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Individualized Education Program (IEP) Services

Technical Assistance Guide

DHS-4439-ENG 8-13

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page A.1 Introduction In Minnesota, the Department of Human Services (DHS) is the state Medicaid agency. Medicaid funds are available to pay for health related services provided by Minnesota public districts to eligible children through an Individualized Education Program (IEP) or Individualized Family Service Program (IFSP). Minnesota Statutes 125A.21, subd. 2(a) requires MN public districts to “seek reimbursement from insurers and similar third parties for the cost of services provided by the districts whenever the services provided by the district are otherwise covered by the child’s health coverage.” This Individualized Education Program (IEP) Technical Assistance Guide is designed for districts enrolled as IEP services providers. The purpose of this guide is to provide districts with Medicaid policy, billing and payment information for covered IEP services. The guide and Minnesota Health Care Programs (MHCP) Provider Manual are available online at: www.dhs.state.mn.us/provider/iep. Minnesota Statutes specific to Medicaid covered IEP services: 125A.21, 125A.74, 125A.744 and 256B.0625, subd. 26 Other relevant statutes: Government Data Practices Act - 13 Children’s Mental Health Act - 245.487-245.4889 Additional parts of 256.0625 *8/2013: Updated

This information is available in accessible formats for individuals with disabilities by calling 651-431-2629 or by using your preferred relay service. For other information on disability rights and protections, contact the agency’s ADA Coordinator.

http://www.dhs.state.mn.us/provider/iep

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page A.2 Update Log The update log is a record of updates to the IEP Services Technical Assistance Guide. To keep your guide current, copy and insert updated pages listed by the date issued or copy the entire guide available online at www.dhs.state.mn.us/provider/iep; select IEP Services Technical Assistance Guide. The date at the top of each page in the guide is the date the page was last updated. The footnote at the bottom of each page is a short description of the reason(s) for the last update.

Update Year-Number & Pages to Replace

Date Issued

09-26 (pages ii, iii, iv, v, A.1, B.1-B.3, C.1-C.3, D.1-D.8, E.1-E.2, E.4, E.6, E.9, E.11-E.15, E.17-E.47, F.1, F.3, F.6-F.8, F.10-F.16, F.20, F.22-F.25, G.2-G.12, H.1-H.10, I.1-I.3, K.1)

April 2009

09-27 (pages i, ii, iii, iv, v, B.1-B.3, C.1-C.4, D.1-D.5, E.2, E.13-E.26, E.29, E.31-E.46, F.1, F.3, F.5-F.8, F.10-F.22, G.1-G.6, G.9, H.3, H.5-H.6)

August 2009

10-28 (pages ii, iv, v, C.2, D.1-D.3, E.1-E.2, E.4, E.6-E.28, E.31, E.34-E.47, F.4-F.7, F.10-F.20, G.1-G.6, H.1-H.13, I.1-I.3)

February 2010

10-29 (pages i, ii, iii, iv, A.1, B1-B.3, C.1, C.3-C.4, D.3-D.8, E.2-E.7, E.9-E.10, E.18-E.23, E.25-E.28, E.31-E.49, F.4-F.11, F.17; G.1-G10, H.2-H.5, H.7-H.9, H.11-H.13, K.1-K.2)

September 2010

11-30 (pages ii, iii, iv, v, B.1-B.3, C.1-C.4, D.1, D.3, E.1-E.7, E.9, E.11, E.14, E.19,- E.21, E.24, E.26, E.29 - E.36, E.39 - E.46, F.1-F.4, F.8-F.14 - F.16, F.19 - F.20, G.1, G.4, G.6, H.2 - H.8, H.12, I.1)

February 2011

12-31 (pages A.1-A.5, B.1-B.3, C.1, C.3-C.4, D.1-D.5, E.1-E.49, F.1-F.15, G.1-G.8, H.1-H.5, H.7-H.9, H.11-H.13, I.1-I.3, J.1, K.1-K.2)

May 2012

12-32 (pages A.1, A.2, E.28, E.35-E.36, E.45, F.9, G.5-G.9) August 2012

12-33 (pages A.2, C.1, D.2, E.2-E.7, E.9, E.18, E.22, E.29, E.34, E.41, E.43, E.45, G.6)

September 2012

13-34 (pages A.1-A.3, A.5, D.1-D.6, E.1- E.35, E.37-E.39, E.41-E.45, E.47-E.48, F.1-F.8, F.10-F.15, G.1-G.4, H.1-H.2, H.4, H.6-H.9, J.1- J.2

August 2013

*8/2013: Updated


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page A.3 Table of Contents

Page

Definitions and Acronyms ..................................................................................... B.1 Eligible Children ................................................................................................... C.1

Eligibility Requirements Verifying Eligibility Managed Care “Carve Out” Locating a District IEP Services Provider

Minnesota Health Care Programs (MHCP) Information IEP Services Providers ........................................................................................ D.1

Eligible Providers DHS IEP Services Contacts MHCP Provider Information IEP Services Provider Contact List MHCP Provider Call Center National Provider Identifier (NPI) MHCP Provider Enrollment Electronic Funds Transfer (EFT)

Covered IEP Services .......................................................................................... E.1 Physical Therapy Occupational Therapy Speech and Language Pathology and Audiology Mental Health Services

Children’s Therapeutic Services and Supports Nursing Services Personal Care Assistance Services Assistive Technology Devices Transportation Services Interpreter Services Spoken Language Interpreter Services Sign Language Interpreter Services Non-covered IEP Services Authorization *8/2013: Updated

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page A.4 Table of Contents - Continued

Page

Billing .................................................................................................................... F.1 Qualified Billers

Billing Agents and Consultants IEP Services Billing: Effects on Other Health Care Services Consent on MHCP Applications

Parent Notification, Release, Consent Third Party Liability (TPL) Timely Billing

Procedure Codes and Billing Information Submitting Claim Attachments

MN-ITS Voids (Take-backs) Rates and Payments ........................................................................................... G.1 Provider Tax

Assistive Technology Devices Rate Transportation Services Rate

PT, OT, Speech and Language Pathology and Audiology, Mental Health Services, Nursing Services, Personal Care Assistance, Interpreter Services Rates

Remittance Advice (RA) and Provider News Interim and Final Rates Reconciling Final Rates Medicaid Federal/Non-Federal Share/Administration Fee Forms:

IEP Rate Calculation Methodology IEP Services Annual Data Report Form

Record Keeping and Documentation ................................................................... H.1 HIPAA & FERPA – Health Insurance Portability Accountability Act of 1996 Family Educational Rights and Privacy Act

Treatment Goals/Care Plan (IEP/IFSP) Health Record Assistive Technology

Physical Therapy, Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health, Nursing, Interpreter Services

Personal Care Assistant Services Special Transportation

Service Time and Encounters Record Retention Forms: IEP/IFSP/IIIP Services Documentation Log Personal Care Assistant Activities Checklist Special Transportation Trip Log *5/2012: Updated

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page A.5 Table of Contents - Continued

Page

Audits .................................................................................................................... I.1 DHS IEP Services Web Page ............................................................................... J.1 Hot Topics Provider News Provider Updates Forms, Checklists, Logs, Reports, Documents and Resources IEP Enrollment Forms CTSS IEP PCA Training and Evaluation

Billing Information IEP Services Technical Assistance Guide Provider Manual MN-ITS View/Access Telephone Numbers and Contacts *8/2013: Updated

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page B.1 Definitions and Acronyms CPT Codes – Current Procedural Terminology (CPT) Codes; billing codes. Centers for Medicare and Medicaid Services (CMS) - U.S. Department of Health and Human Services agency responsible for the Medicare and Medicaid programs. Districts – Term used in this guide to refer to MN public independent districts, charter schools, tribal schools, state academies, intermediate districts, education districts, special education districts and service cooperatives. EDRS - Minnesota Department of Education’s Electronic Data Reporting System. Districts report salary cost data through this system and MDE provides the data to DHS for IEP services rates. Eligibility Verification System - (EVS) Online system providers use to verify eligibility information for children enrolled in Minnesota Health Care Programs (MHCP). Explanation of Benefits - (EOB) Document that lists health care benefit payments. HCPC - Health Care Common Procedure Coding System; billing codes. ICD codes – International Classification of Diseases codes; “diagnosis codes.” Individualized Education Program (IEP) - Written statement for a child with a disability that is developed, reviewed and revised in a meeting according to CFR 34 300.320 through 300.324 and that must include a statement of the special education and related services and supplementary aids and services to be provided. Individualized Education Program (IEP) Service – Program name for covered MHCP services provided to children through an IEP or IFSP. Individualized Family Service Plan (IFSP) - Written plan for providing early intervention services, as defined in 34 CFR Part 303 to an infant or toddler with a disability and the family that includes a statement of the specific early intervention services necessary to address the unique needs of the child and family. MN-ITS (“minutes”) - HIPAA-compliant Web-based billing system used to submit electronic MHCP health care claims and other transactions. Medicaid/Medical Assistance (MA) - Means tested benefit program that provides health care coverage and medical services to low-income children financed jointly by the state and federal governments and is administered by the states. Under broad federal rules, each state establishes a state Medicaid plan that outlines eligibility standards, provider requirements, payment methods and benefit packages tailored to the needs of its citizens. *5/2012: Districts; updated

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page B.2 Definitions and Acronyms – Continued Medicaid Management Information System (MMIS) - Minnesota’s statewide automated eligibility and Medicaid claims payment system. Medically Necessary or Medical Necessity - Health service that is consistent with the child’s diagnosis and condition and:

♦ is recognized as the prevailing standard or current practice by the provider’s peer group; and,

♦ is rendered in response to a life-threatening condition or pain; to treat an injury, illness, or infection; to treat a condition that could result in physical or mental disability; to care for a mother and child through the maternity period; to achieve a level of physical or mental function; or,

♦ is a preventive health service. MinnesotaCare - Subsidized health care program for Minnesota residents who do not have health insurance. The program is open to Minnesota residents who meet program guidelines. Minnesota Department of Education - MDE Minnesota Health Care Programs (MHCP) - Collective term used to refer to Minnesota’s medical assistance and MinnesotaCare programs. Modifiers - Two-character codes used in conjunction with the IEP services CPT codes (T1018 and T1013) to bill for services. Minnesota Department of Health - MDH Minnesota Department of Human Services – DHS Payment Error Rate Measurement (PERM) – Federal paid claims audit Provider - An individual, organization, or entity that has an agreement with Minnesota Health Care Programs (MHCP) to provide health services. Provider News – Messages formerly included on the Remittance Advice. Remittance Advice - Document issued to providers bi-weekly to report claim activity. Service Provider – In this guide, the term used to refer to persons who provide covered IEP services to eligible children: e.g., physical therapist, certified occupational therapy assistant, school nurse, etc. *5/2012: Updated

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page B.3 Definitions and Acronyms - Continued Surveillance and Integrity Review (SIRS) – DHS, Office of the Inspector General unit, responsible for identifying and investigating suspected fraud, theft and abuse; authorized to seek monetary recovery, impose administrative sanctions; and, authorized to seek civil or criminal action through the office of Attorney General (AG). Tax Equity and Fiscal Responsibility Act (TEFRA) - Program available to some disabled children, who ordinarily would not be eligible for MA, due to parent income. Applicants must be reviewed by the State Medical Review Team. A parental fee may apply. Third-Party Payer - Individual, entity, or program that may be liable to pay all or part of incurred health care costs, including private insurance companies and Medicare. UFARS – Minnesota Department of Education’s Uniform Financial Accounting and Reporting Standards system. Districts report transportation cost data and benefits data to this system. MDE provides data from this system to DHS for IEP services transportation rates and the benefits data for other IEP services rates. Waiver Services – Programs that have federal approval to expand coverage for items and services not usually covered under MA: ♦ Developmental Disabilities (DD) ♦ Community Alternative Care for Chronically Ill Individuals (CAC) ♦ Community Alternatives for Disabled Individuals (CADI) ♦ Traumatic Brain Injury Waiver (TBI) *5/2012: Updated

Individualized Education Program (IEP) Services September 2012 Technical Assistance Guide page C.1 Eligible Children Eligibility Requirements Children eligible for IEP services covered by MHCP:

♦ Are under the age of 21

Individuals age 21 or older are not eligible for children’s services including IEP

services beginning on the 21st birthday Claims submitted for covered IEP services for persons age 21 and older will

deny Individuals age 21 and older may still be eligible for adult services

♦ Have a current IEP or IFSP that includes the covered IEP services to be provided

♦ Are enrolled in one of these Medical Assistance or MinnesotaCare major programs:

MA Medical Assistance RM Refugee Medical Assistance LL MinnesotaCare MA

♦ Are eligible for MHCP on the date services are provided

♦ Have received a covered service on the date(s) billed

Verifying Eligibility Check eligibility for one child or multiple children using MN-ITS Interactive

♦ Bolded fields are required; Complete non-bolded fields as appropriate

♦ Eligibility Request for a Single Child Select “Eligibility Request” (270) from the MN-ITS Interactive menu Date of service auto-populates with the current date; date format is

MMDDCCYY. Verify eligibility for the previous 12 months; future eligibility cannot be verified

*9/2012: Minor wording

Individualized Education Program (IEP) Services February 2011 Technical Assistance Guide page C.2 Eligible Children – Continued Verifying Eligibility – Continued

Search for eligible children using one of the combinations (1-11) in chart below:

Combination Subscriber ID Birth Date SSN Last Name First Name 1 X X 2 X X X 3 X X X X 4 X X X 5 X X 6 X X X 7 X X 8 X X X 9 X X X X X 10 X X X 11 X X X

Click the Submit button on the left side of the screen to get an Eligibility

Response. The information on the Eligibility Response applicable to IEP services billing

appearing on the screen is:

* Major programs * Other health insurance (lists child’s private health care plans)

Ignore: Special transportation, in this reference, is not IEP related; Managed Care Organizations (MCO), prepaid medical assistance

plans; pharmacy and dental plans and waiver services.

♦ Eligibility Request for Multiple Children Request eligibility for up to 50 children in one transaction Select Eligibility Request (270) to reach the Single Eligibility Inquiry tab Select the Multiple Eligibility Inquiry tab at the top of the screen Date of service auto-populates with the current date. The appropriate date

format for this field is MNDDCCYY. Eligibility for the previous 12 months can be verified, but eligibility for future dates cannot be checked.

*1/2011: MCO

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page C.3 Eligible Children – Continued Verifying Eligibility - Continued

Search for eligible children using one of the combinations (1-11) in chart under

Eligibility Request for Single Child Click the Add button below the search fields to create the list of children for

eligibility verification (Response at the end of each child line means the 271 Response for each inquiry)

See response chart under Eligibility Request for Single Child Delete an entry by clicking the NPI on the line you want to remove and click

“Delete”

Repeat as needed for up to 50 children When list is complete, click the underlined Response in the first line to open the

271 Response; move to next using Previous or Next at the top of the page Understanding the Eligibility Response (271)

♦ Eligibility Response includes your NPI, date of service, subscriber number, birth date, age, and gender at the top of the page

Print or save information by clicking Print and Close buttons Move through the Multiple Eligibility responses using Previous and Next

buttons

Managed Care “Carve Out” Children eligible for MHCP may have their health care covered by a Managed Care

Organization (MCO) - a prepaid medical assistance plan. IEP services are “carved out,” not covered, by the MCO. IEP services are billed

directly to DHS.

*5/2012: Updated

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page C.4 Eligible Children – Continued Locating a District IEP Services Provider MHCP Provider Directory for Families

♦ DHS maintains a MHCP Provider Directory for families to locate providers in their

area. From **Select** drop down choose “Individual Education Plan/School District.” Type district “ISD #0000” in the name field or select the county from drop down in MN County field

♦ Check list periodically to assure district information is accurate ♦ Report inaccurate information or update information, complete and submit the

MHCP Provider Information Change Form

Minnesota Health Care Programs (MHCP) Information

Districts can help families find MHCP information, contact information for county and tribal offices, and providers, and, learn how to apply for Minnesota Health Care Programs (MHC) Minnesota Health Care Programs. ♦ The Minnesota Health Care Programs Application is available at: How to apply for

Minnesota Health Care Programs. ♦ Information about MN Health Care Programs (MHCP) and assistance with the

MHCP application are also available from: Minnesota Health Care Programs. Minnesota Health Care Programs: Call 1-800-657-3739 or (651) 431-2670;

TTY: MN Relay Services: 1-800-627-3529 or 711; Speech-to-speech relay: 1-877-627-3848.

County and tribal offices: Minnesota Tribal and County Health Care Directory. Minnesota Community Application Agent (MNCAA) organization: Minnesota

Community Application Agent Participants. MinnesotaCare at (651) 297-3862 or 1-800-657-3739; TTY: MN Relay Services

call: 1-800-657-3529 or 711. *5/2012: Updated

http://mhcpproviderdirectory.dhs.state.mn.us/

http://www.dhs.state.mn.us/dhs16_136855





http://edocs.dhs.state.mn.us/lfserver/Public/DHS-5475-ENG

http://edocs.dhs.state.mn.us/lfserver/Public/DHS-5475-ENG

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page D.1 IEP Services Providers Eligible Providers The following Minnesota districts and tribal schools can enroll as IEP services providers and bill for IEP covered services. Out-of-state schools and districts cannot enroll as MN IEP services providers.

♦ Charter schools ♦ Education districts ♦ Intermediate districts ♦ Public school districts ♦ Tribal schools (Schools that receive funding from the

Bureau of Indian Affairs-BIA) ♦ Service cooperatives ♦ Special education cooperatives ♦ State academies

Enrolled IEP services providers MUST bill covered IEP services as IEP services and are responsible for the non-federal share of Medicaid payments. IEP services provided to eligible children attending private schools are billed by and payments are made to public school districts that provide the covered IEP services. U.S. Code, Title 25, Chapter 22, Section 2010 (h) allows tribal schools that receive funds from the Bureau of Indian Affairs (BIA) to use the BIA funds to match other federal funds. This means that tribal schools that receive BIA funds can use those funds as the non-federal match for federal Medicaid funds. DHS IEP Services Contacts

♦ Jesusa Williams, IEP Services Rates, (651) 431-2538 [email protected] ♦ Jenny M. Roth, Provider Relations-IEP Services Trainer, (651) 431-2675

[email protected] ♦ TEFRA (Tax Equity Fairness and Responsibility Act) Parental Fees (651) 431-2670

or 1-800-657-3729 ♦ Provider Call Center: (651) 431-2700; 1-800-366-5411

Provider Information MHCP provider information: www.dhs.state.mn.us/provider

IEP provider information: www.dhs.state.mn.us/provider/iep

*8/2013: Updated

mailto:[email protected]

mailto:[email protected]

http://www.dhs.state.mn.us/provider


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page D.2 IEP Services Providers – Continued IEP Provider Contact List

DHS uses this list to distribute IEP updates and other important information to districts

and to contact districts and billing agencies. To assure receipt of information, keep district contact information updated using the format below.

District Contact Information: District Name and Number: NPI: Address: Telephone: Fax:

Superintendent/Administrator’s Name: e-mail address: Telephone: address if different from the one above:

Special Education Director’s Name: e-mail address: Telephone: address if different from the one above:

Third Party Billing Coordinator’s Name: e-mail address: Telephone: address if different from the one above:

Billing agency (if your district uses national billing agency or state/local billing agency): Name of agency: Agency contact: e-mail address: Address: Telephone: Billing software provider (if your district uses a software to submit claims; no billing agent): Name of provider: Contact: e-mail address: Address: Telephone: Other Billing Information (if another district or person submits claims on your district’s behalf) Name of district/person: Contact: e-mail address: Telephone:

*8/2013: IEP Provider List contact

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page D.3 IEP Services Providers – Continued MHCP Provider Call Center

Available Monday-Friday from 8:00 a.m.-12:00 noon and 12:45 p.m. - 4:15 p.m. Answers to billing, payment and enrollment questions

MN-ITS Users: Review online Troubleshooting Guide

Provider Call Center: (651) 431-2700; 1-800-366-5411

♦ Press 7 to verify a child’s eligibility ♦ Press 9 for MHCP phone numbers, addresses, websites and general information ♦ Press 1 to reach the MHCP Provider Call Center

Press 1 to enter an NPI

Press 2 to enter an UMPI starting with an A Press 3 to enter an UMPI starting with an M (If you enter an invalid NPI/UMPI or do not have an NPI/UMPI, select Option 3 for IEP Services

♦ Press 5 for Provider Enrollment

♦ Press 6 for questions about MN-ITS Registration, MN-ITS Administrator or

Password resets National Provider Identifier (NPI) Obtain an NPI to enroll as MHCP providers

♦ NPI: federally assigned ten-digit number used to bill Medicaid and all other health

care plans

♦ Use the NPI to submit claims, for eligibility requests, calls to the Provider Call Center, and on the MHCP Provider Application, Provider Agreement and other required documents

*8/2013: Updated Call Center information

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_027918

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page D.4 IEP Services Providers – Continued National Provider Identifier (NPI) - Continued

♦ Apply for an NPI from the National Plan and Provider Enumeration System (NPPES)

From the IEP Web page, select “Billing Information;” select National Provider

and Payer Enumeration System (NPPES) and follow the instructions to apply for an NPI

Enter your district’s legal business name (LBN) and the correct Employer

Identification Number (EIN) on the application (information must match that on the Internal Revenue Service (IRS) or the NPI number could be deactivated)

Keep NPPES record updated Choose taxonomy code: LEA Submit the NPI to DHS via MN-ITS Check to be sure DHS received your NPI number (On the NPI/UMPI list, find

the NPI under the letter “I” for ISD and the 4-digit Independent School District number (ex., ISD # 0123)

MHCP Provider Enrollment To bill covered IEP services, districts must enroll as MHCP IEP services providers. For covered IEP Services, employees and contractors do not enroll separately.

♦ Complete the following forms:

Application and Instructions for IEP, Independent School Districts (ISD), Regional Cooperatives, and Charter Schools (DHS 4215)

MHCP Provider Agreement, (DHS 4138)

Disclosure of Ownership and Control Interest (DHS 5259)

MHCP Data Privacy Notice (DHS 6287)

Enrollment forms are also available by mail. Call (651) 431-2700; 1-800-

366-5411to request forms

♦ Providers are responsible for all terms and conditions in the Provider Agreement

*8/2013: Reorganized

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4215-ENG





Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page D.5 IEP Services Providers - Continued MHCP Provider Enrollment – Continued

♦ Disclosure of Ownership and Control Interest of an Entity (DHS 5259) must be

completed for “managers” that work with the special education program and fit the definition on page 5 of the form. Social Security numbers must be provided for these individuals.

♦ Complete and fax all documents to (651) 431-7462. Keep all addresses and contact information updated.

Review Provider Agreement, sign, and date (Person authorized to sign the

agreement assures the terms and conditions are followed). Complete the “Managing Employee” section for general managers, business

managers, administrators, directors, or others who exercise operational or managerial control over or who directly or indirectly conduct the day-to-day operations.

Enter residential addresses and social security numbers for individuals listed.

Enter main business location for business address (not U.S. Postal Service PO Boxes and private company mailbox (e.g. Mailboxes, Etc.) addresses).

Districts are notified of active status in writing.

♦ Tribal schools that receive funding from the Bureau of Indian Affairs (BIA) must also complete and sign the “Provider Agreement Addendum IEP/Tribal” and return with the application. US Code, title 25, Chapter 22, Section 2010 (h) allows tribal schools to use BIA funds as matching funds for federal Medicaid funds.

♦ Changing enrollment information: Use the Organization – MHCP Provider Profile Change Form (DHS-3535A). Only changes submitted on this form are accepted. Report district closings, and changes to district name, number and contact

information to Provider Enrollment immediately.

Report closed districts and acting fiscal agents for closed to the DHS IEP Services Coordinator immediately.

*8/2013: Disclosure of ownership and control; changing enrollment information

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-3535A-ENG

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-3535A-ENG

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page D.6 IEP Services Providers – Continued MHCP Provider Enrollment – Continued

♦ Consolidating and un-consolidating districts When consolidating districts, it may be necessary to obtain a new NPI, new tax

ID number and new FEIN or it may be possible to use one district’s. The decision is up to the districts involved and may be dictated by the process.

Whether consolidating or un-consolidating, report the names and contact

information for the districts involved and any new names and contact information. Also report the acting fiscal agents for un-consolidated districts. Report this information to the DHS IEP Services Coordinator.

♦ MHCP Provider Enrollment Renewal Required: IEP services providers are

required to renew enrollment annually. Notification is sent via the PRVLTR folder in the MN-ITS mailbox when enrollment renewal is due. MHCP mails the renewal packet through the United States Postal Service (USPS). Follow instructions to complete and return the documents within the time period noted in the cover letter. If the documents are not returned within the required time period, DHS is required to terminate enrollment effective 60 days after the date of the letter.

Electronic Funds Transfer (EFT) IEP Services Providers must have a vendor number from the Minnesota Management

& Budget (MMB) Department to receive MHCP payments. MHCP uses EFT to pay providers for services.

♦ Go to MMB Vendor Payment Website

♦ Register for a vendor number and EFT online ♦ When the vendor number and EFT activation notification arrives from MMB, fax a

completed, signed EFT Vendor Number Notification (DHS-3725) form to MHCP Provider Enrollment (651) 431-7462

♦ MHCP will update your provider record with the vendor number within 30 days of

receiving form #3725 ♦ To change banking information to an existing vendor number, use MMB’s EFT

bank change form (PDF). *8/2013: Consolidating/”un-consolidating” districts; EFT; enrollment renewal

http://supplier.swift.state.mn.us/


http://www.mmb.state.mn.us/doc/maps/eft/eft-standard.pdf

http://www.mmb.state.mn.us/doc/maps/eft/eft-standard.pdf

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.1 Covered IEP Services IEP services MUST be included on an IEP/IFSP. Services provided during extended school year (ESY) must be indicated on the IEP/IFSP for covered IEP services to be billed to MHCP. Services eligible for payment must meet all of the following criteria Medically necessary Provided to an eligible MA or MinnesotaCare enrollee under the age of 21 Included in the child’s individualized service plan (IEP, IFSP) Health related services necessary for the child to benefit from his/her education Provided by qualified service providers within the service provider’s scope of practice

and/or licensure/certification Documented in the child’s record Authorized by the child’s IEP/IFSP team Provided during the school day

Districts may qualify to provide and bill for other MHCP services when all requirements for the covered services are met. However, billing for other MHCP covered services may affect a child’s health care limits, thresholds and benefit caps, may require authorization and may require copayments. Refer to the MHCP Provider Manual for information regarding other covered services and requirements, http://www.dhs.state.mn.us/provider/manual. *8/2013: Minor formatting and wording

http://www.dhs.state.mn.us/provider/manual

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.2 Covered IEP Services – Continued Physical Therapy Individual, group and specialized maintenance therapy provided by a physical

therapist or physical therapy assistant under the direction of a physical therapist.

Direction means the actions of a physical therapist who instructs the physical therapy assistant in specific duties to be performed, monitors the provision of services as the physical therapy assistant provides the service, provides on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session of each recipient when treatment is provided by a physical therapist assistant, and meets the other supervisory requirements of MS 148.6432 and MR 9505.0390. Document supervision and direction.

Specialized Maintenance Therapy provided by a physical therapist or physical

therapy assistant, is specified in the child’s IEP/IFSP and is necessary for maintaining a child’s functional status at a level consistent with the child’s physical or mental limitations. Specialized maintenance therapy must meet one of the following: prevent deterioration and sustain function; provide interventions that enable the child to live at his/her highest level of independence (in the case of chronic or progressive disability); or, provide treatment interventions for children who are progressing, but not at a rate comparable to expectations of restorative care.

Telemedicine: Physical therapists may use telemedicine to deliver certain covered

face-to-face therapy services that can be appropriately delivered via telemedicine. Services delivered via this method must meet all other IEP service requirements.

Telemedicine is a service delivery method provided via electronic communication using interactive telecommunications equipment including, at a minimum, audio and video equipment permitting two-way, real-time, interactive communication between the child and a provider who delivers services from a distant site. Services delivered via telemedicine must be medically necessary and appropriate to this delivery method and the child must be able to benefit from this delivery method.

IEP evaluations under physical therapy are provided by a physical therapist, are

health related, and result in an IEP/IFSP with covered IEP services or determine the need for continued services. Pre-IEP evaluations that result in an IEP/IFSP, ongoing assessments to determine progress/need for changes in services and re-evaluations are included. Activities included are: administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered).

*8/2013: Direction; IEP Evaluations

https://www.revisor.mn.gov/statutes/?id=148.6432

https://www.revisor.mn.gov/rules/?id=9505.0390

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.3 Covered IEP Services – Continued Physical Therapy – continued Qualified personnel

♦ Physical Therapist – A person who is licensed by the State Board of Physical

Therapy and meets the requirements in MS 148.65-148.78.

♦ Physical Therapy Assistant - (PTA) A person who is licensed by the State Board of Physical Therapy, who is under the direction and supervision of a physical therapist and meets the requirements in MS 148.65-148.78.

Non-covered services – see partial list at the end of this section.

Coordinate services with other service providers who serve the same children when appropriate.

*8/2013: Qualifications

https://www.revisor.mn.gov/statutes/?id=148l


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.4 Covered IEP Services – Continued Occupational Therapy Individual, group and specialized maintenance therapy provided by an occupational

therapist or occupational therapy assistant under the direction of an occupational therapist.

Direction means the actions of an occupational therapist who instructs the occupational therapy assistant in specific duties to be performed, monitors the provision of services as the therapy assistant provides the service, provides on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session of each recipient when treatment is provided by an occupational therapy assistant, and meets the other supervisory requirements of MS 148.6432 and MR 9505.0390. Document supervision and direction.

Specialized Maintenance Therapy provided by an occupational therapist or

occupational therapy assistant and that is specified in the child’s IEP/IFSP and is necessary for maintaining a child’s functional status at a level consistent with the child’s physical or mental limitations. Specialized maintenance therapy must meet one of the following: prevent deterioration and sustain function; provide interventions that enable the child to live at his/her highest level of independence (in the case of chronic or progressive disability); or, provide treatment interventions for children who are progressing, but not at a rate comparable to expectations of restorative care.

Telemedicine: Occupational therapists may use telemedicine to deliver certain

covered face-to-face therapy services that can be appropriately delivered via telemedicine. Services delivered via this method must meet all other IEP service requirements.


IEP evaluations under occupational therapy are provided by an occupational

therapist are health related, and result in an IEP/IFSP with covered IEP services or determine the need for continued services. Pre-IEP evaluations that result in an IEP/IFSP, ongoing assessments to determine progress/need for changes in services and re-evaluations are included. Activities included are: administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered).

*8/2013: Direction; IEP evaluations




Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.5 Covered IEP Services – Continued Occupational Therapy – continued

Qualified personnel

♦ Occupational Therapist – A person who meets the qualifications in MS 148.6401-

148.6450 and is licensed by the MN Department of Health.

♦ Occupational Therapy Assistant (OTA) – A person who meets the qualifications for an occupational therapy assistant under MS 148.6401-148.6450 and is licensed by the MN Department of Health.


Coordinate services with other service providers who serve the same children when appropriate. *8/2013: OT & OTA qualifications

https://www.revisor.mn.gov/statutes/?id=148



Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.6 Covered IEP Services – Continued Speech-Language Pathology and Audiology Services Individual and group speech and language pathology services provided by a speech

and language pathologist, educational speech or language pathologist who meet the requirements in Minnesota Statutes, section 256B.0625, subd. 26. or clinical fellowship licensee.

Audiology services provided by an audiologist.

Specialized Maintenance Therapy provided by a speech-language pathologist and that is specified in the child’s IEP/IFSP and is necessary for maintaining a child’s functional status at a level consistent with the child’s physical or mental limitations. Specialized maintenance therapy must meet one of the following: prevent deterioration and sustain function; provide interventions that enable the child to live at his/her highest level of independence (in the case of chronic or progressive disability); or, provide treatment interventions for children who are progressing, but not at a rate comparable to expectations of restorative care.

Telemedicine: Speech and language pathologists may use telemedicine to deliver

certain covered face-to-face therapy services that can be appropriately delivered via telemedicine. Services delivered via this method must meet all other IEP service requirements.


IEP evaluations under speech and audiology services are provided by a speech and language pathologist, audiologist, or educational speech and language pathologist who meet the requirements in Minnesota Statutes, section 256B.0625, subd. 26, or clinical fellowship licensee. These evaluations are health related, and result in an IEP/IFSP with covered IEP services or determine the need for continued services. Pre-IEP evaluations that result in an IEP/IFSP, ongoing assessments to determine progress/need for changes in services and re-evaluations are included. Activities included are: administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered).

*8/2013: IEP Evaluations

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.7 Covered IEP Services - Continued Speech and Language Pathology and Audiology – continued

Qualified personnel

♦ Audiologist – A person who has a master’s degree or doctoral degree and meets

the requirements under MS 148.511-148.5198 and is licensed by the MN Department of Health..

♦ (Educational) Speech and Language Pathologist who meets the requirements in

MS 256B.0625, subd. 26 - Holds a master’s degree in speech-language pathology, is licensed by the Minnesota Board of Teaching as an educational speech-language pathologist and either has a Certificate of Clinical Competence (CCC) from the American Speech and Hearing Association or has completed the equivalent educational requirements and work experience necessary for the certificate or is completing a supervised clinical fellowship.

♦ Clinical Fellowship Licensee– A person who has a master’s degree and is

completing a supervised clinical fellowship in speech-language pathology or audiology according to the requirement in MS148.511-148.5196. This is a time limited program.

♦ Speech and Language Pathologist – A person who has a master’s degree or

doctoral degree in speech-language pathology, meets the requirements in MS 148.511-148.5198 and is licensed by the MN Department of Health.


Coordinate services with other service providers who serve the same children when appropriate. *8/2013: Qualifications


https://www.revisor.mn.gov/statutes/?id=256B.0625




Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.8 Covered IEP Services - Continued Mental Health Services NOT covered under Children’s Therapeutic Services and Supports (CTSS) or as IEP Services Psychological testing and Diagnostic Assessments - See MHCP Manual Mental

Health Services for more information

♦ The licensed psychologist or mental health professional must enroll separately as an MHCP provider in order to bill for psychological testing and diagnostic assessments services.

♦ These services cannot be billed under CTSS services or IEP services; the services must be billed according to directions in the MHCP Provider Manual Mental Health Services.

♦ Psychological testing provided by a licensed psychologist with competence in

psychological testing as reported to the Board of Psychology. Psychological tests and other psychometric instruments are used to determine the status of the child’s mental, intellectual, and emotional functioning. DHS does not publish or maintain a list of covered tests, refer to Buros’ Mental Measurement Yearbook, most recent edition.

♦ A diagnostic assessment (DA) is a written evaluation, provided by a mental health

professional or clinical trainee working under the direction of a mental health professional, used to determine a child’s eligibility for mental health services. A DA includes:

an evaluation of the child’s current life situation reason for the assessment the child’s needs based on the child’s baseline measurements, symptoms,

behavior, skills, abilities, resources, vulnerabilities and safety needs a CD screen; assessment methods and use of standardized assessment

tools; the clinical summary, recommendations and prioritization of needed mental health, ancillary or other services

a five axes diagnosis.

MN Rule 9505.0370-9505.0372 requires a written assessment that documents a clinical and functional face-to-face evaluation of the client’s mental health including the nature, severity, impact of behavioral difficulties, functional impairment, and subjective distress of the client, and identifies strengths and resources.

*8/2013: DA requirements





Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.9 Covered IEP Services – Continued Mental Health Services - continued NOT covered under Children’s Therapeutic Services and Supports (CTSS) or as IEP Services

A diagnostic assessment (DA) must have been completed within one year before beginning CTSS services. CTSS services cannot begin or continue without a current DA.

For children under age 18 to continue to receive CTSS services, obtain a new

DA annually.

For children 18-20 years to continue to receive CTSS services, update the DA annually unless child’s condition has changed significantly. If significant changes are noted, a new DA is required.

♦ Diagnostic Assessments billing requirements: There are three types of DAs and six

sets of billing codes using modifiers added to CPT codes 90801 and 90802. The types of DAs are: brief, standard, and extended. See MHCP Manual Mental Health Services for billing requirements. DAs cannot be billed under IEP services.

NOT covered under Children’s Therapeutic Services and Supports (CTSS); COVERED as IEP Services

IEP Evaluations - IEP evaluations are not covered under CTSS

♦ Option 1: Declare the intent to only bill for IEP evaluations on page 1 of the School

District CTSS Application, DHS-4982 – CTSS School Primary Certification Application Form, and submit page 1 to DHS before IEP evaluations can be billed. See the chart in this section and the Billing Section of this guide for additional information about Option 1 and billing for IEP evaluations.

♦ Options 2 or 3: Can also bill for covered IEP evaluations using T1018 U4 (NO HE

modifier). Reimbursement for IEP mental health evaluations is limited to 4 evaluations per year.

*8/2013: DA requirements; IEP evaluations limit



http://edocs.dhs.state.mn.us/lfserver/public/DHS-4982-ENG


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.10 Covered IEP Services – Continued Mental Health Services – continued

♦ IEP evaluations covered under mental health services are provided by a mental health professional or school psychologist, are health related, and result in an IEP/IFSP with covered IEP services or determine the need for continued services. Pre-IEP evaluations that result in an IEP/IFSP, ongoing assessments to determine progress/need for changes in services and re-evaluations are included. Activities included are: administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered. DHS does not publish or maintain a list of covered tests, refer to Buros’ Mental Measurement Yearbook, most recent edition for covered assessments.

IEP evaluations are billed under the same NPI number as other IEP services.

Service providers DO NOT enroll separately. IEP evaluations are billed only if the evaluation results in the child receiving services or continuing to receive services.

Concerns about mental illness or emotional disturbance should be referred to a

mental health professional for mental health diagnostic assessment and treatment.

Children’s Therapeutic Services and Supports (CTSS)

♦ CTSS Application Process

Districts must be certified Children’s Therapeutic Supports and Services (CTSS) providers to bill for covered CTSS services under Options 2 and 3. Option 1 does not require CTSS certification.

Districts can submit required documents for Option 1 and begin billing while

awaiting CTSS certification for Options 2 and 3. Choosing an option does not lock in that option permanently. Districts can apply for

a different option at any time.

BEFORE beginning the CTSS application process, review all of the documents below, all of the information in this section and, for option 3, MHCP Manual Mental Health Services.

*8/2013: DA requirement



Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.11 Covered IEP Services – Continued Mental Health Services Children’s Therapeutic Services and Supports (CTSS) – continued

Application - DHS-4982 – CTSS School Primary Certification Application Form

Application Guide - DHS-4982A – CTSS School Primary Certification Guide – Policies and Procedures

Overview - DHS-4982B – CTSS Overview for Schools and School Districts

Cooperatives and education districts Number of CTSS applications depends on the Annual Special Education

Application submitted to MDE. Billing and reimbursement for CTSS services provided to children with services included on an IEP/IFSP must be consistent with EDRS reporting.

Beginning July 1, 2012, data reported to DHS and MDE must be by providing

district. ♦ CTSS Services To begin CTSS services, both a DA and Individual Treatment Plan (ITP) must

be in place.

To continue services, obtained a new DA annually for each child under age 18 and update the DA annually for each child age 18 through 20 unless child’s condition has changed significantly; significant changes require a new DA.

A diagnostic assessment (DA) that meets the medical assistance definition

must have been completed within one year of initiating services.

Option 1 Option 2 Option 3* CTSS certification: Not required; complete only page 1 of the School District CTSS Application and submit to DHS. No approval required.

CTSS certification: Required; complete the portions of the School District CTSS Application relating to Option 2, submit and receive DHS approval before providing services.

CTSS certification: Required; complete the portions of the School District CTSS Application relating to Option 3 submit and receive DHS approval before providing services.

*8/2013: Therapeutic Preschool; MHBA; reorganized


http://edocs.dhs.state.mn.us/lfserver/public/DHS-4982A-ENG

http://edocs.dhs.state.mn.us/lfserver/public/DHS-4982A-ENG

http://edocs.dhs.state.mn.us/lfserver/Public/DHS-4982B-ENG


Option 1 Option 2 Option 3* Services: IEP Evaluations only – Not a covered CTSS; must declare a choice for Option 1 on the CTSS application.

Services: Skills training, crisis assistance, psychotherapy, MHBA services, day treatment.* Not required to assure all CTSS core services. IEP evaluations

Services: Skills training, crisis assistance, psychotherapy, MHBA services, day treatment.* Must assure availability of all CTSS core services. IEP evaluations

*Day treatment must be available year round; Option 3 providers must have all CTSS services available year round. Mental health professional must be on site more than 50% of the time. Coordination: Not required

Coordination: Must coordinate CTSS services with a Children’s Mental Health (CMH) or Family Service Collaborative (FSC)*

Coordination: IEP/IFSP: must coordinate services with a CMHC or FSC.* No IEP/IFSP: coordinate services with other Mental Health providers.

*For a child receiving services from a Community Mental Health Center, Family Service Center, more than one agency, or who could benefit from multi-agency coordination, with parent consent, there must be a multi-agency plan of care that includes the IEP/IFSP. The person responsible for implementing the multi-agency plan of care must be involved in developing the IEP/IFSP. Eligible children: Enrolled in MA or MinnesotaCare; Evaluation results in IEP /IFSP or continued IEP/IFSP services

Eligible children: Enrolled in MA or MinnesotaCare; Have an IEP/IFSP with CTSS services; meet criteria for ED, SED or SPMI; and, have lost or failed to develop age appropriate skills.

Eligible children: Enrolled in MA/MinnesotaCare; IEP/IFSP has CTSS services; meet criteria for ED, SED, MI, or SPMI; and, have lost or failed to develop age appropriate skills. Enrolled in MA/MinnesotaCare; no IEP/IFSP meet criteria for ED, SED, MI, or SPMI; and, have lost or failed to develop age appropriate skills

Diagnostic Assessment: Not required

Diagnostic Assessment: Required See definition in this section.

Diagnostic Assessment: Required See definition in this section.

*8/2013: Therapeutic Preschool; DA requirements; reorganized

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.13 Covered IEP Services – Continued Mental Health Services Children’s Therapeutic Services and Supports (CTSS) - continued

Option 1 Option 2 Option 3* Eligible providers: Information in IEP TA Guide; districts enrolled as IEP services providers.

Eligible providers: Information in IEP TA Guide; districts enrolled as IEP services providers.

Eligible providers: Children with an IEP/IFSP: use IEP TA Guide; districts enrolled as IEP services providers for children with an IEP/IFSP. Children with no IEP/IFSP: follow instructions in MHCP Manual Mental Health Services; mental health professional enrolls separately.

Documentation: Follow instructions in IEP TA Guide.

Documentation: Follow instructions in IEP TA Guide.

Documentation: IEP/IFSP: follow instructions in IEP TA Guide. No IEP/ IFSP: follow instructions in MHCP Manual-Chapter 16

Authorization: IEP team authorizes services; no prior authorization required.

Authorization: IEP team authorizes services; no prior authorization required.

Authorization: IEP/IFSP: IEP team authorizes services; no prior authorization required. No IEP/IFSP: follow MHCP Manual – Chapter 16.

Individual Treatment Plan (ITP) - Not required

Individual Treatment Plan (ITP) – An ITP must be developed by a mental health professional or mental health practitioner and reviewed and approved by a mental health professional; must be in place before services begin.

Individual Treatment Plan (ITP) – An ITP must be developed by a mental health professional or mental health practitioner reviewed and approved by a mental health professional; must be in place before services begin.

*8/2013: ITP; minor wording; reorganized




Option 1 Option 2 Option 3* Outcome Measures: Not required

Outcome Measures:** Effective July 1, 2009, standardized outcome measures must be used to track progress. Complete the Child & Adolescent Service Intensity Instrument (CASII)* or the Early Childhood Service Intensity Instrument (ECSII)* and the Strengths & Difficulties Questionnaire (SDQ) for children receiving CTSS.

Outcome Measures:** Effective July 1, 2009, standardized outcome measures must be used to track progress. Complete the Child & Adolescent Service Intensity Instrument (CASII)* or the Early Childhood Service Intensity Instrument (ECSII)* and the Strengths & Difficulties Questionnaire (SDQ) for children receiving CTSS.

*Option 3 providers must coordinate services and record the ECSII, SDQ or CASII scores in MN-ITS for children who do not have an IEP and are not already working with a community mental health provider. **Use the outcome measures for intake, periodic review and discharge planning for all children receiving services under Option 2 or 3. Individual Behavior Plan (IBP) – Not required

Individual Behavior Plan (IBP) – Required for MHBA services; developed by a mental health professional or practitioner and approved by the mental health professional.

Individual Behavior Plan (IBP) - Required for MHBA services; developed by a mental health professional or practitioner and approved by the mental health professional.

Clinical Supervision: Not required

Clinical Supervision: Mental Health Practitioner and MHBA work under the clinical supervision of the mental health professional

Clinical Supervision Mental Health Practitioner and MHBA work under the clinical supervision of the mental health professional

Direction of MHBA: Not required

Direction of MHBA: MHBAs work under the direction of the mental health professional or practitioner who is under the clinical supervision of the mental health professional. See definitions in this section.

Direction of MHBA: MHBAs work under the direction of the mental health professional or practitioner who is under the clinical supervision of the mental health professional. See definitions in this section.

*8/2013: IEP evaluations; reorganized

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.15 Covered IEP Services – Continued Mental Health Services Children’s Therapeutic Services and Supports (CTSS) - continued

Option 1 Option 2 Option 3 Billing: Use T1018, U4 – IEP evaluations; limit 4 per year

Billing: Use T1018, U4 & HE to bill for CTSS services Use T1018, U4 to bill for IEP evaluations; limit 4 per year

Billing: IEP/IFSP: use T1018, U4 & HE to bill for CTSS services; use T1018; U4 to bill for IEP evaluations; limit 4 per year No IEP/IFSP: use appropriate codes & modifiers-MHCP Manual

Rates: Individual district IEP rate for mental health services.

Rates: Individual district IEP rate for mental health services.

Rates: IEP/IFSP: individual district IEP rate for mental health services No IEP/IFSP: rates vary by code

Third Party Liability: instructions in IEP TA Guide

Third Party Liability: instructions in this guide

Third Party Liability: IEP/IFSP: instructions in this guide.

No IEP/IFSP services: see MHCP Manual Mental Health Services

PMAP – Managed Care: IEP services are carved out of managed care; bill DHS directly.

Managed Care: IEP CTSS services are carved out of managed care; bill DHS directly.

Managed Care: IEP/IFSP: CTSS services are carved out of managed care; bill DHS directly.

No IEP/IFSP: enroll with and bill managed care organization.

♦ Definitions Day treatment is a structured mental health program consisting of group

psychotherapy and other intensive therapeutic services (such as skills training) provided by a multidisciplinary team. The goal of day treatment is to reduce or relieve the effects of emotional disturbance or mental illness based on the child’s individual needs. This program must be available all 12 months of the year and a mental health professional must be on site and available more than 50% of the time.

*8/2013: IEP evaluations limit; minor wording; reorganized


Emotional Disturbance (ED) is an organic disorder of the brain or a clinically

significant disorder of thought, mood, perception, orientation, memory, or behavior that is listed in the clinical manual of the International Classification of Diseases (ICD-9 CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the corresponding code in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III; and seriously limits a child’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, school, and recreation. “Emotional disturbance” is a general term and is intended to reflect all categories of disorder described in the DSM-MD, current edition as “usually first evident in childhood or adolescence.”

Severe Emotional Disturbance (SED): The child has an emotional disturbance

and meets one of the following criteria: has been admitted to inpatient treatment/residential treatment or has been at risk of being admitted, within the last three years; is a MN resident and is receiving inpatient treatment or residential treatment for an emotional disturbance through an interstate compact; a mental health professional has determined the child has one of the following- psychosis or clinical depression, risk of harming self or others as a result of emotional disturbance, or, psychopathological symptoms as a result of being a victim of physical/sexual abuse or psychic trauma within the past year. A mental health professional has determined the child has a significantly impaired home, school or community functioning lasting at least one year or presents a risk of lasting at least one year as a result of emotional disturbance.

Mental Illness is an organic disorder of the brain or a clinically significant

disorder of thought, mood, perception, orientation, memory or behavior that is listed in the ICD-9 CM, code range 290.0-302.99 or 306.0-316.0.

*8/2013: Therapeutic preschool removed; reorganized


Serious and Persistent Mental Illness (SPMI): The child (at least 18, but under

age 21), has a diagnosis of mental illness and meets at least one of the following criteria: the child has undergone two or more episodes of inpatient care for mental illness within the preceding 24 months; has experienced a continuous psychiatric hospitalization or residential treatment exceeding six months in duration within the preceding 12 months; has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline personality disorder, evidences a significant impairment in functioning, and has a written opinion from a mental health professional stating that he/she is likely to have future episodes requiring inpatient or residential treatment, unless community support program services are provided; or has, in the last three years, been committed by a court as a mentally ill person under Minnesota statutes, or the commitment as a mentally ill person has been stayed or continued; or the child was eligible under one of the above criteria, but the specified time period has expired or the child was eligible as a child with severe emotional disturbance; and has a written opinion from a mental health professional, in the last three years, stating that he/she is reasonably likely to have future episodes requiring inpatient or residential treatment, of a frequency described in the above criteria, unless ongoing case management or community support services are provided.

♦ Telemedicine - CTSS services covered by medical assistance as direct face-to-face services may be provided via telemedicine. Services must be medically appropriate to the condition and needs of the child being served and must meet all IEP service requirements for CTSS services.

Telemedicine is a service delivery method provided via electronic communication using interactive telecommunications equipment including, at a minimum, audio and video equipment permitting two-way, real-time, interactive communication between the child and a provider who delivers services from a distant site. Services delivered via telemedicine must be medically necessary and appropriate to this delivery method and the child must be able to benefit from this delivery method. Telemedicine may be appropriate for psychotherapy, some skills training, or crisis assistance. MHBA services cannot be provided via telemedicine.

*8/2013: Minor wording; reorganized


♦ Individual and group psychotherapy

Psychotherapy is a planned and structured face-to-face treatment of a diagnosed mental illness through the psychological, psychiatric, or interpersonal method most appropriate to the child’s needs as identified by the current diagnostic assessment. Psychotherapy is directed toward change in an underlying mental health condition or disorder; designed to reduce the symptoms of a disorder and ameliorate the effect of symptoms on the child’s functioning; and, provided to the child with diagnosable mental health issues and diagnosed according to current community mental health standards. It is directed to goals and measurable objectives specified in the child’s Individual Treatment Plan (ITP). Psychotherapy is provided by a clinical nurse specialist in mental health, licensed independent clinical social worker, licensed marriage and family therapist, licensed psychologist, licensed professional clinical counselor, psychiatric nurse practitioner, or psychiatrist. Individual and group psychotherapy cannot be provided concurrently with interactive individual or interactive group psychotherapy.

Individual psychotherapy (including interactive individual psychotherapy),

hypnotherapy (conducted by a mental health professional trained in hypnotherapy) and biofeedback training.

Family psychotherapy for the child and one or more family member/s whose

participation is necessary to accomplish the child’s treatment goals. Family members may be related by blood, marriage, or adoption or may be foster parents, primary caregivers or significant others.

Multiple family group psychotherapy designed for at least three, but no more

than five families, regardless of family members’ MCHP eligibility status or the number of family members who participate in the family session.

Group psychotherapy, including interactive group psychotherapy provided by a mental health professional and 3-8 children or two mental health professionals and 9-12 children who because of the nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from interaction in a group setting. This is why a class of students is not a group.

*8/2013: Group size; minor wording; reorganized


Group psychotherapy for crisis intervention is designed for a child to experience

acute social, interpersonal, or environmental stress that threatens the child’s current level of adjustment or causes significant subjective distress.

Interactive psychotherapy uses distinct diagnostic and medical psychotherapeutic procedures aided by physical aids and nonverbal communication to overcome barriers to the therapeutic interaction between the physician and child who: ♦ Lost or has not yet developed the expressive language communication skills

to explain his/her symptoms and response to treatment, or

♦ Does not possess the receptive communication skills to understand the mental health professional if he/she were to use ordinary language for communication.

♦ Skills Training

A child eligible for skills training must meet the criteria for emotional

disturbance, SED, or SPMI, one component of which is a diagnosis of mental illness as determined by the annual diagnostic assessment completed by a mental health professional.

Skills Training is provided by a mental health professional or mental health

practitioner who is under the clinical supervision of a mental health professional.

Unlike a thought, feeling or perception, a skill is observable by others. It is an activity that must be practiced in order to be mastered and maintained. There are right ways and wrong ways to perform the skill. Typically, a skill is performed for a reason and a skill can be generalized and adapted to many different situations.

SkillsTraining is designed to help the child develop psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate, developmental trajectory that has been disrupted by a psychiatric illness. Skills training may also be delivered to help the child self-monitor, compensate for, cope with, counteract, or replace skill deficits or maladaptive skills acquired during the course of a psychiatric illness.

*8/2013: Eligible child; reorganized


● Skills training is subject to the following requirements:

child must always be present during the skills training; however, a brief

absence of no more than ten percent of the session is allowed to instruct family members;

training delivered to the child or family is targeted to the specific deficits

or mal-adaptations of the child’s mental health disorder and must be prescribed in the child’s individual treatment plan;

training delivered to the child’s family must teach skills needed to

enhance the child’s skill development and to help the child use the skills and develop or maintain a home environment that supports the child’s ongoing use of the skills;

group skills training may be provided to multiple participants who, because of the nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from interaction in a group setting: one professional or practitioner with a group of 4-8 participants; two professionals or practitioners or one professional and one practitioner with a group of 9-12 participants. This is why a classroom or class of students is not a group.

♦ Crisis Assistance

Crisis assistance is for the child, child’s family, and all of the child’s service

providers.

Crisis assistance recognizes factors precipitating a mental health crisis; identifies behaviors related to the crisis; and, provides information about resources to resolve the crisis.

A crisis plan is intense, time-limited, and designed to resolve or stabilize a crisis through arrangements for direct intervention and support services to the child and family.

*8/2013: Group size; reorganized


The crisis plan must utilize resources designed to address abrupt or substantial

changes in the child and family’s functioning as evidenced by a sudden change in behavior with negative consequences for well-being, loss of usual coping mechanisms, or presentation of danger to self or others.

A crisis plan is developed by a mental health professional or mental health

practitioner when reviewed and approved by a mental health professional. The plan is implemented in a crisis situation and addresses prevention and intervention strategies that include: arranging admission to acute care hospital inpatient treatment; crisis placement; community resources for follow-up and emotional support to the family during crisis.

♦ Mental Health Behavioral Aide (MHBA) Services

Mental Health Behavior Aide services must be medically necessary treatment

services identified in the child’s IEP/IFSP, individual treatment plan and individual behavior plan.

MHBA services are designed to provide medically necessary services to improve the child’s functioning in the progressive use of developmentally appropriate psychosocial skills. Activities include working directly with the child, child-peer groupings, or child-family groupings to practice, repeat, reintroduce and master the skills as previously taught by a mental health professional or mental health practitioner.

MHBA services are provided by a mental health behavioral aide who meets

all qualifications, training and orientation requirements for an MHBA and who is under the direction of a mental health professional or mental health practitioner who is under the clinical supervision of a mental health professional.

MHBA services are provided one-on-one to an eligible child in an appropriate setting or in a peer or family group. The MHBA practices with the child skills taught to the child by the mental health professional or mental health practitioner. The MHBA does not change or teach the child new skills or practice skills that are not previously taught by the mental health professional or mental health practitioner. The MHBA does not write the Individual Behavior Plan (IBP) but rather carries out the plan that has been developed by the mental health professional or mental health practitioner. The MHBA takes issues that arise in a practice session to the mental health professional or mental health practitioner for resolution.

*8/2013: Reorganized; minor change


MHBA activities:

● providing cues or prompts in one-on-one, peer-to-peer or parent-child skill

building interactions so that the child progressively recognizes and responds to the cues independently

● performing as a practice partner or role-play partner

● reinforcing the child’s accomplishments

● generalizing skill-building activities in the child’s multiple natural settings;

● assigning activities for the child to practice; and,

● intervening as necessary to redirect the child’s target behavior ● intervening to prevent behavior that puts the child or other persons at risk

from escalating

MHBA Responsibilities:

• implement services and treatment strategies in the IEP/IFSP, individual treatment plan and individual behavior plan;

● document activities and services provided including the child’s responses to

the treatment strategies, the number of times an activity is practiced and the number of successes and/or the reasons why the session was unsuccessful;

● demonstrate family friendly behaviors that support healthy collaboration

among child, child’s family and providers as services are planned and implemented;

● communicate effectively with the child, child’s family, mental health

practitioner and mental health professional; and,

● complete all required pre-service training and continuing education requirements.



An Individual Behavior Plan (IBP), in addition to the IEP/IFSP, is required to

provide specific service delivery instructions to the MHBA. It outlines the MHBA’s responsibilities in assisting the child to achieve treatment outcomes. Mental health professionals must approve the services in the IBP before the services are provided by the MHBA. The IBP must include: detailed instructions on the services provided; time allocated for each service; methods of documenting the child’s behavior; methods of monitoring the child’s progress in reaching objectives; and goals to increase or decrease targeted behaviors. The IBP is related to reinforcing the goals and objectives of the Individual Treatment Plan (ITP), based on the Diagnostic Assessment, and should specify the services to be provided by the MHBA to help reduce a child's symptoms and increase function. An IBP is not a behavior management plan.

Direction of MHBA services

• Direction of MHBA services is provided by a mental health professional or a mental health practitioner who is under the clinical supervision of the mental health professional.

• Direction of the MHBA means assuring that services are provided in a

manner determined necessary and appropriate by the mental health professional or practitioner. Direction should provide a balance of initial coaching (for those MHBAs who lack skills and experience) and a minimum amount of intrusion in the therapeutic process. Direction of mental health behavioral aides includes:

ongoing on-site observation by a mental health professional or mental

health practitioner for at least one total hour every forty hours of service provided to a child; and

immediate accessibility to the mental health professional or practitioner during services provision.

• Mental health professionals and practitioners must review progress notes prepared by the MHBA for accuracy and consistency with diagnostic assessment, treatment plan and behavior goals.



Progress notes must: be approved and signed by mental health professionals or practitioners; identify changes in treatment strategies; revise the individual behavior plan and communicate treatment

instructions and methodologies as appropriate to ensure that treatment is implemented correctly;

demonstrate family friendly behaviors that support healthy collaboration among child, child's family and providers as treatment is planned and implemented;

ensure that mental health behavioral aides are able to effectively communicate with the child, child's family and the provider; and,

record the results of any evaluation and corrective actions taken to modify the work of mental health behavioral aides.

♦ Qualified personnel - Licensed Mental Health Professional

● Licensed Psychologist (LP) - Licensed under MS 148.88 to 148.98, stated

competencies to the Board of Psychology in the diagnosis and treatment of mental illness.

• Licensed Independent Clinical Social Worker (LICSW) – Licensed as an

independent clinical social worker, under MS 148E.001-148E.290.

• Clinical Nurse Specialist (CNS) – Registered nurse licensed by the MN Board of Nursing under MS 148.171-148.285 and certified as a clinical nurse specialist in psychiatric or mental health nursing.

• Psychiatric Nurse Practitioner (NP) – Advanced practice nurse licensed to

practice in accordance with the Minnesota Board of Nursing as a registered nurse licensed under MS 148.171– 48.285 and certified as a nurse practitioner in family psychiatric or mental health nursing by a national nurse certification organization.

• Psychiatrist - Physician licensed under MS chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible for board certification in psychiatry.

*8/2013: Qualifications


https://www.revisor.mn.gov/statutes/?id=148E





♦ Qualified personnel – Licensed - continued

• Licensed Marriage and Family Therapist (LMFT) - Licensed under MS

148B.29 to 148B.39 with at least two years of post-master’s experience, under clinical supervision, in the delivery of psychiatric/mental health services to children with emotional disturbances.

• Licensed Professional Clinical Counselor (LPCC) – Licensed under MS

148B.5301 including at least 4,000 hours of postmaster’s supervised experience in the delivery of clinical services in the treatment of mental health disorders or emotional disturbance.

♦ Qualified Personnel – Unlicensed

Unlicensed personnel – mental health practitioners and mental health behavior aids must complete twenty hours of continuing education every two calendar years. Topics covered included in Minnesota Rules, part 9535.4068, subd. 2. Unlicensed personnel must be under the clinical supervision of a mental health professional. Clinical supervision is the process of control and direction of mental health services by which a mental health professional accepts responsibility for the supervisee’s actions and decisions, instructs, oversees and directs the supervisee in their work. The clinical supervisor accepts full professional responsibility and provides on-site observation as clinically appropriate. On-site observations must be at least one hour in length, documented in the child’s record, and signed by the mental health professional. In addition, the mental health professional must document the child’s progress every 30 days. Clinical supervision may also be provided via a live, secure, electronic site (e.g. ITV).

Mental Health Practitioner – Delivers mental health services under the clinical

supervision of a mental health professional and meets at least one of the qualifications listed below. • School Psychologist - Licensed by the Board of Teaching. • Licensed Graduate Social Worker (LGSW) - Licensed by the Board of Social

Work under MS 148E.001-148E.290.

*8/2013: Unlicensed personnel; reorganized

http://www.revisor.leg.state.mn.us/stats/148B/

http://www.revisor.leg.state.mn.us/stats/148B/

https://www.revisor.mn.gov/statutes/?id=148B

https://www.revisor.mn.gov/statutes/?id=148B



♦ Qualified Personnel – Unlicensed

• Licensed Independent Social Worker (LISW) - Licensed by the Board of

Social Work under MS 148E.001-148E.290. • Holds a bachelor’s degree in one of the behavioral sciences or related fields

from an accredited college or university and has 2,000 hours of supervised clinical experience in the delivery of clinical services in the treatment of mental illness to children with emotional disturbances.

• Has completed 6,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness.

• Is enrolled as a graduate student in one of the behavioral sciences or

related fields and is formally assigned to the center for clinical training by an accredited college or university; or,

• Holds a master’s or other graduate degree in one of the behavioral sciences

or related fields from an accredited college or university.

Mental Health Behavioral Aide (MHBA): Paraprofessional, who is not the legal guardian or foster parent of the child, working to implement mental health services identified in a child’s IEP/IFSP, individual treatment plan, and individual behavior plan. The MHBA must be under the direction of a mental health professional or mental health practitioner who is under the clinical supervision of a mental health professional. The mental health professional or practitioner must be employed by a CTSS certified agency or district. • Level I MHBA must: be at least 18 years of age; have a high school

diploma, general equivalency diploma (GED) or, within the last ten years, two years of experience as a primary caregiver for a child with severe emotional disturbance and meet orientation and training requirements.

• Orientation and training requirements for MHBA must be documented in the personnel record.

*8/2013: Unlicensed personnel; reorganized



• Thirty hours of pre-service training required.

Fifteen hours of face-to-face training in mental health services delivery

on the following training topics: MN data privacy law; MN Comprehensive Children’s Mental Health Act; diagnostic classifications of emotional disturbance; uses and potential side effects of psychotropic medications in children; core values and principles of the Child Adolescent Service System Program; coordination between the public education and the mental health systems; culturally appropriate services; and, services to children with developmental disabilities or other special needs.

Eight hours of parent team training on the following topics: partnering with parents; fundamentals of family support; fundamentals of policy and decision-making; defining equal partnerships; complexities of parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses; sibling impacts; support networks; and community resources.

• Level II MHBA must: be at least 18 years of age; have an associate or bachelor’s degree or 4,000 hours of experience in delivering clinical services in the treatment of mental illness for children or adolescents; and meet the orientation, training requirements, pre-service, and continuing education requirements listed above a Level 1 MHBA.

♦ Non-covered services – see partial list at the end of this section.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.28 Covered IEP Services – Continued Nursing Services Face-to-face nursing care - provided by an LPN, RN, PHN, or LSN within nurse’s

scope of practice. Examples of nursing care include: catheterization, tube feeding, suctioning, ventilator care, nursing assessment and diagnostic testing such as glucose testing, vital signs, health counseling (except in-depth nutritional counseling normally performed by a licensed dietician and structured diabetic education programs), activities of daily living when the IEP indicates a one-on-one nurse is required at school and complex medication administration. Complex medication administration is a service that requires the skill of a nurse and is administered rectally or through an IV, injection, nebulizer, or gastrostomy tube.

Simple medication administration is the administration of prescription medications by a licensed nurse who is employed by or under contract with a district. To be a covered service, simple medication administration must be related to a child’s disability and identified in the child’s IEP/IFSP for treatment of the identified disability.

Medication management provided by an RN, PHN, or LSN that includes a review of a child’s current medications and adherence to the prescribed medication regimen (including a review/knowledge of all medications taken; frequency and dosage) and one or more of the following as appropriate: ♦ Nurse evaluation for adverse reactions to medications (could include: nursing

assessment/review health status, identification of health hazards and actual/potential health needs, evaluation of health behavior, physical, emotional, and psychological health and standardized diagnostic tests performed by reagent strips, and vital signs),

♦ Educate the child about his/her medication, and proper medication administration (could include: teaching child about his/her medication, possible side effects and reactions, need for compliance), and

♦ Contacts with the physician about prescriptions, tolerance or adherence to the medication regimen.

*8/2013: Minor change

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.29 Covered IEP Services – Continued Nursing Services IEP evaluations under nursing services are provided by an RN, PHN, or LSN, are

health related, and result in an IEP/IFSP with covered IEP services or determine the need for continued services. Pre-IEP evaluations that result in an IEP/IFSP, ongoing assessments to determine progress/need for changes in services and re-evaluations are included. Activities included are: administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered). (Note: Per MDE, an RN does not meet MDE criteria to complete an IEP evaluation to determine eligibility for special education purposes.)

Qualified Personnel ♦ Licensed Practical Nurse - (LPN) Person who has a current Minnesota Board of

Nursing license.

♦ Registered Nurse - (RN) Person who has a current Minnesota Board of Nursing license.

♦ Public Health Nurse - (PHN) Person who has a current Minnesota Board of Nursing license and is certified in public health nursing by Minnesota Department of Health.

♦ Licensed school nurse - (LSN) Person who has a current Minnesota Board of Nursing and Board of Teaching license.


*8/2013: IEP evaluations

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.30 Covered IEP Services - Continued Personal Care Assistant (PCA) Services

♦ Qualified Providers PCA services are provided by a person who is employed as a PCA or paraprofessional to provide PCA services or has a contract with the district to provide PCA services, meets the qualifications listed in this section and is supervised by a qualified professional.

♦ Qualifying for PCA services

♦ Child must be dependent in at least one activity of daily living (ADL) (see

definitions in this section) or a Level 1 behavior (definition below). If the child is not dependent in at least one ADL or does not have a level 1 behavior, he/she does not qualify to receive covered PCA services.

Dependent means the child requires assistance to begin and complete the

activity of daily living. Level 1 behavior is physical aggression towards self or others or destruction of

property that requires the immediate response of another person:

Self-injurious behavior - causes injury to one’s own body; examples: hitting, biting, head-banging, burning, poking or stabbing, ingesting foreign substances or objects, pulling out hair, and suicide threats.

Physical injury to others - causes physical injury or has the potential for causing physical injury to other people; examples: hitting, biting, pinching, scratching, kicking, stabbing, and pulling out hair.

Destruction of property - causes damage or has the potential to cause damage to things; examples: breaking desks or chairs, tearing clothes, setting fires, and using tools or objects to damage property.

♦ Once a child qualifies for covered PCA services, if appropriate and medically

necessary, the child may receive other covered IEP PCA services.

♦ IEP PCA services are provided to a child who does not have the ability, because of his/her medical diagnosis or condition, to manage the activities him/herself.

♦ IEP PCA services cannot be provided in a child’s home. If the child needs PCA

services at home, the child’s family can make arrangements with a home care PCA provider.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.31 Covered IEP Services - Continued Personal Care Assistant (PCA) Services - continued

♦ IEP PCA services are provided only on scheduled school days during regular school hours (not on weekends, school breaks, holidays, for before or after school activities, or overnight activities).

♦ Service Documentation - Use the DHS checklist in the Record Keeping section of

this guide (already approved) or an alternative checklist approved by DHS. The PCA checklist is used to document daily services provided. See additional information under Record Keeping and Documentation.

♦ Time Documentation - Only time actually providing covered PCA services may be recorded. No time spent monitoring a child who is in seclusion or time-out or time spent restraining a child may be recorded.

♦ Care Plan – For IEP services, the care plan is a detailed written description of the

actual services delivered to an individual child that is included on the PCA checklist or attached to it.

♦ PCA Responsibilities – Communicate effectively with the child (speak the child’s

language, sign, etc); communicate with the qualified professional (report changes in child’s condition to; contact with questions or concerns); provide services according to care plan; respond appropriately to the child’s needs; maintain daily documentation.

Covered services

♦ Activities of daily living (ADL's): The following services and supports furnished to an

individual, as needed, to assist in accomplishing activities of daily living including health and hygiene activities integral to the activity (e.g., cleaning up spills, laundering soiled clothing, and cleaning up toileting accidents): Eating: assistance with hand washing, applying required orthotics, transfers,

food preparation, and feeding.

*8/2013: PCP communication


Toileting: assistance with helping a child with bowel or bladder elimination and

care including diapering, transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting clothing.

Grooming: assistance with personal hygiene including basic hair care, oral care,

shaving, applying cosmetics and deodorant, and the care of eyeglasses and hearing aids (hearing aid checks are not covered). Nail care is included except for children who are diabetic or have poor circulation.

Dressing: assistance with choosing, applying or changing clothing for the child, applying special appliances (orthotics and prosthetics) or clothing (TED hose).

Bathing: assistance with basic personal hygiene and skin care for bathing or

showering including transfers and positioning, using soap, rinsing, drying, skin inspections, and applying lotion.

Transferring: assistance with moving a child from one seating/reclining area to

another (including, standing by to assist if needed, pivoting the person, two person assists and using a Hoyer lift).

Mobility: assistance with ambulation including using a wheelchair and assisting

a person with ambulation. Mobility does not include providing transportation.

Positioning: assistance with positioning or turning a child for necessary care and comfort including relieving pressure areas, positioning using pillows, wedges or bolsters and repositioning him/her in a wheelchair, bed, chair or sofa.

♦ Health related procedures and tasks, including those listed below, that do not

require the skill of a nurse, are supervised by an RN, PHN, or LSN and can be assigned, under state law, to be performed by a PCA when the following are present:

Procedures and tasks meet the definition of health-related procedures and tasks. A qualified professional nurse trains and supervises the PCA. PCA demonstrates competency to safely complete the procedures and tasks.

PCAs cannot complete sterile procedures or give injections.



Health-related tasks include:

• Assistance with self-administered medications, e.g., remind the child to take

the medication, hand the child the medication, assist the child with opening the medication, and/or assure the child has taken the medication. PCAs do not administer or dispense medication.

• Interventions for seizure disorders including monitoring and observation, while the child is having a seizure. Continuous observation and monitoring when the child is not having a seizure is not covered.

• Tracheostomy suctioning and ventilator care - clean not sterile procedures.

• Range of motion to maintain a child’s strength and muscle functioning.

• PCAs must be trained on the individual needs of the child.

• PCAs must be trained about on the use and maintenance of equipment used in tracheostomy suctioning and ventilator care.

Intervene for and redirect behavior that is medically necessary, related to the

child’s disability and fits into one of the categories below.

• Increased vulnerability due to cognitive deficits or socially inappropriate behavior;

• Resisting care and verbal aggression that cause care to take longer than

normally expected;

• Physical aggression towards self or others or destruction of property:

Self-injurious behavior-causes injury to one’s own body (ex: hitting, biting, head-banging, burning, ingesting foreign substances or objects, pulling out hair, and suicide threats).

Physical injury to others - causes physical injury or has the potential for causing physical injury to other people (ex: hitting, biting, pinching, scratching, kicking, pulling hair).


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.34 Covered IEP Services - Continued Personal Care Assistant (PCA) Services – continued

• Destruction of property -causes damage or has the potential to cause damage to things (ex: breaking desks or chairs, tearing clothes, setting fires, and using tools or objects to damage property).

• Intervene for and redirect episodes where there is a need for redirection due

to observed behaviors.

• PCAs must receive training on behavior intervention techniques based on the needs of the child, the care plan, and other available support services.

Qualified personnel

♦ Personal Care Assistant (PCA): Individual who is at least 18 years old and has

completed the required DHS Individual PCA Training. The PCA must: Be employed by the district as a PCA or paraprofessional or be under contract

with an agency that has a PCA service agreement with the district. Be supervised by a qualified professional as required. IEP must designate that

supervision will be by a qualified professional. Complete all required training before providing services.

♦ Required training - Districts are responsible for assuring that PCAs complete all required training prior to providing services.

All PCAs and substitute PCAs must receive all required training and supervision

for services to be billed. Complete the DHS Individual PCA Training before providing services, Individual

Personal Care Assistant (PCA) Training; take the test; print and give a copy of the certificate to the district. The link to the certificate is on the “Congratulations, you passed” page.

Complete training and orientation on the specific needs of the child and the

initial supervision of PCA within 14 days of services beginning for the child. Training includes behavior intervention techniques, proper transfer techniques,

positioning, applying orthotics, etc. This training is provided by the qualified professional.

*8/2013: PCA training; reorganized

http://registrations.dhs.state.mn.us/videoConf/Default.aspx?BusinessUnitID=16



Training of tracheostomy suctioning and services for a child on a ventilator provided by a nurse, respiratory therapist or physician is required. Training must include: proper procedures; necessary tasks; caring for and using equipment; and child’s specific needs. The procedures must be clean, not sterile. Supervision by a licensed nurse is required.

Supervision ♦ Provided within the Qualified Professional’s (QP) scope of practice and as

designated in the IEP; not provided by phone or consulting with third parties; based on the regular school calendar; can be documented separately.

♦ Qualified Professional (QP) – PCA supervision is provided by a licensed RN,

PHN, LSN, mental health professional, physical therapist, occupational therapist, speech-language pathologist, audiologist, physician, social worker or qualified developmental disabilities specialist.

♦ Qualified Developmental Disabilities Specialist- individual with a four year degree in

related field and one year work experience with individuals with developmental disabilities; individual with a two year degree in related field and two year’s work experience with individuals with developmental disabilities; or an individual with a community-based developmental disability services diploma and two year’s work experience with individuals with developmental disabilities. Related fields: human services, sociology, counseling, speech communication, gerontology, human development, anthropology, special education, rehabilitation counseling.

♦ Qualified Professional (QP) responsibilities:

Supervise PCAs and assure competency to provide the services in care plans.

Record any actions taken to correct deficiencies in the PCA’s work, results of evaluations and revision of care plans as necessary.

Develop and monitor the care plan; train and evaluate individual PCA’s;

evaluate effectiveness of services; review documentation.

Provide ongoing monitoring and supervision through direct training, demonstrations, observation, and consultations.

*8/2013: Hyperlink

https://www.revisor.mn.gov/statutes/?id=245B.02

Individualized Education Program (IEP) Services August 2012 Technical Assistance Guide page E.36 Covered IEP Services - Continued Personal Care Assistant (PCA) Services – continued

Appropriately assign tasks;

Ensure through direct observation or consultation that the PCA providing the

service: is capable of providing services; is knowledgeable about the care plan, changes to the plan, essential needs and activities to be provided; understands to notify the QP about concerns and changes to the child’s condition or behavior; and, keeps written documentation as required.

Provide supervision within 14 days of starting to provide regularly scheduled

services or sooner as determined by the qualified professional, every 90 days for the first year and every 120 days after the first year for the same PCA and child. Provide additional supervision as appropriate.

Additional training and evaluations may be conducted based on the child’s

needs and the PCAs ability to meet those needs.

♦ Non-covered services – see partial list at the end of this section. *8/2012: Supervision

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.37 Covered IEP Services - Continued Assistive technology Covered devices

♦ Communication devices for children with severe expressive communication

disorders Must be medically necessary Dedicated to transmitting or producing messages or symbols in a manner that

compensates for a child’s disability or impairment, e.g., communication picture books, communication charts and board

Mechanical/electronic devices, including the hardware and software necessary for the device

♦ Hearing amplification devices – e.g., FM systems ♦ Mobility devices – e.g., wheelchairs, walkers ♦ Positioning devices – e.g., standing boards

Equipment purchased with any Medicaid funds belong to the child.

Covered when:

♦ Medically necessary, the child has a condition that requires use of the device.

♦ Identified in the IEP/IFSP, including the reason the child needs the device.

Description of the child’s need for the device includes information about why the child needs the device (medical need, condition that requires the device). It is not necessary to identify the specific device by model name or number. Example: “Suzie needs a stander at school because she needs weight-bearing time several times a day.”

♦ Appropriate assessments to determine needs have been completed and are included with the attachment when submitting claims.

♦ Rented, repaired or purchased for an eligible child who receives services provided under an IEP or IFSP.

♦ Delivered to the child before billed.

*8/2013: Assessments

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.38 Covered IEP Services - Continued Assistive technology

♦ Used only by the child for whom the device is purchased or rented.

♦ Used as needed in the school, home and community. Under some circumstances MHCP may cover two of the same device (one for school and one for home). For example, devices such as standing boards that cannot be easily transported.

♦ Used by one child, not for a program.

♦ Submitted on electronic claims through MN-ITS with Attachment Control Number (ACN) with faxed attachment. Follow directions for submitting claims and attachments in the Billing section.

Non-covered devices – see partial list at the end of this section.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.39 Covered IEP Services - Continued Special Transportation

“Station-to-station” IEP special transportation includes getting the child to and from the

vehicle, waiting for the vehicle with the child and transporting the child. Covered when

♦ Child is transported to or from school on a day when another covered IEP service

is provided; to or from an off-site covered IEP service; or, to or from a medical appointment (e.g. doctor or therapy appointment) that occurs during the regular school day.

♦ Station-to-station IEP special transportation is covered only when the child has a physical or mental impairment (physiological disorder, physical condition or mental disorder) that prevents him or her from safely accessing and using common carrier transportation.

Common carrier is non-district owned or contracted vehicles including buses, taxis, commercial carriers and private vehicles.

♦ Child requires a special adaptation to the bus such as a wheelchair lift, special

harness, safety vest or special car seat (not a regular car seat or seat belt).

♦ The child requires the assistance of paraprofessional, nurse or PCA with him/her while being transported. Services of bus supervisors and monitors are not covered services. One paraprofessional may assist three children, if appropriate and reasonable

(e.g., one paraprofessional may sit between two small children who have an autism spectrum disorder and who are not able to access special transportation without the paraprofessional sitting with them).

♦ The reason the child needs IEP special transportation must be included on the IEP/IFSP, (e.g., Johnny uses a wheelchair and needs a bus with a wheelchair lift to get to and from school).

Provider Qualifications

♦ Provided by the district in a district owned vehicle or by a contracted school

transportation agency. Vehicles must meet inspection requirements. *8/2013: Minor wording

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page E.40 Covered IEP Services - Continued Special Transportation - continued

Additional information

♦ When special transportation is provided to another covered IEP service, the other

service does not have to be billed; however, the other service must meet IEP service requirements and be documented as required. Listing a service in an IEP/IFSP does not meet documentation requirements.

♦ When special transportation is provided to a medical appointment, the name of the

facility and the location must be documented on the trip log. ♦ IEP special transportation is considered non-medical transportation. ♦ Non-covered services – see partial list at the end of this section.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.41 Covered IEP Services – Continued Interpreter Services

Interpreter services are not covered when provided in conjunction with transportation or personal care assistance services or by a family member, friend or minor child.

Spoken Language Interpreter Services

♦ Effective February 1, 2011, Spoken Language Interpreters must be actively enrolled in the MDH Spoken Language Health Care Interpreter Roster. Districts are responsible for verifying that interpreters are enrolled in the roster. The enrollment fee is $50.00. Applications are available on the MDH website. Services provided by interpreters who are not enrolled in the roster are not covered. Inclusion in the roster is not evidence that the person is “certified” as an interpreter.

♦ Spoken Language Interpreter Services accurate and quality services, covered

when: Provided to a child, with limited English proficiency, in conjunction with another

covered IEP service when the child, service provider and interpreter are present.

Provided to a parent with limited English proficiency in order to obtain and relay information regarding the child during a covered IEP service or evaluation when both the child and parent are present.

Provided in person or by telephone or teleconference.

♦ Competent interpreters

Demonstrate proficiency in both English and the targeted language and have fundamental knowledge of relevant specialized heath terms and concepts in both languages;

Use appropriate interpreting mode given the situation (e.g., consecutive,

simultaneous, or summarizing, or sight translation- reading to oral translation of a document);

Understand their role without deviating into other roles, such as counselor or

legal advisor and are sensitive to the child’s culture; and,

Have appropriate training including instruction in the interpreting skills and ethics and confidentiality and data privacy rules.


http://www.health.state.mn.us/interpreters

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.42 IEP Services - Continued Covered IEP Services Sign Language Interpreter Services

♦ Sign Language Interpreter Services are covered when provided by a competent

sign language interpreter during the course of providing a direct, person-to-person, covered health care service.

♦ Sign Language Interpreter Services are covered when provided to a deaf child,

who communicates by signing, in conjunction with another covered IEP service when the child, service provider and interpreter are present. SLIS is not covered when provided in conjunction with transportation.

♦ Sign Language Interpreter Services are covered when provided to a parent who

communicates by signing, in order to obtain and relay information regarding the child during a covered IEP service or evaluation of a child when the child, parent, service provider and interpreter are present at the evaluation or service.

♦ Sign Language Interpreter Services must be an accurate and quality service

provided by a qualified interpreter. DHS encourages the use of certified sign language interpreters.

♦ Sign Language Interpreter Services may be provided by remote video. ♦ Qualified interpreters

Demonstrate proficiency in signing; Understand the role as an interpreter without deviating into other roles, such as

counselor or legal advisor and are sensitive to the child’s culture Have appropriate training including instruction in interpreting skills and ethics

and confidentiality and data privacy rules Lists of sign language interpreters are available from:

www.interpreterreferral.org; and the Registry of Interpreters for the Deaf which lists agencies and interpreters by zip code and city: www.rid.org.

♦ Non-covered services – see partial list at the end of this section.


http://www.interpreterreferral.org/

http://www.rid.org/

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.43 Non-covered Services The following is a list of some activities and services that are not covered; this is not a complete list. General Activities including: attending staff meetings; supervising staff; developing instructional

and treatment plans or materials; consulting and meeting with parents, teachers and other staff; documenting services; and, billing activities.

IEP activities including: planning, developing or writing the IEP/IFSP, meetings, consultations, and communications except communication with a parent as covered under interpreter services when the child and parent are both present.

Services which are not face-to-face services provided to the child, except as covered under IEP evaluations, communications by telephone with a parent as covered under interpreter services and interactions with the child’s family as covered under CTSS services.

Services which are not medically necessary.

Services which are not included on the child’s IEP/IFSP.

Services provided by service providers who do not meet MHCP qualifications to provide the service.

Services provided for before or after school programs or activities, for example: sports activities, clubs, class projects, tutoring, music lessons or child care.

Supervision or direction and services provided without the required supervision or direction.

Classroom instruction, educational services or teaching activities.

Educational evaluations and assessments and educational components of IEP

evaluations. Communications between the service provider and child which are not face-to-face. Observation or consultation except as specifically included under covered mental

health services, nursing services and PCA services. *8/2013: Minor wording

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.44

Non-covered IEP Services - Continued General – continued Case management and service coordination.

Art, music, recreation therapy, including adaptive physical education.

Parent or staff training. Services provided through 504 plans. Services provided by teachers.

Services provided by parents, stepparents, foster parents or adult siblings (except as

allowed under mental health services). Classroom, school, or kitchen supplies and modifications to school buildings.

Therapy Therapy provided by a student, a PCA, speech therapy assistant or others who do not

meet the medical assistance requirements to provide therapy. Mental health services

Mental health behavior aide (MHBA) services provided by a person who is not employed to provide MHBA services and who does not meet the qualifications to be a MHBA.

Nursing Medical care such as illness and injury care, health education (examples: first aid

classes, chemical abuse classes), and nursing services provided to all children (examples: vision/hearing screening).

Administering medications for the treatment of acute episodic illnesses such as ear-

infections. Nursing services that require the skill of a nurse and simple and complex medication

administration, provided by anyone other than a licensed nurse. Services that require the skill of a nurse are not covered when delegated to someone who is not a nurse.

Supplies including, bandages, gauze, gloves, cotton balls, cotton swabs, masks, etc.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.45 Non-covered IEP Services – Continued Personal Care Assistance Services

Care that requires the skill of a trained nurse or other trained medical professional,

e.g., re-inserting g-tubes; giving injections; administering medication; nurse assessments.

Services provided by drivers of vehicles used to transport eligible children. Services provided in the child’s home; homemaker services, babysitting or child care.

Services provided to a child for before and after school activities including sports,

clubs, class projects, tutoring, music lessons and child care. Services provided by parents, stepparents, paid legal guardians, or foster parents.

Services provided by substitutes who do not receive required training and supervision.

Activities that teach anything, including teaching a child to grocery shop, manage

finances, get around in the community by taking buses. Monitoring and assisting the child to perform assigned “jobs” at school, job training or

coaching or vocational services. Restraining a child, applying restraints or monitoring a child who is placed in isolation

or time-out. Monitoring juvenile offenders to prevent harm to others or inappropriate behavior.

Assisting with school assignments and class activities or redirecting, cueing and

intervening to help a child stay on task to complete school assignments, projects or activities.

Hearing aid checks.

Chasing or continuous monitoring to prevent a child from running away.

Instrumental Activities of Daily Living (IADL) are not covered for children.

Assistive technology devices/equipment Electronic devices that are not dedicated communication devices, repairing and cleaning

these devices, printers, evacuation chairs, changing tables, office equipment, tape recorders, video recorders, telephone answering machines, telephones, alert systems, motorized lifts, modifications to vehicles and schools, medical response systems, exercise equipment, toys and instructional materials.


Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page E.46 Non-covered IEP Services – Continued Facilitated communication. Services of an assistive technology specialist.

Modifications, construction, programming or adaptations of communication systems.

Used equipment, warranties, extended warranties, service agreements, shipping and

handling charges.

AT devices billed with place of service “home.”

Environmental control devices such as switches, control boxes, or battery interrupters.

Speech-generating devices used for education purposes. Any equipment used only for education purposes, or purchased for the school.

Transportation

Transportation for children who do not require a special adaptation to the vehicle (such

as a special seat, wheelchair lift, or harness) or an aide. Transportation provided by parents, stepparents, foster parents, family members, and

neighbors. Transportation to or from home and school on a day when no other covered IEP

service is provided. Transportation by ambulance or another MA covered transportation provider. Adaptations to vehicles.

Transportation services billed with place of service “home.”

Interpreter services Interpreter services for scheduling appointments, meetings with a parent, and

translating printed materials.

Interpreter services provided by a parent, relative, friend or child.

Interpreter services provided to a person other than a child in conjunction with another covered IEP service (except as covered for a parent in conjunction with a covered IEP evaluation or service when the child is also present).

Interpreter services provided in conjunction with transportation or PCA services.

*5/2012: AT devices

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.47 Covered IEP Services – Continued Authorization The IEP team authorizes services included in an IEP/IFSP. A physician’s signature on

or approval of the IEP/IFSP is not required in order for the district to bill for IEP services.

Prior authorization for services included on an IEP/IFSP is not required. Prior authorization means the approval of services provided and is, for some MA services, a condition of payment.

For CTSS services, a mental health professional must develop the treatment program or review and approve the treatment program developed by a mental health practitioner.

Orders are required each school year or when a child’s plan is modified for all nursing

services that require a physician’s order or prescription under the nurse’s scope of practice. ♦ Must describe the actual services needed at school. For example, orders cannot

say, “Nursing services that otherwise required an order.”

♦ Must be signed and dated by physician, nurse practitioner or physician assistant.

♦ Must have a date span of no more than one year. If there is no date span or the date span extends beyond one year, the orders are effective for one year from the date of the signature.

♦ Must be in place before services are billed.

The following services are ordered by practitioners of the healing arts under their

scopes of practice (physical therapist, occupational therapist, nurse, speech-language pathologist, audiologist, mental health professional, mental health practitioner under the clinical supervision of a mental health professional):

♦ physical and occupational therapy and speech-language pathology and audiology

♦ nursing services that do not otherwise require orders or prescriptions

♦ mental health services

♦ assistive technology devices

*8/2013: PCP communication

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page E.48 Covered IEP Services – Continued Authorization – continued

The following services are access services and do not require orders:

♦ transportation

♦ interpreter services


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.1 Billing Qualified Billers Qualified IEP services billers:

♦ Minnesota districts, cooperatives, intermediate districts, education districts, tribal

schools, state academies and charter schools enrolled as MHCP providers. Districts that bill for covered IEP services MUST bill the services as IEP services.

♦ Billing agents that contract with districts to bill for covered IEP services and that are enrolled with DHS as a billing agent

Private schools are not directly reimbursed for covered IEP services. IEP services

provided to children who attend private schools are billed by and payments are made to the public school district that provides the IEP services.

Billing agents and consultants MN Rule on the use of Billing Agents allows a provider to bill MHCP through a billing

agent or business agent only if the agent’s compensation is: ♦ Related to the cost of processing the billing;

♦ Not related on a percentage (or other basis) to the amount that is billed or

collected; and

♦ Not dependent on collection of the payment.

♦ The name and address of the billing agent must be listed on the provider enrollment application or submitted to the DHS Provider Enrollment Unit in writing, if hired after enrollment (include: provider name, ID number, office address and billing agent’s name and address).

♦ Provider enrollment address: Minnesota Department of Human Services Provider Enrollment

PO Box 64987 St. Paul, MN 55164-0987

♦ For additional information, see Billing Organizations/Responsibilities

*8/2013: MN Rule link



Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.2

Billing - Continued Billing agents and consultants – continued Factor - An individual or organization that advances money to a provider for their

accounts receivable for an added fee or a deduction of the accounts receivable worth. Payment for any covered service furnished to a recipient by a provider may not be made to or through a factor, either directly or indirectly.

IEP Services Billing: Effect on Other Health Care Services MHCP IEP Services Information for Families Brochures

♦ Minnesota Health Care Programs (MHCP) Individualized Education Program (IEP) Services – Information for Families brochures are available in eleven languages: www.dhs.state.mn.us/provider/iep; under “Quick links for IEP Providers.”

Children enrolled in MHCP

♦ MHCP payments for IEP services do not count against prior authorization caps for home care services; do not affect waiver (CADI, CAC, TBI, DD) caps or the amount of services available under the waiver; and, do not count against service limits or thresholds.

♦ CADI, CAC, TBI and the DD waivers provide home and community-based

services to certain children with disabilities. These waiver programs have limits on the amount of services a child can use in a year.

♦ The TEFRA parental fee is a sliding fee based on income, family size, and whether the child lives at home. The parental fee cannot exceed the cost of the child's MA and county expenditures. IEP related services are not included in calculating parental fees.

The DHS contact number for TEFRA is 651-431-3806.

♦ MHCP payments for IEP services do not affect MinnesotaCare premiums.

♦ Some children enrolled in MA or MinnesotaCare may have health care coverage

under a managed care organization (MCO). A MCO is a pre-paid medical assistance plan. It is not necessary to obtain payments or denials from an MCO in order to bill for covered IEP services.

*8/2013: TEFRA



Billing- Continued IEP Services Billing: Effect on Other Health Care Services – continued

Children Enrolled in Private Health Care Plans

♦ Payment or a denial of coverage from private health care plans before billing

MHCP for covered IEP services is required. MDE obtains coverage information on behalf of districts. Payments from private health care plans for covered IEP services must be reported on MHCP claims.

♦ Districts may pay or reimburse the family for co-payments, coinsurance, deductibles, and other cost-sharing amounts connected with health-related services provided under an IEP/IFSP.

♦ Districts may not require parents/legal representatives to use health care coverage to pay for services provided under an IEP/IFSP.

♦ Districts may not require the child's parent or legal representative to provide health care coverage information when a child receives covered IEP services.

Consent on MHCP Applications DHS cannot advise districts about consents required under education law; therefore, DHS refers questions regarding consent required under the Family Educational Rights and Privacy Act (FERPA) or the Individuals with Disabilities Education Act (IDEA) to MDE. The following language (required under FERPA and IDEA) is on MHCP initial and

renewal applications: Authorization for Release (Sharing) of My Medical Information I give my consent to the following agencies or individuals to share between them medical information about me only for the limited purposes indicated: Health providers including school districts, health plans, insurance agencies,

Minnesota Health Care Programs, county advocates, my county or state case workers, and their contractors and subcontractors: • To determine who should pay for my health care, and • To provide, manage, and coordinate health care services.

All other agencies or persons as listed on the Notice of Privacy Practices. *8/2013: Private health care plans

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.4 Billing – Continued

Consent on MHCP Applications – continued

This consent applies to medical information about my minor children I applied for on this application. I understand the school district needs a separate consent to share information about my children with private insurance plans. I can stop this consent at any time by asking in writing for it to end. The written notice to stop this consent will not affect information the agency has already given to others. This consent is good while I am enrolled in Minnesota Health Care Programs, up to one year, or longer if the law permits. However, it does not end after one year for records given to consulting providers, records given for payment of my bills, fraud investigations, or quality of care review and studies. An agency or person who gets my information through this consent could give the information to others. If I do not sign or I end this consent, I cannot enroll or stay enrolled in Minnesota Health Care Programs. (This statement on the MHCP applications does not apply to the paragraph above it.)

Parent Notification, Release, Consent

Forms and Information

♦ Contact MDE with questions regarding notification, release, and consent

documents related to IEP services billing and other consents required by education laws.

♦ Notification, consent and release forms are only available from MDE.

Third Party Liability (TPL) Medical assistance is the payer of last resort for all other liable parties except districts. Bill MHCP for covered IEP services (except transportation and PCA services) only after receiving payment or a denial of coverage from all other liable health care plans. IEP transportation and PCA services are not covered by private health care plans. It is not necessary to obtain a denial of coverage for these services before billing MHCP. Retain copies of all correspondence with private health plans regarding determinations for IEP services coverage, including phone conversations for five years.

Determining coverage for children with MHCP and Private Health Care

♦ Check with MDE

*8/2013: Consent; TPL

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.5 Billing – Continued Third Party Liability (TPL) – Continued When private health plans deny coverage and MHCP is billed:

♦ Response from the private health plan must include the reason(s) for the denial.

♦ Refer to the MN-ITS User Guide for IEP Service; follow the instructions in the guide

to complete the Coordination of Benefits (COB) information.

♦ To submit a claim using MN-ITS Direct Data Entry (DDE) on the COB Tab: in the Claim Adjustment Amounts field, select OA – Other Adjustments; in the Reason Code field enter B1; in the Amount field enter the total dollar amount of your claim; select A to add this information to the claim.

♦ Retain copies of the health plan response for five years When there is no response from the private health plan after three attempts to contact

and MHCP is billed:

♦ Submit claims electronically through MN-ITS. Do not complete the COB screen. FAX an attachment with copies of the three attempts to contact the private health plan with each claim. Follow instructions in this section for submitting claims with attachments.

♦ Retain documentation of attempts to contact the private health plan. See electronic

claim attachment information in this section. When the response indicates there may be coverage:

♦ Contact the private health plan for billing information, submit a claim and receive payment or a denial before billing MHCP.

When the private health plan refuses to provide the information requested (e.g., sends

letter back with a refusal):

♦ The state education department on behalf of the district or the district has attempted to gather the required information and does not need to make further attempts.

♦ Bill MHCP for the services, entering “B1” in the appropriate box on the

Coordination of Benefits (COB) screen in MN-ITS


http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs_id_051812.pdf


Billing – Continued

Third Party Liability (TPL) – continued Reporting a Change in Private Health Insurance Coverage

♦ Families must report changes to private health care coverage to the county or state.

District staff cannot report these changes on behalf of the family. Only families can report these changes.

Reporting Private Health Insurance Termination Dates

♦ Districts can report termination dates to DHS when notified by a health plan that the

policy has terminated. Claims will deny if termination dates are not reported.

♦ Fax or mail DHS a copy of the termination notice or denial with termination dates, or fax or mail a letter on your district letterhead and include all of the following information:

Name of private health plan Child’s name and MHCP ID number Termination date Whether the termination applies to the policy or individual; and, Name and phone number of the person contacted to obtain the termination

information.

Mail to: DHS Benefit Recovery Section PO Box 64994

St Paul, MN 55164-0994 Fax to: 651-431-7431

Timely Billing All claims must be submitted correctly and received by DHS not later than 12

months from the date of service. Claims should be submitted on a regular basis, at least monthly is recommended.

DHS pays claims twice monthly. See the online Claim Payment and Cut-Off Calendar

for information on cut off dates for submitting claims and payment dates.

Replacement claims must be submitted and received by DHS within 6 months from the date of incorrect payment, or within 12 months from the date of service, whichever is greater.

*8/2013: Formatting


Billing – Continued Timely Billing – continued Claims For Service Dates More Than One Year Old

♦ Submit claims for IEP services with service dates more than one year old

electronically.

♦ Fax an attachment with required information. ♦ The attachment required depends on the reason the claim is over one year old and

it may be necessary to contact DHS before submitting the claim to determine what documents must be submitted in the attachment.

♦ See instructions for submitting attachments under Billing for AT Devices in this

section and on the MHCP Attachment Criteria.

♦ Claims over one year old are accepted for these reasons (See MHCP Attachment Criteria):

• Child eligibility changed; attach a letter from the county indicating the change/s

• Claim was denied in error; attach a letter with an explanation of the erroneous

denial.

• There is an adjustment in third party liability; attach private insurance payment adjustment information.


http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs16_145264.pdf



Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.8 Billing - Continued Procedure Codes and Billing Information IEP Services procedure codes, modifiers, units of service*; diagnosis code and pointer

*CTSS services provided to children without an IEP/IFSP, see MHCP Manual Service CPT

Code Modifiers Units Diagnosis

Code Diagnosis Pointer

Physical Therapy T1018 U1 1 unit per day per child 315.9 1 Occupational Therapy T1018 U2 1 unit per day per child 315.9 1 Speech-Language Pathology /Audiology

T1018 U3 1 unit per day per child 315.9 1

Mental Health CTSS services under Option 2 & 3 – for children with CTSS services in an IEP/IFSP IEP evaluations for Options 1, 2 & 3

T1018 T1018

U4, HE U4

1 unit per day per child 1 unit per day per child; limit 4 units per year

315.9 315.9

1 1

Nursing Services T1018 U5 1 unit per day per child 315.9 1 Personal Care Assistance Services

T1018 U6 1 unit per day per child 315.9 1

Assistive Technology Devices

T1018 U7 and NU new, RR rented, or RB repaired

1 unit per device 315.9 1

Special Transportation T1018 U8 1 unit = 1 trip (one-way = 1 trip; round trip = 2 trips)

315.9 1

Interpreter Services T1013 No modifier 1 unit per day per child 315.9 1 Billing for IEP services

♦ Districts that bill for covered IEP services MUST bill the services as IEP services.

♦ Submit all claims electronically using MN-ITS. Submit required attachments by

FAX as instructed in this section.

♦ To bill for covered IEP services, districts must enroll as IEP services providers.

♦ Districts MUST bill covered IEP services as IEP services. ONLY districts or the billing agents can bill for covered IEP services.

♦ Use the correct CPT code and modifiers to bill MHCP. Districts are responsible

for correcting billing errors. Providers have one year from each date of service to submit correct claims.

*8/2013: IEP evaluations; billing errors

Individualized Education Program (IEP) Services August 2012 Technical Assistance Guide page F.9 Billing – Continued Procedure Codes and Billing Information - continued

♦ Use only diagnosis code 315.9 and choose diagnosis pointer 1 from the drop

down. ♦ Service documentation must be on file BEFORE billing. ♦ Use only consecutive dates of service in date spans. The maximum number of

consecutive days in a date span for IEP services is five.

♦ Use only a valid charge for services, (e.g. IEP services rate or usual and customary charge).

♦ Enter the appropriate number of units for each service. Multiply the number of units

by the charge/rate and enter the result under charge.

♦ When the same service is provided by two districts on the same day to the same child, both districts must use modifier 77 to avoid denied claims.

♦ Units of service

Service Unit Physical therapy, occupational therapy, speech- language pathology and audiology, mental health, nursing, personal care assistance services, interpreter services

1 unit per service per child per day; maximum of five for five service days in a date span (Document all time for cost reporting, but enter 1 unit per child per day per service on claims)

Assistive technology devices 1 unit for the complete device (Bill the device on one claim line; do not bill the device components separately)

Special Transportation Total number of trips to or from home and school when another covered IEP service is provided on the same day, to or from school and an off-site covered IEP service provided on the same day, and to or from a medical appointment when transported by the district during the school day.

♦ Billing for Interpreter Services:

Bill only for the face-to-face interpreter services or telephone portion of the oral

language interpreter service provided in conjunction with another covered IEP service. The length of time documented for both services should correspond.

*8/2012: Modifier 77


Billing – continued Procedure Codes and Billing Information - continued

Interpreter services are not covered when provided in conjunction with special transportation or Personal Care Assistance services.

♦ Billing for Special Transportation: Identify the child’s need for IEP special transportation on the IEP/IFSP (e.g.

wheelchair; behavior; special harness). It is not sufficient to state that the district will transport the child.

IEP special transportation is covered when another covered IEP service is provided on or off-site on the same day, or when the child is transported to a medical appointment. The other covered IEP service does not have to be billed; however, the other covered service must meet all requirements for that service including documentation, supervision, personnel qualifications, and the documentation must indicate the service was provided on the same day.

Enter the total number of trips (units) for each date of service on one claim line;

do not use date spans. One trip equals transporting the child:

• from home to school on a day when another covered IEP service is provided • from school to home on a day when another covered IEP service is provided • from school to an off-site IEP service during the school day • from the off-site IEP service to school during the school day • from school to a medical appointment during the school day • from a medical appointment to school during the school day

Do not use place of service 12 (home) to bill transportation services.

♦ Billing for AT Devices: Bill the entire device on one claim line and enter the total charge for the

device on the same line to avoid denial for all other lines.

MHCP does not cover shipping and handling charges or warranties.

Do not allow vendors to bill for devices purchased by the district.

AT devices must be obtained and delivered to the child prior to submitting claims to MHCP.

Submit claims through MN-ITS.

*8/2013: Minor changes

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.11 Billing – Continued Procedure Codes and Billing Information - continued

FAX the required attachment. The attachment cannot be submitted electronically. See instructions for submitting the attachment in this section.

Do not use place of service 12 (home) to bill AT devices.

♦ Billing for PCA services:

Do not use place of service 12 (home) to bill PCA services.

Submitting Claim Attachment ♦ Create a unique attachment control number (ACN) of up to fifty characters.

Enter the same ACN on each page of the attachment in the upper right-hand corner and on the MN-ITS claim in the appropriate field; use the same ACN on the attachment and claim:

BATCH – Loop 2300, PWK 06 and include the method by which you send the

attachment information in Loop 2300, PWK02.

INTERACTIVE-Claim Information Tab, Attachment Control Number field; click “OZ” in the drop down field labeled “Type.”

Suggested scheme for the attachment control number: four digit district

number, child’s eight-digit MN Health Care Programs (MHCP) number, and service date (MM/DD/CCYY). To submit attachments for more than one claim for the same service date, add a number at the end to indicate the first, second, third, etc. claim with an attachment for that day.

ACN Example: 0035-00000001-06082009-2

In this example, 0035 is the district number; 00000001 is the child’s MHCP number; 06082009 is the date of service; and, 2 indicates the second claim with an attachment submitted for this service date. The example AUC scheme can be modified or an entirely different unique numbering scheme can be created.

Do not use simple numbers like 123 and 107. Simple numbers can be used by any number of providers and your attachment could attach to a different claim or be lost completely.

♦ Use the MHCP Attachment Criteria form to ensure your claim includes the

necessary documents for the attachment, but do not submit this form with your attachment. Items to include in the attachment:

*8/2013: ACN


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.12 Billing – continued Submitting Claim Attachment - continued

Copy of the invoice Copy of the IEP plan or pages that indicate the child’s need for the device Copy of the therapist assessment of the child’s needs, if applicable (required for

augmentative communication devices)

♦ Use only the AUC Cover Sheet for Health Care Claims to submit attachments for electronic claims. Include the cover sheet when entering the number of pages faxed.

♦ Submit the attachment by FAX with the completed Cover Sheet for Health Care

Claims to 651-431-7786. Attachments cannot be submitted by email, USPS or any other way except by FAX and cannot be sent to any other FAX number.

MN-ITS General Information

♦ MN-ITS (“minutes”) is the DHS Health Insurance Portability and Accountability Act

(HIPAA) compliant, Web-based billing system for electronically-submitted MHCP health care claims and other transactions.

♦ MN-ITS has two components: an interactive (one-by-one, direct data entry) component and a batch X12 (interface with non-DHS billing software) component.

MN-ITS Interactive is available free from DHS. Batch X12 users need to purchase

the necessary software.

MN-ITS is a single point of entry for MHCP providers and billers to:

Verify MHCP eligibility Enter and validate claims Submit claims Track submitted claims online Stay informed Receive HIPAA-compliant Remittance Advices online. (Batch billers receive the

HIPAA-compliant 835 and PDF. Interactive users receive only a PDF file of the RA.) Providers are assigned a unique MN-ITS mailbox, a secure folder for Provider News messages and system availability messages.


http://www.health.state.mn.us/auc/v5010p837bp3.doc



Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page F.13 Billing – continued MN-ITS – continued

♦ MN-ITS Registration Process

MN-ITS registration instructions are available at: Registration

♦ DHS EDI (Electronic Data Interchange) Agreement

Districts that use the Electronic Data Interchange (EDI) administered by DHS to bill for covered services must agree to the terms and conditions of the EDI Agreement as part of the MN-ITS Registration Process.

♦ MN-ITS HIPAA-compliant transactions

270/271 Eligibility verification inquiry and response 837P Professional – Format for submitting claims. Instructions for completing a

claim are in this section.

276/277 Health Claim Status-claims inquiry and response

835 Remittance Advice 278 Prior Authorization (not applicable for IEP services)

Billing Instructions

MN-ITS IEP Services User Guide includes instructions for completing IEP services

claims: MN-ITS User Guide for IEP Services Voids (Take-backs) in MN-ITS Voids (Take-backs) occur when a provider requests the payor to “take back” payment

for a claim. Voids usually involve payments made in error, for example, services billed were not eligible for payment. (To correct a claim error (used wrong modifier or procedure code, etc., replace the claim)

Providers with access to MN-ITS should use MN-ITS to void claims electronically

effective immediately. Effective July 15, 2009 all providers will have to submit Voids electronically.



http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs_id_051812.pdf


Billing – Continued Voids (Take-backs) in MN-ITS - continued

If a claim was denied or is in a to-be-denied status, you cannot void the claim. Submitting Voids in MN-ITS

♦ Can be done through MN-ITS Interactive or Batch.

♦ Can be submitted electronically for claims sent either electronically or on paper. MN-ITS Interactive Voids

♦ Pull up the claim using Request Status.

♦ Select the Void button.

♦ On the Claim Information tab.

The Submission Code on the 837P will auto-populate with void (8) to indicate you are submitting a void claim.

Next to the Original Reference Number check the PCN to be sure it is correct.

♦ Click on the Services tab. Do not make changes to any information on the claim.

Click on Submit button. You will receive a confirmation of your request with the

voided claim number. MN-ITS Batch Voids

♦ If the original claim was submitted through MN-ITS Batch, follow these steps to request to void the claim:

Log in to MN-ITS.

Select MN-ITS Interactive from the left-hand menu to reach the MN-ITS

Interactive Welcome page. Hover over New Claim on the left-hand menu to display the claims options

menu. Select claim type 837P from the shaded menu to reach the online claim entry

screens. *8/2013: Reorganized


Billing – Continued Voids (Take-backs) in MN-ITS – continued

Enter the entire claim over again in MN-ITS Interactive.

Select the Claim Information tab:

• Change the Submission Code from 1-original to 8-void.

• Enter the PCN to be voided in the Original Reference Number field.

Select Validate to verify accuracy.

Submit the claim. You will receive a confirmation of your request.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page G.1 Rates and Payments Provider Tax MN districts, as educational institutions, are exempt from paying the provider tax under

MN Statutes 295.53, subd.1 (a)(13). Per the Department of Revenue, it is not necessary to file any form.

Assistive Technology Devices Rate Cost-based rate - purchase price, rental costs or costs of repairs.

Special Transportation Rate Cost-based rate methodology

1. Total special transportation costs ÷ total number of membership days for children who receive special transportation = daily cost per child

2. Daily cost ÷ 2 = trip cost per child 3. Trip costs X District’s Unrestricted Indirect Cost Percentage 4. Rate = item 2 + item 3

♦ Total special transportation costs include driver salaries, fringe benefits, gas, oil,

insurance and maintenance.

♦ Supervision is covered in the unrestricted indirect cost percentage.

♦ Nursing and PCA services, provided to children who require nursing or PCA services in-route, are covered under the appropriate service. These services are not included in the costs reported to DHS by MDE.

Physical Therapy, Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health Services, Nursing Services, Personal Care Assistance Services, Interpreter Services Rates Cost-based rate methodology*

1. Total Salaries + Benefits ÷ Total Employment Hours 2. Item 1 X Direct Medical Assistance Service Hours 3. Item 2 ÷ Medical Assistance Encounters 4. Item 3 X District’s Unrestricted Indirect Cost Percentage 5. Rate = item 3 + item 4 See the “IEP Services Rate Calculation Methodology” chart in this section.



Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page G.2 Rates and Payments – Continued Physical Therapy, Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health Services, Nursing Services, Personal Care Assistance Services, Interpreter Services Rates – continued

♦ Supervision and direction is included in the unrestricted indirect cost percentage.

Supervision costs are not included in the costs reported to DHS by MDE. Interim and Final Rates

Interim rates are calculated using data from a previous year, provided by MDE and

districts.

Final rates are calculated using indirect cost percentage provided by MDE and actual cost data reported by districts to MDE and DHS. Final rates are used to settle with districts on actual costs. Claims paid at the interim rate are reprocessed and paid at the final rate.

Underpayments and overpayments: See “Reconciling Final Rates” in this section.

Special transportation is initially paid at interim rates calculated using data from a previous year, provided by districts to UFARS and MARSS. DHS settles-up with final rates after all cost data is reported, audited and submitted to DHS and the billing window of one year from each date of service closes.

Physical therapy, occupational therapy, speech and language pathology and audiology, mental health, nursing, personal care assistant services and interpreter services are initially paid at interim rates calculated using cost data from a previous year, provided by districts to EDRS and time and encounter data reported by districts to DHS. DHS settles-up with final rates after all costs data is reported, audited and submitted to DHS and the billing window of one year from each date of service closes.

Final rates are the new interim rates for the current school year. For example, the final

rates for 2011-2012 school year are the new interim rates for the 2013-2014 school year.

Final rates are calculated after June 30 of the year following the school year in which

the services were provided. Districts must bill, receive payment and report all accurate costs for final rates to be

calculated. Final rates and new interim rates are set at $0.00 if any required data element is not reported. See “Reconciling Final Rates” in this section.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page G.3 Rates and Payments - Continued Interim and Final Rates – Continued Reporting cost data - District Responsibilities

♦ Data reported to DHS and MDE for IEP services rates must be reported by the

providing district.

Only costs reported through the data system designated by MDE are included in the cost-based rates for covered IEP services. Costs must be reported in the distinct categories for covered IEP services: physical therapy, nursing, interpreter services, etc.

Districts are responsible for all required costs reported to DHS and MDE

including data prepared by billing agents or others.

Review all data for accuracy before submitting it.

Review data and final rates during data review periods provided by MDE and DHS to avoid costly monetary recoveries.

Report encounter and time data for direct services to DHS on the DHS 5052-

IEP Services Annual Data Reporting Form no later than July 5 one year after the school year during which the services were provided. The accuracy of the data submitted on this form is certified by the special education director or administrator who signs the form.

Track and record actual encounters and direct service hours throughout the

school year and keep this documentation for five years. • Encounter – 1 encounter per day per child per service.

• Direct service time – face-to-face services; covered IEP evaluation activities

when the evaluation results in an IEP or continued IEP services; covered face-to-face mental health services to families.

• When PCA services are provided by more than one person at the same

time, i.e., two person lifts, report the number of minutes required to complete the lift, do not double the time.

• When one service (e.g. PT) is provided by more than one service provider of

the same service at the same time, each service provider should record the face-to-face service time.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page G.4 Rates and Payments - Continued Interim and Final Rates – Continued

• When more than one service (e.g. PT and OT) is provided at the same time

by two service providers, each service provider should record the face-to-face service time.

♦ Appeal Final Rates DHS notifies districts of final rates by letter. Review all of the submitted data

and the final rates within 60 days.

To dispute the final rates, file a written appeal within 60 days from the date the notice was mailed. DHS cannot accept appeals filed after 60 days.

• List the disputed items, reasons for the disputes and the name and address

of the contact person for the appeal. • Send the appeal to: Department of Human Services

IEP Services Rates Specialist MN Department of Human Services

P. O. Box 64984 St. Paul, MN 55164-0984 • When an appeal is resolved, claims are reprocessed with the resulting rates

and will not be adjusted.

If no appeal is filed within 60 days, claims are reprocessed with the final rates and will not be adjusted.

Reconciling Final Rates - Results

Underpayment – final rate is higher than the interim rate paid; districts are underpaid

♦ Claims are re-processed and paid at the final rate. ♦ Re-processed claims and the underpayment amount are included on RA; DHS

issues a warrant for the amount due.

Overpayments – final rate is lower than the interim rate paid; district is overpaid Re-processed claims and total overpayment amount are listed on RA.


Individualized Education Program (IEP) Services August 2012 Technical Assistance Guide page G.5 Rates and Payments - Continued

Reconciling Final Rates – Results – continued

Overpayments are recovered from future payments; payments are deducted from credit balance until entire amount is repaid; no interest is charged.

Credit balances must be repaid within one year through the claims process or DHS

will request immediate re-payment. Medicaid Federal/Non-Federal Share/Administration Fee Federal Share and Non-federal share

♦ Minnesota’s Medicaid federal share is 50%. School districts are responsible for the

non-federal share of the Medicaid payments, also 50%.

♦ The non-federal share is deducted from the total payment at the end of the RA.

Administration Fee ♦ Effective, July 1, 2012, each district that receives IEP services payments in a given

year will receive an invoice for the district’s share of the costs to administer the program following the end of the school year. DHS will no longer deduct a percentage from the federal share to cover the administration costs. Administration fees charged to each district are prorated based on the each district’s payments for covered IEP services for the school year. Payments for administration fees cannot be made from future IEP services payments. Instructions for payments will be included on the invoice. Unpaid administrative fee bills will be turned over to the Department of Revenue for collection.

Remittance Advice (RA) and Provider News

Non-federal share and administration fee deduction(s) are listed as gross adjustment(s) - Provider Adjustment ID #571

RAs are stored in the MN-ITS Mailbox and are available for 12 months; can be saved electronically or printed. Call the Provider Help Desk to request deleted RAs.

How to read a RA: Go to the IEP homepage: www.dhs.state.mn.us/provider/iep; in the

left-hand column under “Billing information and resources," the Reading your RA. *8/2012: Administration fees


http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_148006

Individualized Education Program (IEP) Services September 2012 Technical Assistance Guide page G.6 Rates and Payments - Continued Remittance Advice (RA) and Provider News - continued Most recent Provider News messages and other provider notices are in the MN-ITS

Mail Box; in the Links file, select search to display the notices. To sort by date, click “date” in the blue highlighted area.

Provider News messages are also available from the left-hand column on the IEP Provider homepage: www.dhs.state.mn.us/provider/iep; under Communications and then News.

*9/2012: Heading


Individualized Education Program (IEP) Services August 2012 Technical Assistance Guide page G.7 Rates and Payments – Continued DHS - 4122D 5-04


Individualized Education Program (IEP) Services August 2012 Technical Assistance Guide page G.8 Rates and Payments - Continued DHS – 4122B 5-04


Individualized Education Program (IEP) Services August 2012 Technical Assistance Guide page G.9 DHS – 5052 4-12


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.1 Record Keeping and Documentation For services billed to MHCP: Maintain records that fully disclose the extent of services provided. This requirement is

included in the Provider Agreement signed when districts enroll as MHCP providers. Maintain all required documentation for at least five years and make documents

available for state and federal audits upon request. Maintain service documentation according to requirements.

Maintain cost information including: salaries, benefits, contract hours, contracted

services, encounters and service time according to requirements. Maintain all of the following: (All items do not have to be maintained in one place, but

must be made available upon request during state and federal audits.) ♦ Treatment Goals/Care Plan (IEP/IFSP); individual health plans, behavior plans and

treatment plans

♦ IEP evaluations, ongoing assessments, diagnostic assessments

♦ Health record

♦ Documentation of covered IEP services billed (progress notes, trip logs, documentation logs, PCA checklists, supervision documentation and service notes).

♦ Attendance records

HIPAA/FERPA – Health Insurance Portability and Accountability Act/Family Educational Rights and Privacy Act The U. S. Departments of Health and Human Services and Education issued “Joint

Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records” in November 2008. ♦ To find the joint guide online, go to: FERPA-HIPAA

*8/2013: Link

http://www.ed.gov/policy/gen/guid/fpco/doc/ferpa-hippa-guidance.pdf

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.2 Record Keeping and Documentation - Continued Treatment Goals/Care Plan (IEP/IFSP) IEP/IFSP and attachments, e.g., individual behavior plans, health plans, and individual

treatment plans are considered the “treatment plan.” Treatment plans must include measurable outcomes.

♦ All services billed to MHCP must be included in the IEP/IFSP.

♦ Develop separate treatment plan(s) if IEP/IFSP does not contain measurable

outcomes.

♦ An individual behavior plan (IBP) for mental health behavior aide services is required in addition to the IEP/IFSP.

Document actual services provided and maintain documentation for all covered services billed to MHCP. The IEP/IFSP is not sufficient documentation of services provided.

Health Record A child’s health record must include:

♦ Complete copy of the current IEP/IFSP that includes: frequency, duration, and

scope of all covered IEP services and the individual child’s need for IEP special transportation, assistive technology devices and interpreter services.

♦ Copies of any amendments to the IEP/IFSP and individual health plan, individual behavior plan, etc.

♦ Medical diagnoses and/or condition; copy of the current diagnostic assessment obtained from a mental health professional and required for mental health (CTSS) services.

♦ Results of tests or evaluations relating to covered IEP services; copies of evaluations billed as covered IEP services.

♦ All documentation of actual services provided and billed to MHCP, including: service documentation, progress notes, trip logs, and PCA checklists that document the actual services provided. The IEP/IFSP is not sufficient documentation of actual services provided.


Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page H.3 Record Keeping and Documentation – Continued Health Record - Continued

♦ Supervision and direction as required under occupational therapy, physical therapy, CTSS services, and Personal Care Assistance services.

♦ Required orders for nursing.

♦ Communication with Primary Care Practitioner for PCA services. It is not necessary to maintain all of the required information in one place, but the information must be available to state and federal auditors upon request. Assistive Technology Devices Include in the child’s record:

♦ IEP/IFSP that includes the reason(s) why the child needs the device(s). ♦ Copies of invoices or rental agreements for hardware and software essential to the

device.

♦ Copies of assessments to determine devices needed.

Physical Therapy, Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health, Nursing, Interpreter Services Use the Activity Log in this section or design one. Paper documentation and protected

electronic documentation and electronic signatures are acceptable. Document the following:

♦ Child’s name, date of birth and school, on each page; ♦ Dates of service; number of children in the group (even if group of 1);

♦ Time spent providing medically necessary services (number of minutes or

beginning and ending clock time); Includes covered face-to-face services provided to the child; covered IEP

evaluation activities when the evaluation results in an IEP or continued IEP services; and mental health services provided to families.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.4 Record Keeping and Documentation – Continued Physical Therapy, Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health, Nursing, Interpreter Services – Continued

Supervision and other administrative costs are covered by the indirect cost

percentage added to the rate for each service and cannot be billed separately.

When one service (e.g. PT) is provided by more than one service provider (e.g., PT and PTA) at the same time and each service provider provides a face-to-face service (does not include observing), each service provider should record face-to-face service time.

When more than one service (e.g., PT and OT) is provided at the same time by

two service providers (e.g., PT and OT) and each service provider provides a face-to-face service (does not include observing), each service provider should record face-to-face service time.

Do not use white out, pencil, ditto marks, or arrows

♦ Encounters – document and count no more than 1 encounter per service per child

per day. ♦ Service type (OT, PT, SLP, etc.), CPT code and appropriate modifier(s); ♦ Description of actual services provided (what service was provided, what

goals/objectives were worked on, what progress was made or why progress was not made, whether the goal/objective needs more work, new goals/objectives to work on next time; or new goals/objectives needed).

Interpreter services: Document the child’s name, date of birth, school, date of

service, time spent, and the other MA covered IEP service provided with the interpreter service (progress notes are not required for interpreter services).

MHBA services: Carefully document skills practiced with the child including the

number of times the child successfully completed the skill and/or reasons why the practice session is not successful.


Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page H.5 Record Keeping and Documentation – Continued Physical Therapy, Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health, Nursing, Interpreter Services - Continued

IEP evaluations: Time spent includes, administering the tests, interpreting test results and writing the report. Do not include, time spent discussing evaluation results, making recommendations, meetings, planning or developing or writing the IEP/IFSP.

♦ Service provider’s name, title and signature;

♦ Documentation of required supervision and supervisor’s name, title, and signature

(may be kept separately); ♦ Maintain documentation for at least five years. Billing agents should also retain

copies of service documentation. Claims cannot be submitted without documentation that the service was provided.

Personal Care Assistant (PCA) Services

Use the DHS PCA checklist or a self-designed PCA checklist that includes all of the

information on the DHS PCA checklist. Self-designed checklists must be approved by DHS. DHS form: DHS-4122C: IEP Services Personal Care Assistance Activities Checklist.

Paper documentation and protected electronic documentation and electronic signatures are acceptable.

♦ Do not use white out, pencil, ditto marks, or arrows. ♦ Include all of the following information: Child’s name, date of birth, school, dates of service on each page;

Specific descriptions of actual activities provided to meet the individual child’s

needs for the covered activities on the checklist either front or back or attached to the checklist;

Each PCA enters initials on the checklist each time an activity is provided during the day (for example: if a child needs assistance with toileting, each time the PCA assists the child with toileting during the day, the PCA places his/her initials beside this activity). ONLY the person actually providing the activities can document the services provided (the classroom teacher cannot document services provided).

*8/2013: Minor changes

http://edocs.dhs.state.mn.us/lfserver/legacy/DHS-4122C-ENG

http://edocs.dhs.state.mn.us/lfserver/legacy/DHS-4122C-ENG

Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.6 Record Keeping and Documentation - Continued Personal Care Assistant (PCA) Services – Continued

♦ Number of children in the group (even if the group is 1)

♦ Time spent – Assess time required to provide covered PCA services by

documenting actual time spent providing the services over two-four weeks to determine the amount of time spent on average each day to complete all necessary PCA activities

Add all of the time documented and divide by the number of days to get the average daily time required to provide services; use the time from time assessment to indicate the amount of time required to complete all covered activities during the day Keep time documentation for five years.

Be sure to document and report only all time for covered activities. If needs change significantly, do another time assessment to determine the

average daily time required to complete all activities.

If two PCAs are needed to complete a daily activity such as transferring a child, include the time required by both PCAs in the time assessment.

♦ Encounters – document and count no more than 1 encounter per service per child

per day.

♦ List the name and title of each PCA who provides covered activities to the child during the day;

♦ Include this statement (required by MN statute) in bold black letters above the signature block on the checklist: “It is a federal crime to provide false information on personal care services billings for medical assistance payment.”

♦ Name, title (Personal Care Assistant, education aide, health aide, etc.) and

signature of the main PCA providing this service. ♦ Supervisor’s name, title, signature and date when supervision was provided

according to the PCA services supervision schedule. Supervision required for each PCA working with each child. Documentation can be separate.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.7 Record Keeping and Documentation- Continued Special Transportation The child’s need for special transportation must be included in the IEP/IFSP.

Special transportation is covered when the child is transported to or from home and

school to another covered IEP service or to or from an off-site covered IEP service on the same day. The other covered service(s) provided must meet all requirements and be documented even if the other service is not billed. Special transportation is covered when the child is transported to or from a medical appointment by the school during the school day. Document the name and location of the medical facility on the trip log.

A person, designated by the school (driver, PCA, etc.), who can verify that the child actually received IEP covered transportation services must document the services, sign and date the trip log.

Use the DHS Trip Log or a log with all of the same information to document special

transportation provided under IEP services. The log may be electronic or on paper. Do not use white out, pencil, ditto marks, or arrows.

Paper documentation and protected electronic documentation and electronic

signatures are acceptable. Document the following:

♦ Child’s name and date of birth and school on each page; ♦ Service dates ♦ Service type (special transportation) and service code/modifier (T1018, U8) ♦ Units of service to another covered IEP service on the same day (home to school=

1 trip, school to home =1 trip, school to an off-site IEP covered service =1 trip; off-site IEP covered service to school =1 trip, school to medical appointment = 1 trip, medical appointment to school = 1 trip );

♦ Document trips to and from medical appointments on separate lines on the trip log and include name and location of medical facility

♦ Name and signature of the person who can verify that the child was transported (e.g., PCA, person who takes child to and from vehicle, driver)


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.8 Record Keeping and Documentation- Continued Service Time and Encounters (For Final Rate Calculations for Physical and Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health Services, Nursing, PCA and Interpreter Services) Districts must accurately track, document and report actual cost data for IEP services

provided by qualified providers to MHCP eligible children for whom the district bills.

Districts are responsible for all data submitted including data compiled and submitted by a billing agent.

Districts must maintain back-up documentation of actual costs, service time and encounters.

♦ Keep all required documentation for five years.

Document required cost data for: OT, PT, speech-language pathology and audiology,

mental health, nursing and PCA services.

♦ For each service type listed on “IEP Services Annual Data Report Form,” DHS 5052, document and report the following information on eligible children for whom the school bills.

Document and report:

• All face-to-face service time spent for covered IEP services provided to each

eligible child; include time for each service provider when services are provided by two service providers during the same time period, do not include indirect service time;

• PCA service time calculated using a time assessment to determine the

actual time spent on covered PCA services; include time for each PCA when an activity requires the assistance of two, e.g. lifting a child. (no time spent on educational activities can be included)

• Face-to-face time spent with families as covered under CTSS services;

• Covered IEP evaluation activities when the evaluation results in an IEP or

continued IEP services;

Do not report supervision and direction time. Supervision and direction are considered covered by the unrestricted indirect cost percentage included in the rate methodology.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page H.9 Record Keeping and Documentation- Continued Service Time and Encounters (For Final Rate Calculations for Physical and Occupational Therapy, Speech and Language Pathology and Audiology, Mental Health Services, Nursing, PCA and Interpreter Services)

Record encounters for each eligible child for whom the district bills.

• Encounters: Count each child served once each day per service as an encounter. For example: if a child receives a re-evaluation from the physical therapist in the morning on June 2 and physical therapy from the physical therapy assistant in the afternoon, record one encounter for physical therapy for June 2. Record the time both the physical therapist and the physical therapy assistant spent providing services on June 2.

• Keep the record of the encounter count: number of encounters per child per

service per day, time per service, and services by type. • Keep documentation of encounters for at least five years.

Record Retention Keep all required records for at least five years. (Minnesota Rules, part 9505.2190, subpart 1) Required records include all documentation and recordkeeping required for covered

IEP services and cost reporting including, but not limited to:

♦ Attendance records, ♦ IEP/IFSP and individual treatment plans, health plans, behavior plans, etc.,

♦ Medical diagnosis or condition and evaluations including the required diagnostic

assessments for mental health (CTSS) services, ♦ IEP evaluations, assessments and re-evaluations, and assessments to determine

needs for equipment reimbursed by MHCP, ♦ Signed documentation of actual services provided and billed to MHCP (including:

documentation logs, trip logs, progress notes, PCA checklists, transportation logs),


Individualized Education Program (IEP) Services February 2010 Technical Assistance Guide page H.10 Record Keeping and Documentation- Continued Record Retention - continued

♦ Documentation of required supervision and direction, ♦ Records of required consents, releases or parent notifications, ♦ Required orders and physician statements of need, ♦ Cost documentation required for setting rates, and ♦ Time assessments for PCA services.

*2/2010: Time assessments

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page H.11 DHS 5085-ENG 9-10

*5/2012: Form number and date

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page H.12 DHS 4122C ENG 1-11


Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page H.13 DHS 5086 ENG 2-10


Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page I.1 Audits As MHCP providers, districts are subject to state and federal audits.

Providers that bill for medical assistance services must sign a Minnesota Department

of Human Services Provider Agreement that includes terms and conditions to which the provider, by signing, agrees. The terms and conditions include, but are not limited to the following:

“To maintain records that fully disclose the extent of services provided to individuals under these programs, in accordance with Minnesota Rules, parts 9505.2160 to 9505.2245.”

“To furnish the Department of Human Services, the Secretary of the U.S. Department of Health and Human Services, or the Minnesota Medicaid Fraud Control Unit with such information as it may request regarding payments claimed for services provided under these programs.”

Complete list of terms and conditions on the DHS Provider Agreement, see section D.

The DHS Surveillance and Integrity Review (SIRS) unit in the Office of the Inspector General Division is responsible for post payment reviews to ensure compliance with MHCP requirements.

♦ Activities include: Monitoring claim activity Performing on-site audits of records Conducting investigations

♦ Authorized to: Seek monetary recovery (interest can be charged) Impose administrative sanctions Seek civil or criminal action through the office of the Attorney General

SIRS/OIG monitors the use, delivery and documentation of health services, and is

responsible for identifying and investigating suspected fraud, theft and abuse, including billing errors.

Districts are required to provide state and federal auditors access to child records upon request as a condition of accepting MHCP payment for services provided.

*5/2012: Updated

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page I.2 Audits - Continued

Records must be made available for review upon request. All records do not have to

be maintained in the same place. Records reviewed may include, but may not be limited to: ♦ Attendance records, ♦ IEP/IFSP and individual treatment plans, health plans, behavior plans,

♦ Medical diagnosis or condition and evaluations ♦ IEP evaluations and assessments to determine needs for equipment and services

reimbursed by MHCP ♦ Signed documentation of actual services provided and billed to MHCP (including:

documentation logs, trip logs, progress notes, PCA checklists, transportation logs) ♦ Documentation of required supervision and direction ♦ Personnel records of staff providing services ♦ Required consents, releases or parent notifications ♦ Required orders ♦ Cost documentation required for setting rates ♦ Time studies for PCA services

Notice of a review by DHS is given at least 24 hours in advance of the review.

Quality assurance letters that address issues that need improvement are sent when no

monetary recovery is necessary.

Notices of agency action with information and instructions about the recovery process are sent when reviews result in a monetary recovery.

*5/2012: Updated; Personnel records

Individualized Education Program (IEP) Services May 2012 Technical Assistance Guide page I.3 Audit – Continued

♦ Procedures for LEAs to Dispute Sanctions or Monetary Recoveries

♦ If DHS identifies a Medicaid overpayment to a district or determines that the conduct of a district justifies the imposition of a sanction or monetary recovery, and

♦ If the district disputes the proposed action by DHS to recover the overpayment or

impose a sanction, DHS shall follow procedures set forth in Minn. Stat. §256B.064 and Minn. Rules 9505.2160 – 9505.2245. These procedures provide for prior notice and the opportunity for a hearing with DHS.

♦ If the district requests a hearing with DHS, the hearing shall be a contested case

proceeding, in accordance with the provisions of Minn. Stat. §14.57-14.62, the Minnesota Administrative Procedure Act. These procedures allow the district to request an informal meeting with DHS regarding the matter in dispute.

♦ MDE is not responsible for initiating or conducting an appeal, but to the extent that

MDE assists a district, MDE understands that information in the hands of DHS about a proposed sanction or monetary recovery is classified as confidential under Minn. Stat. §13.46. DHS cannot release any information to MDE about the matter in dispute, and MDE cannot participate in informal meetings between DHS and a district if information about the proposed sanction or monetary recovery is discussed.


Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page J.1 DHS IEP Services Home Page-www.dhs.state.mn.us/provider/iep Hot Topics

♦ Provider News

♦ Provider Updates

• Recently Added Updates • Updates by service category and by year • Archived Updates

♦ Forms, Checklists, Logs, Reports, Documents and Resources

• Checklists and logs • Communication and Notification of School Based Services • Data Collection and Annual Reports • Related Information • Additional Resources • Brochures for Parents • Other Resources

♦ IEP Enrollment Forms

• IEP Provider Enrollment Applications and Agreements

♦ CTSS

• Materials for initial school CTSS certification • School CTSS re-certification • School CTSS tracking • Notification of change • Addendum • Related Links

♦ IEP PCA Training and Evaluation

• Training opportunities for IEP service providers

*8/2013: Updated









Individualized Education Program (IEP) Services August 2013 Technical Assistance Guide page J.2 DHS IEP Services Home Page-www.dhs.state.mn.us/provider/iep

♦ Billing Information

• MN-ITS • Additional Billing Resources

♦ IEP Technical Assistance Guide ♦ Provider Manual

• Provider Manual Chapters ♦ MN–ITS View/Access

• MN-ITS Screen Options

Telephone Numbers and Contacts

*8/2013: Updated





http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_154247#childrens