Definition

The State Department of Education and the Department of Health and Welfare, Division of Medicaid, come together quarterly as a School-Based Medicaid Advisory Committee. These meetings are necessary to help facilitate better communication between school districts (School- Based Medicaid providers), Medicaid policy, and Medicaid Integrity. This committee meets to address changes in School-Based Medicaid IDAPA rules, discuss audit findings and ways to make practice corrections, as well as providing clarification to districts on School-Based Medicaid policies and procedures. This site provides the minutes to Advisory meetings, documentation that is relevant to the implementation of School-Based Medicaid rules, training material, and other related materials.

For additional resources including IDAPA rule and current forms please contact Shannon Dunstan: sdunstan@sde.idaho.gov

or

Alternative Care Coordinator
Idaho Department of Health and Welfare Medicaid
Phone: (208) 287-1169
Fax: (208) 332-7286

What's New?

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Any school district that has a School-Based Medicaid question, concern, or recommendation can submit the following form.

  • Upon receipt of the form, it will be assigned to the appropriate agency to provide a written response.
  • A written response will be sent back to the district.
  • All responses will be posted to this site as part of the FAQs.
  • If addition action needs to be taken regarding a submission, the School-Based Medicaid Advisory Committee will work to provide additional guidance.

Medicaid Guidance Handbook (Documents folder) or Direct Download Scroll down to documents section of page.

Minutes and other documents now published under 2016 Advisory Board Meetings.

The Division of Family and Community Services (FACS) is responsible for processing the renewal applications for individuals who hold a Habilitative Intervention (HI) Certificate of Completion as outlined in IDAPA 16.03.10.685.07.

FACS has identified renewal applications that are not consistently meeting the required number of continuing training hours. FACS will incorporate the following steps to address these renewals that are out of compliance with IDAPA.

When an individual submits the renewal application for their Certificate of Completion, if it is determined that the individual did not meet the HI continuing training requirement during year one (1), and a gap in training hours occurred, a letter will be sent to the HI Certificate of Completion holder and a letter will be sent to the Medicaid provider identifying that the staff’s qualifications are out of compliance with IDAPA.

It is the responsibility of Medicaid providers (Developmental Disability Agencies, School Districts, and Charter Schools) to ensure that HI providers are qualified to provide services. The Medicaid provider is responsible for ensuring the accuracy of claims submitted and shall immediately repay the Department for any services the Department or provider determines were not properly provided or documented.

If you have questions with regards to the Habilitative Intervention Certificate of Completion continuing training requirements, please contact Bobbi Hamilton, BCaBA at hamiltob@dhw.idaho.gov or 1 (208) 334-5777.


FAQ

Answer: The candidate would need to meet the following qualification to provide the service. Because the candidate does not meet the certification requirements, unless the candidate met the criteria for and held a Habilitative Intervention certification. The candidate would meet the qualification of a paraprofessional.

855.SCHOOL-BASED SERVICE: PROVIDER QUALIFICATIONS AND DUTIES.
Medicaid will only reimburse for services provided by qualified staff. The following are the minimum qualifications for providers of covered services: (7-1-13)

01. Behavioral Intervention. Behavioral intervention must be provided by or under the supervision of
a professional. (7-1-13)

a. A behavioral intervention professional must meet the following: (7-1-13)

i. An individual with an Exceptional Child Certificate who meets the qualifications defined under
IDAPA 08.02.02, “Rules Governing Uniformity,” Section 028; or (7-1-13)

ii. An individual with an Early Childhood/Early Childhood Special Education Blended Certificate
who meets the qualifications defined under IDAPA 08.02.02, “Rules Governing Uniformity,” Section 019; or
(7-1-13)

iii. A Special Education Consulting Teacher who meets the qualifications defined under IDAPA
08.02.02, “Rules Governing Uniformity,” Section 029; or (7-1-13)

iv. Habilitative intervention professional who meets the requirements defined in IDAPA 16.03.10
“Medicaid Enhanced Plan Benefits,” Section 685; or (7-1-13)

v. Individuals employed by a school as certified Intensive Behavioral Intervention (IBI) professionals prior to July 1, 2013, are qualified to provide behavioral intervention; and (7-1-13)

vi. Must be able to provide documentation of one (1) year’s supervised experience working with
children with developmental disabilities. This can be achieved by previous work experience gained through paid
employment, university practicum experience, or internship. It can also be achieved by increased on-the-job
supervision experience gained during employment at a school district or charter school. (7-1-13)

b. A paraprofessional under the direction of a qualified behavioral intervention professional, must
meet the following: (7-1-13)

i. Must be at least eighteen (18) years of age; (7-1-13)
ii. Demonstrate the knowledge, have the skills needed to support the program to which they are
assigned; and (7-1-16)

iii. Must meet the paraprofessional requirements under the Elementary and Secondary Education Act
of 1965, as amended, Title 1, Part A, Section 1119. (7-1-13)
c. A paraprofessional delivering behavioral intervention services must be under the supervision of a
behavioral intervention professional or behavioral consultation provider.

Answer: Residential treatment facilities are not a Medicaid Provide in the State of Idaho and would be considered the student's home. The school district could provide homebound School-Based Medicaid services as long as the services are identified on the student's IEP.

Answer: The school district must follow the definition of SED as outlined in Idaho Code. The student must have a DSM-V diagnosis that meets the criteria that is outlined in that section of Code from a qualified mental health provider.

(13) "Serious emotional disturbance" means an emotional or behavioral disorder, or a neuropsychiatric condition which results in a serious disability, and which requires sustained treatment interventions, and causes the child's functioning to be impaired in thought, perception, affect or behavior. A disorder shall be considered to "result in a serious disability" if it causes substantial impairment of functioning in family, school or community. A substance abuse disorder does not, by itself, constitute a serious emotional disturbance, although it may coexist with serious emotional disturbance.

IDAPA 16.03.09.852.01

01. Community Based Rehabilitation Services (CBRS). To be eligible for CBRS, the student
participant must meet one (1) of the following: (7-1-16)

a. A student who is a child under eighteen (18) years of age must meet the Serious Emotional
Disturbance (SED) eligibility criteria for children in accordance with the Children’s Mental Health Services Act,
Section 16-2403, Idaho Code. A child who meets the criteria for SED must experience a substantial impairment in
functioning. The child’s level and type of functional impairment must be documented in the school record. A
Department-approved assessment must be used to obtain the child’s initial functional impairment score. Subsequent scores must be obtained at least annually in order to determine the child’s change in functioning that occurs as a result of mental health treatment. (7-1-16)

Answer: Individuals that were hired prior to November 1, 2010 would have already received their PRA certification. The rules prior to this date are found in archived IDAPA rules. I have copied and provided you the section of rule.

See 16.03.10.131

131. PSYCHOSOCIAL REHABILITATIVE SERVICES (PSR) - AGENCY STAFF QUALIFICATIONS. All agency staff delivering direct services must have at least one (1) of the following credentials: (5-8-09)

01. Any of the Professions Listed Under IDAPA 16.03.09, “Medicaid Basic Plan Benefits,” Subsection 715.01. (5-8-09)

02. Clinician. A clinician must hold a master's degree, be employed by a state agency and meet the minimum standards established by the Idaho Division of Human Resources and the Idaho Department of Health and Welfare Division of Human Resources. (5-8-09)

03. Psychosocial Rehabilitation (PSR) Specialist. (5-8-09)

a. As of June 30, 2009, persons who are working as PSR Specialists delivering Medicaid- reimbursable mental health services may continue to do so until January 1, 2012, at which time they must be certified as PSR Specialists in accordance with USPRA requirements. (5-8-09)

b. As of July 1, 2009, applicants to become PSR Specialists delivering Medicaid-reimbursable mental health services must have a bachelor’s degree from a nationally-accredited university in Primary Education, Special Education, Adult Education, Counseling, Human Services, Early Childhood Development, Family Science, Psychology, or Applied Behavioral Analysis. Applicants who have a major in one (1) of these identified subject areas, but have a bachelor’s degree in another field, also meet this requirement. (5-8-09)

c. An applicant who meets the educational requirements under Subsection 131.03.b. of this rule may work as a PSR Specialist for a period not to exceed eighteen (18) months while under the supervision of a staff member with a Master's degree or higher credential or a certified PSR Specialist. In order to continue as a PSR Specialist beyond a total period of eighteen (18) months, the worker must obtain the USPRA certification. (5-8-09)

d. An individual who has been denied licensure or who is qualified to apply for licensure to the Idaho Bureau of Occupational Licenses, in the professions identified under Subsections 131.01 through 131.03 of this rule, designation of PSR Specialist with the exception of those individuals who SPRA PSR Specialist certification. (5-8-09)

Answer: The School-Based services are Personal Care Services (PCS) and nursing services. As long as the plan of care identified the need for nursing services and the IEP identifies who is providing the service, the the school can bill nursing services. School-Based rules do not delineate between an LPN and RN. If the service can be delineated to a non-profession then the service is considered PCS services not nursing.

IDAPA 16.03.09.853.03.d

d. Nursing Services. Skilled nursing services must be provided by a licensed nurse, within the scope
of his or her practice. Emergency, first aid, or non-routine medications not identified on the plan as a health-related service are not reimbursed.

Answer: The assessment codes, as outlined in the CPT manual - psychological evaluations 96101, allows school personnel to complete reports when school is not in sessions. The report would reflect the activities involving the student that would occur Monday-Friday or during school, but report writing can be done at other times..

Answer: 24.13.01.10 Definitions

03. Physical Therapist. An individual who meets all the requirements of Title 54, Chapter 22, Idaho
Code, holds an active license and who engages in the practice of physical therapy. (3-19-07)

04. Physical Therapist Assistant. An individual who meets the requirements of Title 54, Chapter 22,
Idaho Code, holds an active license, and who performs physical therapy procedures and related tasks that have been selected and delegated only by a supervising physical therapist.

16.03.09.734.02
The following provider is qualified to provide therapy services as Medicaid provider.

Physical Therapist, Licensed. A person licensed by the Physical Therapy Licensure Board to
conduct physical therapy assessments and therapy in accordance with the Physical Therapy Practice Act, Title 54,
Chapter 22, Idaho Code, and IDAPA 24.13.01, “Rules Governing the Physical Therapy Licensure Board.” (4-2-08)

Since both individuals must be licensed in the State of Idaho to provide the service, both would bill at the professional rate.

Documents

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    Trainings

    Title: SPED - Medicaid Webinar
    Date: March 5, 2015
    Presenters: Elaine Eberharter-Maki, Attorney at Law, also presenting: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF) ; Medicaid Position Paper Amended 12 23 14 with Chart (PDF) ;Medicaid Position Paper 2 18 15 with chart (PDF)
    Recording:  Link to view recorded Webinar

    kids smiling

    Medicaid Training:

    The Department of Education in collaboration with the Department of Health and Welfare, Division of Medicaid, have created and posted training material for districts to access in training their staff on the utilization of School-Based Medicaid services.  These trainings are developed to assist Special Education Directors, Special Education Teachers, Behavioral Services, Behavioral Consultants, RN, Related Service Providers (SLP, OT, and PT), and Medicaid billing staff in the implementation of School-Based Medicaid Services.

    Title: Overview of School-Based Medicaid Services
    Date:  March 10, 2015
    Presenters:  Shannon Dunstan, Idaho State Department of Education., also presenting: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts: Presentation Slides (1 slide per page PDF); Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF).  Additional files related to this area can be found in the School-based Medicaid Community Portal
    Recording:  Link to view recorded Webinar

    Title: Statewide Processes for Districts (Updated January 20, 2015)
    Presenters: Shannon Dunstan, Idaho State Department of Education and Frede' Trenkle-MacAllister Idaho Department of Health and Welfare
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF);
    Recording:  Link to view recorded Webinar

     

    Medicaid Training: New Rules effective July 1, 2016

    Title: Nursing and Personal Care Services - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: Evaluation_Assessment - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: CBRS - Idaho School-Based Mental Health Services - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: BEHAVIOR-INTERVENTION-and-BEHAVIOR-CONSULTATION - July 1, 2016 Rules
    Date: April 6, 2016
    Presenters: Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts:  Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slide per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: Occupational Therapy Physical Therapy and Speech/Audiological Therapy - July 1, 2016 Rules
    Date:  April 8, 2016
    Presenters:  Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Title: Transportation Services & Interpretive Services EPSDT - July 1, 2016 Rules
    Date:  April 8, 2016
    Presenters:  Frede' Trenkle-MacAllister Idaho Department of Health and Welfare, Shannon Dunstan, Idaho State Department of Education
    Handouts: Presentation Slides (1 slide per page PDF) ; Presentation Slides (3 slides per page PDF); Presentation Slides (1 slide per page with speaker notes PDF)
    Recording:  Link to view recorded Webinar

    Contact Us

    Shannon Dunstan


    Early Childhood and Interagency Coordinator
    Idaho State Department of Education
    P.O. Box 83720 Boise, Idaho 83720
    208-332-6908 (Office)
    208-703-1660 (Cell)
    sdunstan@sde.idaho.gov

    sde Idaho State Department of Education
    650 W. State Street
    PO Box 83720
    Boise, ID 83720-0027