Steve SisolakGovernor

Richard WhitleyDirector

State of Nevada

Department of Health and Human Services

MSM 2800 – School Based Child Health Services (SBCHS) Updates

Division of Health Care Financing and Policy

Gladys Cook and Julie Lindesmith

12/13/2019 Helping people. It’s who we are and what we do.

Agenda

1. General proposed changes (chapter wide)• Names/terms• Removal of Individualized Education Program (IEP)

requirement• Chapter structure

2. Service/Section specific proposed changes

There will be opportunity for questions and comments throughout the presentation.

Agenda

Acronyms• ABA- Applied Behavior Analysis

• ACD- Assistive Communication Devise

• ADLS- Activities of Daily Living

• APRN- Advance Practice Registered Nurse

• ASD- Autism Spectrum Disorder

• CFR- Code of Federal Regulations

• DHCFP- Division of Health Care Financing and Policy

• DHHS- Department of Health and Human Services

• DME- Durable Medical Equiment

• DPBH- Division of Public and Behavioral Health

• EPSDT- Early and Periodic Screening, Diagnostic and Treatment

• FASD- Fetal Alcohol Spectrum Disorders

• FERPA- Family Educational Rights and Privacy Act

• IADLS- Instrumental Activities of Daily Living

• IDEA- Individuals with Disabilities Education Act

• IEP- Individualized Education Program

• IFSP- Individual Family Service Plan

• LEA- Local Education Agency

• LRI- Legally Responsible Individual

• MDC- Multidisciplinary Conference

• MSM- Medicaid Services Manual

• NCU- Nevada Check-Up

• NRS- Nevada Revised Statues

• OPR- Ordering, Prescribing, Referring

• PA- Physician’s Assistant

• PCA- Personal Care Assistant

• PCS- Personal Care Services

• POC- Plan of Care

• QIO- Quality Insurance Organization

• SBCHS- School Based Child Health Services

• SEA- State Education Agency

• SFASP- School Functional Assessment Service Plan

• SHS- School Health Services

• SPA- State Plan Ammendment

• TPL- Third Party Liability

Acronyms

Chapter Wide Changes

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Name/Term Changes

• School Based Child Health Services (SBCHS) is now School Health Services (SHS)

• School districts replaced with Local Education Agency (LEA)/ State Education Agency (SEA)

• Parent replaced with Legally Responsible Individual (LRI)

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Removal of IEP Requirement

• Most IEP language has been removed from the chapter and been replaced with Plan of Care (POC).

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Chapter Structure

• Consistent order for listed services

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Service/Section Specific Proposed Changes

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2800 Introduction

• Added POC language• Added Early and Periodic Screening, Diagnostic and

Treatment (EPSDT) Code of Federal Regulations (CFR) 440.40(B)

• Removed Individuals with Disabilities Education Act (IDEA) and IEP language

• Updated Nevada Check-Up (NCU) manual reference

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2801 Authority

• Split authorities into Federal and State• Updated State Plan Amendment (SPA) page(s)

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2802 Definitions- Added• 504 Accommodation Plan• Activities of Daily Living (ADLs)• Applied Behavior Analysis (ABA)• Autism Spectrum Disorder (ASD)• By or Under Direction of• Fetal Alcohol Spectrum Disorders (FASD)• Individual Family Service Plan (IFSP)• Instrumental Activities of Daily Living (IADLs)• Legally Responsible Individual (LRI)• Medical Necessity• Medical Team Conference (with Interdisciplinary Team)• Personal Care Assistant (PCA)• Personal Care Services (PCS)• Plan of Care (POC)• Preventive and Diagnostic Services• School Functional Assessment Service Plan (SFASP)• State Education Agency (SEA)• Third Party Liability (TPL)• Treatment Services

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2802 Definitions- Removed

• Removed definitions• Counseling Services• Parent- replaced by LRI• Multidisciplinary Conference (MDC)- Replaced by

Medical Team Conference• Present Levels of Educational Performance• Progress Monitoring• Related Services• Review and Revision of IEP• Special Education• Support Services

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2802 Definitions- Revised

• Revised definitions• Assistive Communication Devise (ACD)• Early and Periodic Screening, Diagnosis, and Treatment

(EPSDT)• Local Education Agency (LEA)• Short-Term Objectives/Benchmark

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2803.1 Policy Overview

• Added POC language• Added categories

• Screening and Diagnostic Services• Treatment Services

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2803.1A Screening and Diagnostic Services• New Section• Refers to Chapter 1500, Healthy Kids Program

services that will now be covered in SHS• Services that can be covered without a POC

because they are screening and assessment services

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2803.1B Treatment Services

• New Section• Refers to all services that will be included in SHS

except those from 2803.1A Preventive and Diagnostic

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2803.1C Coverage and Limitations

• Previously Section 2803.1A• IEP development meeting changed to medical team

conference• Added the language to “3. Covered Services” to

make it more inclusive of preventive services• Rearranged services to match order described later

in the chapter• Updated the MSM Sections referenced

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2803.1C Coverage and Limitations Added Covered Services• Added to Covered Services (2803.1C3)

• Screening, diagnostic, and treatment services• Mental Health and alcohol/substance abuse (replaced

psychological counseling)• Personal Care Services (PCS)• Applied Behavior Analysis (ABA)• Dental services• Optometry services• Case management• Services delivered by telehealth

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2803.1C Coverage and LimitationsChanges to Non-Covered Services• Added

• Medical necessity requirement• Reference to Ordering, Prescribing, Referring (OPR)

section

• Removed• Dental or related services (these will now be covered)• Treatment of obesity (this will now be covered)• Any examination and laboratory tests for preventable

diseases (this will now be covered)

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2803.1D Provider ResponsibilityOPR and Under the Direction Of• Previously Section 2803.1B• Replaced “Medical or Treatment Services” Section

with “Ordering, Prescribing, and Referring (OPR)” Section.

• The OPR Section was newly drafted

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2803.1D Provider ResponsibilityPOC and Medical Team Conference• Replaced “Reserved for Future Use” Section with

“Plan of Care (POC)” Section• POC Section is newly drafted language• Replaced “Individualized Education Program (IEP)”

Section with “Medical Team Conference (with Interdisciplinary Team)” Section

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2803.1D Provider Responsibility- Assessments, Records, and Non-Discrimination

• Removed Sections• IEP Assessment/Evaluation• Assessment

• Records Section- added statement that documentation must be completed as appropriate for the service being provided as detailed in the corresponding MSM chapter

• Made Non-Discrimination Section more general and reference back to MSM 100

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2803.1D Provider ResponsibilityTPL and Katie Beckett Recipients• Third-Party Liability (TPL)

• Pay & Chase will only apply to IEP services• Medicaid will pay for services if the third-party insurance

does not pay in a school setting

• Katie Beckett Recipients• Replaced Parental Notification and Consent Section• Parental Notification and Consent was removed as it is a

Family Educational Rights and Privacy Act (FERPA) regulation not a Medicaid regulation.

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2803.1F Authorization Process

• Previously Section 2803.1D• POC serves as prior authorization• Added OPR refence

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2803.2 Provider QualificationsOverview• Licensed replaced with qualified as not all services

require a license (example PCS).

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2803.2 Provider QualificationsDetails• Added sections with qualification specification for each

type of providerA. Physician, Physician’s Assistant (PA) & Advanced Nurse

Practitioner ServicesB. Mental Health and Substance AbuseC. NursingD. Physical TherapyE. Occupational TherapyF. Speech Therapy and AudiologyG. PCSH. ABAI. DentalJ. OptometryK. Case ManagementL. Telehealth

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2803.3 Screening, Diagnostic Services and Treatment• Newly drafted language• Based off MSM Chapter 1500, Healthy Kids

Program

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2803.4 Physician, Physician’s Assistant & Advanced Nurse Practitioner Services

• Defined the list of covered services in 2803.4A as examples, not an exhaustive list

• Added new and established patient visited to covered services

• Added Limitations Section (2803.4B)

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2803.5 Mental Health and Alcohol/Substance Abuse Services• Replaced Psychological Counseling• Based off MSM Chapter 400, Mental Health and

Alcohol and Substance Abuse Services• Added Limitations Section

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2803.6 Nursing Services

• Added that nursing services must be under the order and supervision of a physician, or Advanced Practice Registered Nurse (APRN)

• Added Limitations Section (2803.6B)

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2803.7 Physical Therapy Services

• Added Limitations Section (2803.7B)

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2803.8 Occupational Therapy Services

• Added Limitations Section (2803.8B)

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2803.9 Speech Therapy and Audiology Services• Added Limitations Section (2803.9B)

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2803.10 Audiological Supplies, Equipment, Medical Supplies and Other DME

• Added Limitations Section (2803.10B)

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2803.11 Personal Care Services (PCS)

• Newly drafted language based off MSM 3500, Personal Care Services Program, Nevada Revised Statues (NRS) Chapter 449 and the Division of Public and Behavioral Health (DPBH) requirements for PCS providers

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2803.12 Applied Behavior Analysis (ABA)

• New service added to SHS• Based off MSM Chapter 3700, Applied Behavior

Analysis

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2803.13 Dental

• New service added to SHS• Based of MSM Chapter 1000, Dental

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2803.14 Optometry

• New service added to SHS• Based on MSM Chapter 1100, Ocular Services

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2803.15 Case Management

• New service added to SHS• Based on MSM Chapter 2500, Case Management

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2803.16 Telehealth

• New service added to SHS• Based on MSM Chapter 3400, Telehealth Services

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2804 Reserved for Future Use

• Added to leave a spot to add a Quality Assurance Section

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2805 Hearings

• Previously Section 2804

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2806 References and Cross References• Previously Section 2805• Added references to

• Chapter 1000, Dental• Chapter 1100, Ocular Services• Chapter 2500, Case Management• Chapter 3400, Telehealth Services

• Removed 2805.3 Contracted Quality Insurance Organization (QIO)-Like Vendor and Fiscal Agent Section

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Attachment A

• Removed Attachment A

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Questions?

tionsQues

Contact InformationContact Information

Gladys Cook Julie LindesmithSocial Service Program Specialist III Social Service Program Specialist II

gcook@dhcfp.nv.gov j.Lindesmith@dhcfp.nv.gov

775-684-7596 775-684-3693

SchoolHealthServices@dhcfp.nv.gov

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