MINNESOTA THIRD PARTY REIMBURSEMENT (TPR) …...Wednesday, April 20, 2016 . Minnesota Department of...
Transcript of MINNESOTA THIRD PARTY REIMBURSEMENT (TPR) …...Wednesday, April 20, 2016 . Minnesota Department of...
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)
612-788-9095 [email protected];
Carolyn Zachariason, M.A., OTR/L; Minneapolis Schools Occupational Therapist
Minneapolis Public Schools Voicemail: 612-692-1233
Jennifer Nordstrand, MS, RN, Licensed School Nurse, CPNP, Coordinator -Section 504
Saint Paul Public Schools 651-767-8382
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
651-431-2333 [email protected];
Jesusa Williams Setting rates for reimbursement of professional and paraprofessionals
651-431-2538 [email protected];
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
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
Phone: 651-582-8403
MDE TPR Network x x x Sue Benolken Interagency Partnerships Team Special Education Division
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
Phone: 651-582-8416 [email protected];
Kara Temple Part C Coordinator Early Childhood Team
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
Phone: 651-582-8495 [email protected];
Mary Hunt Related Service Providers Division of Special Education Special Education Division
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
Phone: 651-582-8676 [email protected];
Bridgette Ramaley, Supervisor Fiscal Monitoring Compliance and Assistance Division
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
Phone: 651-582-8479 [email protected];
Laura Waldoch, Fiscal Monitor, Compliance and Assistance Division
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
Phone: 651)582-8404 [email protected];
Michael Brooks Fiscal Services - TPR
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113;
Steve Collins Fiscal Services - EDRS
Minnesota Department of Education 1500 Highway 36 West Roseville, MN 55113
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
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
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
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
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
Julie Neururer Regions 5 & 7 Central (Rural/Small districts)
Little Falls Public Schools 1001 5th Ave SE Little Falls, MN 56345
Phone: 320-632-2003 [email protected];
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
Julie Stoneking Region 9 – SC (Small/Rural Districts)
Albert Lea Area Schools #241 211 W. Richway Drive Albert Lea, MN 56007
Phone: 507-379-4820 [email protected];
Denise Moody Region 10 (Mental Health Services)
Rochester Public Schools #535 615 SW 7th Street Rochester, MN 55902
Phone: 507-328-4273 [email protected];
Dawn Willson Suburban Districts (Licensed School Nursing)
Burnsville-Eagan Public Schools 202 West Burnsville Parkway Eagan, MN 55337
Phone: 952-707-6043 [email protected];
Cynthia Ritter Region 11W- Metro (Metro/Large Districts)
Anoka-Hennepin Schools 2740 Wingfield Ave. North Anoka, MN 55303
Phone: 763-506-7832 [email protected];
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
Rachel Sande Third Party Billing
Owatonna Public Schools 515 West Bridge Street Owatonna, MN 55060
Phone: 507-444-8618 Fax: 507-444-8699
Linda Goldman Cherwitz (Parent Advocate)
PACER Center 8161 Normandale Blvd. Bloomington, MN 55437
Phone: 952-838-9000 [email protected];
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).
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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.
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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.
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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.
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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).
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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.
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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.
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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
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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
TPR Statewide Spring Forum - April 20, 2016
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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
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Minnesota Department of Education (MDE)Third Party Reimbursement (TPR)
Special Education – Interagency Partnerships
Tom Delaney (651) [email protected]
Ruth Ellen Luehr (651) [email protected]
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Third Party Reimbursement (TPR)Components
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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
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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
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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
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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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TPR SharePoint - Navigating
TPR SharePoint – Navigating 2
Announcements and Calendar
Shared DocumentsPrivate insurers denial listDataSHARE documents
FORUM Resources
ICD-10-CM
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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
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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
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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
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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.
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
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Revalidation
Procedure Codes, Modifiers and Units
Explanation of Benefits
Tidbits of
Information
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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
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See instructions in the IEP Services Provider Manual -
left hand column, Billing and Authorization Requirements,
then IEP Procedure Codes, Modifiers and Units
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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
education.state.mn.us 3
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
education.state.mn.us 4
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:
education.state.mn.us 5
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
education.state.mn.us 6
• 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
education.state.mn.us 7
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)
education.state.mn.us 8
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)
education.state.mn.us 9
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
education.state.mn.us 10
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
education.state.mn.us 11
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
education.state.mn.us 12
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)
education.state.mn.us 13
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.
Purchased Services and Contracted Services (2)
education.state.mn.us 14
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.
Purchased Services and Contracted Services (3)
education.state.mn.us 15
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.
Purchased Services and Contracted Services (4)
education.state.mn.us 16
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
education.state.mn.us 17
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
education.state.mn.us 18
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
education.state.mn.us 19
The data reported on EDRS includes the time and expenditures for the Physical Therapist and Physical Therapy Assistants.
EDRS Personnel Type Code 04
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 150 – Salaries or 394 – Contracts
Physical Therapy
education.state.mn.us 20
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
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 416– Object Code 152 – Salaries or 394 – Contracts
Speech Language/Hearing Services
education.state.mn.us 21
Audiologist
EDRS Personnel Type Code 14
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 153 – Salaries or 394 – Contracts
Speech Language/Hearing Services (2)
education.state.mn.us 22
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
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 154 – Salaries or 394 – Contracts
Nursing Services
education.state.mn.us 23
Licensed Nursing Services
EDRS Personnel Type Code 44
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 155 – Salaries or 394 – Contracts
Nursing Services (2)
education.state.mn.us 24
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)
education.state.mn.us 25
School Psychologist
EDRS Personnel Type Code 13
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 157 – Salaries or 394 – Contracts
Mental Health Services (2)
education.state.mn.us 26
Qualified Mental Health Professional
EDRS Personnel Type Code 49
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 158 – Salaries or 394 – Contracts
Mental Health Services (3)
education.state.mn.us 27
Mental Health Practitioner
EDRS Personnel Type Code 52
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 160 – Salaries or 394 – Contracts
Mental Health Services (4)
education.state.mn.us 28
Mental Health Behavioral Aid
EDRS Personnel Type Code 50
UFARS Expenditures– Finance Dimension 740 or 317– Program/Disability Code 401 – 420– Object Code 159 – Salaries or 394 – Contracts
Mental Health Services (5)
education.state.mn.us 29
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
education.state.mn.us 30
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)
education.state.mn.us 31
Interpreters (Deaf)
EDRS Personnel Type Code 28
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)
education.state.mn.us 32
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
education.state.mn.us 33
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)
education.state.mn.us 34
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)
Verification of IEP-MA EDRS Data (2)
education.state.mn.us 35
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”
Verification of IEP-MA EDRS Data (3)
education.state.mn.us 36
Report: “Special Education Salary and FTE
Information for Medial Assistance”
education.state.mn.us 37
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)
education.state.mn.us 38
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.
District Use of Third Party Revenue (2)
education.state.mn.us 39
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.
District Use of Third Party Revenue (3)
education.state.mn.us 40
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
education.state.mn.us 41
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)
education.state.mn.us 42
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)
education.state.mn.us 43
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)
education.state.mn.us 44
Special Transportation Nursing Services
EDRS Personnel Type Code 60
UFARS ExpendituresFinance Dimension 723Program/Disability Code 760Object Code 155
Transportation (4)
education.state.mn.us 45
Special Transportation Personal Care Assistants
EDRS Personnel Type Code 61
UFARS ExpendituresFinance Dimension 723Program/Disability Code 760Object Code 161
Special Transportation (5)
education.state.mn.us 46
Please direct all questions regarding IEP-MA data and EDRS entries to:
Michael Brooks651-582-8240
Stephen Collins651-582-8467
Questions
education.state.mn.us 47
Prior Information and Parental Consent for Sharing Data
and Billing Medical Assistance
Tom DelaneySupervisor, Interagency Partnerships
TPR Statewide Spring Forum - April 20, 2016
*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
*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
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
Prior Information: Recommended Text - 3
• 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
Prior Information: Recommended Text - 4
• 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
Prior Information: Recommended Text - 5
• 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
Prior Information: Recommended Text - 6
• 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
Prior Information: Recommended Text - 8
• 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
Prior Information: Recommended Text - 10
• 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
Methods to Ensure Prior Information - 5
• 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
Methods to Ensure Prior Information - 6
• 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
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]
TPR Statewide Spring Forum, April 20, 2016
“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)
education.state.mn.us 2
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)
education.state.mn.us 3
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
\
education.state.mn.us 4
TPR-Transportation
• Document on IEP– Accommodations
\
education.state.mn.us 5
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
education.state.mn.us 6
education.state.mn.us 7
0
20
40
60
80
100
120
Not enrolled Did not seekreimbursement
No parentalnotice
LEAs with findings
LEAs monitored
Recent Findings
Jesusa Williams, DHS
TPR Statewide Spring Forum, April 20, 2016
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
TPR Statewide Spring Forum - April 20, 2016
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
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)).
PCA Care Plan Requirements and Added IEP or TSES Components - 3
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)).
PCA Care Plan Requirements and Added IEP or TSES Components - 4
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.
PCA Care Plan Requirements and Added IEP or TSES Components - 5
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.
PCA Care Plan Requirements and Added IEP or TSES Components - 6
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• “…name of responsible party and instructions
for contact…”
• Ensure that the IEP case manager is identified by name in the IEP.
PCA Care Plan Requirements and Added IEP or TSES Components - 7
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• “…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…
PCA Care Plan Requirements and Added IEP or TSES Components - 8
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• “…description of the individualized needs for
assistance with activities of daily living,
instrumental activities of daily living, health-
related tasks and behaviors…”
• “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…
PCA Care Plan Requirements and Added IEP or TSES Components - 9
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• “…description of the individualized needs for
assistance with activities of daily living,
instrumental activities of daily living, health-
related tasks and behaviors…”
• 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
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• “…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.
PCA Care Plan Requirements and Added IEP or TSES Components - 11
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• “…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…
PCA Care Plan Requirements and Added IEP or TSES Components - 12
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• “…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.
PCA Care Plan Requirements and Added IEP or TSES Components - 11
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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.
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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.
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• 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
TPR Statewide Spring Forum - April 20, 2016
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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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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?
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ICD-10-CM logically relates to the
child‘s needs and IEP provider/service
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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
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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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School PsychologistsSally Baas, Ed. D., Ed. S. – School PsychologyMinnesota School Psychologists Association MSPA
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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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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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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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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
Signs and symptoms involving the
musculoskeletal system Occupational Therapy R29.91
Signs and symptoms involving the
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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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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