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

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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.

February 8, 2017.
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: DHW will accept any version of a Department Approved assessment.

Currently we are working to add a statement to this fact on the www.sbs.dhw.idaho.gov website. In the Idaho Medicaid Guidance Document posted on the Idaho Training Clearinghouse topic site School-Based Medicaid on page 71 there is a document that helps clarify the scoring of varies assessments.

Answer: It will be the responsibility of the school psychologist to interpret the testing results and justify whether they can be considered as a substantial limitation. So with the example above if the student is 6 years 4 months of age and functioning at a 1 year 1 month of age, this can be considered a substantial limitation. The responsibility goes back to the justification from the school psychologist.

Answer:The MedicAide Newsletter June 2011, see link below,

https://www.idmedicaid.com/MedicAide%20Newsletters/Forms/All.aspx?Paged=TRUE&p_Year=2012&p_FSObjType=0&p_ID=49&p_Order0=31.0000000000000&View={1E1118F5-2F79-4879-82E6-5DBF2BB05030}&FolderCTID=0x012001&PageFirstRow=51

This newsletter provides specific guidance related to this issues, page 8. This addresses specifically same service same day.

"Several CPT and HCPCS codes used for evaluations, therapy modalities and procedures
specify that one unit equals 15 minutes. Providers may bill a single 15-minute unit for treatment
that is greater than or equal to eight minutes. Two units should be billed when the interaction
with the participant is greater than or equal to 23 minutes but is less than 38 minutes. This
pattern remains the same when calculating the time spent providing the
service."

Your question was related to the same service within the same week or month, so if the sessions are 25 minutes on different days the school would bill 2 units for the 25 minutes. The IEP can say 120 minutes per month for any related service.

This information was verified by the Medicaid Integrity Unit.

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: 42 CFR 483.102 - Applicability and definitions

IDAPA 16.03.09.852.1.b refers you to 42 CFR 483.102(b)(1) which is summarized below. PLEASE pull up the full citation and read for clarification.

(b) Definitions.

(1) An individual is considered to have a serious mental illness (MI) if the individual meets the following requirements on diagnosis, level of impairment and duration of illness:

(i) Diagnosis.
(A) A schizophrenic, mood, paranoid, panic or other severe anxiety disorder; somatoform disorder; personality disorder; other psychotic disorder; or another mental disorder that may lead to a chronic disability; but

(ii) Level of impairment. The disorder results in functional limitations in major life activities within the past 3 to 6 months that would be appropriate for the individual's developmental stage. An individual typically has at least one of the following characteristics on a continuing or intermittent basis:

(A) Interpersonal functioning.

(B) Concentration, persistence, and pace.

(C) Adaptation to change. T

(iii) Recent treatment. The treatment history indicates that the individual has experienced at least one of the following:

(A) Psychiatric treatment more intensive than outpatient care more than once in the past 2 years (e.g., partial hospitalization or inpatient hospitalization); or

(B) Within the last 2 years, due to the mental disorder, experienced an episode of significant disruption to the normal living situation, for which supportive services were required to maintain functioning at home, or in a residential treatment environment, or which resulted in intervention by housing or law enforcement officials.

Answer:Per IDAPA 16.03.09.855.10.k

k. Community Based Rehabilitation Services specialist. A CBRS specialist is:
(7-1-16)
i. An individual who has a Bachelor’s degree and holds a current PRA credential; or
(3-20-14)

ii. An individual who has a Bachelor’s degree or higher and was hired on or after November
1, 2010, to work as a CBRS specialist to deliver Medicaid-reimbursable mental health services. This
individual may continue to do so for a period not to exceed thirty (30) months from the initial
date of hire. The individual must show documentation that they are working towards this
certification. In order to continue as a CBRS specialist beyond a total period of thirty (30)
months from the date of hire, the worker must have completed a certificate program or
rehabilitation based upon the primary population with whom he works in e requirements set by
the PRA. (7-1-16)

iii. Credential required for CBRS specialists.

The following link with take you to the PRA recertification site: http://psychrehabassociation.org/cfrp-recertification

In 2016 the Psychiatric Rehabilitation Association transitioned from a certificate to certification. Individuals wanting to obtain PRA credentialing after May 1, 2016 will be required to meet specific educational requirements, passing a test, and be re-certified every three years. Current holders of a PRA certificate (not certification) do not have a recertification requirement and continue to meet the current IDAPA rule qualification.

Answer:16.03.09.853.3.a
a. Behavioral Intervention. Behavioral Intervention is used to promote the student’s ability to
participate in educational services, as defined in Section 850 of these rules, through a consistent, assertive, and
continuous intervention process to address behavior goals identified on the IEP. It includes the development of
replacement behaviors by conducting a functional behavior assessment and behavior implementation plan with the purpose of preventing or treating behavioral conditions for students who exhibit maladaptive behaviors. Services include individual or group behavioral interventions.

16.03.09.854.02
02. Evaluations and Assessments. Evaluations and assessments must support services billed to
Medicaid, and must accurately reflect the student’s current status. Evaluations and assessments must be completed at
least every (3) years.

Medicaid does not require annual completion of an FBA or BIP, but does require 3 year reevaluation. This aligns with IDEA and our obligation to conduct reevaluations every 3 years. IDEA does not require behavioral assessments, however, if there is an IEP goal addressing a student's behavior, this would need to be reviewed annually and updated when necessary.

Answer: CBRS does not have a yearly requirement for a FBA, Behavioral Intervention for students who qualify under the Developmental Disabilities rules has this requirement.

16.03.09.853.03.a
a. Behavioral Intervention. Behavioral Intervention is used to promote the student’s ability to participate in educational services, as defined in Section 850 of these rules, through a consistent, assertive, and continuous intervention process to address behavior goals identified on the IEP. It includes the development of replacement behaviors by conducting a functional behavior assessment and behavior implementation plan with the purpose of preventing or treating behavioral conditions for students who exhibit maladaptive behaviors. Services include individual or group behavioral interventions.

Regarding the date question, you will need to complete a new FBA within 365 days from the date of the completion of the previous assessment.

Answer: Yes, a therapist can provide services to a homebound student any day of the week as long as it is documented on the IEP that homebound services do not follow a traditional school day and identifies that student's school day. The therapist documentation would then reflect the service.

Answer: The school has no obligation to provide this IQ test. Often school district, if they have the assessment, provide this service to the family, but it is not an obligation. The parent will need to go to a community based psychologist to acquire the appropriate IQ test. Please suggest to the family to contact the Medicaid contracted assessor, Liberty or case manager.

Answer: T1002 CPT code is only billed when providing RN oversight of an LPN.
T1002 TD CPT code is the RN actually performing the nursing services.

To clarify the T1002 codes are only allowable when service is delivered by an RN.

T1003 CPT code is billed when LPN is providing the nursing service.

Clarification you will receive RN rates for RN service delivery. LPN will NOT receive RN reimbursement rates. Nurses will be reimbursed by on their license. If there is a nursing shortage of LPNs a RN can provide the service and be reimbursed as an RN. The LPN would never be reimbursed at the RN rate, because they do not meet the qualification to deliver that level of service.

Answer: The activity of compiling various pieces of information gathered from various sources into a Medicaid/Social History is billable to Medicaid if completed by a qualified person outlined in this rule. If a questionnaire is part of the information gathered, it is a billable activity to summarize in the report.

Answer: Per the MedicAide newsletter in January 2017 describes "High, Medium, and Low Complexity that directs you to the new fee schedule. The new fee schedule then defines the time, complexity, and rate for each evaluation level. The new codes are related to how much time is needed to complete the OT/PT evaluations. Student that require 20 minutes to complete the PT evaluation would be considered a "Low Complexity", students requiring 30 minutes would be "Medium Complexity", and 45 minutes a "High Complexity". Evaluations taking longer than 45 minutes cap at the "High Complexity" rate. The rates and times of OT are spelled out in the same way. Please refer to the School-Based Medicaid fee schedule.

Answer: Activities conducted through evaluation and assessment following the IDAPA rule cited below, are billable activities. The questionnaire, interpretation, and child observation are all assessment activities.

Utilizing the AOTA guidelines that were posted on the ITC under FAQs this will help you OT determine what level of complexity the questionnaire would fall under.

Please let us know if you have additional questions.

2. Evaluation And Diagnostic Services. Evaluations to determine eligibility or the need for health-related
services may be reimbursed even if the student is not found eligible for health-related services. Evaluations
completed for educational services only cannot be billed. Evaluations completed must: (3-30-07)
a. Be recommended or referred by a physician or other practitioner of the healing arts. A school
district or charter school may not seek reimbursement for services provided prior to receiving a signed and dated
recommendation or referral; (7-1-13)
b. Be conducted by qualified professionals for the respective discipline as defined in Section 855 of
these rules; (3-20-14)
c. Be directed toward a diagnosis; (7-1-16)
d. Include recommended interventions to address each need; and (7-1-16)
e. Include name, title, and signature of the person conducting the evaluation. (7-1-16)

 

Answer: Per the MedicAide newsletter in January 2017 describes "High, Medium, and Low Complexity that directs you to the new fee schedule. The new fee schedule then defines the time, complexity, and rate for each evaluation level. However, it does not outline the different components for each level. The new codes are related to how much time is needed to complete the OT/PT evaluations, in addition to how the performance deficits are identified and counted.

CMS for 2017 has changed the related service provider codes for OT and PT. OT and PT codes differ in their reimbursement methodology. The traditional evaluation code has be broken into 3 new complexity codes, which are all reimbursed at the same rate. In addition a new re-evaluation code has been added. The re-evaluation code is reimbursed at a different rate than the initial evaluation.

CMS has identified 2017 as a data collection year to determine if in subsequent years the 3 new evaluation codes might result in a tiered level of reimbursement rate. CMS is requesting that service provides (OT and PT) be critical in choosing the most accurate code for the level evaluation complexity.

CMS is allowing 2017 to be a training year for practitioners on the use of the new coding system. Medical reviewers will not be able to penalize providers regarding the Medical Necessity for the new medical evaluation requirements for the billing year of 2017.

Both the OT and PT national associations have developed guidance for their respective members. Please refer to those association documents.

Additional assessment requirements related to the new complexity codes can be found at the two following links:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9782.pdf

https://www.webpt.com/blog/post/farewell-97001-how-to-use-the-new-pt-and-ot-evaluation-codes

This document: AOTA Evaluation-Codes-Overview-2016 is another resource that may provide guidance.


Answer: Low, medium or high (97161-97163 and 97165-97167) codes are for initial evaluation and on-going therapy service delivery. You will use the following codes for OT/PT re-evaluations (97164 and 97168).


Answer: The categories on the PCS Assessment and the Health Care Plan section 8 - Transferring and 9 - Mobility provide an opportunity to address both positioning and Other Special Care/Considerations that a nurse can use to specifically identify the safety needs for this student. The nurse would be specific in the proper body alignment/positioning, head alignment, and breathing and swallowing concerns.

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:A 3-year evaluation can be billed as a psychological evaluation as long as the following rule is followed without new testings, unless required in another section of these rules. See 16.03.09.852.01.a where CBRS requires annual assessment. Other services might also require specific annual testing.

02. Evaluation And Diagnostic Services. Evaluations to determine eligibility or the need for
health- related services may be reimbursed even if the student is not found eligible for
health-related services. Evaluations completed for educational services only cannot be billed.
Evaluations completed must: (3-30-07)

a. Be recommended or referred by a physician or other practitioner of the healing arts. A school
district or charter school may not seek reimbursement for services provided prior to receiving a
signed and dated recommendation or referral; (7-1-13)
b. Be conducted by qualified professionals for the respective discipline as defined in Section 855 of
c. Be directed toward a diagnosis; (7-1-16)
d. Include recommended interventions to address each need; and (7-1-16)
e. Include name, title, and signature of the person conducting the evaluation. (7-1-16)

Answer: Yes.

The school psychologist will be completing a psychological evaluation that takes in multiple sources of information to determine the need for services in a school environment. You would use a psychological evaluation code 96101.

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.

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:1) We put Special Ed Teacher in Grid then our optional statement will state "...services provided by a BI Professional...and/or will be provided by a BI Paraprofessional ...under the direction of a BI Professional." As Special Ed Teacher is the provider/supervisor and para is under their supervision. Is this in compliance OR must we add Paraprofessional to the Grid above also?

This issue was a result of school district using M-Codes on the IEP services grids. If the district does not use the M-Code there is not conflict.

2) Do the minutes in Grid need to match the Optional Statement of Services? We only have conflict for BI services.
As these are provided throughout the school day, if we put all the BI minutes also in the GRID we appear to be providing services over the school day total. Confusing for parents. Our optional statement of services is the accurate minutes provided for BI services. Are we in compliance?

No. The number of BI minutes do not need to be in the grid, Medicaid requires that all of the components are there. This can be in the "optional section".

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:16.03.09.853.3.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.

What is the LPN doing while monitoring the student? What activities is the LPN doing when working directly with the student? Medicaid does not reimburse of monitoring activities only for the actual nursing service.

If the student's medical condition is severe enough to require constant supervision for health and safety issues and the current level of support is beyond what Medicaid is currently providing reimbursement, the district can always submit an EPSDT request. You can find this form at the following link under Forms on the far right column at the bottom of the page. Be sure to provide all of the necessary paperwork and utilize the student's primary care physician, when making an EPSDT request.

http://healthandwelfare.idaho.gov/Medical/Medicaid/SchoolBasedServices/tabid/1587/Default.aspx

The RN can bill for PCS oversight and supervision. Are the activities conducted by the RN related to the student's health care plan or PCS services.

16.03.09.855.6.c.

c. The RN must conduct supervisory visits on a quarterly basis, or more frequently as determined by
the IEP team and defined as part of the PCS plan of care.

Answer: The MedicAide Newsletter June 2011 (click link to be redirected).

This newsletter provides specific guidance related to this issue, page 8. This addresses specifically same service same day. "Several CPT and HCPCS codes used for evaluations, therapy modalities and procedures specify that one unit equals 15 minutes. Providers may bill a single 15-minute unit for treatment that is greater than or equal to eight minutes. Two units should be billed when the interaction with the participant is greater than or equal to 23 minutes but is less than 38 minutes. This pattern remains the same when calculating the time spent providing the service." Your question was related to the same service within the same week or month, so if the sessions are 25 minutes on different days the school would bill 2 units for the 25 minutes. The IEP can say 120 minutes per month for any related service. This information was verified by the Medicaid Integrity Unit.

Answer:If I understand your question correctly, you are wanting to know if you could bill at a professional level if a 3 C'd, licensed, ASHA certified SLP was supervising the entire grad student's therapy session. Per the rule below the SLP would be providing supervision to a para you would be billing the para rate while the para is providing the therapy. If the licensed SLP was providing the therapy and the para was observing the therapy then you would be billing at the professional rate. You bill based on who is providing the therapy or service, not who is in the room.

16.03.09.855.14.c
14. Therapy Paraprofessionals. The schools may use paraprofessionals to provide occupational
therapy, physical therapy, and speech therapy if they are under the supervision of the appropriate
professional. The services provided by paraprofessionals must be delegated and supervised by a
professional therapist as defined by the appropriate licensure and certification rules. The
portions of the treatment plan that can be delegated to the paraprofessional must be identified in
the IEP or transitional IFSP. (7-1-16)

c. Speech-Language Pathology (SLP). Refer to IDAPA 24.23.01, “Rule of the Speech and Hearing
Services Licensure Board,” and the American Speech-Language-Hearing Association (ASHA) guidelines
for qualifications, supervision and service requirements for speech-language pathology. The
guidelines have been incorporated by reference in Section 004 of these rules. (7-1-16)

i. Supervision must be provided by an SLP professional as defined in Section 734 of this
chapter of rules. (7-1-16)

ii. The professional must observe and review the direct services performed by the
paraprofessional on a monthly basis, or more often as necessary, to ensure the paraprofessional
demonstrates the necessary skills to correctly provide the SLP service. (7-1-16)

16.03.09.734.3

03. Speech-Language Pathologist, Licensed. A person licensed by the Speech and Hearing Services
Licensure Board to conduct speech-language assessments and therapy in accordance with the Speech and Hearing Services Practice Act, Title 54, Chapter 29, Idaho Code, and IDAPA 24.23.01, “Rules of the Speech and Hearing Services Licensure Board,” who possesses a certificate of clinical competence in speech-language pathology from the American Speech, Language, and Hearing Association (ASHA) or who will be eligible for certification within one (1) year of employment.

Answer: Per Idaho Special Education Manual Glossary:
Homebound student. A student whose IEP team determines the child’s home is the least restrictive environment. So if a student is homebound they are receiving all of their instructional time in that environment.

1 - who determines when the student is at school or at home? If the IEP team has determined that the LRE for education is in the student's home then the IEP service would be considered "homebound services." The school would then send in the BI staff and educational staff, since they are not the same person, to provide "homebound" educational services.

2 - If the student is home due to modified school schedule then the activities at home would not be school related. The services provided at home would be community based services, not provided by the school and not a school-based, educational service.

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