Anderson School District Five Medicaid Handbook for Special Education Teachers and Providers
The purpose of this handbook is to provide a quick reference for staff. It provides basic information on the most common issues concerning school-based Medicaid services. For complete SC DHHS policies on Medicaid you should consult the LEA Manual by following this link: http://www.scdhhs.gov/serviceproviders/providermanualsall.asp?ptype=local%20education 2
Table of Contents About Medicaid 4 Consent for Release of Information and Treatment 5 Excent 6 Individual 7 Emer. Med. Info. 8-9 LPHA 10 Speech/Language 12 for Teachers 13 for SLPs 15 Referral Form 18 Occupational Therapy 19 for Teachers 20 for OTs 22 Referral Form 25 Physical Therapy 26 for Teachers 27 for PTs 28 Referral Form 30 Special Needs Transportation 31 for Teachers 32 for Providers 33 Nursing 34 for Teachers 35 for Nurses 36 Orientation and Mobility 38 for Teachers 39 for O & M therapists 40 Referral Form 42 Rehabilitative Behavioral Health Services 43 for Teachers 44 for RBHS staff 45 Referral Form 51 Psychological Evaluation 48 for Psychologists 49 Referral Form 51 3
About Medicaid The South Carolina Department of Health and Human Services (SCDHHS) provides Medicaid reimbursement for medically necessary services provided to Medicaid-eligible individuals in the Local Education Agency (LEA). This includes, but is not limited to, children under the age of 21 who have or are at risk of developing sensory, emotional, behavioral, or social impairments, physical disabilities, medical conditions, intellectual disabilities, or developmental delays. 4
Medicaid Consent for Release of Information A Release of Information form must be signed by the child s parent or guardian authorizing the release of any medical information necessary to process Medicaid claims. This is required for requesting payment of government benefits on behalf of the child. This may be incorporated into a Consent for Treatment form. In Anderson School District Five, this is obtained at the IEP meeting using the Medicaid Consent form found in Excent. Consent is also obtained on the Emergency Medical Form which is completed at each school. There is also an individual form available. 5
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Student s Name Date of Birth Medicaid # School CONSENT FOR TREATMENT, RELEASE OF INFORMATION, AND FOR MEDICAID REIMBURSEMENT Anderson School District Five and the State Department of Education have my permission to provide health-related services to my child and to release and exchange medical and other confidential information, as necessary, to the Department of Health and Human Services and any third party insurance carrier regarding health-related services provided to my child prior to the date of this consent or thereafter for services that the school district/agency will provide in the future. By signing this form, I give Anderson School District Five and the State Department of Education my permission to bill Medicaid and any third party insurance and receive payment from Medicaid or any third party insurer for health-related services as set forth in my child s individualized education program (IEP), and for psychological evaluation services, nursing services, and other health-related treatment services billable to Medicaid. I understand that Medicaid reimbursement for health-related services provided by Anderson School District Five and the State Department of Education will not affect any other Medicaid services for which my child is eligible. I understand that my child will receive the services listed in the IEP regardless of whether I enroll my child in public or private benefits or insurance programs. I also understand that my refusal to allow access to the Department of Health and Human Services or any third party insurance carrier does not relieve the District of its responsibility to ensure that all required services are provided at no cost to me. I understand that the granting of consent is voluntary on my part and may be revoked at anytime. If I later revoke consent, that revocation is not retroactive (i.e., it does not negate an action that has occurred after the consent was given and before the consent was revoked). I also understand that Anderson School District Five and the State Department of Education will operate under the guidelines of the Family Educational Rights and Privacy Act (FERPA) to ensure confidentiality regarding my child s treatment and provision of health-related services. Signature of Parent/Guardian Green copy-medicaid Compliance Coordinator, Pink copy-school Nurse, Canary copy-speech/language Therapist 11/8/2006 Date 7
RETURN THIS FORM TO SCHOOL ANDERSON SCHOOL DISTRICT FIVE EMERGENCY MEDICAL INFORMATION Student s Name: Last First Middle Sex: Male Female Grade: *Social Security Number: Date of Birth: Teacher: *You are not required to provide your child s Social Security Number to District Five. If you choose not to provide a Social Security Number, a state-issued identification number will be assigned to your child. Home Phone Number: Mom s Cell Number: Dad s Cell Number: I DO NOT want the phone numbers above to be included in District Five s automated Emergency Notification System. In conjunction with Anderson County Emergency Services, the automated system will be used to notify families of school or local emergencies. Initial to opt out Mom s Email Address: Dad s Email Address: Name of Mother: Name of Father: Student lives with: Mother: Father: Both: Other: If other, relationship to student: *If student s parents are separated or divorced, may school contact either parent if needed to pick student up or come in for conference about student?: Yes No ***** IF CUSTODY PAPERS ARE ON FILE THE SCHOOL MUST HAVE A COPY FOR THE STUDENT S PERMANENT RECORDS. ***** Student s Legal Guardian Home Address of Student Zip Code: Father s Place of Work: Work Number: Shift Worked: Mother s Place of Work: Work Number: Shift Worked: Transportation to School: If Bus, #: Transportation from school: If Bus, #: Persons To Contact In Case Student Needs To Be Picked Up From School (List only people who can provide transportation for your child and who you would allow to sign your child out of school.) Your home/work/cell telephone number will be called first in any emergency. PLEASE BE SURE TO KEEP THE NAMES AND PHONE NUMBERS UP TO DATE. Name Relationship to Child Phone Number Name Relationship to Child Phone Number 8
MEDICAL INFORMATION Does your child have a Medical Doctor? Yes No If yes, Doctor s name: Phone # Does your child have a Dentist? Yes No If yes, Dentist s name: Phone # Is your child covered by Health Insurance? Yes No By Dental Insurance? Yes No Is your child covered by S.C. Medicaid? Yes No Medicaid Number Does your child have any medical problems? Yes No If yes, please list and state any treatment and/or medication(s): Does your child have allergies? Yes No If yes, please list and state any treatment and/or medication(s): Medication(s): List name and dosage directions: EMERGENCY AUTHORIZATION FORM AND RELEASE OF INFORMATION I, the undersigned, do herby authorize officials of ANDERSON SCHOOL DISTRICT FIVE to contact directly the persons named on this form, and do authorize the named physician(s) to render such treatment as may be deemed necessary in an emergency, for the health of said child. I authorize release of any information on this form to medical personnel to insure prompt treatment of my child. In the event physician(s), other persons named on this form, or parents cannot be contacted, the school officials are authorized to take whatever action is deemed necessary in their judgment, for the health of the aforesaid child. I understand that information on this form is confidential and will only be shared with those who have a medical need to know. I will not hold the school district financially responsible for the emergency care and/or transportation for said child. Signature of Parent or Guardian CONSENT FOR TREATMENT, RELEASE OF INFORMATION AND Date MEDICAID REIMBURSEMENT Anderson School District Five and the State Department of Education have my permission to provide health-related services to my child and to release and exchange medical and other confidential information, as necessary, to the Department of Health and Human Services and any third party insurance carrier regarding health-related services provided to my child prior to the date of this consent or thereafter for services that the school district/agency will provide in the future. By signing this form, I give Anderson School District Five and the State Department of Education my permission to bill Medicaid and any third party insurance and receive payment from Medicaid or any third party insurer for health-related services as set forth in my child s individualized education program (IEP), and for psychological evaluation services, nursing services, and other health-related treatment services billable to Medicaid. I understand that Medicaid reimbursement for health-related services provided by Anderson School District Five and the State Department of Education will not affect any other Medicaid services for which my child is eligible. I understand that my child will receive the services listed in the IEP regardless of whether I enroll my child in public or private benefits or insurance programs. I also understand that my refusal to allow access to the Department of Health and Human Services or any third party insurance carrier does not relieve the District of its responsibility to ensure that all required services are provided at no cost to me. I understand that the granting of consent is voluntary on my part and may be revoked at anytime. If I later revoke consent, that revocation is not retroactive (i.e., it does not negate an action that has occurred after the consent was given and before the consent was revoked). I also understand that Anderson School District Five and the State Department of Education will operate under the guidelines of the Family Educational Rights and Privacy Act (FERPA) to ensure confidentiality regarding my child s treatment and provision of health-related services. Signature of Parent or Guardian Date 9
Licensed Practitioner of the Healing Arts (LPHA) The following list indicates the professional designations of those considered as Licensed Practitioners of the Healing Arts for the purpose of Medicaid reimbursement of School-Based Rehabilitative Therapy Services (Speech- Language Pathology, Occupational Therapy, Physical Therapy, Orientation & Mobility Services, and Audiology): Licensed Physician Assistant Advanced Practice Registered Nurse (AN) Registered Nurse (RN) Licensed Practical Nurse (LPN) Licensed Audiologist Licensed Occupational Therapist: Lindsay Busha Licensed Physical Therapist: Mariana Travis Licensed Speech-Language Pathologist: Carol Jane Anderson Caroline Davis Jada Goodwin Beth Gray Beverly Harrison Charity Hawkins Gabi Hilliard Judy Jones Pauli Thomason April Tucker Linda Wooten Licensed Professional Counselor: Royce Miller Licensed Marriage and Family Therapist Licensed Psycho-Educational Specialist Licensed Psychologist Ashlynn Jordan Kristen Wilson Licensed Independent Social Worker Licensed Master Social Worker Licensed Baccalaureate Social Worker 10
Licensed Practitioner of the Healing Arts (LPHA) The following professionals are considered Licensed Practitioners of the Healing Arts and must confirm medical Necessity for Rehabilitative Behavioral Health Services: Psychiatrist Physician Ph.D. Psychologist Registered Nurse with a Master s Degree in Psychiatric Nursing Advanced Practice Registered Nurse Licensed Independent Social Worker-Clinical Practice Master Social Worker Physician s Assistant Professional Counselor: Royce Miller Marriage and Family Therapist Psycho-educational Specialist Ashlynn Jordan Kristen Wilson 11
Speech Language Therapy Speech-Language Pathology Services involve the evaluation and treatment of speech and language disorders for which medication or surgical treatments are not indicated. Services include preventing, evaluating, and treating disorders of verbal and written language, articulation, voice, fluency, mastication, deglutition, cognition/communication, auditory and/or visual processing and memory, and interactive communication; as well as the use of augmentative and alternative communication systems (sign language, gesture systems, communication boards, electronic automated devices, mechanical devices) when appropriate. 12
Speech-Language Medicaid Checklist for Teachers Notify the Speech-Language Therapist well in advance of the annual review. Make sure he/she is on the letter of invitation. Confirm that the SLT has completed all quarterly progress reports and completed all Medicaid billing prior to opening a new IEP in Excent. The IEP must have present levels of performance which indicate the need for speech-language therapy. In Section V of the IEP, list speech-language therapy as a special ed service (not a related service) with the exact amount of time per week. In the description you must specify group or individual therapy (not both). Speech-Language Therapist needs to sign the IEP. If not present for the meeting, he/she may sign as reviewed with date. If the speech therapist requires supervision (doesn t have Cs ), the supervising therapist is required to sign the IEP. It is also acceptable for the supervising SLP to provide you with a signed supplementary statement which you may attach to the IEP. Ask the student s SLT if this is needed. Give SLT a copy of the signed Medicaid Consent for Release of Information. 13
Please mark your new IEPs completed in Excent in a timely manner. Medicaid providers are unable to enter their Medicaid documentation in Excent until you do this. 14
Speech-Language Medicaid Checklist for Providers BILLING Medicaid billing should be entered into Excent by the 10 th day of the following month for the previous month s billing. If you need additional time to complete this, contact David Hendricks. Your narrative must justify the amount of time billed a pertinent description of the activities that took place during the session, including an indication of the child s response to treatment. Use only approved abbreviations and symbols in your documentation. Should correction to documentation be required after an encounter becomes read only in Excent, print the encounter and make hand-written corrections. Then file the corrected hard copy in the student s Medicaid file. Electronic signature in Excent is accomplished by clicking Save at the bottom of the encounter and then click OK. If you require supervision under Medicaid, you Will click Save and then cancel. Your supervising SLP will click OK. Please notify her when you have encounters that need signing. MEDICAID FILE All items in the student s Medicaid folder should be arranged in a logical, sequential order. 15
Medicaid folders should be ready for review upon request at any time. During the year, you will be asked to submit at least one Medicaid file for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for speech is available to you on request. REEVALUATION AND ANNUAL REVIEW Secure a signature from an LPHA for the Medicaid Referral for Speech Language Evaluation and Treatment prior to conducting the annual reevaluation. (Both evaluation and treatment should be checked on this form.) Conduct the annual reevaluation after the date on the referral and prior to the date of the annual review. Enter documentation into Excent for billing this reevaluation. The annual reevaluation should be one year or more from the date of the last speech reevaluation. Sign the IEP and include your title and the date. If you were not present at the meeting, sign as reviewed with title and date. If you require supervision for Medicaid purposes, your supervising SLP needs to sign as well. Get a copy of the signed Medicaid Consent for Release of Information. 16
Place all of the above into the student s Medicaid folder (the IEP signature page will suffice for the IEP). CREDENTIALS Submit a copy of your credentials to David Hendricks at the District Office any time they are renewed. 17
ANDERSON SCHOOL DISTRICT FIVE Anderson, South Carolina MEDICAID REFERRAL FOR SPEECH/LANGUAGE EVALUATION/TREATMENT Student Name: DOB: School: The student is being referred for the following: Speech/Language Evaluation Treatment of Speech/Language Disorder The reason for this referral is: The student failed the speech/language screening on. (Maintain evidence in clinical record) One of the following speech/language disorder(s) is/are Documented or Suspected Developmental Language Disorder Acquired Language Disorder Articulation/Phonological Disorder Fluency Disorder Voice Disorder Resonance Disorder Dysphagia See the Medicaid LEA Manual at pages 2-32 and 2 33 for descriptions of these disorders. Other reason: Additional Comments:... Referral made by (Name or names of IEP/IFSP multi-disciplinary team members):. LPHA Signature:. Credentials Title of LPHA:. Date of Referral:... The referral must be upgraded no later than the annual renewal of the IEP/IFSP. It must be obtained from a Licensed Practitioner of the Healing Arts (LPHA) acting within the scope of practice under state law. The referring entity may not be the same person who conducts the evaluation or provides treatment. The referral must be clearly documented in the clinical record with the name, date and title of the provider. The Medicaid LEA Manual defines Licensed Practitioner of the Healing Arts (LPHA) at pages 2 5 to 2 6. 3/05 18
Occupational Therapy Individual or Group Occupational Therapy involves the development and implementation of specialized Occupational Therapy programs that incorporate the use of appropriate interventions, occupational therapy activities in the school environment, and recommendations on equipment needs and adaptations of physical environments. 19
OT Medicaid Checklist for Teachers The Occupational Therapist should be notified of the annual review well in advance of the meeting. Confirm that the OT has completed all quarterly progress reports and completed all Medicaid billing prior to opening a new IEP in Excent. The IEP must have present levels of performance which indicate the need for occupational therapy. The IEP must have OT listed as a related service under Section V and must give the specific amount of time per week and must indicate whether the therapy will be individual or small group. This cannot be stated as small group OR individual. The Occupational Therapist should be invited to the meeting and sign the IEP with title. If the OT is unable attend the meeting, you must review the IEP after the fact and get her signature/title and date on the signature page. If the Occupational Therapist is a COTA (Certified Occupational Therapy Assistant), the IEP should be signed by the COTA and the supervising Occupational Therapist. Provide the OT with a copy of the Medicaid Consent for Release of Information. 20
Please mark your new IEPs completed in Excent in a timely manner. Medicaid providers are unable to enter their Medicaid documentation in Excent until you do this. 21
OT Medicaid Checklists for Providers BILLING Medicaid billing should be entered into Excent by the 10 th day of the following month for the previous month s billing. If you need additional time to complete this, contact David Hendricks. Your narrative must justify the amount of time billed a pertinent description of the activities that took place during the session, including an indication of the child s response to treatment. Use only approved abbreviations and symbols in your documentation. Should correction to documentation be required after an encounter becomes read only in Excent, print the encounter and make hand-written corrections. Then file the corrected hard copy in the student s Medicaid file. Electronic signature in Excent is accomplished by clicking Save at the bottom of the encounter and then click OK. If you require supervision under Medicaid, you will click Save and then cancel. Your supervising therapist will click OK. Please notify her when you have encounters that need signing. MEDICAID FILE All items in the student s Medicaid folder should be arranged in a logical, sequential order. 22
Medicaid folders should be ready for review upon request at any time. During the year, you will be asked to submit at least one Medicaid file for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for OT is available to you on request. REEVALUATION AND ANNUAL REVIEW Secure a signature from an LPHA for the Medicaid Referral for Occupational Therapy Evaluation and Treatment prior to conducting the annual reevaluation. (Both evaluation and treatment should be checked on this form.) Conduct the annual reevaluation after the date on the referral and prior to the date of the annual review. Enter documentation into Excent for billing this reevaluation. The annual reevaluation should be one year or more from the date of the last OT reevaluation. Sign the IEP and include your title and the date. If you were not present at the meeting, sign as reviewed with title and date. If you are a COTA, your supervising OT needs to sign as well. Get a copy of the signed Medicaid Consent for Release of Information. 23
Place all of the above into the student s Medicaid folder (the IEP signature page will suffice for the IEP). CREDENTIALS Submit a copy of your credentials to David Hendricks at the District Office any time they are renewed. 24
ANDERSON SCHOOL DISTRICT FIVE Anderson, South Carolina MEDICAID REFERRAL FOR OCCUPATIONAL THERAPY EVALUATION/TREATMENT Student Name: DOB: School: The student is being referred for the following: Occupational Therapy Evaluation Occupational Therapy The reason for this referral is: The student has a diagnosis of Additional Comments:... Referral made by (Name or names of IEP/IFSP multi-disciplinary team members):.. LPHA Signature:. Credentials Title of LPHA:. Date of Referral:.. The referral must be upgraded no later than the annual renewal of the IEP/IFSP. It must be obtained from a Licensed Practitioner of the Healing Arts (LPHA) acting within the scope of practice under state law. The referring entity may not be the same person who conducts the evaluation or provides treatment. The referral must be clearly documented in the clinical record with the name, date and title of the provider. The Medicaid LEA Manual defines Licensed Practitioner of the Healing Arts (LPHA) at pages 2 5 to 2 6. 3/05 25
Physical Therapy Physical Therapy Services involve evaluation and treatment to prevent, alleviate, or compensate for movement dysfunction and related functional problems. Physical Therapy involves the use of physical agents, mechanical means, and other remedial treatment to restore normal physical functioning following illness or injury. 26
PT Medicaid Checklist for Teachers The Physical Therapist should be notified of the annual review well in advance of the meeting. Confirm that the PT has completed all quarterly progress reports and completed all Medicaid billing prior to opening a new IEP in Excent. The IEP must have present levels of performance which indicate the need for physical therapy. The IEP must have PT listed as a related service under Section V and must give the specific amount of time per week and must indicate whether the therapy will be individual or small group. This cannot be stated as small group OR individual. The Physical Therapist should be invited to the meeting and sign the IEP with title. If the PT is unable attend the meeting, you must review the IEP after the fact and get her signature/title and date on the signature page. Provide the PT with a copy of the Medicaid Consent for Release of Information. Please mark your new IEPs completed in Excent in a timely manner. Medicaid providers are unable to enter their Medicaid documentation in Excent until you do this. 27
PT Medicaid Checklists for Providers BILLING Medicaid billing should be entered into Excent by the 10 th day of the following month for the previous month s billing. If you need additional time to complete this, contact David Hendricks. Your narrative must justify the amount of time billed a pertinent description of the activities that took place during the session, including an indication of the child s response to treatment. Use only approved abbreviations and symbols in your documentation. Should correction to documentation be required after an encounter becomes read only in Excent, print the encounter and make hand-written corrections. Then file the corrected hard copy in the student s Medicaid file. MEDICAID FILE All items in the student s Medicaid folder should be arranged in a logical, sequential order. Medicaid folders should be ready for review upon request at any time. During the year, you will be asked to submit at least one Medicaid file for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for PT is available to you on request. 28
REEVALUATION AND ANNUAL REVIEW Secure a signed Medicaid Referral for Physical Therapy Evaluation and Treatment from the student s physician prior to conducting the annual reevaluation. (Both evaluation and treatment should be checked on this form.) Conduct the annual reevaluation after the date on the referral and prior to the date of the annual review. Enter documentation into Excent for billing this reevaluation. The annual reevaluation should be one year or more from the date of the last PT reevaluation. Sign the IEP and include your title and the date. If you were not present at the meeting, sign as reviewed with title and date. Get a copy of the signed Medicaid Consent for Release of Information. Place all of the above into the student s Medicaid folder (the IEP signature page will suffice for the IEP). CREDENTIALS Submit a copy of your credentials to David Hendricks at the District Office any time they are renewed. 29
ANDERSON SCHOOL DISTRICT FIVE Anderson, South Carolina MEDICAID REFERRAL FOR PHYSICAL THERAPY EVALUATION/TREATMENT Student Name: DOB: School: The student is being referred for the following: Physical Therapy Evaluation Physical Therapy The reason for this referral is: The student has a diagnosis of Additional Comments:... Referral made by (Name or names of IEP/IFSP multi-disciplinary team members):.. LPHA Signature:. Credentials Title of LPHA:. Date of Referral:.. The referral must be upgraded no later than the annual renewal of the IEP/IFSP. It must be obtained from a Licensed Practitioner of the Healing Arts (LPHA) acting within the scope of practice under state law. The referring entity may not be the same person who conducts the evaluation or provides treatment. The referral must be clearly documented in the clinical record with the name, date and title of the provider. The Medicaid LEA Manual defines Licensed Practitioner of the Healing Arts (LPHA) at pages 2 5 to 2 6. 3/05 30
Special Needs Transportation The Special Needs Transportation Program is designed to provide transportation to Medicaid-eligible school students with special needs requiring transportation to medically necessary services in school-based settings. Special Needs Transportation reimbursement is available for transportation provided to the following rehabilitative therapy and related health care services: Physical Therapy Occupational Therapy Speech and Language Pathology Psychological Testing and Evaluation Orientation and Mobility Rehabilitative Behavioral Health Services Nursing Services An appropriate Medicaid-reimbursable School-Based Service other than transportation must be rendered on the date of transport to be reimbursable for Special Needs transportation. Medicaid transportation is not reimbursable when the requirement for transportation service is not identified in the IEP. 31
Special Needs Transportation Checklist for Teachers The IEP must include reasons indicating the need for special needs transportation under present levels of performance. The IEP must have SNT listed as a related service under Section V and must give a description of the service required: to and from school, to school every AM, to home PM only, to AVCC during school day, etc. Get a signed Medicaid Consent for Release of Information and submit with paperwork to your special education secretary. 32
Special Needs Transportation Checklist for Providers DOCUMENTATION A Trip and Passenger Pupil Log Form is used daily by the driver to record route information and other ridership data as required by SCDHHS for billing and claims reimbursement for each Medicaid passenger (pupil) accessing transportation each day. This form will provide: 1. District Name, Address, Phone Number 2. Route Number (as applicable) 3. Driver (Name) 4. Vehicle Number/License Tag Number/District Number 5. Date 6. Passenger Name Upon completion, drivers are required to sign the log in the space provided. Pupil Log Forms and drivers credentials are kept on file in the Office of Transportation. QUALITY ASSURANCE REVIEW In the spring, the Office of Transportation will be asked to submit one month s collection of Trip Logs for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for SNT is available on request. In addition, credentials for all drivers for the selected month will be requested for review. 33
Nursing Services IEP Title V Nursing Services are those specialized health care services including nursing assessment and nursing diagnosis; direct care and treatment; administration of medication and treatment as authorized and prescribed by a physician or dentist and/or other licensed/authorized healthcare personnel; nurse management; health counseling; and emergency care. Reimbursable nursing services under this program will include any service that an RN or LPN is allowed to provide under state licensure and regulation. Nursing Services for Children Under 21 applies to Medicaideligible students with IEPs which list Nursing as a Related Service. Title V Nursing Services applies to all Medicaid-eligible students. 34
Nursing Services Checklist for Teachers If the student requires the services of the school nurse in order to benefit from his/her special education services, the IEP Team must list Nursing Services as a related service on the IEP. In this case, the school nurse should be invited to attend the IEP meeting and listed on the invitation in Excent. Please notify her well in advance of the meeting date. Under present levels of performance you should document the need for nursing services. Describe the exact service(s) to be provided and the frequency of the service in Section V of the IEP. If medication is administered, the name of the medication should be stated. If the nurse is unable to attend the meeting, the IEP should be reviewed with her and signature ( reviewed by ), title and date obtained. If your school nurse is an LPN, the IEP must be signed or co-signed by a Registered Nurse. Provide the nurse with a copy of the IEP. Provide the nurse with a copy of the signed Medicaid Consent for Release of Information. 35
Nursing Services Checklist for Providers BILLING Enter documentation in the Nursing Module for all Medicaid-eligible children. Eligibility will be updated in the Nursing Module on the first day of the month. Your narrative must justify the amount of time billed a pertinent description of the activities that took place during the session, including an indication of the child s response to treatment. Procedure codes: T1015 is for encounters lasting less than 15 minutes in duration. RNs will use the TD modifier and LPNs will use the TE modifier. T1002 is for visits of 15 minutes duration or more with an RN. T1003 is for visits of 15 minutes duration or more with an LPN. Each nursing encounter (T1015) must be documented as a separate encounter, even if there are several on one day for the same procedure (i.e. meds). For T1015, units may be either left blank or 1. T1002/T1003 may be written as multiple units for a single extended visit to the nurse. Multiple visits may not be written on a single line. Documentation for a completed month should be entered into the Nursing Module by the 10 th day of the following month. If you need additional time, contact David Hendricks. 36
MEDICAID FILE All items in the student s Medicaid folder should be arranged in a logical, sequential order. If you bill for medication administration, a copy of the physicians order should be in the student s file. A copy of a signed Medicaid Consent for Release of Information should be in the student s file. These are available on the school s Emergency Contact Form. However, if you are unable to locate one, contact David Hendricks. Clinical Service Notes are stored in the Nursing Module. No hard copy is maintained unless hand-written corrections were made. Medicaid folders should be ready for review upon request at any time. During the year, you will be asked to submit at least one Medicaid file for Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for Nursing Services for Children Under 21 and Title V Nursing Services is available to you on request. 37
Orientation and Mobility Orientation and Mobility (O&M) Services are provided to assist individuals who are blind and visually impaired to achieve independent movement within the home, school, and community settings. O&M Services utilize concepts, skills, and techniques necessary for a person with visual impairment to travel safely, efficiently, and independently through any environment and under all conditions and situations. The goal of these services is to allow the individual to enhance existing skills and develop new skills necessary to restore, maximize, and maintain physiological independence. 38
O & M Medicaid Checklist for Teachers Notify the O & M specialist well in advance of the annual review. Make sure he/she is on the letter of invitation. Confirm that the O & M specialist has completed all quarterly progress reports and completed all Medicaid billing prior to opening a new IEP in Excent. The IEP must have present levels of performance which indicate the need for Orientation and Mobility services. In Section V of the IEP, list O & M services as a related service with the exact amount of time and frequency. In the description you must specify individual therapy. The O & M specialist needs to sign the IEP. If not present for the meeting, she should sign as reviewed with date and title. Get a signed Medicaid Consent for Release of Information and submit to your special education secretary. Please mark your new IEPs completed in Excent in a timely manner. Medicaid providers are unable to enter their Medicaid documentation in Excent until you do this. 39
O & M Medicaid Checklists for Providers BILLING Medicaid billing should be entered into Excent by the 10 th day of the following month for the previous month s billing. If you need additional time to complete this, contact David Hendricks. Your narrative must justify the amount of time billed a pertinent description of the activities that took place during the session, including an indication of the child s response to treatment. Use only approved abbreviations and symbols in your documentation. Should correction to documentation be required after? an encounter becomes read only in Excent, print the encounter and make hand-written corrections. Then file the corrected hard copy in the student s Medicaid file. Electronic signature in Excent is accomplished by clicking Save at the bottom of the encounter and then click OK. MEDICAID FILE During the year, you will be asked to submit at least one Medicaid file for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for O & M is available to you on request. 40
REEVALUATION AND ANNUAL REVIEW Work with the student s Vision Itinerant teacher to secure a signature from an LPHA for the Medicaid Referral for Orientation and Mobility Evaluation and Treatment prior to conducting the annual reevaluation. (Both evaluation and treatment should be checked on this form.) Conduct the annual reevaluation after the date on the referral and prior to the date of the annual review. Enter documentation into Excent for billing this reevaluation. The annual reevaluation should be one year or more from the date of the last O & M reevaluation. Sign the IEP and include your title and the date. If you were not present at the meeting, sign as reviewed with title and date. Get a copy of the signed Medicaid Consent for Release of Information and submit to the Office of Special Education. 41
ANDERSON SCHOOL DISTRICT FIVE Anderson, South Carolina MEDICAID REFERRAL FOR ORIENTATION AND MOBILITY SERVICES EVALUATION/TREATMENT Student Name: DOB: School: The student is being referred for the following: Orientation and Mobility Evaluation Orientation and Mobility Services The reason for this referral is: The student has a diagnosis of Additional Comments:... Referral made by (Name or names of IEP/IFSP multi-disciplinary team members):.. LPHA Signature:. Credentials Title of LPHA:. Date of Referral:.. The referral must be upgraded no later than the annual renewal of the IEP/IFSP. It must be obtained from a Licensed Practitioner of the Healing Arts (LPHA) acting within the scope of practice under state law. The referring entity may not be the same person who conducts the evaluation or provides treatment. The referral must be clearly documented in the clinical record with the name, date and title of the provider. The Medicaid LEA Manual defines Licensed Practitioner of the Healing Arts (LPHA) at pages 2 5 to 2 6. 3/05 42
Rehabilitative Behavioral Health Services Rehabilitative Behavioral Health Services are medical or remedial services that have been recommended for maximum reduction of mental disability and restoration of a beneficiary to their best possible functional level. These services include Behavioral Health Screening, Diagnostic Assessment, Rehabilitative Psychosocial Services, Group and Individual Therapy, Family Support, Behavior Modification, Crisis Management and Family Therapy. 43
RBHS Medicaid Checklist for Teachers Notify a Masters-level RBHS staff member well in advance of the annual review. Make sure he/she is on the letter of invitation. The IEP must have present levels of performance which indicate the need for RBHS. In Section V of the IEP, list RBHS as a related service with the specific RBHS services to be provided as well as their frequency. The RBHS Masters-level staff needs to sign the IEP. If not present for the meeting, he/she should sign as reviewed with date and title. Provide the RBHS staff with a copy of the IEP. Provide the RBHS staff with a copy of the signed Medicaid Consent for Release of Information. Please mark your new IEPs completed in Excent in a timely manner. Medicaid providers are unable to enter their Medicaid documentation in Excent until you do this. 44
RBHS Medicaid Checklist for Providers BILLING Medicaid billing should be entered into Excent by the 10 th day of the following month for the previous month s billing. If you need additional time to complete this, contact David Hendricks. Your narrative must justify the amount of time billed a pertinent description of the activities that took place during the session, including an indication of the child s response to treatment. Use only approved abbreviations and symbols in your documentation. Should correction to documentation be required after an encounter becomes read only in Excent, print the encounter and make hand-written corrections. Then file the corrected hard copy in the student s Medicaid file. Electronic signature in Excent is accomplished by clicking Save at the bottom of the encounter and then click OK. MEDICAID FILE During the year, you will be asked to submit at least one Medicaid file for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for RBHS is available to you on request. 45
ANNUAL REVIEW Secure a signature from an LPHA for the Medical Necessity Statement for Rehabilitative Services prior to conducting the annual review of the IEP. Sign the IEP and include your title and the date. If you were not present at the meeting, sign as reviewed with title and date. Get a copy of the signed Medicaid Consent for Release of Information and submit to the Office of Special Education. 46
MEDICAL NECESSITY STATEMENT FOR REHABILITATIVE SERVICES Beneficiary s Name: Social Security Number: Date of Birth: Medicaid Number: Diagnosis code(s): [Diagnosis codes must be based on the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD).] I recommend that the above-named Medicaid beneficiary receive Rehabilitative Services(s) for the maximum reduction of emotional, behavioral, and functional developmental delays and restoration of the beneficiary to his or her best possible functioning level. This beneficiary meets the Medical Necessity criteria for Rehabilitative Services as evidenced by a Psychiatric diagnosis from the current edition of the DSM or the ICD. Indicate the specific Rehabilitative Service(s) being recommended on each line below. Rehabilitative Service(s):,, Rehabilitative Service(s):,, Rehabilitative Service(s):,, Rehabilitative Service(s):,, Identify the Beneficiary s problem areas for Rehabilitative Services listed above. The recommendation must be based on recent clinical information, staffing recommendations, review(s) of treatment history and/ or evaluation(s) made within federal and state standards (Signature of Physician or other Licensed Practitioner of the Healing Arts) (Professional Title) (Please print name signed above) (Phone Number) Signature Date: (Services must be initiated within 45 calendar days.) Must be handwritten Note: The Referral/Authorization for Rehabilitative Services form (DHHS Form 254) and the MNS must be sent to the provider prior to the provision of services, or at the time the services are rendered Revised: 05/2010 47
Psychological Services School-based Psychological Evaluation and Testing services involve the evaluation of the intellectual, emotional, and behavioral status of a child for the purpose of interventions designed to alleviate dysfunction or distress. Testing and evaluation must involve face-to-face interaction between the school psychologist and the beneficiary. Testing may include measures of intellectual and cognitive abilities, neuropsychological status, attitudes, emotions, motivations, and personality characteristics, as well as use of other nonexperimental methods of evaluation. 48
Psychological Services Medicaid Checklist for Providers GETTING STARTED Prior to evaluation, secure a signature from an LPHA for the Medicaid Referral for Psycho-Educational Evaluation. Prior to evaluation, secure a signed copy of the Medicaid Consent for Release of Information. BILLING A Psychological Services Log Form must be completed for each Medicaid-reimbursable testing/evaluation service provided. In Anderson Five the Encounter Log in Excent is used as a log form. Medicaid billing should be entered into Excent by the 10 th day of the following month for the previous month s billing. Your narrative must justify the amount of time billed. Use only approved abbreviations and symbols in your documentation. The ICD-9-CM diagnosis code and the time spent on each service component must be documented on a log form. For assistance with diagnosis codes, contact David Hendricks. Only psychologists who are licensed may bill for evaluations which result in a diagnosis of emotional disability. Electronic signature in Excent is accomplished by clicking Save at the bottom of the encounter and then click 49
OK. If you are a School Psychologist I, you will click Save and then click Cancel. Your supervising psychologist will then co-sign by clicking Save, then OK. EVALUATION REPORT Your evaluation report must have your signature with a date beside it. CREDENTIALS Submit a copy of your credentials to David Hendricks at the District Office any time they are renewed. MEDICAID FILE During the year, you will be asked to submit at least one of your evaluations for our Quality Assurance Review conducted by the SC Department of Education. The Quality Assurance Review tool for Psychological Services is available to you on request. 50
ANDERSON SCHOOL DISTRICT FIVE Anderson, South Carolina MEDICAID REFERRAL FOR PSYCHO-EDUCATIONAL EVALUATION Student Name: DOB: School: The student is being referred for a comprehensive psycho-educational evaluation. The reason for this referral is: Referral made by (Name or names of IEP/IFSP multi-disciplinary team members):. LPHA Signature:. Credentials Title of LPHA:. Date of Referral:... It must be obtained from a Licensed Practitioner of the Healing Arts (LPHA) acting within the scope of practice under state law. The referring entity may not be the same person who conducts the evaluation or provides treatment. The referral must be clearly documented in the clinical record with the name, date and title of the provider. The Medicaid LEA Manual defines Licensed Practitioner of the Healing Arts (LPHA) at pages 2 5 to 2 6. 09/10 51