Medicaid School Based Services

Transcription

1 Medicaid School Based Services An Educator s Guide to Fee for Service and Administrative Outreach Programs Newaygo County Regional Educational Service Agency Newaygo County Regional Educational Agency Page 1

2 Table of Contents Introduction.. 3 Medicaid Overview.. 4 Reimbursement Requirements....6 Qualifications for Medicaid Claims...8 Physician Authorization Parent Consent..13 Service Documentation and Claim Procedures 14 For Case Managers For Speech Therapists For Physical Therapists For Occupational Therapists For Early Childhood Specialists...20 IDEA Assessment Random Moment Time Study Appendix A Parent Permission for Medicaid School Based Services..24 Appendix B Providers Guide to GoClaim. 26 Appendix C Random Moment Time Studies A Guide for Direct Service Providers 54 Newaygo County Regional Educational Agency Page 2

3 Introduction This Medicaid School Based Services Manual has been developed by Newaygo County Regional Educational Agency (NC RESA) as a guide for educators within the Newaygo County Regional Education Services Agency and constituent districts, including Fremont Public Schools, Grant Public Schools, Newaygo Public Schools, Hesperia Community Schools and White Cloud Public Schools. The purpose of this manual is to provide information regarding requirements for documenting services that qualify for reimbursement under Michigan s School Based (SBS) Medicaid Program, both as part of the Fee for Service system and Administrative Outreach, as well as to deliver specific technical information on processes and procedures used in working with Medicaid vendors in an effort to seek payment for covered medical services rendered in the school-based setting. The information contained in this manual is based on the MICHIGAN MEDICAID PROVIDER MANUAL, dated October 1, 2012, developed by The Michigan Department of Community Health (MDCH), Michigan's Medicaid agency. For questions or assistance, please contact the following: For site access and technical program assistance: Megan Fleming Go Solutions Group, Inc. Phone: Fax: Megan.Fleming@go-sgi.com For claiming assistance: Leslye Fries, Supervisor NC RESA Phone: lfries@ncresa.org Andrea Wood, Supervisor NC RESA Phone: awood@ncresa.org Kelly Hager, Supervisor NC RESA Phone: khager@ncresa.org Lynette Suchner, Director NC RESA Phone: lsuchner@ncresa.org Newaygo County Regional Educational Agency Page 3

4 Medicaid Overview The Medicaid SBS Program Michigan s School Based Services (SBS) program has its legal basis in the 1988 amendment to the Social Security Act [42USC1396 b(c)]. This Act allows for partial reimbursement to schools for health services. These services are provided to Medicaid eligible students with disabilities who qualify under the federal Individuals with Disabilities Education Act (IDEA). Nationally, more than 25 million children rely on Medicaid for health care and 43 states participate in the SBS program. In Michigan, nearly 900,000 children rely on Medicaid for health care. All 57 Michigan intermediate School Districts participate in the SBS program. The Washtenaw Intermediate School District and the local school districts have participated in the program since What the SBS Program Provides In Michigan, the Medicaid School Based Services program: Provides partial reimbursement for services such as Occupational therapy Physical therapy Speech therapy Psychological services Social work services Orientation and mobility services Transportation Nursing services Case management Assistive technology services Should not affect a family s Medicaid insurance benefits or other insurance plans (Blue Cross/Blue Shield, HAP, MiChild, etc.) and there is NO cost to the family for school based services. If your child receives therapy services outside the school setting for similar services, you may want to discuss with the provider their reimbursement procedures Helps school districts because it offsets some of the costs of health care that schools provide to children and students. Is voluntary and requires parents/guardians to provide written consent to release information about their child in order to bill Medicaid. This consent may be revoked at any time by the parent or guardian. Confidentiality Newaygo County Regional Educational Agency Page 4

5 Only authorized school personnel will be advised of your child s Medicaid eligibility or personal information. New Regulations New regulations -- which became effective in October, require school districts to obtain parent/guardian consent to release information to bill the Medicaid program. Your school district requests this consent at the time of your child s IEP. If you have any questions regarding this information, please contact your school district special education supervisor. Newaygo County Regional Educational Agency Page 5

6 SBS Medicaid Reimbursement Requirements Requirements For school districts to submit claims under the provisions of the School Based Services (SBS) Medicaid Program, the services reported must: be provided for a Medicaid eligible student under the age of 21 be provided for a student with an active IEP/IFSP, or be provided for a student who will have an IEP/IFSP within one year in the case of the IDEA Assessment service be provided by a qualified practitioner based on SBS Policy address a student s physical, mental, or emotional disability be consistent with the intent of the IEP/IFSP identified services and planned goals. Covered Services (See specific Provider Tip Sheets for detailed information on covered services) The following services are reimbursable when provided according to SBS program guidelines: Individual or group therapy and counseling Evaluations for medical services are covered when: Performed as part of the IDEA Assessment The student left special education and is re-entering special education or related programs At any time when initiation, development, review or revision of the student s IEP/IFSP treatment plan will occur When a change or decrease in function occurs Personal Care Services Equipment assessments, adjustments, and repairs IEP/IFSP related activities Developmental Testing (to determine if motor, speech, language or psychological problems exist to detect the presence of any developmental delays) Crisis Intervention (psychologists and social workers only) Designated Case Management Arranging evaluations Linking families with services/community agencies Maintaining case records Facilitating the IEP or IFSP Follow-up on treatment and diagnostic services Examples of Non-Reimbursable Services & Activities Newaygo County Regional Educational Agency Page 6

7 Provider travel to/from the place of service IDEA assessments that do not result in implementation of an IEP/IFSP within one year Educational occupational, physical, and speech therapies that do not have medically related goals Vocational and work skills services Art, music, and recreation therapy Supplies or equipment utilized in service delivery are included as part of the services and are not reimbursed separately. Report writing related to an evaluation is not separately reimbursable Dispensing of medications by staff other than RN or LPN Services considered observational or stand-by in nature, including supervision of medication administration or other medical services First Aid Consultations or consultative services Manifestation Determination Review meetings Children s Special Health Care Services (CSHCS) Services for students with both CSHCS and Medicaid coverage are reimbursed by the Medicaid program. Services are not reimbursable for students enrolled only in the CSHCS program. Newaygo County Regional Educational Agency Page 7

8 Qualifications for Medicaid Claim Submission Designated Case Manager The Designated Case Manager is the person responsible for the implementation of the plan of care/treatment plan (e.g. IEP). The Designated Case Manager must be an individual who meets one of the following criteria: A licensed RN in Michigan; A bachelor's degree with a major in a specific special education area; Has earned credit in coursework equivalent to that required for a major in a specific special education area (such as SLP, OT or PT); or Has a minimum of three years personal experience in the direct care of an individual with special needs. Nursing Services Nursing services may be reimbursed when provided by: A licensed Registered Nurse (RN) in Michigan; or A Licensed Practical Nurse (LPN) in Michigan. Occupational Therapy Services OT services may be reimbursed when provided by: A certified and registered occupational therapist in Michigan (OTR); or A certified occupational therapy assistant (COTA) registered in Michigan and under the direction of a currently-michigan-registered OTR (i.e., the COTA s services must follow the evaluation and treatment plan developed by the OTR and the OTR must supervise and monitor the COTA s performance with continuous assessment of the beneficiary s progress). All documentation must be reviewed and signed by the supervising OTR. Assistive technology device services may be reimbursed when provided by a certified and registered occupational therapist (OTR) in the state of Michigan; or by a certified occupational therapy assistant (COTA) in the state of Michigan. Orientation and Mobility Services Orientation and mobility services may be reimbursed when provided by: A certified orientation and mobility specialist with current certification from the Academy for Certification of Vision Rehabilitation and Education Professionals Newaygo County Regional Educational Agency Page 8

9 Personal Care Services The Personal Care paraprofessional personnel are employed in the Special Education Program and shall be qualified under the requirements established by their respective ISD plan. Providers must be trained in the skills needed to perform covered services, and must be under the direction of a qualified professional as Targeted in the IEP/IFSP. Paraprofessional personnel include: Teacher Aides Health Care Aides Instructional Aides Bilingual Aides Program Assistants Trainable Aides Physical Therapy Services PT services may be reimbursed when provided by: A licensed physical therapist (LPT) in Michigan; or A certified physical therapy assistant (CPTA) in Michigan and under the direction of a licensed physical therapist in Michigan (i.e., the LPT supervises and monitors the CPTA s performance with continuous assessment of the beneficiary s progress). All documentation must be reviewed and signed by the appropriately licensed supervising LPT. Assistive technology device services may be reimbursed when provided by a licensed physical therapist (LPT) in the state of Michigan; or a physical therapy assistant (PTA) in the state of Michigan. Psychological, Counseling, and Social Work Services Psychological, counseling and social work services may be reimbursed when provided by: A licensed physician or psychiatrist in Michigan; A fully licensed psychologist (Doctoral level) in Michigan; A limited-licensed psychologist (Master's or Doctoral level) under the supervision of a licensed psychologist; A temporary limited-licensed psychologist (Master's or Doctoral level) under the supervision of a licensed psychologist; A licensed master s social worker in Michigan; or a limited licensed master s social worker under the supervision of a licensed master s social worker Developmental Testing Newaygo County Regional Educational Agency Page 9

10 Developmental testing services may be reimbursed when provided by the following qualified staff in accordance with their professional credentials: A fully-licensed psychologist (Doctoral level) in the State of Michigan; A limited-licensed psychologist (Doctoral level) under the supervision of a licensed psychologist; A licensed master s social worker in Michigan; A limited licensed master s social worker under the supervision of a licensed master s social worker; or A licensed physician or psychiatrist in Michigan. Speech, Language, and Hearing Services Speech, language and hearing services may be reimbursed when provided by: A speech-language pathologist (SLP) possessing a current ASHA Certificate of Clinical Competence (CCC); A licensed audiologist in Michigan A speech-language pathologist (SLP) and/or audiology candidate (i.e., in his clinical fellowship year or having completed all requirements but has not obtained a CCC), under the direction of a qualified SLP or audiologist. All documentation must be reviewed and signed by the appropriately-credentialed SLP or licensed audiologist; or A teacher of students with speech and language impairments (TSLI), under the direction of an ASHA-CCC SLP or audiologist. All documentation must be reviewed and signed by the appropriately-credentialed supervising SLP or licensed audiologist. Newaygo County Regional Educational Agency Page 10

11 Physician Authorization Annual physician authorization is required for: physical therapy (PT), occupational therapy (OT), assistive technology device (ATD) services as part of OT and PT nursing services orientation and mobility services Annual physician referral is required for speech language services and ATD as part of speech services. A compliance check for physician authorization will be completed prior to claim submission. NC RESA may not submit claims to the DCMH until we have a signed authorization or referral from a physician for the required services. Procedures for physician authorization - REVIEW Physical Therapy Services The physical therapist is responsible for obtaining a physician authorization for special education services annually. A copy of the authorization should be sent to the NC RESA Medicaid Office by October 15 of each school year. Any new students added to the physical therapist caseload during the school year require physician authorization within 90 days of the initiation of services. A copy of the authorization form should be forwarded to NC RESA to be kept on file for audit purposes. Nursing Services Medicaid SBS requires a physician authorization for nursing services. The RN or LPN is responsible for obtaining and maintaining current physician authorization for nursing services. A copy of the physician authorization should be kept on file in the local school district, and must be available for auditing purposes. Occupational Therapy Services The occupational therapist is responsible for submitting a signed referral form to NC RESA on an annual basis. All forms for services that are documented as of the start of the school year should be submitted to the NC RESA Medicaid Office by October 15 of each school year. NC RESA will obtain physician authorization. Any new students added to the occupational therapist caseload during the school year require physician authorization. The Occupational Therapist is responsible for completing a referral form be to forwarded to NC RESA for physician authorization as soon as possible to allow new services to be authorized by a physician with 90 days of the start of services to be reimbursed. Newaygo County Regional Educational Agency Page 11

12 Orientation and Mobility Services The Orientation and Mobility Specialist is responsible for submitting a signed referral form to NC RESA on an annual basis. All forms for services that are documented as of the start of the school year should be submitted to the NC RESA Medicaid Office by October 15 of each school year. NC RESA will obtain physician authorization. Any new students added to the occupational therapist caseload during the school year require physician authorization. The Orientation and Mobility Specialist is responsible for completing a referral form to be forwarded to NC RESA for physician authorization as soon as possible to allow new services to be authorized by a physician with 90 days of the start of services to be reimbursed. Speech and Language Services The Speech and Language Pathologist is responsible for submitting a signed referral form to NC RESA on an annual basis. All forms for services that are documented as of the start of the school year should be submitted to the NC RESA Medicaid Office by October 15 of each school year. NC RESA will obtain physician authorization. Any new students added to the Speech and Language Pathologist s caseload during the school year require physician authorization. The Speech and Language Pathologist is responsible for completing a referral form be to forwarded to NC RESA for physician authorization as soon as possible to allow new services to be authorized by a physician with 90 days of the start of services to be reimbursed. Hearing Services The Audiologist is responsible for submitting a signed referral form to NC RESA on an annual basis. All forms for services that are documented as of the start of the school year should be submitted to the NC RESA Medicaid Office by October 15 of each school year. NC RESA will obtain physician authorization. Any new students added to the Audiologist s caseload during the school year require physician authorization. The Audiologist is responsible for completing a referral form be to forwarded to NC RESA for physician authorization as soon as possible to allow new services to be authorized by a physician with 90 days of the start of services to be reimbursed. Newaygo County Regional Educational Agency Page 12

13 Parent Consent The Individuals with Disabilities Education Act (IDEA) requires school districts to notify and obtain consent from families whose students qualify for Medicaid. Parental consent means the following: To be fully informed about the School-Based Services program. To provide consent to release school records containing the student's information to Michigan Medicaid and claim processing agencies for the purpose of participating in the School-Based Services program. To understand that consent is voluntary and can be revoked. To ensure all parents/guardians are given the opportunity to provide informed consent for the School- Based Services Medicaid Program, the Parent Consent for Medicaid form will be signed at the student s IEP meeting. Several documents have been developed by NC RESA to help parents and special education providers understand the Parental Consent Process and the Medicaid School Based Services Program. (See Appendix C for a copy of the NC RESA Parent Consent Form, a Q and A for Parent Consent for Medicaid, Presenting Parent Consent, and a copy of the brochure, A Parent s Guide to School-Based Services.) For a copy of the Parent Consent form used apart from the consent given on the IEP, see Appendix A. Newaygo County Regional Educational Agency Page 13

14 Service Documentation and Claim Procedures Beginning with the school year, Medicaid covered services will be logged using the Go Claim system from Go Solutions Group, Inc., a Medicaid billing vendor. For specific technical assistance, refer to Appendix B. Billing Entry Notes Service Entry in Go Solutions Medicaid Billing System - New Procedures Implemented Fall For Case Managers You may need to change this from the default of "School," depending on Place of Service whether services are provided on school grounds or in the home. CPT Code Description What is included for Targeted Case Managers: T2023 Targeted case management per month *Complete a minimum of three entries per month and one monthly summary *Coordinating IEP services, evaluations and development/review of IEP's *Assisting parents in communications with providers and outside agencies PS Progress Summary *Monitoring student progress toward IEP outcomes (an example would be a staffing meeting) *Maintaining case records Billing Entry Notes Diagnosis Code You must complete this in the month that you are billing for one of the above services. There is a dropdown menu for Progress - mastering, progressing, etc. (This doesn't appear until after you have chosen "PS- Progress Summary" under CPT Code.) Choose one of them. Do not complete. Field is uploaded from student data system. Enter start and end times of service Start Time and End Time Notes Calendar Add descriptive note Click on the calendar to report the date of service. It will not allow you to "save" without entering a date. When you do "Progress Summary" you must choose a date, but it doesn't matter what date. Be sure to click on "Save" after each service entry. Newaygo County Regional Educational Agency Page 14

15 Service Entry in Go Solutions Medicaid Billing System - New Procedures Implemented Fall For Speech Therapists Billing Entry Notes You may need to change this from the default of "School," depending on Place of Service whether services are provided on school grounds or in the home. CPT Code Description What is included for Speech Language Therapist W/C's: TM Multi Disciplinary Team Evaluation Develop, review, revise IEP/IFSP plan Bill for this when you have helped with development of the IEP or goals. (Including when you have developed the IEP for Early On children.) The billing for this must be a different date than the next code. You can t bill the evaluation and the IEP on the same date HT IDEA Evaluation performed for the IDEA (Individuals with Disabilities Education Act) Assessment Assessment/eval not related to the IDEA Assessment or IEP/IFSP treatment plan Indiv- Treatment of Speech, Language, voice, comm., and/or auditory processing disorder Group Treatment of Speech, language, voice, comm, and/or auditory processing disorder Self-Care/Home Management training Assistive technology assessment Bill for this when you have done initial evaluation on the child or reevaluation on the child. You don't use this codebecause the evaluations that you do are related to the special education eligibility and needs of the child. Choose most appropriate code for direct service provided Do not use T2023 Targeted case management per month For use when SLP is case manager PS Progress Summary You must complete this in the month that you are billing for one of the above services. There is a dropdown menu for Progress - mastering, progressing, etc. (This doesn't appear until after you have chosen "PS- Progress Summary" under CPT Code.) Choose one of them. Billing Entry Notes Diagnosis Code Do not complete. Field is uploaded from student data system. Start Time and End Time Notes Calendar Enter start and end times of service Add descriptive note Click on the calendar to report the date of service. It will not allow you to "save" without entering a date. When you do "Progress Summary" you must choose a date, but it doesn't matter what date. Be sure to click on "Save" after each service entry. Newaygo County Regional Educational Agency Page 15

16 Billing Entry Notes Service Entry in Go Solutions Medicaid Billing System - New Procedures Implemented Fall For Physical Therapists Place of Service You may need to change this from the default of "School," depending on whether services are provided on school grounds or in the home. CPT Code Description What is included for Speech Language Therapist W/C's: 97001TM Multi Disciplinary Team Evaluation Develop, review, revise IEP/IFSP plan Therapeutic procedure (each 15 minutes) to develop strength, endurance, range of motion and flexibility Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting Gait Training (each 15 min.) Therapeutic Procedures, group Bill for this when you have helped with development of the IEP or goals. (Including when you have developed the IEP for Early On children.) The billing for this must be a different date than the next code. You can t bill the evaluation and the IEP on the same date. Choose most appropriate code for direct service provided HT TM Dynamic activities to improve Functional performance (each 15 min.) Wheelchair management/propulsion training, each 15 min. Multi Disciplinary Team Evaluation Performed for the IDEA assessment Assessment/evaluation not related to the IDEA Assessment or IEP/IFSP treatment plan development/review/revision Assistive technology assessment. (to restore, augment or compensate for existing functional tasks and/or maximize environment Multi Disciplinary Team Evaluation Develop, review, revise IEP/IFSP plan Self-Care/ Home Management Training (ADL conpensatory training, meal preparation, safety prcedures and instructions For use when providing assessment. Do not use. Choose most appropriate code for direct service provided. Newaygo County Regional Educational Agency Page 16

17 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity, lower extremity Prosthetic training, upper and/or lower extremity, each 15 min T2023 Targeted case management per month For use when PT is Case Manager - See Case Manager sheet PS Progress Summary Billing Entry Notes Diagnosis Code Start Time and End Time Notes Calendar *Maintaining case records You must complete this in the month that you are billing for one of the above services. There is a dropdown menu for Progress - mastering, progressing, etc. (This doesn't appear until after you have chosen "PS- Progress Summary" under CPT Code.) Choose one of them. Do not complete. Field is uploaded from student data system. Enter start and end times of service Add descriptive note Click on the calendar to report the date of service. It will not allow you to "save" without entering a date. When you do "Progress Summary" you must choose a date, but it doesn't matter what date. Be sure to click on "Save" after each service entry. Newaygo County Regional Educational Agency Page 17

18 Service Entry in Go Solutions Medicaid Billing System - New Procedures Implemented Fall For Occupational Therapists Place of Service You may need to change this from the default of "School," depending on whether services are provided on school grounds or in the home. CPT Code Description What is included for Speech Language Therapist W/C's: 97003HT Multi Disciplinary Team Evaluation performed for the IDEA assessment For use providing evaluation of students G9041 V Assessment/evaluation not related to the IDEA Assessment or IEP/IFSP treatment plan development/review/revision Assistive technology assessment. (to restore, augment or compensate for existing functional tasks and/or maximize environment Rehabilitation services for low vision by qualified OT direct one-on-one contact each 15 min. Vision services, miscellaneous Prosthetic training, upper and/or lower extremity, each 15 min Do not use. Choose most appropriate code for direct service provided. T2023 Targeted Case Management For use when OT serves as case manager - See case manager page TM Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct oneon-one Self-Care/ Home Management Training (ADL conpensatory training, meal preparation, safety prcedures and instructions Multi Disciplinary Team Evaluation Develop, review, revise IEP/IFSP plan Therapeutic procedure (each 15 min) to develop strength, endurance, range of motion and flexibility Neuromuscular re-education of balance, coordination, kinesthetic sense, posture, proprioception for sitting and other Choose most appropriate code for direct service provided. Bill for this when you have helped with development of the IEP or goals. (Including when you have developed the IEP for Early On children.) The billing for this must be a different date than the next code. You can t bill the evaluation and the IEP on the same date. Choose most appropriate code for direct service provided Gait Training (each 15 min.) Therapeutic Procedures, group Newaygo County Regional Educational Agency Page 18

19 97542 PS Wheelchair management/propulsion training, each 15 min. Progress Summary Billing Entry Notes Diagnosis Code Start Time and End Time You must complete this in the month that you are billing for one of the above services. There is a dropdown menu for Progress - mastering, progressing, etc. (This doesn't appear until after you have chosen "PS- Progress Summary" under CPT Code.) Choose one of them. Do not complete. Field is uploaded from student data system. Enter start and end times of service Notes Calendar Add descriptive note Click on the calendar to report the date of service. It will not allow you to "save" without entering a date. When you do "Progress Summary" you must choose a date, but it doesn't matter what date. Be sure to click on "Save" after each service entry. Newaygo County Regional Educational Agency Page 19

20 Service Entry in Go Solutions Medicaid Billing System - New Procedures Implemented Fall For Early Childhood Specialists Billing Entry Notes You may need to change this from the default of "School," depending Place of Service on whether services are provided on school grounds or in the home. CPT Code Description What is included for Targeted Case Managers: T2023 Targeted case management per month *Coordinating IEP services, evaluations and development/review of IEP's *Assisting parents in communications with providers and outside agencies PS Progress Summary *Monitoring student progress toward IEP outcomes (an example would be a staffing meeting) *Maintaining case records Billing Entry Notes You must complete this in the month that you are billing for one of the above services. There is a dropdown menu for Progress - mastering, progressing, etc. (This doesn't appear until after you have chosen "PS- Progress Summary" under CPT Code.) Choose one of them. Diagnosis Code Start Time and End Time Notes You don't need to do anything with this. It is automatically pulled in and coordinates our MET diagnosis with the medical terminology. This must be entered for the submission to be recorded Add descriptive note Calendar Click on the calendar to report the date of service. It will not allow you to "save" without entering a date. When you do "Progress Summary" you must choose a date, but it doesn't matter what date. Be sure to click on "Save" after each service entry. Newaygo County Regional Educational Agency Page 20

21 IDEA Assessment and IEP/IFSP Development IDEA (MET) Assessments and IEP/IFSP Development, Review and Revision IDEA assessments, tests and evaluations are reimbursable when the following conditions are met: Provider Qualifications In order to be qualified for reimbursement by Medicaid, the staff that provide services must have credentials as follows: An Occupational Therapist must be currently registered in Michigan (OTR). A Physical Therapist must be a Licensed Physical Therapist (LPT) in Michigan. An Audiologist must be a Licensed Audiologist. A Speech-Language Pathologist must possess a current ASHA Certificate of Clinical Competence (CCC). A Psychologist must be fully-licensed Psychologist (Doctoral level) in Michigan, or a limited-licensed Psychologist (Master s level) under the supervision of a licensed Psychologist (Doctoral level) a temporary limited-licensed Psychologist (Masters or Doctoral level) under the supervision of a licensed Psychologist (Doctoral level). A Social Worker must be licensed or a limited licensed Master s degree social worker under the supervision of a licensed Master s social worker. A Physician or Psychiatrist (M.D. or D.O.) must have a current State of Michigan license to practice. A Registered Nurse (RN) must have a current Michigan license. An Orientation and Mobility Specialist must be certified. IDEA Assessment Services IDEA assessments are evaluations, tests and related activities performed to determine if an individual is eligible for special education or early intervention services under the provisions of the Individuals with Disabilities Education Act of These services are related to the evaluation and re-evaluation of the functioning of the individual. Comprehensive evaluations must occur annually, and re-evaluations are performed when a change or decrease in function occurs. Services are reimbursable only after they result in the implementation of an IEP or IFSP. If an IEP or IFSP is not implemented within one year of the date of service, services are not covered. Newaygo County Regional Educational Agency Page 21

22 An evaluation includes: Professional evaluations performed as part of the IDEA Assessment may be claimed using appropriate evaluation/assessment codes. Please see the specific covered services. The treatment diagnosis and the medical diagnosis, if different, from the treatment diagnosis Medical history as it relates to the current course of therapy The student s current functional status (functional baseline) The standardized and other evaluation tools used to establish the baseline and to document progress Assessment of the student s performance components (status of sensory skills, proficiency of the use of travel tools, current ageappropriate independence, complexity or introduction of new environment, caregiver input, assessment in the home/living environment, assessment in the school environment, assessment in the neighborhood/ residential environment, assessment in the commercial environment, and assessment in the public transportation environment). Assessment of the student s cognitive skill level (e.g. ability to follow directions, including auditory and visual, comprehension) Evaluation of the needs related to assistive technology device services, including a functional evaluation of the student Newaygo County Regional Educational Agency Page 22

23 Random Moment Time Study Newaygo County is participating in the Random Moment Time Study (RMTS) process as part of the Administrative Outreach Program for Medicaid School-Based Services. This is a separate process from the Fee for Service process in which providers claim their services. Eligible participants include but are not limited to Administrators, Audiologists, Counselors, Early Identification/intervention Personnel, Occupational Therapists, Occupational Therapy Assistants, Orientation and Mobility Specialists, Physical Therapists, Physical Therapy Assistants, Program Specialists, Psychologists, Registered Nurses, Social Workers, Speech-Language Pathologists, Teacher Consultants, Case Managers and Personal Care aides. Michigan has chosen Public Consulting Group, Inc. (PCG) as it s vendor for The RMTS is being performed to gather information about the amount of time that certain school staff spend performing direct service activities in support of special education students. This information is needed to determine federal reimbursement for which your ISD and district is eligible. Individual completion of moments is monitored by the Department of Community Health. It s important that you clearly describe the activity you are performing. What is a Random Moment Time Study? Random Moment Time Study is the methodology that Michigan has been using for several years to determine the amount of time school staff spends on activities that are in support of the Medicaid program. When is the RMTS? The RMTS will occur on a quarterly basis throughout the school year. You could be chosen at any point to participate in one or more of these random moment time study surveys. What will I have to do for the RMTS? In the Random Moment Time Study, a moment is one minute of time. Completion of the time study moment will require you to answer three questions regarding the activity you were performing during that one moment of work time. If you are selected to participate, you will simply need to complete a RMTS survey. Completing the moment should take no more than 10 minutes of your time. It is important that if you are selected to complete a RMTS survey that you do so in a timely manner. See Appendix C Random Moment Time Studies A Guide for Direct Service Providers Newaygo County Regional Educational Agency Page 23

24 Appendix A PARENT PERMISSION FOR MEDICAID SCHOOL BASED SERVICES Date: 1. Student Information: Name: Birth Date: Attending District: 2. Purpose: Since 1993 the Newaygo County Regional Education Service Agency and its local school districts have participated in the Medicaid School Based Services program. This program allows the districts to bill the Medicaid program for reimbursement for health services provided in the schools to special education students who are eligible for Medicaid. The Medicaid School Based Services Program in Michigan: Provides partial reimbursement for services such as Occupational Therapy, Physical Therapy, Speech Therapy, Psychological Services, Social Work Services, Orientation and Mobility Services, Transportation, Nursing Services, Case Management and Assistive Technology Services. Does NOT affect a family s Medicaid insurance benefits and there is NO cost to the family, now or in the future. Helps school districts because it offsets some of the costs of health care that we provide to children and students. Is voluntary and requires parent or guardian to provide written consent to release information about their child in order to bill Medicaid. This consent may be revoked at any time by the parent or guardian. Requires information about your child s school based services (which could include date of birth, disability, gender, school, date of therapy, type of therapy, and progress reports) by the Michigan Medicaid and billing agencies to obtain this reimbursement. If your child receives any of the above services and qualifies for Medicaid benefits at any time during the length of the IEP or IFSP, we request your permission for Newaygo County Regional Education Service Agency and its local school districts to bill your child s Medicaid insurance to receive reimbursement. If you do not provide consent, the district will still provide the services bu the district will not receive any Medicaid reimbursement for these services. 3. Parent/Guardian Authorization: I authorize Newaygo County Regional Education Service Agency (NCRESA) to disclose to Public Consulting Group, Inc. (PCG) the following information: my child s name, date of birth, assigned unique student number, eligibility as a student with a disability, the type(s) and number of services provided, the service date(s), and name of the provider(s). This information may be disclosed for the purposes of processing a claim to the Medical Services Administration in the Michigan Department of Community Health for Medicaid reimbursement for these services. I agree to allow the school district to bill Medicaid for reimbursement of School Based Services for special education related services for my child (as applicable) and I understand that personally identifiable student information is needed to submit a claim, which will be kept confidential. I under stand that my consent and authorization is voluntary and may be revoked at any time. I understand if I refuse to allow access, the district is not relieved of its responsibility to ensure that these services are provided at no cost to me. I also give my consent for Newaygo County RESA to have my child s school records reviewed by a qualified physician for the sole purpose of obtaining a prescription for occupational, physical, or speech/language therapy services Parent/Guardian Providing Consent Signature: Date: Parent/Guardian Providing Consent Signature: Date: Appendix B Newaygo County Regional Educational Agency Page 24

25 Insert Providers Guide to GoClaim Appendix C Insert Random Moment Time Studies A Guide for Direct Service Providers Newaygo County Regional Educational Agency Page 25