School Nurse Organization of School Nurse Organization of Minnesota Annual ConferenceMinnesota Annual Conference

November 2, 2013November 2, 2013

Janet Lowe, RN, LSN, CPNP, MAJanet Lowe, RN, LSN, CPNP, MA

Connecting School Connecting School Nurses to Nurses to

ReimbursementReimbursement

ImpactImpact

InfluenceInfluence

OutcomesOutcomes

Connecting School Nurses to Reimbursement

Reimbursement• Impact• Influence• Outcome

Background• Regulations

Best Practices FAQ Resources

Connecting School Nurses to Connecting School Nurses to Reimbursement: Reimbursement: ImpactImpact

Connecting School Nurses to Connecting School Nurses to Reimbursement: Reimbursement: ImpactImpact

ReimbursementReimbursement• Increases Increases

RevenueRevenue

School Nurse School Nurse PositionsPositions

Connecting School Nurses To Connecting School Nurses To Reimbursement: Reimbursement: InfluenceInfluence

School Nurses School Nurses are an Integral are an Integral Part of the Part of the Health Care Health Care DeliveryDelivery

Increases Access Increases Access to Health Careto Health Care

Connecting School Nurses to Connecting School Nurses to Reimbursement: Reimbursement: OutcomesOutcomes

Reduces Reduces Health Related Health Related Barriers to Barriers to LearningLearning

Increases Increases AchievementAchievement

Increased Increased Graduation Graduation RatesRates

Where To Begin?Where To Begin?

MedicaidMedicaid Federal and StateFederal and State

1965 – Social 1965 – Social Security ActSecurity Act

Reimbursement for Reimbursement for Health Care Health Care ServicesServices

QQ3 3 = Reimbursement= Reimbursement

QQualified Children/ ualified Children/ YouthYouth

QQualified Providersualified Providers

QQualified Covered ualified Covered Medicaid Services Medicaid Services

Qualified ProvidersQualified Providers

Licensed School Licensed School NursesNurses

RNs, LPNsRNs, LPNs

Advanced Practice Advanced Practice Registered NursesRegistered Nurses• CNPsCNPs

Qualified ServicesQualified Services

Federal Federal RegulationsRegulations

State Medicaid State Medicaid RegulationsRegulations

Covered ServicesCovered Services

Individualized Individualized Education Program Education Program (IEP) Plan Health (IEP) Plan Health Related ServicesRelated Services

• (34C.F.R.300.154)(34C.F.R.300.154)• (MS256B.0625)(MS256B.0625)

• School Nursing School Nursing ServiceService

Covered IEP Health Related Covered IEP Health Related Nursing Service Nursing Service (IEP Technical Assistance Guide, DHS)(IEP Technical Assistance Guide, DHS)

Face to face nursing care within Face to face nursing care within nurse’s nurse’s scope of practicescope of practice

Examples, but not limited to:Examples, but not limited to:• Catheterization, tube feeding, Catheterization, tube feeding,

suctioning, ventilator caresuctioning, ventilator care• Nursing assessment and diagnostic Nursing assessment and diagnostic

testing such as glucose testingtesting such as glucose testing• Vital signsVital signs• Health counselingHealth counseling

Covered IEP Health Related Covered IEP Health Related Nursing Service Nursing Service (IEP(IEP

Activities of Daily Living when the IEP Activities of Daily Living when the IEP indicates a one on one nurse is required indicates a one on one nurse is required at schoolat school

Medication administration – Medication administration – • Complex – IV, injection, nebulizer, or Complex – IV, injection, nebulizer, or

gastrostomy tubegastrostomy tube• Simple – administration of prescription Simple – administration of prescription

medications related to the child’s disability medications related to the child’s disability and in the IEPand in the IEP

Covered IEP Health Related Covered IEP Health Related Nursing ServiceNursing Service

Medication ManagementMedication Management• Review of medication and adherence to Review of medication and adherence to

regimen, and one of the following:regimen, and one of the following: Evaluation for adverse reactionsEvaluation for adverse reactions

Education about medicationEducation about medication

Contacts with the physicianContacts with the physician

Covered IEP Health Related Covered IEP Health Related Nursing ServiceNursing Service

IEP EvaluationsIEP Evaluations• Health relatedHealth related• Result in an IEPResult in an IEP• Includes:Includes:

Pre-IEP evaluationsPre-IEP evaluations Ongoing assessments to determine needsOngoing assessments to determine needs Re-evaluationsRe-evaluations Face to face Health Assessments, Face to face Health Assessments,

interpreting test results and writing reportsinterpreting test results and writing reports

Medicaid – Reimbursement in MNMedicaid – Reimbursement in MNfor IEP Health Related Services - Over 200 Millionfor IEP Health Related Services - Over 200 Million

$-

$5,000,000.00

$10,000,000.00

$15,000,000.00

$20,000,000.00

$25,000,000.00

$30,000,000.00

$35,000,000.00

$40,000,000.00

2002 2003 2004 2005 2006 2007 2008 2009 2010

Other Requirements

Enroll as a Provider (DHS)

Must provide notification/consent one time• District• MA consent

Must obtain denial through MDE, or private insurance company, for students with a combination of MA and private insurance

Covered ServicesCovered Services Early and Periodic Early and Periodic

Screening, Diagnosis, Screening, Diagnosis, and Treatment and Treatment

(EPSDT) (EPSDT) (42C.F.R.441.50-441.62)(42C.F.R.441.50-441.62)

MN- Child and Teen MN- Child and Teen Checkups (CTC)Checkups (CTC)

(MS256B.0625)(MS256B.0625)

ImmunizationsImmunizations

Enroll as a Public Enroll as a Public Health Nursing ClinicHealth Nursing Clinic

Childhood Immunizations (MS256B.0625, Subd.

39)

Must enroll in the pediatric vaccine administration

Budget Reconciliation Act of 1993. Medical assistance shall pay for administration of the vaccine to children eligible for medical assistance. • Medical assistance does not pay for vaccines

that are available at no cost from the pediatric vaccine administration program.

Public Health Nursing Clinic

Be department of, or operate under the direct authority of a unit of government. Examples of a unit of government include county, city, or school district

Eligible Providers• Public Health Nurses (PHN)• Licensed registered nurses, supervised by a

PHN, practicing in a PHNC

Public Health Nursing Clinic

Covered Services • Health Promotion and Counseling • Medication Management: Review of current

medications and adherence to the prescribed medication regime. Education on proper medication use and contact with the prescribing physician when necessary

• Nursing Assessment Treatment and Diagnostic

Testing

Erickson, C., Splett, P., Mullett, S., & Heiman, M. (2006). Thehealthy learner model for student chronic condition management—Part 1. Journal of School Nursing, 22, 310-318.

Diabetes Diabetes Chronic Disease ManagementChronic Disease Management

Public Health Clinic (PHC) Covered Services

• Preventive health services• Early periodic screening, diagnosis, and

treatment services, also known as Child and Teen Checkups or C&TC

• Dental services• Tuberculosis case management and directly

observed therapy

Eligible Providers• Advanced practice registered nurses (APRN)•

Nurse practitioners (NP)

Covered ServicesCovered Services

Nurse Practitioner Nurse Practitioner ServicesServices• Advanced Practice Advanced Practice

Registered Nurse Registered Nurse (APRN)(APRN)

(MS256B.0625)(MS256B.0625)

Best Practices in the Development of a Reimbursement Program

Administrative Support

• Superintendent

• Board of Education

Collecting Data on Health Care Collecting Data on Health Care Services Provided in Your SchoolServices Provided in Your School

Chronic Disease Chronic Disease ManagementManagement• Asthma, Diabetes, Asthma, Diabetes,

Hearing Conditions, Hearing Conditions, ADHD ADHD

MedicationsMedications

TreatmentsTreatments

Best Practices in the Development of a Reimbursement Program

Strategic Goals and the Racial Equity Policy• Achievement

• Alignment

• Sustainability

Best Practices in the Development of a Reimbursement Program

Inter-Department Support

• Finance

• Legal

• Purchasing

• Technical Department

Best Practices in the Development of a Reimbursement Program

Work Across Disciplines• OT• PT• Speech and

Language and Audiology

• Social Workers• School

Psychologists

Best Practices in the Development of a Reimbursement Program

Adhere to Standards of Practice

Develop Policies and Procedures

Best Practices in the Development of a Reimbursement Program

Documentation• Name, student ID• Date of Service• Duration of Service• Description of Service• Progress• Plan

SOAP• Subjective, Objective,

Assessment, Plan DAP

• Data, Assessment, Plan DARP

• Data, Assessment, Response, Plan

CCC• Concept, cueing,

clicking

Best Practices in the Development of a Reimbursement Program

Secure Data• Electronic

Firewalls, encryption, security

Retrievable for Audits  

Best Practices in the Development of a Reimbursement Program

Build the Infrastructure for an Audit

Internal Audits

Other Areas for Reimbursement Other Areas for Reimbursement for School Nurses in Minnesota for School Nurses in Minnesota

Electronic Data Reporting System (EDRS) – State Electronic Data Reporting System (EDRS) – State Special Education fundsSpecial Education funds• Minnesota Department of EducationMinnesota Department of Education

Local Collaborative Time Study (LCTS)Local Collaborative Time Study (LCTS)• MN Department of Human ServicesMN Department of Human Services

Other Grants, or other Other Grants, or other

Affordable Health Care ActAffordable Health Care Act

Coordination of Coordination of Health Care Health Care ServicesServices

PreventionPrevention

Outcome BasedOutcome Based

The Time is NowThe Time is NowYou can Make an

IMPACT

OUTCOMESFor Students!!

INFLUENCE and be an Advocate

Tell Your Story

Questions from School Nurses

IEP Health Related Nursing Services• “If the nurse has listed direct time and it

is very little, can she track and charge for more time. For instance, the nurse put in 15 min. a month for seizure care and management but she is needing to go to the classroom every time the student has a seizure and it is more often than when they wrote the IEP.”

Questions from School Nurses

“Do the physician orders need to order medication management in order to bill medication management.”

Questions from School Nurses

Is adding nursing as a related service limited by the category of disability?

For example, can nursing only be on an OHD? What about LD, speech, and other categories?

Questions from School Nurses

How do you document nursing services on the IEP?

ResourcesResources Minnesota Department of Human Services, IEP Technical Assistance GuideMinnesota Department of Human Services, IEP Technical Assistance Guide

Minnesota Department of Education, Ruth Ellen Luehr, TPL denials, sharepointMinnesota Department of Education, Ruth Ellen Luehr, TPL denials, sharepoint

Centers for Medicare and Medicaid (CMS)Centers for Medicare and Medicaid (CMS)http://www.cms.gov/

National Alliance for Medicaid in Education (NAME)National Alliance for Medicaid in Education (NAME)http://medicaidforeducation.org/

National Association of School NursesNational Association of School Nurseshttp://www.nasn.org/

School Nursing: A Comprehensive Text, available for ordering June 23, 2012School Nursing: A Comprehensive Text, available for ordering June 23, 2012 Contact Contact apyles@nasn.org bookstore bookstore

Erickson, C., Splett, P., Mullett, S., & Heiman, M. (2006). Thehealthy learner model for student chronic condition management—Part 1. Journal of School Nursing, 22, 310-318.