IEP Coverage and Billing Basics

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 1

Agenda

• Welcome and Introductions

• Results: District Revenue and Billing by Type of Service

• Online Resources

• IEP homepage

• IEP manual

• Basics for all IEP Services

• Specific IEP Services

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 2

Purpose

The purpose of this training is to familiarize those that are new or need a refresher about billing Minnesota Medicaid for IEP health related service.

This presentation will provide guidance on where to find information, what services are reimbursable and what documentation is required.

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 3

Department of Human Services (DHS) Staff

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 4

MHCP Provider - IEP SERVICES Jenny Roth, IEP Services Coordinator

(651) 431-2622 jenny.m.roth@state.mn.us

Jesusa Williams, IEP Services Rates(651) 431-2538 jesusa.williams@state.mn.us

Jeri Boomgaarden, Provider Relations(651) 431-3242 MN-ITS training; jeri.boomgaarden@state.mn.us

Jill Johnson, CTSS (Children’s Mental Health)(651) 431-2333 jelaine.johnson@state.mn.us

Minnesota Department of Education (MDE) Staff

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 5

Special Education - Third Party Reimbursement (TPR)Ruth Ellen Luehr, Interagency Education Specialist(651) 582-8403 ruthellen.luehr@state.mn.us

School FinanceMichael Brooks - EDRS(651) 582-8889 mde.spedfunding@state.mn.us

Early LearningKara Tempel, Specialist, 0-2yr – Part C Special Education651-582-8495 kara.tempel@state.mn.us

Side by Side

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 6

Minnesota Department of Human Services

Minnesota Health Care Programs (MHCP):

MHCP Provider of IEP Services

Schools are MHCP Providers (health care providers) of IEP Services

MED

Minnesota Department of Education

Special Education:

Third Party Reimbursement (TPR)

Schools provide and bill for IEP health-related services

ED

Overview

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 7

Minnesota School District Revenue from Third Party Reimbursement

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 8

2014-15 Percent of School Districts Billing by Type of IEP Health-Related Service

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 9

MHCP Online Resources

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 10

MHCP Enrolled Provider-IEP Homepagewww.dhs.state.mn.us/provider/iep

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 11

Provider News

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 12

Previously Published Provider News Items

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 13

Provider Updates

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 14

Watch for Legislative, MHCP and IEP Updates

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 15

Forms, Checklists, Logs, Reports, Documents & Resources

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 16

Provider Manual

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 17

IEP Services Manualwww.dhs.state.mn.us/main/dhs16_151385#

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 18

Latest Revisions to this Manual

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 19

Return to IEP Services Manual

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 20

Basics for All IEP Providers

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 21

IEP Providers

IEP Providers

• Overview• Eligible Providers • National Provider Identifier (NPI)• MHCP Provider Enrollment Electronic Funds Transfer (EFT)• Provider Information and Resources

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 22

MHCP Eligible Children

MHCP Eligible Children• Overview• Eligible Children• Verifying Eligibility

• Understanding Eligibility Response• Managed Care “Carve out”

• Protections for Families and Children for other MHCP Services• Minnesota Health Care Programs (MHCP)

• Parent consent on MHCP Applications • Parent Notification, Release, Consent

• Locating a District IEP Service Provider• MHCP IEP Services Information for Families Brochure

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 23

MDE Third Party Reimbursement (TPR) webpage

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 24

MDE TPR web link

Parent Consent to Share Records and to Bill

Parent Informed Consent – MDE Special Education TPR website link

Schools must • inform parent of intent to bill• get parent consent to share information and to bill• notify parents of rights:

May decline consent; may stop consent at any timeMay ask for billing records

For public insurance (MHCP – MA and MinnesotaCare):One time consent – lasts until change in amount and type of serviceAnnual Notice of parent rights

For private insurance:Annual active consentAnnual notice of parent rights

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 25

Parent Consent Process: Inform

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 26

1. First Inform: Use MDE Model Notice of Procedural Safeguards or local district form

Parent Consent Process: Request Consent – a

2. Then get Consent (a): Use MDE Model Parent Consent form or local district form… or

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 27

Parent Consent Process: Request Consent - b

or 2. Then Consent (b): Use parent’s MHCP application as signed consent.

• MHCP (Medication Assistance (MA) or MinnesotaCare) application via (MNSURE.org).

• Parents give permission to share information and to bill to providers –including schools.

QUESTIONS: Was the parent INFORMED? Does the parent know he/she CONSENTED?

Was the parent informed before providing consent? (wait a year to bill)

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 28

Parent Consent – Handle with Care

• Family finances are a personal, family matter.

• Public support for family health care is a PRIVATE matter.

• Honor families’ privacy and dignity:

Discuss consent for billing in PRIVATE.

Keep information private – data, records, conversations.

Provide the same services for children whether billing for services or not.

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 29

Covered and Noncovered IEP Health-Related Services

Covered and Noncovered IEP Health-Related Services

• Overview• Covered Services

• Coverage Criteria for All Health-Related Services

• Noncovered Services• Criteria for Providing Services via Telemedicine

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 30

Billing and Authorization Requirements

IEP Billing and Authorization Requirements• Overview• Authorization and Orders• Billing requirements

• ICD Codes• Seek Reimbursement for other payers• Benefits and Limitations • Timely Billing• MHCP Eligible Children with Private Health Insurance• Coordination of Benefits (COB)• Electronic Claim Attachments• IEP Procedure Code, Modifiers and Units• Using a Date Span• Submitting a Claim

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 31

Private Insurers - MDE TPR SharePoint

From MDE TPR webpage, at bottom, find instructions to SharePoint.

CONTENTS: ANNOUNCEMENTS

DOCUMENTS - Shared Documents: Private Insurers statewide denialsData

LISTS: CalendarWhere to find info….

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 32

Rates and Payments

Rates and Payments• Overview• Provider Tax• Cost Based Rates

• Assistive Technology• Special Transportation• All Other Health-Related Services

• Interim Rates and Final Rates• Appeal Final Rates• Reconciling Final Rates – Results• Reporting cost data – Districts Responsibility

• Payments• Administration Fee• Remittance Advice (RA)

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 33

Data Needed to Calculate IEP Cost Based Rates

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 34

School Districts

• Direct Service Time

• Direct Encounters

MDE

• Total Annual Salary (per personnel type code)

• Total Contract Expenses (per personnel type code)

• Full Time Equivalence FTE (per personnel type code)

• District Fringe Benefit %

• District Unrestricted Indirect Cost %

• District Contract Days

• District Daily Hours

Example: Calculation of IEP Rates for Physical Therapy

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 35

EDRS Data:PT Salaries $150,000 PT Contract Exp. 20,000

School District Data: MA Direct Hours 3,218

MA Encounters 2,582

Total FTE 3.5 Contract Days 180Contract Hours 7.50

UFARS Data:Fringe Benefit % - 20% ($150,000 *20%) = $30,000

MDE Data:Unrestricted Indirect Cost % - 0.127

Example: Calculation of IEP Rates Physical Therapy per Day (unit)

MA Rate = ($150,000 + $30,000 + $20,000) = $42.32804(3.5 x 180 x 7.50)

= $ 42.32804 x 3,218 = $136,211.60

= $136,211.60/2,582 = $52.75

= $ 52.75 x 0.127 = $ 6.70

= $ 52.75 + $ 6.70

= $59.45/day4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 36

Record Keeping and Documentation

Record Keeping and Documentation• Overview• Health Service Records

• Assistive Technology Devices• Special Transportation• Personal Care Assistant Services• Occupational Therapy, Physical Therapy and Speech Language Pathology ,

Audiology, Mental Health, Nursing and Interpreter Services

• Service Time and Encounters• Record Retention

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 37

IEP Manual Home Page - IEP Health Related Services

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 38

Assistive Technology (AT) Devices

Assistive Technology (AT) Devices• Overview• Authorization and Orders• Covered Services

• Coverage Criteria• Noncovered Services• Health Records and Documentation• Required Documentation for Electronic Claims Attachments• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 39

Interpreter Services

Interpreter Services• Overview• Authorization and Orders• Spoken Language Interpreter Services

• Competent Spoken Language Interpreters

• Sign Language Interpreter Services• Qualified Sign Language Interpreters

• Covered Services• Noncovered Services• Health Records and Documentation• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 40

Mental Health Services

Mental Health Services• Overview

• Eligible Providers• CTSS Certification• Cooperatives and education districts

• Eligible Service Providers• Mental Health Professionals (MHP) – Licensed• Mental Health Practitioners and Behavioral Aids – Unlicensed

• Eligible Recipients

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 41

Mental Health Services (cont.)

Mental Health Services (cont.)• Covered Services

• Assessments and Evaluations• Psychological Testing and Diagnostic Assessments• Children’s Therapeutic Services and Supports (CTSS) Services

• Record Keeping and Documentation• Noncovered Services• Billing• Choices for Billing Diagnostic Assessments and Psychological Testing• Mental Health CTSS Definitions and Acronyms

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 42

Nursing Services

Nursing Services• Overview

• Authorization and Orders: IEP team authorizes health-related services• Medical orders for delegated medical functions

• independent nursing functions

• Qualified Service Providers• Professional Nurses – RN, RN/Public Health Nurse, RN/Licensed School

Nurse • Practical Nurses – LPN

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 43

Nursing Services (cont.)

Nursing Services (cont.)• Covered Services - Nurse Practice Act

• Nursing assessment – Evaluation, ongoing assessment• Medication management • Activities of Daily Living

• Noncovered ServicesRoutine health services provided to all others: first aid, antibioticsSupervision of LPN, PCA

• Health Records and Documentation• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 44

Occupational Therapy Services

Occupational Therapy Services• Overview• Authorization• Qualified Service Providers

• Supervision and Direction of an OTA• Covered Services• Noncovered Services• Health Records and Documentation• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 45

Personal Care Assistance Services

Personal Care Assistance (PCA) Services• Overview• Eligible Providers

• People Eligible to Provide PCA• Required Training

• Scope of PCA Services• Eligible Recipients• Covered Services

• Activities of Daily Living (ADL’s)• Level 1 Behaviors• Other Health-related Procedures and Tasks

• Noncovered Services

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 46

Personal Care Assistance Services (cont.)

Personal Care Assistance Services (cont.)• Documentation• Activities Checklist• Supervisions

• QP Qualifications• QP Duties

• PCA Plan of Care• Evaluation of the Person Providing PCA Services

• Initial Evaluation• Periodic Evaluations • Documentation of Evaluations

• Record Keeping and Documentation• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 47

Physical Therapy Services

Physical Therapy Services• Overview• Authorization• Qualified Service Providers

• Supervision and Direction of a PTA• Covered Services• Noncovered Services• Health Records and Documentation• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 48

Special Transportation Services

Special Transportation Services• Overview• Authorization• Eligible Service Providers• Eligible Children• Covered Services• Health Records and Documentation • Noncovered Services• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 49

IEP Transportation Rates

• In FY 2010 MDE began calculating “trip rates” for each school district based upon the actual expenditures reported to MDE through UFARS Finance 723

• The total transportation expenditures reported in Finance 723 (salaries of drivers only, fringe benefits, gas, oil, insurance, maintenance) are divided by the number of days that students with special education transportation required by the IEP (MARSS Transportation Category 3) to get a daily rate, divided by two to get a trip rate (to and from school.)

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 50

IEP Transportation Rates Formula

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 51

SpEd Trans. ExpSpEd Mem Days

= Daily Rate 2

= Trip Rate

Trip Rate x District’s Unrestricted Indirect Cost Percentage

= Indirect Costs

Trip Rate + Indirect Costs = Special Transportation Rate per Trip

IEP Transportation Rate Example

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 52

$2,468,595 23,902.55

= $103.28 2

= $51.64

$51.64 x 0.115% = $ 5.94

$51.64 + $5.94 = $57.58 Special Transportation Rate per Trip

Speech Language Pathology and Audiology Services

Speech Language Pathology and Audiology Services• Overview• Authorization Requirements• Qualified Service Providers• Covered Services• Noncovered Services • Health Records and Documentation• Billing

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 53

DHS Contacts

Contacts:

Provider Call Center: Select option 3, 651-437-2700

Jeri Boomgaarden: MN-ITS Provider Trainer, 651-431-3242

Jesusa Williams: IEP Rates and payment Consultant, 651-431-2538

Jill Johnson: Children's Mental Health Consultant, 651-431-2333

Jenny Roth: DHS IEP Coordinator, 651-431-2622

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 54

MDE Contacts

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 55

Special Education - Third Party Reimbursement (TPR)Ruth Ellen Luehr, Interagency Education Specialist(651) 582-8403 ruthellen.luehr@state.mn.us

School FinanceMichael Brooks - EDRS(651) 582-8889 mde.spedfunding@state.mn.us

Early LearningKara Tempel, Specialist, 0-2yr – Part C Special Education651-582-8495 kara.tempel@state.mn.us

Questions?

4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 56

4/17/2017 57

IEP SERVICES

Thank you!