before billing Medical Assistance or MinnesotaCare for health related services the first time, the district must obtain your consent, including specifying (cont.):– the purpose of the disclosure, the agency to

which the disclosure may be made (i.e. the Department of Human Services) and which specifies that you understand and agree the school district may access your (or your child’s)

public benefits or insurance to pay for health related services.

9


• The district will bill Medical Assistance or MinnesotaCare for the health related services on your child’s IEP (Minn. Stat. § 125A.21, Subd. 2(c)(1)); [not new]

• The district may not require you to sign up for or enroll in Medical Assistance or MinnesotaCare or other insurance programs in order for your child to receive special education services.

10


• The district may not require you to incur an out-of-pocket expense, such as the payment of a deductible or co-pay amount incurred in filing a claim for health services provided, but may pay the cost that you otherwise would be required to pay;

11


• The district may not use your child's benefits under Medical Assistance or MinnesotaCare if that use would:

– decrease available lifetime coverage or any other insured benefit;

– result in your family paying for services that would otherwise be covered by the public benefits or insurance program and that are required for the child outside of the time your child is in school;

12

Prior Information: Recommended Text - 7• The district may not use your child's benefits under

Medical Assistance or MinnesotaCare if that use would (cont.):

– increase your premiums or lead to the discontinuation of benefits or insurance; or

– risk your loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.

13


• You have the right to receive a copy of education records the district shares with any third party when seeking reimbursement for IEP health-related services.

14

Prior Information: Recommended Text – 9

• You have the right to stop your consent for disclosure of your child’s education records

to a third party, including the Department of Human Services, at any time.

• If you stop consent, the district may no longer share your child’s education records

to bill a third party for IEP health-related services.

15


• You can withdraw your consent at any time and your child’s IEP services will not change

or stop (Minn. Stat. § 125A.21, Subd. 2(c)(3)).

16

*Methods to Ensure Prior Information

• Provide all parents of students with disabilities with a copy of Due Process and Procedural

Safeguards on an annual basis (i.e. at least once a year).

17

Methods to Ensure Prior Information - 2• If a child has had an IEP within the same school

district for more than a year…

• …then a school district may conclude that the parents received a copy of Procedural

Safeguards information prior to their most recent (re-)enrollment in MA.

• Federal requirements for information prior to consent are therefore met and MA-billing can proceed.

18

Methods to Ensure Prior Information - 3

• If a child has had an IEP for less than a year, then in order to ensure information was provided prior to consent the school district must:

– Complete their own inform and consent process (e.g. with MDE forms); or

19

Methods to Ensure Prior Information - 4• If a child has had an IEP for less than a year, then, in

order to ensure information was provided prior to consent, the school district must:

– Provide parents with Procedural Safeguards

information and wait out a subsequent one year period prior to submitting bills to MA, during which time the parents may re-enroll in MA and federal regulations requiring information prior to consent are fulfilled.

20


• These approaches require and assume that the school district’s Procedural Safeguards

information meet federal requirements for information prior to consent for data sharing and third-party billing.

21


• A school district may need to use its own consent process, or wait a year, for students who transfer into the school district if it cannot be established that parents received information prior to consent that meets the requirements of federal regulations.

22

*Parent Consent

• The revised MHCP enrollment form meets federal and state requirements for parental informed consent (34 CFR §300.9 and Minn. Stat. §125A.21, Subd. 2).

23

*Parent Consent - 2

• Effective July 1, 2013• School districts do not need to complete

additional consent paperwork if it can be established that:– Parents received required information before

signing their most recent enrollment in Minnesota Healthcare Programs (MHCP); AND

– Are actively enrolled in MHCP.

24

*Legal Citations

• Federal Regulations– 34 CFR §300.154– http://www.gpo.gov/fdsys/pkg/FR-2013-02-

14/pdf/2013-03443.pdf

• State Statute– Minn. Stat. § 125A.21– https://www.revisor.mn.gov/statutes/?id=125A.21

25

http://www.gpo.gov/fdsys/pkg/FR-2013-02-14/pdf/2013-03443.pdf

https://www.revisor.mn.gov/statutes/?id=125A.21

MDE CONTACT

Tom DelaneySupervisor, Interagency PartnershipsSpecial Education DivisionE-mail: [email protected]: 651-582-8324

26


Special Education Fiscal Monitoring and Third Party Reimbursement

Expectations, Findings, Recommendations

Laura Waldoch, Fiscal MonitorCompliance & Assistance Division

Phone - (651)582-8404; Email - [email protected]


“Leading for educational excellence and equity. Every

day for every one.”


Monitoring Third Party Reimbursement

• Registered as MHCP Provider

• Received reimbursement– Source Code 071– Source Code 072

• Expenditures– Finance Code 372

Minn. Stat. 125A.21 Subd. 2(a)IDEA 34 CFR § 300.154(a)


Monitoring Third Party Reimbursement (cont)

• Notified parents of intent to seek reimbursement– Annual notification– No requirement to enroll in or use public benefits or

insurance– No requirement to incur expense

• Tracking parental consents or denials

IDEA 34 CFR § 300.154(d)-(e)Minn. Stat. 125A.21 Subd. 2(b-c)


TPR-Procurement

• Expenditures from Finance Code 372

– Third Party Reimbursement Administrative Costs– Third Party Reimbursement Training & Technical

Assistance– Benefit students with IEPs

Purchases for individual students: Student is title holder

\


TPR-Transportation

• Document on IEP– Accommodations

\


TPR-Time & Effort

• Time & Effort Support– Accurately support all time paid with SPED funds– Third Party Reimbursement activities eligible for

payment with SPED funds

• Time Studies vs. Time & Effort support



0

20

40

60

80

100

120

Not enrolled Did not seekreimbursement

No parentalnotice

LEAs with findings

LEAs monitored

Recent Findings

Jesusa Williams, DHS


MHCP Rates and Payments

Averting Paybacks During Final

Settle-up

2

Rates and PaymentsInterim RatesRates initially paid on the claim.

Final RatesRate calculated using a full year of historical cost and encounter information from the school district and MDERates that retro-actively replace the interim rates for that period of timeRates that become the interim rates for the current school year

3

Basic DetailsDistricts are initially paid an interim rate. Since IEP rates are cost based – once the final costs for the various IEP services are determined and provided by the school district and MDE, the interim rates must be adjusted to the final IEP ratesbased actual historical costs, time and encounter information.

4

FINAL SETTLE-UP - WHENOccurs after a year to bill for IEP services is up.

Illustration: Last Day of School – June 30, 2015 (7/1/2014 –

6/30/2015) Schools have until June 30, 2016 to bill DHS for

IEP services provided to MA eligible kids in the district.

Settle-up for FY 14-15 will occur after June 30, 2016

Final Reprocessing of paid IEP Claims usually happen in the Fall.

5

What Happens During Settle UP ??Final Direct Service Time and Direct Encounters

from School Districts

Final Total Salary and FTE Information from MDE

Final Fringe Benefits/Unrestricted Indirect Cost Percentages from MDE

Final IEP rates are recalculated and paid IEP claims are reprocessed and paid at the Final rates.

Illustration:Interim Rate for PT Service - $ 50.00Final Rates for PT Service - $ 60.00

Difference – Underpayment $ 10.00

All paid PT claims are taken back and reprocessed using the final rates. The underpayment difference of $10.00 is multiplied with ALL PAID PT CLAIMS processed for that period of time and additional monies are credited or given to the district.

Under Payment – SETTLE UP

Supplemental RA Report

Illustration:Interim Rate for OT Service - $ 70.00Final Rates for OT Service - $ 50.00

Difference – Over Payment ( $ 20.00 )

All paid OT claims are taken back and reprocessed using the final rates. The overpayment difference of ($20.00) is multiplied with ALL PAID OT CLAIMS processed for that period of time and the amount of overpayment is reported as a credit balance in the district’s Remittance Advice. This overpayment is adjusted against the district’s future claims until the credit balance is reduced to zero.

Over Payment – SETTLE UP

Supplemental RA Report (1)

Supplemental RA Report (2)

Can Districts Prevent / Avert / Stop Huge Underpayments/Overpayments at Settle-up?

No…..Yes….. Maybe…???

What can Districts do?? Underpayments/Overpayments = Manageable Does not freeze/cripple/paralyze the Districts, bring the district to a standstill or halt

UNDERPAYMENTS / OVERPAYMENTS

Review the IEP Rate Worksheets

Review the Supporting Data used in setting the Rates

Salary and FTE Data reported to MDE Time and Encounter Data reported to DHS

SCHOOL DISTRICTS

School Districts

Direct Service Time

Direct Encounters

MDE

Total Annual Salary (per personnel type code)

Total Contract Expenses(per personnel type code)

Full Time Equivalence FTE (per personnel type code)

District Fringe Benefit %District Unrestricted Indirect

Cost %District Contract DaysDistrict Daily Hours

13

Data Needed to Calculate IEPCost Based Rates

14

IEP Services Annual Data Report Form

Service HoursDirect Face to Face Time with MA Eligible childMultiple Service Providers = combine time of service

providers and record in MA eligible child’s activity logs

EncounterCount 1 encounter per child per IEP service per day Multiple Encounters with Child for same service –

record as 1 Encounter for service for the day

Service Hours and Encounters

16

MDE Salary and FTE ReportRUN DATE 08/07/15 MINNESOTA DEPARTMENT OF EDUCATION SPEDMA285401007

SPECIAL EDUCATION SALARY AND FTE INFORMATION FOR MEDICAL ASSISTANCEFISCAL YEAR 15-16

DISTRICT 0001-01 SAMPLE PUBLIC SCHOOL DISTRICT

NUMBER OF MINUTES IN A SCHOOL DAY 440 NUMBER OF DAYS IN A SCHOOL YEAR 180 NUMBER OF HOURS IN A SCHOOL YEAR 1320

TOTAL CONTRACTEDELIGIBLE SERVICE TOTAL SALARIES TOTAL FTE SERVICE COST TOTAL FTE

PHYSICAL THERAPY 0.00 0.00 0.00 0.00OCCUPATIONAL THERAPY 0.00 0.00 0.00 0.00SPEECH LANGUAGE/HEARING THERAPY 0.00 0.00 0.00 0.00NURSING 0.00 0.00 0.00 0.00MENTAL HEALTH 0.00 0.00 0.00 0.00PERSONAL CARE 0.00 0.00 0.00 0.00INTERPRETER 0.00 0.00 0.00 0.00

Only costs reported through the Electronic Data Reporting System (EDRS) designated by MDE are included in the cost based rates for IEP services

Districts are responsible for all required data reported to DHS and MDE, including data prepared by 3rd parties

Review all data for accuracy

Review all data during the data review periods specified by MDE and DHS

REMINDERS

18

Request for Rate Revisions

Rates are funky or far out – too high/too lowChanges in Salary Costs/Contract ExpensesChanges in School Staff PersonnelNew HiresRetirement of StaffChanges in Services being provided in District Increase/Decrease in the # of Kids in DistrictAdmission/Release of High Needs Child in District

19

Rate Revision Request Inquire about Rate Revision RequestsProvide DHS with the new information

Salary and/or Contract Expenses Increase/DecreaseUpdated Time and Encounter Data

DHS will review new/updated information and will issue revised Interim rate worksheets, if necessary. Interim Rates can be adjusted/amended/correctedUnless appealed during the 60 day review period –

Final Rates set are considered FINAL, since these rates are based on final data reported to MDE and DHS.

20

FINAL RATES District notifies districts of final rates by email.

Districts must review all submitted data and final rates within 60days

To dispute the final rates, a written appeal must be filed within 60 days from the date the notice was mailed

DHS cannot accept appeals filed after 60 days

If no appeal is filed within 60 days, all paid claims are reprocessed with the final rates.

21

FORMAL APPEALAppeal must list the disputed items, reasons for the

dispute and the name and address of the contact person for the appeal.

Send the appeal to: Dept. of Human ServicesIEP Services Rates Specialist

P.O. Box 64984

St. Paul, Minnesota 55164

22

Final and Interim Rates Reminders Effective September, 2015 – DHS will no longer mail IEP Final and

Interim Rate worksheets to school districts during Settle-up and/or when rate revision requests are made by the school districts

IEP Final and Interim rate worksheets will be dropped off to the School District’s Individual MN-Its mailbox Miscellaneous Received folder under the file type IEP.

IEP Final and Interim Rate worksheets are identified by the IEP Rate File Name.

IEP Final and Interim Rate worksheets will stay in the MN-IT’s

Miscellaneous Received folder for 90 days. Schools Districts will be notified by email – if new rate worksheets

are dropped off in their individual MN-ITS mailbox.

Added Components for Utilizing the IEP as the

Personal Care Assistance (PCA) Care Plan

Tom DelaneySupervisor, Interagency Partnerships Team

Special Education Division


Unofficial GuidanceThis presentation is unofficial guidance from the Minnesota Department of Education and the Minnesota Department of Human Services and is not for distribution or training purposes. A forthcoming joint agency memorandum will provide formal guidance to Minnesota school districts.

The information is being shared at this time to gather feedback from school districts and to improve technical assistance and dissemination planning.

2

Purpose• Can the Individualized Education Program (IEP)

serve as the Personal Care Assistance (PCA) Care Plan?

• If so, what added elements must be included in order for the IEP to serve that purpose?

3

Workgroup• Minnesota Department of Education• Minnesota Department if Human Services• Minnesota Administrators for Special Education• Rochester Public Schools• Saint Paul Public Schools

4

ReviewThe workgroup reviewed the alignment of

- required components in the PCA Care Plan (Minnesota Statute § 256B.0659, Subdivision 7)

- required components of the IEP (Minnesota Administrative Rule 3525.2810)

- required components of the Total Special Education System (TSES)

(Minnesota Administrative Rule 3525.1100)

5

https://www.revisor.mn.gov/statutes/?id=256b.0659

https://www.revisor.mn.gov/rules/?id=3525.2810

https://www.revisor.mn.gov/rules/?id=3525.1100

ConclusionsThe IEP can function as the PCA Care Plan if (and only if) additional required information

- is added to the IEP and/or

- written documentation of third-party billing procedures are added to the school district’s

Total Special Education System (TSES).

6

IMPORTANTUsing the IEP as the PCA Care Plan does not

modify or eliminate any of the requirements for the IEP and TSES detailed in state and federal special education law.

These requirements always apply, and PCA Care Plan requirements and information may only be in addition to state and federal special education requirements.

7

• In the following slides the PCA Care Plan

requirement (Minnesota Statute § 256B.0659, Subdivision 7)

will be presented first and in italics….

• …and matching components currently required

in, or to be added to, the IEP or the school district’s TSES to meet the listed PCA Care Plan

requirement will be presented second and in regular font.

PCA Care Plan Requirements and Added IEP or TSES Components

8

• Identification of the Care Plan document.

• A statement somewhere that the IEP is serving as the PCA care plan.

PCA Care Plan Requirements and Added IEP or TSES Components - 2

9

• “Each recipient must have a current personal

care assistance care plan based on the service

plan...” (Minnesota Statute 256B.0659

Subdivision 7(a)).

• Already included in IEP’s: “The IEP includes a

statement of the pupil’s needs for and the

specific responsibilities of a paraprofessional”

(Minnesota Rule 3525.2810, subpart 1(A)(10)).


10

• “…start and end date of the care plan…”

• Already included in IEP’s: “Projected date for

the beginning of the services and modifications and the anticipated frequency, location and duration of those services and modifications”

(Minnesota Rule 3525.2810, subpart 1(A)(6)).


11

• “…recipient demographic information including

name and telephone number…”

• Ensure the parents’ phone number(s) is included in the IEP or have a policy statement (e.g. district’s third-party billing procedures chapter in the TSES) that references the standard location of parent’s contact info.


12

• “…emergency numbers, procedures, and a

description of measures to address identified

safety and vulnerability issues, including a

backup staffing plan…”

• Ensure a written policy statement somewhere (e.g. district’s third-party billing procedures chapter in the TSES) that references the standard location of emergency numbers, and may include specifying that procedures are provided in health emergency plans or other plans (e.g. Behavioral Intervention Plans) by the school district as well.


13

• “…name of responsible party and instructions

for contact…”

• Ensure that the IEP case manager is identified by name in the IEP.


14

• “…description of the individualized needs for

assistance with activities of daily living,

instrumental activities of daily living, health-

related tasks and behaviors…”

• Already included in the IEP: “A statement of the

special education and related services and supplementary aids and services to be provided to the pupil, or on behalf of the pupil, and a statement of the program modifications or supports for school personnel…” Minnesota Rule 3525.2810, Subpart 1 (A)(3); and…


15





• “The IEP includes a statement of the pupil’s

need for and the specific responsibilities of a paraprofessional” (Minnesota Rule 3525.2810, subpart 1(A)(10)); and…


16





• Ensure the written specific responsibilities for PCA-billed paraprofessionals clearly describes specific student needs identified in the Special Education evaluation (e.g. interpretation of an assessment of adaptive behavior) for assistance with activities of daily living, health related tasks and/or behaviors.

PCA Care Plan Requirements and Added IEP or TSES Components – 10

17

• “…dated signatures of recipient or responsible

party and qualified professional…”

• Ensure that third-party billing district procedures (e.g. in the TSES manual) identify that the case manager and/or qualified professional (for PCA purposes, see DHS “Qualified Professional” criteria) and the parent(s) are members of the IEP team and are the joint co- authors of the IEP/care plan, which is dated, etc.


18

• “…instructions [and] comments about the recipient’s

needs for assistance and any special instructions or

procedures required…requested a personal care

assistant of the same gender… updated as needed

when there is a change in need for personal care

assistance services…“

• Already included in IEP’s: “The IEP includes a

statement of the pupil’s need for and the specific responsibilities of a paraprofessional” (Minnesota Rule 3525.2810, subp. 1(A)(10)); and…


19

• “…instructions [and] comments about the recipient’s

needs for assistance and any special instructions or

procedures required…requested a personal care

assistant of the same gender… updated as needed

when there is a change in need for personal care

assistance services…“

• “…whether or not the recipient requested a personal

care assistant of the same gender…” – Note whether requested or refer to previous guidance above that district third-party-billing procedures identify parents are co-authors of the IEP.


20

Unofficial Guidance - RThis presentation is unofficial guidance from the Minnesota Department of Education and the Minnesota Department of Human Services and is not for distribution or training purposes. A forthcoming joint agency memorandum will provide formal guidance to Minnesota school districts.

The information is being shared at this time to gather feedback from school districts and to improve technical assistance and dissemination planning.

21

IMPORTANT - RUsing the IEP as the PCA Care Plan does not

modify or eliminate any of the requirements for the IEP and TSES detailed in state and federal special education law.

These requirements always apply, and PCA Care Plan requirements and information may only be in addition to state and federal special education requirements.

22

• Jenny RothIEP CoordinatorDepartment of Human ServicesE-Mail: [email protected]: 651-431-2622

• Tom DelaneySupervisor, Interagency PartnershipsSpecial Education DivisionDepartment of EducationE-Mail: [email protected]: 651-582-8324

• Ruth Ellen LuehrInteragency Education SpecialistSpecial Education DivisionDepartment of EducationE-Mail: [email protected]: 651-582-8403

State Agency Contacts

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ICD-10-CM Codes - Nearly a Year of Experience

Janet Lowe, Panel Moderator – TPR Statewide Network ChairDan Porter, Minnesota School Social Workers AssociationSally Baas, Minnesota School Psychologists AssociationTao Yuan Li, Minnesota Speech-Language-Hearing AssociationCarolyn Zachariason, Occupational Therapist, Minneapolis Public SchoolsJennifer Nordstrand, Licensed School Nurse, Saint Paul Public Schools


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DHS-MDE Guidance – ICD-10-CM Reporting for Schools

MHCP Enrolled Providers – Individualized Education Program (IEP)

Trainings for webinars

ICD-10-CM Reporting for Schools - Review

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https://edocs.dhs.state.mn.us/lfserver/Public/DHS-7092-ENG

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_009280

Site for Locating ICD10Data.com

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http://www.icd10data.com/

The ICD-10-CM code must: Clearly represent the child’s medical need as

identified in the child’s IEP / IFSP

Logically relate to the IEP provider/service Relate to the activities / tasks provided Be valid, billable and specific to the child Be medically necessary codes, not education codes

What do IEP health related service professionals need to do?

4

ICD-10-CM logically relates to the

child‘s needs and IEP provider/service

5

Who Determines the ICD-10-CM Codes?

Provider DiagnosisSigns/

Symptoms

Primary Care (MD, PA, APRN (Advan Pract RN)) x xProfessional Nurse (LSN/PHN/RN, not LPN) o xOccupational Therapist o xPhysical Therapist o xSpeech-Language Pathologist; Audiologist x xSchool Psychologist o xSchool Social Worker (LSW with 4000 clinical practice hours or higher level license)

o x

Mental Health Professional (LICSW, LP & others) x x

6

School Social Workers Dan Porter M.S.W., L.I.C.S.W.Minnesota School Social Workers AssociationMSSWA > Education > ICD-10-CM

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http://www.msswa.org/

School PsychologistsSally Baas, Ed. D., Ed. S. – School PsychologyMinnesota School Psychologists Association MSPA

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http://www.mspaonline.net/

Speech/Language Pathologists and Audiologists

Tao Yuan Li, PhD, CCC-SLPMinnesota Speech-Language-Hearing AssociationMSHA> Consumer Information > Resources for SLP/A

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http://www.msha.net/

MSHA Activities for SLPs and AUDs on Third Party Reimbursement

Platforms for training and discussion:

• Webinar for school SLPs and AUDs(Still available: no cost to members, small fee for nonmembers)

• 4-hour in-person workshop in September 2015

• MSHA annual convention - April 2016:– Round table discussions on school-based third

party billing – 90-minute breakout session.

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https://msha.site-ym.com/?webinar201509

Occupational Therapists and Physical Therapists

Carolyn Zachariason, M.A., OTR/L- work in progress through the Metro ECSU >

Programs and Services > Special Education

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http://www.metroecsu.org/programsServices/index.html

Common Physical Therapy ICD-10 codes

Definition Service Code

Abnormality of gait and mobility Physical Therapy R26.9

Disorder of coordination Physical Therapy R27.9

Signs and symptoms involving the

musculoskeletal system Physical Therapy R29.91

Signs and symptoms involving the nervous

system Physical Therapy R29.90

Developmental disorder of scholastic

skills, unspecified Physical Therapy F81.9

Unspecified disorder of psychological

development Physical Therapy F89

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Common Occupational Therapy ICD-10-CM codes

Definition Service Code

Developmental delay Occupational Therapy F81.9

Psychological/cognitive

developmental disorder Occupational Therapy F89

Autism spectrum disorder (if

medically diagnosed) Occupational Therapy F84.0

Disorder of coordination Occupational Therapy R27.9


musculoskeletal system Occupational Therapy R29.91


nervous system Occupational Therapy R29.90

Emotional behavioral disorder Occupational Therapy F98.9

Mental disorder (18 yrs and up) Occupational Therapy F99 13

Example for selecting a code - OT

• The student has a recent diagnosis of muscular dystrophy. The student is beginning to show signs at school of having difficulty walking steady on stairs, using a pencil to print or draw for longer periods of time, and is having difficulty manipulating self care fasteners.

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Signs and symptoms involving the musculoskeletal system-ICD-10-CM code R29.91• Therapy service will involve treating the signs and

symptoms for weak muscles and delayed fine motor skills which result in dexterity problems and eye hand coordination difficulties. Adaptations may need to be added to assist the student such as assistive technology for written work completion and strategies for clothing fasteners.

• The goals and objectives will focus on helping the student to maintain her independence self care skills and use of tools/written work completion at school.

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http://www.icd10data.com/Search.aspx?search=R29.91

Jennifer Nordstrand, MS, APRN, RN, Licensed School Nurse

- Straightforward to identify ICD-10-CM codes when there is a diagnosis or health condition the nurse is working with directly

School Nursing Practice

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• Questions, consultation and amendments waning

• Helpful to have a point person for support and problem solving

• Codes for PCAs providing ADL Support

Who determines the code?

Progress toward identifying codes

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• Ensuring that codes reflect signs and symptoms – avoid making medical diagnosis

• Encouraging nurses to continue to identify nursing diagnoses as part of the nursing process separate from the ICD-10-CM selection or billing process

• How to best capture nursing care management with ICD-10 coding

Challenges

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And just for fun…..

The Most Bizarre ICD-10 Code Awards

Medical Economics

Questions and Suggestions

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http://www.poweryourpractice.com/revenue-cycle-management/the-most-bizarre-icd-10-code-award

http://medicaleconomics.modernmedicine.com/medical-economics/news/20-bizarre-new-icd-10-codes