Idaho Training Clearinghouse > Topics > N-Z

Introduction

What is the School-Based Medicaid page?

Answer:

Welcome to the School-Based Medicaid webpage. We acknowledge that School-Based Medicaid services and billing can be complicated and confusing to understand and implement. The purpose of this webpage is to provide information, resources, clarification, and training to better help you serve your students with disabilities and support your staff. This webpage has seven sections:

Introduction – This first section provides a brief overview and describes the organization of this webpage, including contact information.

What’s New – This section includes new information as it becomes available. Check this section frequently to learn about any exciting news or upcoming events. Information in this section will move into other relevant sections as it ages.

Clarification Form – Use this form to ask questions, seek clarification, or share thoughts and suggestions regarding School-Based Medicaid and/or associated IDAPA rules. Specific details regarding how to use the Clarification Form are described in that section.

Clarifications – Here is where you can learn from each other’s questions. This section contains responses to the questions and issues submitted on Clarification Forms. Clarifications appear in alphabetical order by topic. Consider browsing the Clarifications section before submitting your own Clarification Form because one of your peers may have already asked your question. However, do not hesitate to submit your own Clarification Form if you cannot find an answer to your question or issue in this section.

Trainings – This section includes recordings from webinars, web-based training modules, and associated handouts. As new webinars happen their recordings will be added to this section.

Resource Links – This section includes links to School-Based Medicaid resources.

Resources - This is where you will find the most up-to-date sample documents within the 2017 Idaho Medicaid Guidance Handbook for Educators. Simply use the search bar to find a specific document, search by category, or scroll through the list.

The Department of Health and Welfare, Division of Medicaid, and the State Department of Education come together quarterly in the School-Based Medicaid Advisory Committee. These meetings are necessary to facilitate better communication between school districts (School-Based Medicaid providers), Medicaid policy makers, and the office Medicaid Integrity. This committee meets to address changes in School-Based Medicaid IDAPA rules, discuss audit findings and ways to make practice corrections, and provide clarification to districts on School-Based Medicaid policies and procedures. Quarterly meeting agendas, meeting minutes, and other supporting documents are located in the Documents section of this webpage.

You may address any questions or concerns related to School-Based Medicaid to Angie Williams. We look forward to working with you.

Angie Williams
Alternative Care Coordinator, School Based Services
Bureau of Developmental Disability Services
Idaho Division of Medicaid
208-287-1169
Angie.Williams@dhw.idaho.gov

What's New

SCHOOL-BASED MEDICAID ADVISORY COMMITTEE INFORMATION – Don’t forget that you can find agendas, handouts, and minutes from all School-Based Advisory Committee meetings in the Resources section below. They are grouped by meeting date. (Posted April 2018)

INTERAGENCY STUDENT SERVICES SUPPORT COMMITTEE (ISSSC) – The ISSSC is a school-based Medicaid advisory group formed by the governor that includes representatives from the School-Based Medicaid Advisory Committee, legislators, and other professional groups. The ISSSC meets quarterly, in the mornings before the School-Based Medicaid Advisory Committee meets. Since these are public meetings, you are welcome to observe. Agendas, handouts, and minutes from all ISSSC meetings are located in the Resources section below, and are organized by date. (Posted April 2018)

NEW AND IMPROVED - Medicaid Clarification Form REV. Newly posted Clarifications now include the date of posting. We hope this will make it easier for you to find what you are looking for. (Posted August 2017; updated April 2018)

Clarification Form

How do I download and use the Clarification Form?

Answer:

Use this form to ask questions, seek clarification, or share thoughts and suggestions regarding School-Based Medicaid implementation and/or associated IDAPA rules. Follow the steps below to submit and get a response to your Clarification Form.
1. Download the form.
2. Open the form using Adobe PDF Reader.
3. Complete all fields comprehensively and to the best of your ability.
4. Please “Save As” with your district number and date in the file name. For example: D91 Aug 14 Medicaid Clarification Form.
5. Save the document for your future reference.
6. Send as an e-mail attachment to Angie.Williams@dhw.idaho.gov
7. A written response will be returned to you using your form. You may need to click the View Response at the bottom of page one for the response to be visible.
8. The response to your question/issue/suggestion will be posted to the What’s New section for one month, then added alphabetically to the list of responses under the Clarifications section.
9. If additional action is required, the School-Based Medicaid Advisory Committee will provide additional guidance.

ARE YOU GETTING THIS ERROR MESSAGE?

Breathe...You need to install the latest version of Adobe PDF Reader to open and complete the form. Opening the document in your browser will not work.

Clarifications

Assessment and Evaluation

2018-3-19 Billing for WISC-V Administered on iPad for Spanish Translation: 2018-3-19 Billing for WISC-V Administered on iPad for Spanish Translation

Answer: 96103 is used when the testing is administered by a computer. If the qualified professional is administering the test, then the school will bill 96101.

2018-3-19 VB-MAPP Assessment: Two part question regarding the VB-MAPP Milestones Assessment:
1. Can this assessment be reimbursed under CPT code 96150?
2. Can this assessment be reimbursed when provided by a Consulting Teacher, or someone other than a school psychologist?

Answer: Question 1. This is a behavior assessment, therefore, the school would bill it under 96150.

Question 2. Assessments/evaluations must be provided by a qualified professional who is trained to administer the assessment. If the consulting teacher or other staff are qualified to administer this assessment, then the school can seek reimbursement.

2018-3-19 FBAssessment VS FBAnalysis: In qualifying a student for behavior intervention, IDAPA 16.03.09.853.03.a states: "It includes the development of replacement behaviors by conducting a functional behavior assessment ..." Can a Functional Behavior Analysis be used in place of a Functional Behavior Assessment?

Answer: IDAPA 16.03.09.853.03.a requires a functional behavior assessment, which includes a functional behavior analysis component. During a compliance review we would look for a functional behavior assessment, not a functional behavior analysis.

2018-3-19 Clinical and Skilled Observations: 16.03.09.854.02 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.
Please define what qualifies an evaluation/assessment means when seeking reimbursement from Medicaid. Does a "Clinical Observation" or "Skilled Observation" performed by an SLP/OT/PT meet the requirements for an evaluation/assessment or does Medicaid require a specific formal evaluation/assessment?

Answer: If the evaluation/assessment has a clinical observation or skilled observation component to it, then, yes, the school can receive Medicaid reimbursement for these activities provided for the evaluation/assessment.

2018-3-19 Verbal Consent for Evaluation: Would Medicaid allow a verbal consent from the parents to add an additional test to an already signed consent for assessment? The district would document in the contact log that parent agreed to add XYZ test to an already signed consent for assessment. Would this be acceptable in a Medicaid audit?

Answer: Would Medicaid allow a verbal consent from the parents to add an additional test to an already signed consent for assessment? The district would document in the contact log that parent agreed to add XYZ test to an already signed consent for assessment. Would this be acceptable in a Medicaid audit?

If you are asking about the physician recommendation or referral for the assessment, as identified in the specific regulation you referenced, the school would need to get a new physician recommendation or referral for any additional assessments.

2018-3-19 Qualifications for FBA-BIP-Psychological Testing Technician: Two questions: 1. Who can complete a FBA and BIP for a BI student? Specifically, can our Licensed Master Social Worker and/or our Special Ed Teacher (who meets qualifications) create the FBA and BIP and bill Medicaid as Behavioral Assessment (96150) ? What are the required qualifications of provider for FBA and BIP? 2. 96102 - Evaluation done by a Technician. Who can provide Pyschological Testing by a Technician? What are the required qualifications of a technician?

Answer: Question 1: Yes, as long as the Licensed Master Social Worker and/or Special Ed Teacher meet the qualifications identified below and have been trained to conduct the FBA and develop the BIP. See IDAPA rule quoted below.

16.03.09.853.03.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 goal 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.(7-1-13)

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

A behavioral intervention professional must meet the following:

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)
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)
A Special Education Consulting Teacher who meets the qualifications defined under IDAPA 08.02.02, “Rules Governing Uniformity,” Section 029; (7-1-13)
Habilitative intervention professional who meets the requirements defined in IDAPA 16.03.10
“Medicaid Enhanced Plan Benefits,” Section 685; or (7-1-13)
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)
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)

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)

3-Year Evaluation Date VS Eligibility Date:Rule: 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.
I am looking for clarification on '3-year Assessment Requirement' when we accept transfer student Eligibility from another district. Our Occupational Therapist reviews an OT Assessment dated 03/15/16, observes child and determines the eligibility is sufficient, child is eligible for services . OT includes the 2016 Assessment in the Eligibility Report dated 02/08/17. My question: is the next 3 year Assessment due on 03/15/19 (3 years from date of original assessment) OR 02/08/20 (3 years from Eligibility Report). When we evaluate an incoming student with outside testing, does that 'reset' the 3 year evaluation/assessment to 3 years from the date of the Sufficiency Review Report?

Answer: Medicaid requires an assessment every 3 years. This is different from the date of eligibility. Therefore, you should measure the need for the 3-year assessment from the date of the assessment. See IDAPA Rule below.

16.03.09.854.02 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.

Back Billing After Parent Signature: I am wondering, in order for the district to be able to get reimbursed for the administration of assessments, do we need to have the parent's signed permission to bill and authorization to exchange information prior to conducting the assessments? Sometime we do not find out the child is on Medicaid until the eligibility meeting.
A "Consent to Bill School-Based Medicaid" was signed and dated by parents/guardians on November 1, 2017 for a student that is Medicaid eligible.
Can we bill for services provided prior to November 1, 2017 utilizing the 30-day Retroactive Billing Temporary Rule that went into effect August 1, 2017?
Or can we only bill from the actual date the parents/guardians signed the form and gave permission?

Answer: DHW will accept any version of a Department Approved assessment.

IDAPA 16.03.09.851.05: Parental Consent. Providers must obtain a one-time parental consent to access public benefits or insurance from a parent or legal guardian for school-based Medicaid reimbursement.

IDAPA 16.03.09.854.07: Parental Notification. School districts and charter schools must document that parents were notified of the health-related services and equipment for which they will bill Medicaid. Notification must comply with the requirements in Subsection 854.08 of this rule.
08. Requirements for Cooperation with and Notification of Parents and Agencies. Each school district or charter school billing for Medicaid services must act in cooperation with students’ parent or guardian, and with community and state agencies and professionals who provide like Medicaid services to the student.
a. Notification of Parents. For all students who are receiving Medicaid reimbursed services, school districts and charter schools must document that parents are notified of the Medicaid services and equipment for which they will bill Medicaid. Notification must describe the service(s), service provider(s), and state the type, location, frequency, and duration of the service(s). The school district must document that they provided the student’s parent or guardian with a current copy of the child’s plan and any pertinent addenda; and
b. Primary Care Physician (PCP). School districts and charter schools must request the name of the student’s primary care physician and request a written consent to release and obtain information between the PCP and the school from the parent or guardian.
c. Other Community and State Agencies. Upon receiving a request for a copy of the evaluations or the current plan, the school district or charter school must furnish the requesting agency or professional with a copy of the plan or appropriate evaluation after obtaining consent for release of information from the student's parent or guardian.
You may not seek reimbursement prior to the date the parents/guardians sign the one-time consent form.

The 30-day Retroactive Billing Temporary Rule applies to the physician's signature only.

Behavioral Intervention - Assessment Clarification IDAPA 16.03.09.852: Our school district is considering purchasing the Vineland-III Adaptive Behavior Scales. Currently, Vineland-II Adaptive Behavior Scales is listed on the Department Approved Standardized Assessment for Behavioral Intervention/Behavioral Consultation. Before we make the decision to move to Vineland-III, we are wanting to know if that will be an approved assessment for Behavioral Intervention? It is simply an updated version to the currently approved Vineland-II. Additionally, do you have guidance for scoring of the approved assessments? Specifically, the Behavior Assessment System for Children (BASC) and the Vineland-II or Vineland-III. In IDAPA Rule (cited above), "evidenced by a score of at least 1.5 standard deviations from the mean in at least 2 behavior domains and by a rater familiar with the student, or at least 2 standard deviations from the mean in one composite score that consists of at least 3 behavior domains by a rater familiar with the student, on a standardized behavioral assessment approved by the department." Please guide us in the practical application of this rule to the BASC and Vineland-II or Vineland-III assessments.

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.

FBA: Is FBA part of the 3-year Assessment Process? Or is it to be done annually? Training says FBA is part of the Behavioral Assessment, so every 3 years? The BIP is done annually.

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.

FBA Yearly Requirement REV 9-26-17: For CBRS students that are required to complete a yearly FBA what is the date requirement? For example, if the previous FBA was completed 4/7/2017 does the new FBA need to be completed by 4/7/2018 or can it be started by that date and completed at a date after the year mark?

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 NOT need to complete a new FBA within 365 days from the date of the completion of the previous assessment, rather we recommend they are REVIEWED ANNUALLY to accurately reflect the student's current status.

IQ testing for Adult Services: We have a student who will be attending ISU next school year in their 18-21 year old program. The parent has stated that the state will not accept the Woodcock IQ testing results from last school year and is requesting that the Wechsler Adult intelligence Scale test be given with our school psychologist signature on the last page. The student will need a DD Waiver to qualify for Medicaid in order for them to pay her education at ISU. The insurance company that insures people for the DD Waiver program need to obtain an intelligence test showing that the student has an intelligence disability. Once the parent has the results, then Medicaid can schedule their own assessments to get it approved.
The parent has been told that the school is the only one who is required to give the assessment and get the parent the testing results.
Our district does not have the requested IQ assessment. What other solutions are available to us to assist our parent.

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.

Medical Social History: There has never been any clear guidance on the expectations for a Medical/Social History. Is it permissible to bill for this service if a questionnaire is sent home to the parent and information gathered form the questionnaire is used to write a Medicaid/Social History without directly speaking to the parent in person or by the phone.

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.

Occupational Therapy (OT) and Evaluation: The Occupational Therapists in our district complete sensory profiles in which they give questionnaires to teachers and then score and interpret the data. At times observation of the child may occur as it relates to the questionnaire. The questionnaire and interpretation look to see if the student has any sensory processing challenges that may adversely impact their specifically designed instruction. The questionnaire has questions related to auditory processing, visual processing, touch processing, movement processing, and behavioral modulation. It determines where a student has difficulties processing sensory input and as a result of the assessment accommodations can be provided or sensory equipment for the student to help them learn better without all of these other distracting sensory stimuli getting in the way. If the student also receives Occupational Therapy the OT can get valuable treatment ideas for the student.
If this is a billable evaluation what code should be used to bill Medicaid?

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)

Occupational Therapy (OT) and Evaluation: CPT Coding Change - I was wondering if you have received clarification or definitions with regards to the new OT/PT evaluations and the "low, medium or high complexity" designations?

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.

Psychological Evaluation: Is it okay to bill for psychological evaluations (or any other related service evaluation) on a date other than Monday - Friday when school is regularly in session for a brick and mortar school? Psychs will administer an assessment to a student during the week and then complete their analysis of the assessment and write up of the assessment on the weekend. Additionally, some psychs work with virtual schools and schedule to see students on the weekends, at other times psychs will evaluate students during the summer since virtual schools may have sessions during the summer.

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..

Psychological Evaluation: Given the new guidance and procedures from the SDE regarding 3 year Eligibility Evaluations, is it permissible to bill for psychological evaluations that are solely comprised of an observation of the student and file review? The purpose of the observation and file review would be to determine if the student continues to demonstrate a need for special education based on the evidence of continuing to have a disability, the disability having an adverse impact on his/her education and a continued need for specially designed instruction.

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)

Speech Language Pathology, Audiology, Evaluation: If we have an IEP stating 50 minutes a week of SLP service, most conservatively this is 3 units of billing. But in reality, the SLP service was delivered in two 25 minute sessions, so it really is 4 units of billing. We were directed that we could not bill the 4 units unless our IEP delivery statements specified, “service to be delivered in two 25 minute session."

Another example: If our IEP states 100 minutes per month of OT, Medicaid’s conservative sum is 6 units. However, our OT service is delivered in four 25 minute sessions, actually being 8 units of billing. If we specify in the IEP delivery, “service to be delivered in 25 minute sessions”, will that allow us to correctly bill 8 units instead of 6?

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.

Speech Language Pathology, Audiology, Evaluation: When an SLP in the schools is supervising a grad student, we are billing the grad student's therapy under the para code. If the qualified SLP is providing 100% supervision, can that time be billed under the SLP code?

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.

Behavioral Intervention/Behavioral Consultation

2018-3-19 Related Condition: When requesting the Physician's Statement regarding a "Related Condition" when qualifying a student for behavior intervention reimbursement, can a physician other than the child's primary care physician complete the form? For example, can a neuropsych complete the Physician's Statement?

Answer: Any physician may sign the physician's statement regarding a "related condition" for his/her patient, as long as it is within his/her scope of practice. See page 48 of the Idaho School-Based Medicaid Guidance Handbook: “Related Condition: If the child is qualifying for developmental disability services under a ‘related condition,’ the school must have documentation from a professional able to diagnose the related condition. The ‘DD related condition form’ can be found on the School-Based Medicaid webpage (www.sbs.dhw.idaho.gov) and must be filled out by a qualified professional.”

Qualifications for BI Substitute: Can a district bill for a long-term substitute providing services in place of a student’s BI-Para? What are the guidelines on this?

Answer: Any BI-paraprofessional, including a long-term substitute, must meet the qualifications defined in IDAPA Rule 16.03.09.855.01.b and c, quoted below.

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

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

16.03.09.855.01.c. A paraprofessional delivering behavioral intervention services must be under the supervision of a behavioral intervention professional or behavioral consultation provider. 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 behavioral intervention service. (7-1-13)

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

A behavioral intervention professional must meet the following:

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)
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)
A Special Education Consulting Teacher who meets the qualifications defined under IDAPA 08.02.02, “Rules Governing Uniformity,” Section 029; (7-1-13)
Habilitative intervention professional who meets the requirements defined in IDAPA 16.03.10
“Medicaid Enhanced Plan Benefits,” Section 685; or (7-1-13)
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)
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)

2018-3-19 Signature on Physician’s Statement: When requesting the Physician's Statement regarding a "Related Condition" when qualifying a student for behavior intervention reimbursement, can a physician other than the child's primary care physician complete the form? For example, can a neuropsych complete the Physician's Statement?

Answer: Any physician may sign the physician's statement regarding a "related condition" for his/her patient, as long as it is within his/her scope of practice.

See page 48 of the Idaho School-Based Medicaid Guidance Handbook: “Related Condition: If the child is qualifying for developmental disability services under a ‘related condition,’ the school must have documentation from a professional able to diagnose the related condition. The ‘DD related condition form’ can be found on the School-Based Medicaid webpage (www.sbs.dhw.idaho.gov) and must be filled out by a qualified professional.”

Behavioral Intervention: Can we bill BI Professional rate for provider who is with a 1.5 SD student (who of course meets all the eligibility requirements)? When I started I was told by my predecessor that we could not bill Pro with a 1.5 SD student. But I do not see where that is the case per the code.

Answer: Can we bill BI Professional rate for provider who is with a 1.5 SD student (who of course meets all the eligibility requirements)? When I started I was told by my predecessor that we could not bill Pro with a 1.5 SD student. But I do not see where that is the case per the code.

Yes. A BI professional and/or a BI paraprofessional can provide services to any child who meets the eligibility requirements for behavioral intervention (16.03.09.855.a, 16.03.09.855.b). This means that a child scoring 1.5 SD below the mean can receive services from the BI professional and/or BI paraprofessional (16.03.09.852.2.b,). This also means that you can bill and be reimbursed for BI services provided by a BI professional working with a student scoring 1.5 SD below the mean.

Behavioral Intervention: Does a teacher who is granted an Alternative Authorization-Content Specialist for Exceptional Child-Generlaist-K/12 from Idaho Sate Certification meet the behavioral intrervention requirement of having an "exceptional child certitifcate". In this case they do not get an actual certificate, but just a letter from certification. The SDE funding department treats this just as if they hav an actual certificate, and they reimburse us for their teaching salary just as if they held an actual certificate. It looks to be treated as if they have an actual certificate in IDAHo under the rules for governing authority as well.

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.

Behavioral Intervention - Substantial Limitation: We have a student that we are updating the DD Checklist and are not able to get a standard score, but have an age- equivalent that puts the student significantly below age level peers – does that count as a substantial limitation as we go through and complete the adaptive part of the DD Checklist?
SOCIAL/COMM 1-1 0-9 1-6 -- -- -- -- very ltd to ngl
Social Inter 0-8 very ltd to ngl
Language Comp 2-4 very limited
Language Expr 1-0 very ltd to ngl
This area was low that we don’t have a standard score, but the school psychologist would consider that to be a substantial limitation. Would this student meet eligibility on the DD Checklist?

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.

BI Paraprofessional and Title 1 Qualifications: I have a CNA who had the attached Habilitative Supports Certificate. I am new so I want to verify that this H & W Certification meets the "formal State or local academic assessment'" requirement to provide BI paraprofessional services in our district.

Answer: Here is the hyperlink to the paraprofessional requirements set out by the Idaho State Department of Education. The certification that the individual provided does not meet the Title 1 Paraprofessional requirements.
https://www.sde.idaho.gov/federal-programs/basic/files/professional/Title-I-A-Paraprofessional-Requirements.pdf
Title I Paraprofessional Requirements
All instructional paraprofessionals and working in a program supported by title I funds must have the following qualifications:
High school diploma (or GED) AND
1) Two years of college (32 credit hours) OR
2) Associate’s degree OR
3) Rigorous standard of quality on formal state or local assessment* In Idaho, the “rigorous formal state assessment” is the ParaPro Assessment offered by the Education Testing Service (ETS). For more information, go to www.ets.org . Click on ‘Tests’ link and then the ParaPro Assessment link. Information about the test and how and when to register to take the test is available at this website. All paraprofessional who provide instructional services and who work in a program supported with Title I funds must meet these qualifications. This means that in a schoolwide program, the Title I requirements apply to all instructional paraprofessionals, for the same reasons that all teachers in a schoolwide program are considered Title I-paid teachers. However, in a targeted assistance program, the paraprofessional qualification requirements apply to instructional paraprofessionals who are paid with Title I, Part A funds. It does not apply to paraprofessionals who are paid from other federal funds such as Title I-C, 21st Century Schools, of IDEA or from non-federal funds, even if those individuals are working with Title I students. For more information, contact Kathy Gauby at kgauby@sde.idaho.gov .

FBA: Is FBA part of the 3-year Assessment Process? Or is it to be done annually? Training says FBA is part of the Behavioral Assessment, so every 3 years? The BIP is done annually.

FBA Yearly Requirement: For CBRS students that are required to complete a yearly FBA what is the date requirement? For example, if the previous FBA was completed 4/7/2017 does the new FBA need to be completed by 4/7/2018 or can it be started by that date and completed at a date after the year mark?

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.

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.

Service Grid: Can I please get clarification on the 09/29/2016 Medicaid Program Integrity Audit Update (attached). It states under pending audits "Service grid listing what services are being delivered sometimes conflicts with the optional statement of delivery. One section should not say professional and another section state paraprofessional."
Two questions:
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?
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?

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".

Billing/CPT Codes/Fee Schedule

2018-3-19 Billing for WISC-V Administered on iPad for Spanish Translation: 2018-3-19 Billing for WISC-V Administered on iPad for Spanish Translation

Answer: 96103 is used when the testing is administered by a computer. If the qualified professional is administering the test, then the school will bill 96101.

Answer: Question 1. This is a behavior assessment, therefore, the school would bill it under 96150.

2018-3-19 PCS Assessment and Allocation Tool : On the PCS Assessment Tool when assessing a student and preparing to transfer scores to the PCS Allocation Tool:
1. Section 5 (Bladder Continence) there are no age restrictions specified on 1, 2, 3 and 4 like there are in the majority of the other sections. Since there are no age restrictions specified, can a student of any age qualify for a 1, 2, 3 or 4?
2. Section 6 (Bowel Continence) there are no age restrictions specified on 1, 2 and 3 (there are age restrictions on #4) like there are in the majority of the other sections. Since there are no age restrictions specified, can a student of any age qualify for 1, 2, or 3?
3. Section 8 (Transferring) there are age restrictions on 1 and 3 but not 2 and 4. Since there are no age restrictions specified on 2 and 4, can a student of any age can qualify for 2 or 4?

Answer: If there is not age restriction identified on the answers, then, yes, it is meant for a child of any age.

2018-3-19 Medicaid Explanation of Benefits Statement: We have had several parents inquire if they will receive a statement/notice from Medicaid when the district has billed for school-based services. Does Medicaid send any formal statement/notice to Medicaid recipients when a school has billed for school-based services? If Medicaid does send a formal statement/notice, how frequently is that sent to recipients? Can you provide us with a copy of what that statement looks like? If parents receive a statement, does it reflect dollar amount before or the match-fund?

Answer: Molina does not currently send an explanation of benefits to individuals receiving school-based services, as these services do not come out of their budget. If a statement was to be sent, the explanation of benefits would include the dollar amount at 100%, not the match.

Qualifications for BI Substitute: Can a district bill for a long-term substitute providing services in place of a student’s BI-Para? What are the guidelines on this?

Answer: Any BI-paraprofessional, including a long-term substitute, must meet the qualifications defined in IDAPA Rule 16.03.09.855.01.b and c, quoted below.

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

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

2018-3-19 After School Services: We have a student that is receiving Mobility and Orientation services, as well as transportation. The parent would like these service after school, so they don't interfere with her academics. Can we still bill Medicaid if these services are provided after school? If so, what diagnosis code, procedure code, and fee will we bill for this service? Do we need the same documentation we use on Service Detail Report?

Answer: No. Services provided during the school day and defined on an IEP (not recreational, vocational, or educational) are considered reimbursable through School-Based Medicaid funds. Services provided before or after school are considered Community-Based services. The district would not seek reimbursement for there services.

2018-3-19 Billing for reimbursement of services provided by a physical therapist assistant: Would you clarify for me a Physical Therapist Assistant providing services? Is a licensed physical therapist assistant allowed to bill for Medicaid reimbursement? Can the physical therapist sign off on the SDR with a date of review with the assistant? Can an Idaho licensed Physical Therapy Assistant’s services be reimbursed by Medicaid? On page 92 of the Idaho School-Based Medicaid Guidance Handbook it is written: "Services provided by physical therapy assistants CANNOT be reimbursed by Medicaid." However, a Clarification on Idaho Training Clearinghouse states, "Physical Therapy (PT) and Evaluation: “...we do not see billing codes specific to PT aid." Are there billing codes for services performed by PT aid..." To which the answer is a listing of PT and PT Assistant definition, Code 16.03.09.734.02 and the answer: "Since both individuals must be licensed in the State of Idaho to provide the service, both would bill at the professional rate."

Answer: A licensed physical therapist assistant is not allowed to bill for Medicaid reimbursement. However, if a PT assistant performs the physical part of the service, the licensed PT must have written the POC and be present at the session and supervise the session directly, only then can the session be billed to Medicaid. It a PT assistant is involved, you can only seek reimbursement for the PT when directly supervising the PT assistant. See IDAPA rules referenced below.

IDAPA 16.03.09.855.07 of Medicaid School-Based Services refers to Therapy Specific Rules IDAPA 16.03.09.732.01.f. The services of occupational or physical therapy assistants used when providing covered therapy benefits are included as part of the covered service. These services are billed by the supervising therapist. Therapy assistants may not provide evaluation services, make clinical judgments or decisions, or take responsibility for the service. The therapist has full responsibility for the service provided. Therapy assistants act at the direction and under the supervision of the treating therapist and in accordance with state licensure rules. (7-1-16)

The Idaho MMIS Provider Handbook Therapy Services – Occupational and Physical, January 29, 2018 Page 13 (https://www.idmedicaid.com/Provider%20Guidelines/Therapy%20Services%20-%20Occupational%20and%20Physical.pdf) clarifies further:

2.3.2. Independent Therapist Qualifications: Medicaid will only reimburse for PT services rendered by or under the supervision of a licensed PT who is:

Identified by Medicare as an independent practitioner, and
Enrolled as an Idaho Medicaid provider.

A therapy assistant/aide cannot bill Medicaid directly. Services provided by a licensed assistant can be billed by the supervising PT. Any services provided by supportive personnel are not reimbursable by Medicaid.

Answer: DHW will accept any version of a Department Approved assessment.

The 30-day Retroactive Billing Temporary Rule applies to the physician's signature only.

Billing: One Time Consent If we have a one-time Authorization for a student, the student leaves our district for another district for a few months and then returns to our district, do we still have to get another one-time Authorization?

Answer: No. Federal regulations and IDAPA rule address one-time parental consent. This means that the district only has to obtain parental consent one time, regardless of whether or not the student is continuously enrolled. However, it is incumbent the district to provide annual written notification to the parents regarding their one-time parental consent. Quotations from CFR and IDAPA are below: IDAPA 16.03.09.851.05 Parental Consent. Providers must obtain a one-time parental consent to access public benefits or insurance from a parent or legal guardian for school-based Medicaid reimbursement.

34 CFR 300.154(d)(2)(iv) Prior to accessing a child's or parent's public benefits or insurance for the first time, and after providing notification to the child's parents consistent with paragraph (d)(2)(v) of this section, must obtain written, parental consent…

34 CFR 300.154(d)(2)(v): Prior to accessing a child's or parent's public benefits or insurance for the first time, and annually thereafter, must provide written notification, consistent with § 300.503(c), to the child's parents…

Billable Units: If we have an IEP stating 50 minutes a week of SLP service, most conservatively this is 3 units of billing. But in reality, the SLP service was delivered in two 25 minute sessions, so it really is 4 units of billing. We were directed that we could not bill the 4 units unless our IEP delivery statements specified, “service to be delivered in two 25 minute session”.
Another example: If our IEP states 100 minutes per month of OT, Medicaid’s conservative sum is 6 units. However, our OT service is delivered in four 25 minute sessions, actually being 8 units of billing. If we specify in the IEP delivery, “service to be delivered in 25 minute sessions”, will that allow us to correctly bill 8 units instead of 6?

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.

This information was verified by the Medicaid Integrity Unit.

CBRS IEP Goals: Our contracted behavior consultant told staff that only one behavior goal is needed for a student who has all day adult support from a CBRS or a BI. From BCBA perspectives, it is very difficult to implement more than two goals when the student is that intensive. This is my understanding why BI consultant recommends fewer goals, the fewer the more likely they will be implemented with fidelity.

When I attended a Medicaid training two years ago in the Magic Valley, we were told that they are expecting 3-4 goals if a student has all day support. Currently in Vallivue we are requiring a minimum of two behavior goals. We do a FBA and BIP for all of these students even though it is not required for CBRS. What is the requirement in order to pass Medicaid audits and how many goals would they be expecting to see? I like at least two since a student may meet their goal on one during a school year so that we still have the other goal to work on until we can get the IEP amended by collecting data on a new goal and implementing another behavior goal. Other districts in this area are saying that they have an informal guidance of two behavior goals if the student is receiving full day support.

Answer: There is no minimum requirement for the number of goals that should be included on a student's IEP. The number of goals on a student's IEP should be based on the student's individual needs. The Medicaid reimbursement requirement is that the service must be listed on the student's IEP and have measurable goals.

IDAPA 16.03.09.853.03.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. (7-1-16)

IDAPA 16.03.09.853.03.j: Community Based Rehabilitation Services (CBRS) Services and Evaluation. Community Based Rehabilitation Services and evaluation services that are interventions to reduce the student’s disability by assisting in gaining and utilizing skills necessary to participate in school. Training in behavior control, social skills, communication skills, appropriate interpersonal behavior, symptom management, activities of daily living, and coping skills are types of interventions that may be reimbursed. This service is to prevent placement of the student into a more restrictive educational situation. (7-1-16)

IDAPA 16.03.09 854.01.c: Measurable goals, when goals are required for the service; (7-1-13)

Community-Based Rehabilitation Services (CBRS): Can we get additional guidance regarding the specific emotional, behavioral or neuropsychiatric conditions that would qualify a student for CBRS?

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)

Community-Based Rehabilitation Services (CBRS): This clarification is regarding the 07/01/17 updated SBS rate sheet:
#1: 96152 and H2017 have historically been the same rate. 96152 increased to $17.51 July 1st. Will the rate for H2017 also be increased to $17.51 as well, or will it remain at $11.35?
#2: 96153 now says “Behavior Intervention, Group, Paraprofessional”. 96153 was the Professional code on previous rate sheets. Is this an oversight? I wanted to verify since it had changed from Professional to Paraprofessional and the rate had also decreased.
#3: Can you also please confirm that the rate for 96153 decreased from $4.56 to $3.98?

Answer: Answers from School-Based Fee Schedule revised 08/08/17:

#1 The rates set on July 1, 2017 are rates calculated by Idaho based on guidance from the Centers for Medicare and Medicaid Services (CMS). The H2017 rate did not increase and will remain at $11.35 per unit.

#2 The 96153 code without the modifier "HM" has been corrected to reflect "Professional" and just updated on the 08/08/17 revision of the School-Based Fee Schedule. The 96153 code with the modifier "HM" remains correct to reflect "Paraprofessional."

#3: Yes, the rate for 96153 decreased from $4.56 to $3.98.

Diagnosis Code VS Eligibilty Category: Billing Diagnosis Code: What Diagnosis code should we use? The Eligibility Category on the IEP or what the provider preforming the service used? Example: Eligibility Category on the IEP is Intellectual Disability ICD - 10 is F71 Moderate Intellectual Disability. Or do I use the Physical Therapy Diagnosis Code ICD - 10 is F82 Specific Developmental Disorder of Motor Function.

What Diagnosis code should we use when seeking Medicaid reimbursement for physical therapy? Do we use the Eligibility Category on the IEP or the diagnosis code used by the provider preforming the service? Example: Do I use the Eligibility Category on the IEP as Intellectual Disability ICD - 10 is F71 Moderate Intellectual Disability, or do I use the Physical Therapy Diagnosis Code ICD - 10 is F82 Specific Developmental Disorder of Motor Function.

Answer: When seeking Medicaid reimbursement, you should use the diagnosis code associated with the service being provided. As in your example, you would use the physical therapy diagnosis code, not a diagnosis code based on the eligibility category on the IEP.

Evaluation and Diagnostic Services: Two Part Question:
A) If an FBA and/or a BIP is completed as part of a 3-year eligibility, would it be billed under 96101?
B) If an FBA and/or a BIP is completed separately and it is NOT part of a 3-year eligibility, would it be billed under 96101 or 96150? For example, a student already has a current eligibility report, however it does not include an FBA. The student needs an FBA in order to meet eligibility requirements for Behavior Intervention. The team will be completing only an FBA at this time, no additional assessments are needed. Would this be 96101 or 96150?

Answer: A) If an FBA and/or BIP are completed during the psychological evaluation they can be included in the units billed under 96101 [School Based Fee Schedule: Psychological Testing for Diagnosis/Evaluation by School District – Psychologist/Physician (1 unit = 1 hour)].

B) If the FBA and/or BIP are completed separately from the psychological evaluation, they should be included in the units billed under 96150 [School Based Fee Schedule: Behavioral Assessment (1 unit = 15 minutes)].

IEP Signatures: IDEA does not require that IEP documents be signed, only asks for a check mark to indicate attendance. Our question is whether Medicaid requires the IEP document to be signed by all of the service providers or do only the billable service providers sign?

Answer:The IDAPA rule below outlines the IEP requirements. Note: The list does not include a signature requirement on the IEP.

IDAPA 16.03.09.854.01 SCHOOL-BASED SERVICE: PROCEDURAL REQUIREMENTS.
The following documentation must be maintained by the provider and retained for a period of five (5) years: (7-1-16)
01. Individualized Education Program (IEP) and Other Service Plans. School districts and charter schools may bill for Medicaid services covered by a current Individualized Education Program (IEP), transitional Individualized Family Service Plan (IFSP), or Services Plan (SP) defined in the Idaho Special Education Manual on the State Department of Education website for parentally placed private school students with disabilities when designated funds are available for special education and related services. The plan must be developed within the previous three hundred sixty-five (365) days which indicates the need for one (1) or more medically-necessary health-related service, and lists all the Medicaid reimbursable services for which the school district or charter school is requesting reimbursement. The IEP and transitional IFSP must include: (7-1-16)
a. Type, frequency, and duration of the service(s) provided; (7-1-13)
b. Title of the provider(s), including the direct care staff delivering services under the supervision of the professional; (7-1-13)
c. Measurable goals, when goals are required for the service; and (7-1-13)
d. Specific place of service, if provided in a location other than school. (7-1-16)

Nursing - RN and LPN billing codes: The Skilled Nursing Services that SD91 is providing for a Diabetic DD student is provided by our LPN.

According to an earlier FAQ on this forum I can bill the RN rate for the LPN time, because, "School Based Services do not delineate between an LPN and RN." To be clear, may I bill T1002TD or T1003? And if billing T1002TD I will subsequently bill T1002 for a monthly documentation of RN supervision, correct?

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.

Nursing Oversight and Billing: If a skilled nurse is conducting continuous oversight of 2 students with the need for tracheotomy care and oral pharyngeal suctioning, can observation by the nurse of the students be billed? Can it be billed at the same time? Should oral suctioning be time specific per student?

Answer: The district can bill Medicaid for nursing services if the task is identified on the nursing plan with a medical reason to receive reimbursement. Nursing services can only be billed for one child at a time; nursing services do not allow for group services. This means that one nurse can only bill for oversight of one child at a time, even thought she may be observing two students at once. For example: When the nurse suctions one child the district can bill for him. When the nurse steps over to suction the second child, the district has to stop billing for the first child and bill for second.

The district will be reimbursed for the nurse observing the entire school day, but the services may be split between more than one student. Even though the nurse is observing two students, the district can only be reimbursed for the hours worked; not the hours worked times two (for two children).

OT PT Billing Codes for High Medium and Low: I was wondering if you have received clarification or definitions with regards to the new OT/PT evaluations and the "low, medium or high complexity" designations?

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.

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.

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.

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.

Occupational Therapy (OT) and Physical Therapy (PT) Evaluation Codes: I have a question that I just want some clarification on, concerning the new School Based Service Codes and billing. On the OT/PT I am seeing Therapy Re-Evaluation by the district, is this for all re-evals we as a district do? So we will bill our first/initial evaluation as low, medium or high (97161-97163 and 97165-97167), then every three years we will only bill for the Re-Evaluation-Established (97164 and 97168), correct?

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).

ParaPro Credential for Billing: My question is regarding the Parapro Praxis test and submitting claims to Medicaid for reimbursement. I was not sure who to address the question to because the Para Praxis is a requirement for both IDEA and Medicaid.
If a school district hires an individual that meets the Medicaid requirements; 1. 18 years of age, 2. demonstrates knowledge, but 3. has not passed the Parapro Praxis test by date of hire can the district seek Medicaid reimbursement?
If the individual takes and passes the Parapro Praxis test in October can the district submit for Medicaid reimbursement prior to the passing of that test?
In this example the individual does not have the optional college credits completed.

Answer: 16.03.09.855.01.b.iii states that the paraprofessional must meet the requirements under the Elementary and Secondary Education Act of 1965, as amended, Title 1, Part A, Section 1119. Page 160 of the Idaho Special Education Manual provides clarification:
1. All Title I paraprofessionals must have a secondary school diploma or its recognized equivalent.
2. Additionally, except as noted below, paraprofessionals hired after January 8, 2002, and working in a program supported with Title I, Part A funds must have:
a. Completed two years of study at an institution of higher education (In Idaho, this is thirty-two (32) credits from an accredited university or college); or
b. Obtained an associate’s (or higher) degree; or
c. Met a rigorous standard of quality and be able to demonstrate, through a formal State or local academic assessment, knowledge of and the ability to assist in instructing, reading, writing, and mathematics (or, as appropriate, reading readiness, writing readiness, and mathematics readiness) (in Idaho this is the ETS Parapro Praxis with a minimum score of 460).

The paraprofessional must meet the above requirements before the district can file for Medicaid reimbursement.

PR/PO Evaluations: When the school district submits a PR/PO for evaluations how specific must it be? For example, the OT, PT, and SLP evaluations have multiple individual CPT codes and parameters. Must the PR/PO state the exact CPT code or may it state a more general nominal description? For example, 92523UC or Speech and Language Evaluation; 97132 or Physical Therapy Evaluation, etc.

Answer: The rule below does not specify a need to identify the evaluation complexity code. The therapy professional will complete their evaluation assuring the following rule is in compliance and bill according to the activities completed. 01. Physician Orders. (4-2-08) a. All therapy must be ordered by a physician, nurse practitioner, or physician assistant. Such orders must include at a minimum, the service to be provided, the frequency, and, where applicable, the expected duration of time for which the therapy will be needed. If the initial order is to evaluate and treat, but does not specify at least the type of service ordered and the frequency, then: (7-1-16) i. The therapist may perform a therapy evaluation based on the initial physician order for the evaluation; and (7-1-16) ii. The therapist must then develop a therapy plan of care based on that evaluation and send the plan to the ordering physician, nurse practitioner, or physician assistant and begin care; and (7-1-16) iii. The physician, nurse practitioner, or physician assistant must either sign an order specifying the service to be provided, the frequency and the duration, or they must sign the therapy plan of care that includes that information within thirty (30) days for therapy to continue. No claims may be billed until the complete order or the plan of care is signed by the physician, nurse practitioner, or physician assistant. (7-1-16)

Psychological Evaluation - Billing Using Outside Material: May we bill when we have consent for an external assessment and our school psychologist reviews that report for interpretation and determining school based classifications, impact and need? If so, and assuming the Physician Referral for Evaluation is in place already, and our psychologist put forth their professional time and effort, which code do we use?

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.

Physical Therapy (PT) and Evaluation: IDAPA rule allows for the use of PT "paraprofessionals", but we do not see billing codes specific to services provided by a PT aid (which may be a PT student who is under direct supervision of the PT). Are there billing codes for services performed by the PT aid similar to the OT aids?

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.

Reimbursement for Daily Nutrition: We have a student under a PCS Plan which includes ensuring daily nutrition needs are met (feeding tube). Can school-based services purchase the "food" and be reimbursed by Medicaid?
If no, can you please give me information on where the parent can find Medicaid financial help to pay for the daily nutrition required by this DD student?

Answer: No. According to IDAPA 16.03.09.853.03: Reimbursable Services. School districts and charter schools can bill for the following health-related services provided to eligible students when the services are provided under the recommendation of a physician or other practitioner of the healing arts for the Medicaid services for which the school district or charter school is seeking reimbursement. A school district or charter school may not seek reimbursement for services provided more than thirty (30) days prior to the signed and dated recommendation or referral. The recommendations or referrals are valid up to three hundred sixty-five (365) days.
a. Behavioral Intervention
b. Behavioral Consultation
c. Medical Equipment and Supplies
d. Nursing Services
e. Occupational Therapy and Evaluation
f. Personal Care Services
g. Physical Therapy and Evaluation
h. Psychological Evaluation
i. Psychotherapy
j. Community Based Rehabilitation Services (CBRS)
k. Speech/Audiological Therapy and Evaluation
l. Social History and Evaluation
m. Transportation Services
n. Interpretive Services

Families can seek financial help to pay for daily nutrition through the Idaho Food Stamps Program at http://healthandwelfare.idaho.gov/Default.aspx?TabId=90.

Residential Treatment Facility: We have a student who will be placed into a Residential Treatment Facility soon. Can we provide services,
specifically CBRS services as this is the LRE educational setting for this child at this time?

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.

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.

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".

School-Based Medicaid Fee Schedule: Can a psychologist who is going to college to finish their degree complete the diagnosis/evaluation under a physician's supervision? If so what is the correct procedure?

Answer: A school can bill 96102 for the technician to conduct the Psychological Testing for Diagnosis/Evaluation. The technician must have the experience and training and be qualified to conduct the evaluation. The mental health professional (school psychologist) must interpret the results from the Psychological Testing for Diagnosis Evaluation. To demonstrate compliance, the school would have the evaluation and the results in addition to a service detail report from the technician and the professional. They can perform the assessment but the school psych must interpret the assessment and bill for that interpretation under 96101.

School-Based Medicaid Fee Schedule: I am seeking clarification for CPT code 96125. From what I can find, this code is used only by Speech/Language Pathologists for billing for a Ross Information Processing Assessment? Does this code cover any other providers or assessments, such as a WISC-4 given by a school psychologist?

Answer: The description for CPT code 96125, found on the Idaho School-Based Medicaid Fee Schedule, reads: "Standardized cognitive performance testing per hour both face to face administering tests to the patient and time interpreting the test results and preparing the report. (This a Speech and Language test)." Note the reference in parentheses...This is a Speech and Language assessment.

The 2017 Medicare Fee Schedule for Speech-Language Pathologist, published by the American Speech-Language-Hearing Association (http://www.asha.org/uploadedFiles/2017-Medicare-Physician-Fee-Schedule-SLP.pdf) reads: "Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face to face administering tests to the patient and time interpreting the test results and preparing the report."

CPT code 96125 is not a code for other assessments, such as the WISC-4 given by a school psychologist.

Student living in a group home: If a student who is enrolled in our district and resides in a group home receives services from the home such as Behavior Intervention during schooling, is this considered homebound services? Can the school district bill for the behavior intervention? How should this be reflected on the IEP? If the student splits their school day time between the group home and the school and services are provided at both does this need to be reflected on the IEP separately or can it be combined? Are there any delivery statements that should be on the IEP for this situation?

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.

Third Party Payer: What exactly needs to happen for billing a service if a student's Medicaid coverage is secondary? Is there specific documentation that we need to have and/or do from the student's primary insurance before we bill Medicaid for services that they receive?

Answer: IDAPA 16.03.09.856.02 Third Party. For requirements regarding third party billing, see Section 215 of these rules. IDAPA 16.03.09.215.05: Billing Third Parties First. Medicaid providers must bill all other sources of direct third party payment...

Medicaid is the payer of last result. Therefore, the district should seek reimbursement from the student's primary insurance FIRST. Keep all documentation associated with billing the primary insurance.

Transportation by Parent: Our school district is going to be the district of residence for a student that will actually be going to school in Gooding at ISDB. Parent has requested transportation to and from school (ISDB) and ISDB has responded that they don't have door to door transportation so the parent has asked if she could transport the student but be reimbursed for her expenses or what her other options would

We are looking for all appropriate options. Please advise how this should be written into the IEP. Please specify if parent is unable to transport that day if a substitute would be allowed for Medicaid reimbursement. How would Medicaid be billed if parent does transportation?

Per phone conversation: ISDB provides transportation for out of district students from Bliss. The parent would need to have her child in nearby tow by 6:45 AM, then have a 75-90 minute bus ride. Parent does not want child to ride the bus so long and have such a long day. The parent gets reimbursed for taking children to doctor's appointments. Can she get reimbursed for taking child to school? Can the district "hire" parent to transport.

Answer: Medicaid reimburses only for the school-based transportation described below. Your scenario does not describe a school-based Medicaid reimbursable service.

In IDAPA 16.03.09.853. SCHOOL-BASED SERVICE: COVERAGE AND LIMITATIONS.
03. Reimbursable Services.
m. Transportation Services. School districts and charter schools can receive reimbursement for mileage for transporting a student to and from home and school when:
i. The student requires special transportation assistance, a wheelchair lift, an attendant, or both, when medically necessary for the health and safety of the student;
ii. The transportation occurs in a vehicle specifically adapted to meet the needs of a student with a disability;
iii. The student requires and receives another Medicaid reimbursable service billed by the school-based services provider, other than transportation, on the day that transportation is being provided;
iv. Both the Medicaid-covered service and the need for the special transportation are included on the student's plan; and
v. The mileage, as well as the services performed by the attendant, are documented.

The requirement is that transportation is justified and documented on the student's plan (IEP).

Transportation on the IEP and Billing for Attendant: #1 For transportation service does the transportation need to be on IEP Services for example: Service: Special Transportation
Position Responsible: Bus Company
Frequency: 30 min Week
Location: 05 Community
Start and End Date.
Or can it just be Checked on OTHER CONSIDERATIONS: As Special Transportation.
#2. Also can we bill for a bus attendant , that help with the children? Can you bill group or individual? And if so what documentation do we need to have?

Answer: Question 1: IDAPA 16.03.09.853. SCHOOL-BASED SERVICE: COVERAGE AND LIMITATIONS.
03. Reimbursable Services.
m. Transportation Services. School districts and charter schools can receive reimbursement for mileage for transporting a student to and from home and school when:
i. The student requires special transportation assistance, a wheelchair lift, an attendant, or both, when medically necessary for the health and safety of the student;
ii. The transportation occurs in a vehicle specifically adapted to meet the needs of a student with a disability;
iii. The student requires and receives another Medicaid reimbursable service billed by the school-based services provider, other than transportation, on the day that transportation is being provided;
iv. Both the Medicaid-covered service and the need for the special transportation are included on the student's plan; and
v. The mileage, as well as the services performed by the attendant, are documented.

The requirement is that transportation is documented on the student's plan (IEP).

Questions 2: No; Letter m. Transportation Services. School districts and charter schools can receive reimbursement for mileage for transporting a student to and from home and school ...

Type of Service on IEP: We are now using a new software. I have notice that on the IEP Service page there is NO Individual or Group. Do we need to have this on the Service page? I know that when billing, this is needed on the Service Detail Report.

Answer: Yes, the the type of service, including individual or group, MUST be documented on the IEP for Medicaid reimbursement. It can appear in the Services grid or under the Optional Statement of Service Delivery. See relevant IDAPA rule below.

854. SCHOOL-BASED SERVICE: PROCEDURAL REQUIREMENTS. The following documentation must be maintained by the provider and retained for a period of five (5) years: (7-1-16)

01. Individualized Education Program (IEP) and Other Service Plans. School districts and charter schools may bill for Medicaid services covered by a current Individualized Education Program (IEP), transitional Individualized Family Service Plan (IFSP), or Services Plan (SP) defined in the Idaho Special Education Manual on the State Department of Education website for parentally placed private school students with disabilities when designated funds are available for special education and related services. The plan must be developed within the previous three hundred sixty-five (365) days which indicates the need for one (1) or more medically-necessary health-related service, and lists all the Medicaid reimbursable services for which the school district or charter school is requesting reimbursement. The IEP and transitional IFSP must include: (7-1-16)
a. Type, frequency, and duration of the service(s) provided; (7-1-13)
b. Title of the provider(s), including the direct care staff delivering services under the supervision of the professional; (7-1-13)
c. Measurable goals, when goals are required for the service; and (7-1-13)
d. Specific place of service, if provided in a location other than school. (7-1-16)

CBRS

2018-3-19 Number of Students in a Group Setting: Please advise how many students can be in a group setting with a professional for the following therapies: SLP, OT, PT, CBRS

Answer: Medicaid does not set a limit for the size of group for the services identified above. The professionals should make a determination of the size of the group based on each individual student's needs.

2018-3-19 Medical Mental Health Diagnosis: How often does a school need to obtain a medical mental health diagnosis from a qualified professional for a student to be eligible to receive CBRS? Is it every 3 years when the three-year reevaluation IEP is due?

Answer: The medical mental health diagnosis from a qualified professional must reflect the student's current status. The diagnosis should be repeated anytime the student's medical mental health status changes. Below is the rule related to three-year re-evaluations:

DAPA 16.03.09.854.02 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. (7-1-13)

2018-3-19 CBRS Medicaid Enhanced Eligibility?: Do CBRS students need to have Medicaid Enhanced Eligibility? Do they need History and Physical Examination (Wellness Child Care) every year? If so, how do I determine Diagnosis codes to use when billing for these CBRS students?

Answer: Medicaid Enhanced Eligibility and the annual requirement for history and physical examination are not related to CBRS eligibility. Students receiving CBRS services need ONLY meet the qualifications outlined in IDAPA 16.03.09.852.01, as quoted below. The student's diagnosis determines the diagnosis code to be used.

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)

b. A student who is eighteen (18) years old or older must meet the criteria of Serious and Persistent Mental Illness (SPMI). This requires that a student participant meet the criteria for SMI, as described in 42 CFR 483.102(b)(1), have at least one (1) additional functional impairment, and have a diagnosis under DSM-V, or later edition, with one (1) of the following: Schizophrenia, Schizoaffective Disorder, Bipolar I Disorder, Bipolar II Disorder, Major Depressive Disorder Recurrent Severe, Delusional Disorder, or Borderline Personality Disorder. The only Not Otherwise Specified (NOS) diagnosis included is Psychotic Disorder NOS for a maximum of one hundred twenty (120) days without a conclusive diagnosis. In addition, the psychiatric disorder must be of sufficient severity to affect the participant’s functional skills negatively, causing a substantial disturbance in role performance or coping skills in at least two (2) of the areas listed below on either a continuous or intermittent basis, at least once per year. The skill areas that are targeted must be consistent with the participant’s ability to engage and benefit from treatment. The detail of the participant’s level and type of functional impairment must be documented in the medical record in the following areas: (7-1-16)

Vocational/educational (3-20-14)
Financial (3-20-14)
Social relationships/support (3-20-14)
Family (3-20-14)
Basic living skills (3-20-14)
Housing (3-20-14)
Community/legal (3-20-14)
Health/medical (3-20-14)

IDAPA 16.03.09 854.01.c: Measurable goals, when goals are required for the service; (7-1-13)

CBRS PRA Certification: With new CBRS staff, what are you specifically looking for in showing documentation that they are working towards their certification. This is referring to the 30 months they have after the hire date to complete certification program. How often does documentation need to be proven?
Thank you!

Answer: When a district hires an employee for CBRS who has not yet obtained their PRA certification, the district must have on hand that person is working towards PRA certification. This could be a printout of the individual's registration to take the certification assessment, evidence of enrollment in and/or completion of coursework (enrollment and/or transcript), signed statement by individual working toward the PRA certification with anticipated date of completion, etc. The documentation should be on-hand before the individual begins working. There is no requirement for how often the documentation should be updated, but it is advisable that the documentation be updated as the individual completes required components. See IDAPA and School-Based Medicaid Guidance Handbook references below.

IDAPA 16.03.09.855.10.k.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 earned a certification in psychiatric rehabilitation based upon the primary population with whom he works in accordance with the requirements set by the PRA. (7-1-16)

School-Based Medicaid Guidance Handbook, Chapter 6: "Districts must monitor the candidate’s progress during the 30-month process to obtain the PRA Certification and the limitation of exam deadlines" (page 68).

Community-Based Rehabilitation Services (CBRS): Can we get additional guidance regarding the specific emotional, behavioral or neuropsychiatric conditions that would qualify a student for CBRS?

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)

Community-Based Rehabilitation Services (CBRS): I have a contracted agency CBRS provider that has a Bachelor Degree and was hired prior to November 1, 2010. What, if any, are the additional qualifications for this person to provide CBRS? IDAPA 16.03.09.855.10, section K,ii, only refers to PRA certification requirements for staff "hired on or after November 1, 2010."

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)

Community-Based Rehabilitation Services (CBRS): PRA Certification to provide CBRS 3 year recertification - My understanding is that at the end 2016 a new regulation was passed requiring PSR certifications be renewed every 3 years. Looking over some of our contracted workers PRA certifcates, I do not see an expiration date only the date they received it. So, when did the regulation take effect? Do they have until a certain date (grace period) to renew their certificates if they are more than 3 years past? Does the regulation apply to school based staff as well as contracted staff? Do they recertify through PRA only?

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.

CBRS Eligibility 18+: Code says: The detail of the participant's level and type of functional impairment must be documented in the medical record in the following areas:......list of 8 areas....

Our question: What is the functional impairment criteria for over 18 years old? We need criteria to know if we meet the requirement. Thank you, Jackie Haxton, Medicaid Specialist

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.

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

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.

Qualifying Professional for CBRS: Where is it specified in code and/or policy the type of "qualified professional" who can diagnose the medical mental health diagnosis for CBRS services?

Answer: The eligible student must be diagnosed by a licensed professional that can give a DSM-V Diagnosis.

PCS/Nursing

Answer: If there is not age restriction identified on the answers, then, yes, it is meant for a child of any age.

2018-3-19 PCS Assessment Toileting Question 4: On the PCS Assessment Toileting Question 4, the previous version of the Assessment had a #5 and now there is no score associated with that section any more. Is the intention that the previous #5 be scored under #4 of the previous paragraph?

Answer: The PCS Assessment Tool has not been updated since June 2016. The section under toileting that states, "Physically unable to go to the bathroom on own. Required protective garments to be checked, changed, and pericare done on a regular basis. Child unable to care for catheter or ostomy," is a description of why one might check item #4.

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.

The paraprofessional must meet the above requirements before the district can file for Medicaid reimbursement.

Personal Care Services (PCS): There are currently three different PCS Assessment Tool's available for school use. Please specify which is the correct and most current version we should be using? One is in draft mode and there are different age restrictions on two of them. I would like to make sure our RN's are using the most up to date and accurate version.
1: The PCS Assessment Tool on http://healthandwelfare.idaho.gov/Medical/Medicaid/SchoolBasedServices/tabid/1587/Default.aspx that has different age restrictions from the ITC website.
2: The PCS Assessment Tool on http://idahotc.com/Topics/N-Z/School-Based-Medicaid#10785 under Personal Care Services. This PCS Assessment Tool is watermarked with "DRAFT". It has different age restrictions than the PCS Assessment Tool found on the H&W website.
3: There is an additional PCS Assessment Tool on http://idahotc.com/Topics/N-Z/School-Based-Medicaid#10785 under Medicaid Guidance Handbook. This PCS Assessment Tool is not marked as draft, however, it has different age restrictions than the other ITC document that is marked in draft mode.

Answer: Thank you for bringing our attention to these discrepancies. The draft version of the Personal Care Services (PCS) Nursing Assessment Tool posted on the Idaho Training Clearinghouse is being removed. The other two forms are correct and have a revised date of 06/2017.

PCS Health Care for Positioning Needs: This is the service we currently provide (student already has a PCS Assessment, Allocation Tool and Care Plan in place):
We have a student with built in rest periods throughout the day where the student requires supervision by a para to make sure that the student’s airway is not impaired d/t flaccidity. Student will be positioned in varying positions with proper body alignment and joints supported. This is especially imperative during episodes of hemiplegia or quadriplegia. Student’s head position should not be hyperextended either forward or backward and should remain midline - in a position that facilitates adequate breathing and swallowing. Be mindful that when the student’s head drops down on the neck or chest area, we must support the student’s head to avoid obstruction of her airway. "

Would this qualify under Personal Care Services? If so, which category would it be under? This is a service that CAN be delegated to a para, so the student does not qualify for private duty nursing services. (The student does not have a tracheotomy.)

Families can seek financial help to pay for daily nutrition through the Idaho Food Stamps Program at http://healthandwelfare.idaho.gov/Default.aspx?TabId=90.

Skilled Nursing Services: The state is having a difficult time finding LPN's to assist our current PDN client's. For most of our client's we have had to provide an RN in order to get them staffed. Due to the LPN shortage Medicaid has changed most of these participates to RN services instead of LPN. For those participants who may have an RN currently providing their care, that rate is different than an LPN rate. The hourly rate for an RN is $40.76.

Please let me know if this is something your district can accommodate.

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.

Skilled nursing services for Student with Diabetes: We are encountering a new situation, a young DD student with a recent Diabetes One diagnosis. An LPN is at the school about 3 hours a day to monitor the student's numbers, but actually only sees the child for about an hour of that. Information from home is inconsistent, some days the LPN has to wait to see the numbers peak and drop. Our RN is also spending a large amount of time documenting our services and communicating with the Primary Physician.
I would like to know if the Skilled Nursing Service, provided by the LPN, can be billed for all of her time or only when the student is in her presence? And how can we bill for the RN's time documenting and communicating?

Answer:16.03.09.853.3.d

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.

Therapies – OT, PT, SLP

2018-3-19 Number of Students in a Group Setting: Please advise how many students can be in a group setting with a professional for the following therapies: SLP, OT, PT, CBRS

2.3.2. Independent Therapist Qualifications: Medicaid will only reimburse for PT services rendered by or under the supervision of a licensed PT who is:

Identified by Medicare as an independent practitioner, and
Enrolled as an Idaho Medicaid provider.

Homebound services: We have a homebound student enrolled in our district and is currently on an IEP. We have a Physical Therapist who travels to her home to provide services.
Would it be ok to bill out these homebound services even on days the regular schools are closed? The P.T. can only serve the student on certain days and what if those days fall on a day that other kids are out of school?? I hope my question makes sense. I do not recall finding any info on this in our Handbook or Rule.
Thank you for your help!!!

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: 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.

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.

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.

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: 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)

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

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

SLP-Aide Assistant Billing Rate: What is required for a SLP assistant to bill at the PRO rate instead of PARA rate? I know at least a BA in speech and language pathology, but wasn't sure of what else is needed. Thank you!

Answer:
Medicaid Billing Chart (Updated February 2017)

Professional Level	Qualifications	Billing Rate
License, CCC’s and PPC	State License, ASHA CCC’s and Pupil Personnel Certificate from State Board of Education	Professional rate No supervision requirements
License and CCC’s	State License, ASHA CCC’s	Professional Rate No supervision requirements
CCC’s and PPC	ASHA CCC’s and Pupil Personnel Certificate from The State Board of Education	Paraprofessional rate Need supervision by State Licensed SLP and ASHA CCC’s
SLP PPC	Master’s Degree in Speech, Language Pathology, Pupil Personnel Certificate from State Board of Education	Paraprofessional rate Need supervision by State Licensed SLP and ASHA CCC’s
SLP Aide, License	Master’s Degree in Speech, Language Pathology, but not ASHA Certified, pass IBOL examination for Licensure	Professional rate Need supervision by State Licensed SLP and ASHA CCC’s
SLP Aide, License	BS Degree, pass IBOL examination for Licensure	Professional rate Need supervision by State Licensed SLP and ASHA CCC’s
SLP Aide, no License	BS Degree	Paraprofessional rate Need supervision by State Licensed SLP and ASHA CCC’s
SLP Assistant, License	Associates Degree	Paraprofessional rate Need supervision by State Licensed SLP and ASHA CCC’s
SLP Assistant and Paraprofessional, no License	May have Associate Degree but not required	Paraprofessional rate Need supervision by State Licensed SLP and ASHA CCC’s

Compiled and Prepared by Marcia Williams, MS, CCC-SLP (President of ISHA 2015); and Tammy Emerson, MS, CCC-SLP (ASHA/ISHA STAR)

Disclaimer: The information presented in this chart is for general information purposes only. The Idaho Speech Language Hearing Association and authors assume no responsibility for changes or omissions in the contents of this chart. Please reference the sources as indicated when it pertains to licensure and rules

SLP-Aide Assistant Supervision: SLP Supervision of Aide-
This is on page 148 of a Medicaid handbook, updated 08/05/2016, Supervision Requirements. 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. The school must have documentation of the supervision and what the professional observed and reviewed during their supervisory visit.

On page 96 of a previous handbook it states supervising observed for "each recipient"

In talking at the meeting on November 13th, 2017, it came out that it doesn't have to be each recipient, just the professional observing the paraprofessional on a monthly basis.

Answer: The SLP must observe and review the paraprofessional monthly, but does not need to observe and review the paraprofessional working with each recipient (student receiving SLP services) during the monthly supervision observation. This monthly supervision ensures that the paraprofessional demonstrates the necessary skills to deliver services. The SLP's responsibility is to see each recipient at the BEGINNING OF AND PERIODICALLY DURING TREATMENT (2017 School-Based Medicaid Guidance Handbook, p. 96).

The current 2017 School-Based Medicaid Guidance Handbook, page 96, which supersedes all previous editions, states the following:
School-based services provided under the direction or supervision of a speech-language pathologist or audiologist must:
- Meet the qualifications listed in the Provider Qualifications.
- See each recipient at the BEGINNING OF AND PERIODICALLY DURING TREATMENT (emphasis added), be familiar with the treatment plan, have continued involvement in the care provided, and review the need for continued services throughout treatment.
- Assume professional responsibility for the services provided under his or her direction.
- Ensure that the individual working under his or her direction can contact him or her as necessary during the course of treatment.
- Not supervise more service providers than is reasonable, ethical, and in keeping with professional practice in order to permit the supervising speech-language pathologist or audiologist to adequately fulfill his or her supervisory obligations and to ensure quality care.

The current 2017 School-Based Medicaid Guidance Handbook, page 96, continues:
Supervision requirements. SLP paraprofessional supervision must be provided by an SLP professional who has a state license from Idaho Bureau of Occupational Licenses and their CCC’s from ASHA or within one year of receiving their ASHA CCC’s. 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. The school must have documentation of the supervision and what the professional observed and reviewed during their supervisory visit.

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.

This information was verified by the Medicaid Integrity Unit.

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

16.03.09.734.3

SLP Review of Outside Sources: If a qualified SLP reviews evaluation/assessment results from an outside agency to be used on an eligibility report for a student but does not complete a new evaluation/assessment for a student - can it be billed to Medicaid? If so, which CPT code would be billed?

Answer: Yes, the SLP will be completing a speech language evaluation that takes in multiple sources of information to determine the need for services in a school environment. You would use the SLP evaluation code that address the part of speech being reviewed. The SLP will need to determine if it is fluency, articulation, etc.

Resources

Links

Center for Medicaid and Chip Services

Idaho School-Based Medicaid

Molina Medicaid Solutions Provider Handbook

School-Based Fee Schedule

Contact Us

karren streagle, ph.d

Early Childhood/Alternate Assessment Coordinator
Idaho State Department of Education
P.O. Box 83720 Boise, Idaho 83720
208-332-6824
kstreagle@sde.idaho.gov

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