Training Documents: Crosswalk Services Document Qualifications - - PowerPoint PPT Presentation

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Training Documents: Crosswalk Services Document Qualifications - - PowerPoint PPT Presentation

Sep 21, 2023 221 likes •544 views

What will be presented: Overview of School Based Medicaid Behavioral Intervention Services Who needs this information: Special Education Directors, School Psychologist, Teachers, School Paraprofessionals, Medicaid Billing Staff Training

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What will be presented: Overview of School Based

Medicaid Behavioral Intervention Services

Who needs this information: Special Education Directors,

School Psychologist, Teachers, School Paraprofessionals, Medicaid Billing Staff

Training Documents:

  • Crosswalk Services Document
  • Qualifications for Professional Services
  • Qualifications for Paraprofessional Services
  • Replacement Crosswalk Document
  • Definition and Eligibility
  • New Medicaid IEP Form
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Behavioral Intervention (BI)

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  • Assess student

needs

  • Prioritize needs
  • Develop IEP

Priorities

Now let’s talk Medicaid

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Consistent, assertive and continuous intervention process designed to:

  • Assist student to access

educational environment

  • Develop replacement behaviors
  • Intervene and prevent

maladaptive behaviors

  • Instruct in tools and strategies

What is Behavioral Intervention?

IDAPA 16.03.09.852

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Behavioral Intervention is available for children that have been diagnosed with a medically necessary need and exhibit maladaptive behaviors including but not limited to frequent disruptive behaviors, aggression, self-injury, or other dangerous behaviors. These maladaptive behaviors impede the learning of themselves or the learning of others.

This service would require Teams to develop a FBA and BIP and/or an IEP goal to define delivery of intervention. IDAPA 16.03.09.852.03

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Eligibility

Student qualifies for Behavioral intervention based on a score that is 1.5 SD below the mean in 2 behavior sub-tests on a Standardized Behavioral

  • Assessment. Services are delivered

with an IEP Goal in place and billed at paraprofessional rate with a teacher/paraprofessional to student ratio of no greater than 1:3. Student qualifies for Behavioral Intervention based on a score that is 2 SD from the mean in 1 index score on a Standardized Behavioral Assessment. Services are delivered with a BIP/FBA in place and billed at the professional rate with a student teacher ratio of no greater than 1:2. A paraprofessional would bill at the para rate with no greater than a 1:1 ratio. IDAPA 16.03.09.851.06

OR

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Student Assessed using Standardized Behavior Assessment Scores 2 standard deviations below mean

  • n 1 index score

FBA, BIP, and IEP Goal required Paraprofessional rate 1:1 paraprofessional to student ratio Professional rate no greater than 1:2 professional to student ratio Scores 1.5 standard deviations below mean in 2 behavior subtests IEP Goal required. A BIP/FBA may be written. Paraprofessional rate no greater than 1:3 professional or paraprofessional to student ratio

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Who Can Provide Behavioral Intervention?

Professional

  • Credentialed Special Education

Teacher

  • Credentialed Early Childhood /Early

Childhood Special Education Blended Certificate

  • Habilitative intervention professional

who meets the requirements defined in IDAPA 16.03.10 “Medicaid Enhanced Plan Benefits”, Section 685. Paraprofessional

IDAPA 16.03.09.854

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IDAPA 16.03.09.854.01

Behavioral Intervention Medicaid School Based Services Qualifications

  • Exceptional Child Certificate
  • Early Childhood/Early Childhood Special Education Blended

Certificate

  • Special Education Consulting Teacher
  • Habilitative intervention professional
  • Individuals employed by a school as certified Intensive Behavioral

Intervention (IBI) professionals prior to July 1, 2013, are qualified to provide behavioral intervention;

  • Must be able to provide documentation of one (1) year’s

supervised experience working with children with developmental disabilities. This can be achieved by previous work experience gained through paid employment, university practicum experience, or internship. It can also be achieved by increased on-the-job supervision experience gained during employment at a school district or charter school.

Professional

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Behavioral Intervention Medicaid School Based Services Qualifications A paraprofessional under the direction of a qualified behavioral intervention professional or behavioral consultation, must meet the following:

  • i. Must be at least eighteen (18) years of age;
  • ii. Demonstrate the knowledge, have the skills needed to support the

program to which they are assigned, and meet the requirements under the “Standards for Paraprofessionals Supporting Students with Special Needs,” available online at the State Department of Education website; and

  • iii. Must meet the paraprofessional requirements under the

Elementary and Secondary Education Act of 1965, as amended, Title 1, Part A, Section 1119. The professional must observe and review the direct services performed by the paraprofessional on a monthly basis, or more

  • ften as necessary, to ensure the paraprofessional

demonstrates the necessary skills to correctly provide the behavioral intervention service.

IDAPA 16.03.09.854.01

ParaProfessional

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IDAPA 16.03.09.11.1

  • It is a reasonable calculated service to prevent, diagnose,
  • r treat conditions in the participant that endanger life,

cause pain, or cause functional significant deformity or malfunction; and

  • There is no other equally effective course of treatment

available or suitable for the participant requesting the service which is more conservative or substantially less costly.

  • Medicaid services must be of a quality that meets

professionally-recognized standards of health care and must be substantiated by records including evidence of such medical necessity and quality. Those records must be made available to the Department upon request.

Must Be Medically Necessary

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F B A

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B I P

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Do we need to do PLOP’s and goals for Behavioral Intervention Services?

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What needs to be in an IEP?

  • Goal(s) and

Objectives when appropriate

  • Service Page
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G O A L

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Example Goals

  • Given positive reinforcement for raising their hand, Student will

decrease classroom interruptions (blurting out answers, talking out, yelling) from an average of 15 times a day to an average of 2 times a day for 2 consecutive weeks as documented in daily behavior record.

  • Following one verbal cue to return to an instructional area, Student will

comply without physical outburst from an average of 10 incidents a day to an average of 2 incidents per day for 2 consecutive weeks as documented in daily behavioral record.

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S E R V I C E S

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New Medicaid IEP Form

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1 1 2 2

Social and Emotional Speech/Language Speech/Language Social and Emotional

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Documentation Prior to Billing

  • Current IEP – indicates the

need for service(s).

  • Physician’s Orders – makes

recommendation or referral for Medicaid services.

Idaho Administrative Code IDAPA 16.03.09

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Service Detail Record Must Include:

  • Student’s name
  • Name and title of person

providing the service

  • Date, time, duration for

service

  • Place of service
  • Student’s response to the

services

  • A review of progress

towards goals is completed every 120 days

Idaho Administrative Code IDAPA 16.03.09

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  • Providers must check both the Idaho Medicaid Exclusion List and the HHS-OIG Exclusion

List to determine whether a provider, individual, or entity is excluded and, if so, the dates

  • f such exclusion.
  • The HHS-OIG Exclusion List is accessed at http://exclusions.oig.hhs.gov and Idaho Medicaid

Exclusion list is accessed at http://www.healthandwelfare.idaho.gov/Providers/MedicaidProviders/tabid/214/Default. aspx

  • Providers are responsible for screening all employees and contractors to identify excluded

individuals and are responsible for searching the HHS-OIG website and the Idaho Medicaid Exclusion List monthly to capture exclusions and reinstatements. Providers, individuals and entities are not automatically reinstated at the end of the state or federal exclusion period. If providers, individuals or entities on the state or federal exclusion list do not have a reinstatement date listed, they are not eligible to provide services. (Idaho Medicaid Exclusion List - last updated May 4, 2012)

Exclusion List

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Don’t forget…

  • Districts must be enrolled as a Medicaid

provider to be reimbursed for school based Medicaid services.

  • Each service must be specifically identified
  • n the IEP.
  • Services cannot be educational.
  • Services must be medically necessary for

the student to access their educational program.

IDAPA 16.03.09

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Need More Help?

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www.idahotc.com

  • Training Calendar
  • Online Registration
  • Webinars
  • Learning Communities
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Contact Information:

Shannon Dunstan Early Childhood & Interagency Coordinator Idaho State Department of Education Division of Student Achievement and School Improvement Division of Special Education (208) 332-6908 sdunstan@sde.idaho.gov

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