What is the data? Julie Neururer B.A. LICSW Interagency Services - - PowerPoint PPT Presentation
What is the data? Julie Neururer B.A. LICSW Interagency Services Specialist April 18, 2019 Student Data Our children count 600,139 children ages 0-21 were enrolled in Minnesota Health Care Programs (MHCP) 35,214 children enrolled in
Julie Neururer B.A. LICSW Interagency Services Specialist April 18, 2019
Our children count…
(MHCP)
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Minnesota Special Education Child Count - Ages 0-21
123,241 124,560 126,091 127,863 128,480 128,812 129,669 130,886 133,678 137,601 142,270 147,605 110,000 115,000 120,000 125,000 130,000 135,000 140,000 145,000 150,000 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19
Child Count School Year
Special Education Enrollment as Percent of Total Enrollment Public School Students, Birth-21
Fiscal Year 2003 Fiscal year 2007 Fiscal year 2011 Fiscal Year 2015 Fiscal Year 2019 13.4% 14.2% 15.0% 15.0% 16.3%
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Special Education Enrollment by Primary Disability, FY 2019 Public School and Nonpublic Shared Time Students, Birth-21
Primary Disability Percent special education enrollment Traumatic Brain Injury 0.3% Developmentally Delayed 13.1% Autism Spectrum Disorders 13.9% Other Health Disabilities 13.6% Deaf-Blind 0.1% Emotional Behavioral Disorders 11.4% Severely Multiply Impaired 1.0% Speech/Language 15.5% Developmental Cognitive: Mild- Moderate 3.7% Developmental Cognitive: Severe- Profound 1.3% Physically Impaired 1.1% Deaf Hard-of-Hearing 1.7% Visually Impaired 0.3% Specific Learning Disability 22.9%
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Primary Disabilities with Largest Enrollment Growth, FY 2013-FY 2019 Public School and Nonpublic Shared Time Students, Birth-21
Primary Disability Fiscal Year 2013 Fiscal Year 2016 Fiscal Year 2019 Autism Spectrum Disorder 15,967 17,648 20,485 Developmentally Delayed 15,115 16,759 19,390 Other Health Disabilities 17,171 18,786 20,056 Specific Learning Disability 29,762 30,306 33,834 Emotional Behavioral Disorders 14,984 14,928 16,814 4/15/2019 6
356 387 402 419 415 50.00 100.00 150.00 200.00 250.00 300.00 350.00 400.00 450.00 2014 2015 2016 2017 2018 Series 1 4/15/2019 7 MDE Data Based on Schools Reporting on Receipted Medicaid Revenue (17/18 NOT COMPLETE)
Total number of unduplicated billed students
4/15/2019 8 17/18 NOT COMPLETE 2014-15, 32,735 2015-16, 35,192 2016-17, 37,493 2017-18, 38,733 29,000 30,000 31,000 32,000 33,000 34,000 35,000 36,000 37,000 38,000 39,000 40,000
2014-15 2015-16 2016-17 2017-18
1 50 2500 125000 6250000 312500000 Interp PT-E PT-T OT-E OT-T SP-E SP-T MH-E MH-T Nursing-E Nursing-T PC-T AT-T ST-T 2014-2015 2015-2016 2016-2017 2017-2018 4/15/2019 17/18 NOT COMPLETE 9
1 10 100 1000 10000 100000 Interp PT-E PT-T OT-E OT-T SP-E SP-T MH-E MH-T Nursing-E Nursing-T PC-T AT-T ST-T 2014-15 2015-16 2016-17 2017-18 4/15/2019 10 17/18 NOT COMPLETE
Cost of Special Education Employees and Contracted Staff
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2014-15, $825,821,895 4.56%, 2015-16, $863,447,829 6.70%, 2016-17, $921,329,588 4.25%, 2017-18, $960,451,403 $750,000,000 $800,000,000 $850,000,000 $900,000,000 $950,000,000 $1,000,000,000
2014-15 2015-16 2016-17 2017-18
Total Employee & Contracted Staff Service Hours
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2014-15, $26,872,233 3.28%, 2015-16, $27,752,564 4.42%, 2016-17, $28,978,664 2.88%, 2017-18, $29,814,562 25,000,000 25,500,000 26,000,000 26,500,000 27,000,000 27,500,000 28,000,000 28,500,000 29,000,000 29,500,000 30,000,000 30,500,000
2014-15 2015-16 2016-17 2017-18
Minnesota School District Revenue from MHCP Reimbursement
37,793,452 41,500,788 50,132,622 52,562,891 53,000,000 2012-13 2013-14 2014-15 2015-16 2016-17
District Revenue in Millions School Year
Billing MHCP for IEP Health-Related Services by School Year
4/15/2019 13 Minnesota Department of Human Services | mn.gov/dhs
Julie Neururer
Julie.neururer@state.mn.us 651-582-8660
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Division of School Finance| Paul Ferrin April 18, 2019
The Special Education Funding and Data Reference Guide will serve as an important resource for identifying fiscal and compliance criteria for most of the special education funds disbursed to local educational agencies (LEAs) through the Minnesota Department of Education (MDE). This information should assist you in your analysis of financial activity; enhance your ability to maximize financial resources; and accurately report special education financial and student data.
Special Education Funding Guide
(MDE > Districts, Schools and Educators > School Finance > Special Education > Special Education Funding Guide)
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Education for Students with a Disability
Estimates
Instructional Services
Services
FAPE – Free Appropriate Public Education FIN – Finance Code FFY – Federal Fiscal Year GenEd – General Education IEP – Individualized Education Program IFSP – Individualized Family Service Plan IOwA – Identified Official with Authority LEA – Local Educational Agency MA – Medical Assistance MARSS – Minnesota Automated Reporting Standards System MDE – Minnesota Department of Education MFR – Minnesota Funding Reports MOE – Maintenance of Effort PTC – Personnel Type Code SEA – State Education Agency SEDRA – Special Education Data Reporting Application SERVS – State Educational Record View and Submission SFIN – SERVS Financial SFY – State Fiscal Year SpEd – Special Education UFARS – Uniform Financial Accounting Reporting Standards
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Individualized Education Program (IEP) health related services are paid a “cost based” per diem rate. IEP rates are calculated using the actual costs incurred per local education agency (LEA) or school district in the provision of service to MA eligible children in school districts in Minnesota.
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MDE Total Annual Salary (per personnel type code) Total Contract Expenses (per personnel type code) Full Time Equivalence FTE (per personnel type code) District Fringe Benefit % District Unrestricted Indirect Cost % District Contract Days District Daily Hours
School Districts
Service Hours
child’s activity logs
Encounter
the day
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Medical Assistance Reports Special Education Data Reporting Application (SEDRA) MA Rate Calculation Using MA Funds MA Reporting
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Funding Source codes:
Service codes:
Eligible expenditures must not be made from federal funds or funds used to match
Employees and contracted service providers cannot be paid with federal special education funds (Finance 419, 420 or 422), IEP-MA Funds (Finance 372) or LCTS (Finance 799) AND billed for IEP-MA reimbursement.
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Service SEDRA PTC
Physical Therapy 4 Occupational Therapy 5 Speech Lang/Hearing 7 and 14 Nursing 6, 44, 60 and 62 (SRV Code “d”) Mental Health 11, 13, 49, 50 and 52 Personal Care 43, 61, 8, 53 and 62 (SRV code “c”) Interpreter 26, 28 and 62 (SRV code “a”)
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Total benefits coded to UFARS: Program codes 401 – 420 Finance codes 317, 320, 335, 372, 419 - 446, 619 – 635, 740 and 799 Object codes 191, 199 – 251, 270 – 280, 299 and 397 Total Salaries coded to UFARS: Program codes 401 – 420 Finance codes 317, 320, 335, 372, 419 - 446, 619 – 635, 740 and 799 Object codes 110 – 186 and 396 If all benefits are codes to Federal Finance codes or FIN 372 the benefit rate will be zero.
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Indirect costs are generally administrative costs such as the salaries and expenses for people who are engaged in administrative activities from which the entire LEA benefits. An indirect cost rate is the ratio of total indirect costs to total direct costs, based on an LEA’s actual expenditures, exclusive of any extraordinary or distorting expenditures, such as capital outlay and major subcontracts. When calculating the indirect cost rate, the expenditures for the second preceding fiscal year are used. For example, expenditures for FY 2016 will be used when calculating the rates for FY 2018. The second preceding year is used because the actual costs for the immediately preceding year will not be available at the time the LEA needs to calculate the rate for the following year.
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Minnesota Statutes, section 125A.74, Subdivision 5 protects other special education funding from being reduced by third party revenue. Revenue obtained from a third party source does not reduce any other revenue a district receives for a child. The revenue received from third party sources must be tracked through the Uniform Financial and Reporting System (UFARS) according to Minnesota Statutes, section 125A.76, Subdivision 2. UFARS Finance Code 372: Report expenditures using third party revenue with this code. UFARS Source Code 071: Report all revenue received from Minnesota Health Care Programs (MA and MinnesotaCare) in UFARS with Source Dimension Code 071. UFARS Source Code 072: Report all revenue received from private health plans (Blue Cross, Medica, etc.) in UFARS with Source Dimension Code 072.
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Use of Third Party Revenue (section 125A.21, subdivision 3)
administrative costs of obtaining reimbursements;
ability to access third-party payments for individualized education program or individualized family service plan health-related services; or
education programs or individualized family service plans in the district.
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Pay for the administrative/contracted staff that does the billing to DHS – Not eligible for special education aid; code to program 400 (not in SEDRA) Pay for training on how to use your MA funds and how to better bill DHS – Not eligible for special education aid; code to program 400 (not in SEDRA). Use the funds to benefit a student/s with an IEP. This could include paying for an EBD teacher’s salary, benefits, vehicles (exclusive to SpEd), student and/or teacher supplies and equipment – Eligible for SpEd aid; code to program 401- 420 (enter on SEDRA using i, j or m).
Non-licensed Substitutes Teachers are not an eligible use of MA funds.
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Assistive technology (equipment) may be purchased with state and local funds and the district will receive third party revenue reimbursement. Pieces
whole or in part, are the property of the child for whom they are purchased. There is no specific law or rule in Minnesota about ownership of equipment purchased with local or state education funds. Districts are not violating any law or rule by assigning ownership of equipment to the student.
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https://education.mn.gov/MDE/dse/sped/caqa/fis/058269
inventory?
purposes?
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By federal definition, “Equipment means tangible, nonexpendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. A grantee may use its own definition of equipment provided that such definition would at least include all equipment defined above.” Board policies may define a threshold lower than $5,000 for equipment. In these instances, the stricter board policy supersedes the federal threshold. Similarly, board policies may define sensitive items, defined below, as also being treated as equipment. The state does not provide further guidelines regarding equipment purchased with state special education funds. We recommend that items purchased with state funds follow the same definition and procedures as those purchased with federal funds. Authority: 2 C.F.R. § 300.33
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Sensitive items are items purchased for less than the established dollar value threshold for identification as equipment, but whose nature places them at an increased risk of being lost, misplaced, or stolen. For example, an iPad may not have a dollar value that meets the district’s definition of “equipment.” However, the attractiveness of an iPad left unsecured and unaccounted for would place it at an increased risk of being stolen compared to an adaptive study cube purchased at the same dollar value. The adaptive study cube is at little risk of being stolen but an iPad would be a very attractive or “sensitive” item where additional accountability measures would be warranted. Authority: The User Guide to State Property Management, Section 5 Sensitive Items, Minnesota Department of Administration, May 1, 2014 (http://www.mn.gov/admin/images/Surplus_PropertyManagementGuide_Complet e.pdf)
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What is the minimum purchase price of an item that requires it to be included on the LEA’s inventory?
Federal rules require that any item valued over $5,000 be included as a required inventory item as long as it fulfills the remaining elements of the definition as stated in question one. However, LEAs are also required to have the administrative and fiscal controls in place necessary to ensure the security and appropriate use of grant funds. To ensure this requirement is fulfilled, we recommend that the LEA put in place a sensitive item list, as defined in question 2. The items on this list would be included on the inventory records in order to safeguard them against theft, regardless of price. Authority: 2 C.F.R. § 200.313
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What kinds of special transportation equipment are eligible special education expenditures?
braces, brackets, restraints, seatbelts, vests).
control methods, including tinted windows.
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What elements are required on the LEA’s equipment inventory form?
a) The description of the property. b) The serial number or other identification number. c) The funding source of the property. d) The name of the entity that holds title. e) The acquisition date and cost. f) The percentage of federal/state participation in the cost of the property. g) The location of the property. h) The use of the property. i) The condition of the property. j) Any disposition date including date of disposal and sale price of the property.
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How often is an LEA required to complete a physical inventory
LEAs are required to conduct a physical inventory at least once every two
firsthand knowledge of the facts presented in order to verify the inventory was completed and when completion occurred. The inventory should verify that the physical location, identification number and description information is complete and accurate. The review should also assess the condition of the equipment and verify that it is still being used. If the equipment is not being used, LEAs should determine whether it is surplus
Authority: 2 C.F.R. § 200.313 (d)(2)
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Why must LEAs complete property records and physical inventories?
An internal control system must be developed to ensure adequate safeguards to prevent loss, damage, or theft of the property. Any loss, damage, or theft must be investigated. Authority: 2 C.F.R. § 200.313 (d)(3)
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How should an LEA dispose of equipment that is no longer needed for special education purposes?
Procedures for Disposition of Equipment in Excess of $5,000:
Course Code for the purpose of tracking the receipt(s) and expenditures of the sale of a piece of equipment that was federally funded.
include a description of the equipment, the date of sale, the proceeds of the sale, and the unique Course Code established by the LEA that will designate the use of these funds.
Code and established Course Code.
is less, for the LEA’s selling and handling expenses.
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How should an LEA dispose of equipment that is no longer needed for special education purposes (2)?
Procedures for Disposition of Equipment in Excess of $5,000:
delivery of special education, and related services and must be accounted for using UFARS Program Code 400, Course Code as established with the appropriate expenditure UFARS Object Code. For example, special education instructional supplies would be coded: 01-XXX-400-000-433-YYY where YYY = unique UFARS Course Code.
Maintenance of Effort requirement of the Individuals with Disabilities Education Act (IDEA).
fiscal year to document expenditures.
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How should an LEA dispose of equipment that is no longer needed for special education purposes (3)?
sell, or otherwise dispose of the equipment with no further obligation.
maintained with the equipment inventory.
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Procedures for Disposition of Equipment:
with the equipment inventory. Authority: 2 C.F.R. § 200.313 (e)(1 - 4)
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SEDRA – UFARS Code Sheets (https://education.mn.gov/MDE/dse/schfin/sped/fund/)
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This is the term used to mean the unreimbursed cost of special education that is covered by a school’s general education revenue. It is calculated as followed:
the SpEd classroom/resource room (this is called the GenEd to Defray).
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https://education.mn.gov/MDE/about/rule/leg/rpt/index.htm MDE > About MDE > Legislation, Rulemaking and Reports > Legislation > Legislative Reports This report is posted annually once the entitlements are final. The report shows the state’s cross subsidy along with each district’s individual cross subsidy. Individual district cross subsidy reports are located on the MFR under each district and the category of special education.
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Concerns? What if?
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Special Education Funding and Data Team
mde.spedfunding@state.mn.us
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Laura Waldoch | Special Education Fiscal Monitor April 18, 2019
Why do we need to document time and effort?
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Federal time and effort records must:
Uniform Grant Guidance 2 C.F.R. §200.430(i)
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Support records must:
activities or cost objectives
Uniform Grant Guidance 2 C.F.R. §200.430(i)
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Budget estimates alone do not qualify as support for charges to Federal awards.
Uniform Grant Guidance 2 C.F.R. §200.430(i)(1)(viii)
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Time & Effort
time periods throughout the school year paid with special education funds. Time Study
the duration of the time study.
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Concerns? What if?
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Laura Waldoch
laura.waldoch@state.mn.us 651-582-8404
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Third Party Forum April 18, 2019
The practice of speech-language pathology means identification, assessment, interpretation, diagnosis, habilitation, rehabilitation, treatment and prevention of disorders of speech articulation, fluency, voice and language. The practice of audiology means identification, assessment, interpretation, diagnosis, rehabilitation and prevention of hearing disorders. Authorization Requirements The Individualized Education Program (IEP) team authorizes services included in an IEP or Individualized Family Service Plan (IFSP). Physicians (primary care providers) orders or referrals are not required. The licensed speech and language pathologist or audiologist working within his or her scope of practice will evaluate services needed, develop the treatment plan and goals or the care plan, treat the patient, or supervise and give direction to a clinical fellowship licensee.
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Speech Language Pathologist and Audiologist Licensure
The following providers can perform speech or audiology services:
is licensed by the Minnesota Department of Health (MDH)
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
pathology, meets the requirements in MS 148.511-148.5198 and is licensed by MDH
language pathology or audiology according to the requirement in MS148.511-148.5196 (This program is available for a limited time.)
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Education and Certificate: 148.5192 SPEECH-LANGUAGE PATHOLOGY
ASSISTANTS.
Must have an associate degree from a speech-language pathology assistant program or a bachelor's degree in the discipline of communication sciences or disorders and completion of supervised field work experience as a speech- language pathology assistant student. SLPA services are not covered by medical assistance at this time. Legislation for licensure and billable services may proceed in the near future.
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Responsibilities: (under the supervision of a licensed/certified SLP)
Implement treatment plans or protocols as directed by speech-language pathologists. Document clients' progress toward meeting established treatment objectives. Assist speech-language pathologists in the remediation or development of speech and language skills and assessments Perform support duties, such as preparing materials, keeping records, maintaining supplies, and scheduling activities.
Limitations:
Complete standardized , formal or informal assessments including interpretation of results; Write , develop or modify reports or IEPs . Treat swallowing disorders . Make referrals, select clients for services or discharge clients from services . Notification. Any agency or clinic that intends to utilize the services of a speech-language pathology assistant must provide written notification to the client or, if the client is younger than 18 years old, to the client's parent or guardian before a speech- language pathology assistant may perform any of the duties described in this section.
Speech Language Pathology & Audiology in the Schools
A speech-language pathologist is authorized to provide specialized speech-language services to prekindergarten through grade 12 students with identified communication disabilities including those affecting language, articulation, fluency, and voice. Speech-language services can be a primary disability or related service. In order to qualify for speech/language services, the pattern interferes with communication, as determined by an educational speech language pathologist and either another adult of the pupil in any of the above four communication disabilities. Also, the patterns are not attributed only to dialectical, cultural or ethnic differences or to the influence
An audiologist identifies children with hearing loss by determining the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing. They also provide counseling and guidance of children, parents, and teachers regarding hearing loss; and determination of children's needs for group and individual amplification, selecting and fitting an appropriate aid, and evaluating the effectiveness of amplification.
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An articulation disorder is the atypical production of speech sounds characterized by substitutions,
with intelligibility. A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. This may be accompanied by excessive tension, struggle behavior, and secondary mannerisms. A voice disorder is characterized by the abnormal production and/or absences of vocal quality, pitch, loudness, resonance, and/or duration, which is inappropriate for an individual's age and/or sex.
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A language disorder is impaired comprehension and/or use of spoken, written and/or other symbol
language (phonology, morphology, syntax), (2) the content of language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination. Audiological Services include the identification of hearing loss that may include recommendations for amplification.
MHCP covers the following services:
language pathologist who meets the requirements, or a clinical fellowship licensee
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 or 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
provided is just as effective as if it was provided face to face)
recommendations are not covered).
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Speech/Language Pathology:
Articulation: iPad, following 2 step directions 70%. Initial /f/ words 75% Language: Spontaneously labeled 5/10 school tools, 6/10 occupations, 8/10 furniture, 8/10 clothes. Language: functional switch activation to activate a repeated line in a story given visual and verbal prompting - judged to be meaningful near 60% of activations
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sentences - distortion on a few bleeds and prevocalic /r/ sounds. helped fix a voiced /th/ "the"
in spontaneous speech X3; signing m own
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Concerns? What if?
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MN Statute148.171 Minnesota Nurse Practice Act
Professional Nursing -
4 year (Baccalaureate Degree) in Nursing with public health practicum
a School Nurse by the Board of Teaching and licensed. Has a Baccalaureate Degree in Nursing or higher Practical Nursing -
Professional Nurse. Average of 1 year training Unlicensed Assistive Personnel - (UAP)
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School Nurse - Assists the IEP team in determining if the student needs nursing services as a related service provider - completes the evaluation report RN and LPN - Can assist in gathering data and completing the health assessment. LSN/RN/LPN - Under DHS, ALL are eligible to bill for nursing services, within their nursing scope
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○ “Nurse evaluation” (nursing assessment) for adverse reactions to medications; eval of behavior/physical/emotional/psychological health ○ Health teaching and counseling the child about his or her medication and proper medication administration. Contact with the health care provider about prescriptions or treatment orders, tolerance or adherence ○ Independent nursing interventions (bowel or bladder program, head injury protocols, chemical assessment, etc) ○ Chronic disease management ○ Nursing assessment and diagnostic testing, such as vital signs and glucose testing
*Billable activities include administering face-to-face assessments, interpreting test results and writing reports.
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(chronic vs acute)
with self administration of meds)
including health assistants and personal care attendants (PCA)
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When to include the LSN? Best Practice (all) vs Statute (need) vs Capacity (staffing)
Speech would be included on the evaluation team.
conduct an assessment. The Evaluation Report will specify the health condition and the nursing services that may be needed.
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evaluated for Special Education
treatments in order to be at school, ask to be included on the evaluation team
and complete the IEP Evaluation Report
accommodations section)
and on the IEP
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Concerns? What if?
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According the Minnesota Board of Occupational Therapy Practice:
maximize the independence and the maintenance of health of an individual who is limited by a physical injury or illness, a cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or learning disability, or an adverse environmental condition. The practice encompasses evaluation, assessment, treatment, and consultation. Occupational therapy services may be provided individually, in groups, or through social systems. Overview-Provider Manual
maintain the health of a person who is limited by a physical injury or illness, a cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or learning disability,
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The following providers can perform occupational therapy services:
require OT license renewal every two years. Continuing education requirements of 24 contact hours for OT for every two-year cycle.
regulations require OTA license renewal every two years. Continuing education requirements of 18 contact hours for OTA are needed for every two-year cycle. (education.mn.gov)
Qualified Service Providers: From the provider manual
Health.
148.6450 and is licensed by the MN Department of Health.
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Who monitors licenses?
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Supervision requirements: b) Face-to-face collaboration between the occupational therapist and the occupational therapy assistant shall
The OT should be present on the initial treatment session with the OTA.
based on the condition of the child, the complexity of the treatment procedure and the proficiencies of the OTA.
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Covered Services
maintaining a child’s functional status at a level consistent with the child’s physical or mental
and sustain function; provide interventions that enable the child to live at his or 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
discuss evaluation results or make recommendations are not covered)
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What is included in a clinical note/service documentation
A clear description of the actual service provided during the session, related to the goals and objectives written on the IEP/IFSP.
session different than what a teacher/paraprofessional would do?)
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required moderate physical assistance to place the scissors in her right hand correctly, with the thumb up position, for 2/3 trials. She placed the scissors in her hand correctly on her third trial. She was able to make snips up to 3” across the paper, but needed help to hold and position the paper to cut all the way across the 8” paper. Plan: next sessions continue to work on cutting tasks but add cutting out simple pictures or on mazes to increase her motivation.
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According to the Minnesota Board of Physical Therapy: The practice of physical therapy (M.S. 148.65) means the evaluation or treatment or both of any person by the employment of physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting,
heat or cold, air, light, water, electricity and sound. Physical therapy includes evaluation other than medical diagnosis, treatment planning, treatment, documentation, performance of appropriate tests and measurement, interpretation of orders or referrals, instruction, consultative services, and supervision of supportive personnel. From the Provider Manual Physical therapy means the evaluation or treatment, or both, of a person by employing physical measures and using therapeutic exercises and rehabilitative procedures with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability.
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The following providers can perform physical therapy services:
in sections MS 148.65 to 148.78. Physical therapy regulations require PT license renewal every year. Continuing education requirements of 20 contact hours, including 2 contact hours of Ethics, are needed for every two-year cycle.
under the direction and supervision of a physical therapist, and who performs physical therapy interventions and assists with coordination, communication, documentation, and patient-client-related instruction.
including a minimum of 2 contact hours of professional ethics directly related to the practice of physical therapy, are needed for every two-year cycle (MS 148.66; 148.74). Additionally, PTs and PTAs must take a yearly jurisprudence examination on the Board of Physical Therapy Practice Act (MS 148.73). Physical Therapy Record Retention: all patient records including directions and orders within the control of the physical therapist shall be retained for at least seven years, or six years after the patient's majority (Minnesota Administrative Rules 5601.1300).
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Supervision and Direction of a PTA
Direction means the actions of a PT who:
every sixth treatment session of each child or youth when treatment is provided by a PTA
The PT must document supervision and direction.
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MHCP covers the following OT & PT services:
(under the direction of a PT)
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 or 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
recommendations are not covered). MHCP Authorization Requirements
A physician’s (primary care providers) orders or referral is not required. The licensed OT or PT working within his or her scope of practice will evaluate services needed, develop the treatment plan and goals or the care plan, treat the patient, or supervise and give direction to an OTA or PTA.
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R demonstrated improved focus with eye gaze today while working on the mobile tablet. Black background with bright colors appeared to assist in maintaining longer periods of visual attention, with increased increments noted
movement out of a resting position towards the tablet, however, accuracy was limited in his ability to touch the tablet with consistency. He was noted to verbalize on both occasions where he was able to make bright marks on the screen when contact was made. Student seen for functional fine motor. Student participated in adaptive scissors cutting activity with switch mounted
visual attention 3-4 seconds 70% of time. Student participated in paper shredding holding button to activate shredder on average 3-4 seconds 70% of
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PT consulted with para in regards to the stander and did adjust the footrests a bit more. A tolerated the stander for 10 minutes and went well. Jason from HCA will consult next week on stander. Continue to progress. Hamstring stretching, heelcord stretching performed at 2 x 30 seconds along with 20 sit-ups and bridges. He did 15 marches, kicks with 2# weights and hams using red TB. Worked on standing balance,hopscotch, stepping stones, jumping on the trampoline with throwing tennis balls, rockerboard activity throwing the ball and toe/heel raises along with balance beam.Worked on reaching activity in sitting. Tolerated it well. Worked on rockerboard with reaching activity. Hopped forward 4x without LOB.Performed hopscotch without LOB with HHA on left. Played Elefun without any LOB.
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Concerns? What if?
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148E.050 LICENSING; SCOPE OF PRACTICE. § Requirements. The practice of social work must comply with the requirements of subdivision 2, 3, 4, or 5.§
worker must not engage in clinical practice.§
a licensed graduate social worker must not engage in clinical practice except under the supervision of a licensed independent clinical social worker or an alternate supervisor according to section 148E.120.§
except that a licensed independent social worker must not engage in clinical practice except under the supervision of a licensed independent clinical social worker or an alternate supervisor according to section 148E.120.§
work practice, including clinical practice.
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Scope of Practice Authority for all Licenses: As stated in Minnesota Statutes, Section 148E.050, an LSW, LGSW, LISW, and LICSW may engage in social work practice. An LSW must not engage in clinical social work practice. An LGSW and LISW may engage in clinical social work practice only under the supervision of an LICSW, or a licensing supervisor approved by the Board. An LICSW may independently engage in clinical practice. Dually licensed: School Social Workers must by dually licensed by Minnesota Professional Educator Licensing and Standards Board (PELSB) and the Minnesota Board of Social Work.
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245.462 Subd. 17.Mental health practitioner.
(a) "Mental health practitioner" means a person providing services to adults with mental illness or children with emotional disturbance who is qualified in at least one of the ways described in paragraphs (b) to (g). A mental health practitioner for a child client must have training working with
*All school social workers meet the criteria of a mental health practitioner or mental health professional.
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245.462 Subd. 18.Mental health professional.
"Mental health professional" means a person providing clinical services in the treatment of mental illness who is qualified in at
least one of the following ways: (1) in psychiatric nursing 148.171 to 148.285; and: (2) in clinical social work (3) in psychology: an individual licensed by the Board of Psychology under sections 148.88 to 148.98 (4) in psychiatry (5) in marriage and family therapy 148B.29 to 148B.39 (6) in licensed professional clinical counseling, the mental health professional shall be a licensed professional clinical counselor under 148B.5301 (7) in allied fields: a person with a master's degree from an accredited college or university in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services in the treatment of mental illness. *All school social workers meet the criteria of a mental health practitioner or mental health professional.
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Difference between billable Mental Health diagnostic assessment and IEP evaluation:
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Assessments and Evaluations
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 or IFSP with covered IEP services or determine the need for continued services.
IEP evaluations include:
IEP evaluation activities include:
If CTSS certified please refer to manual for list of covered services.
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Concerns? What if?
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Patricia C Sullivan,-MS-CCC/SLP Moorhead Area Public Schools Dawn Wilson LSN, RN, PHN-Wayzata Public Schools Carolyn Zachariason MA, OTR/L-Minneapolis Pubic schools Dan Porter M.S.W., L.I.C.S.W.-Northeast Metro 916 Intermediate School District
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Renelle Nelson M.A. PACER Parent Advocate/Children’s Mental Health and EBD Project Coordinator
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Special Education Due Process Overview
Rachael Arndt| Compliance Specialist Division of Compliance and Assistance May 15, 2019
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Participants will grasp a beginner’s understanding of special education due process …in 30 minutes or less! Disclaimers:
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Federal Regulations/IDEA State Statutes & Rules District Policies/ TSES Evaluation & IEP
Districts must provide a free appropriate public education (FAPE) to students with disabilities. FAPE = Special education and related services that:
(IEP)
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responsibility
interventions
Child Find
Process
from intervention
Child Study
Due Process
members
data, existing and new
Special Education Evaluation
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Progress Reports inform present levels for reevaluation and/or PLAAFP for next IEP
Purpose of evaluation process: To gather relevant data about the child’s present levels of performance To ascertain educational needs of the child To determine if the child is (or continues to be) eligible for special education and related services Required materials and procedures: Qualified team Information from parents Variety of assessment tools and strategies Review of existing data Valid, reliable and nondiscriminatory assessments
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The evaluation must be sufficiently comprehensive to identify all of the child's special education and related services needs, whether or not commonly linked to the disability category in which the child has been classified.
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A PWN is required whenever the district proposes or refuses to initiate or change the identification, evaluation, educational placement, or provision of FAPE to the child. The PWN must inform the parents that the school district will not proceed with the initial placement and provision of services...without prior written consent of the pupil's parents. The PWN must inform the parent that except for the initial placement of a child in special education, the school district will proceed with its proposal for the child’s placement or for providing special education services unless the child’s parent notifies the district of an objection within 14 days of when the district sends the prior written notice to the parent.
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Input from the parents A summary of all evaluation results The student’s present levels of performance The student’s educational needs that derive from the disability Determination of whether the student has a particular category of disability Determination of whether the student needs special education and related services For a reevaluation only: whether any additions or modifications to the special education and related services are needed to enable the student to meet the measurable annual goals and to participate, as appropriate, in the general curriculum.
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The parents of the child Not less than one regular education teacher of the child (if the child is, or may be, participating in the regular education environment) Not less than one special education teacher of the child, or where appropriate, not less then one special education provider of the child
A district representative An individual who can interpret the instructional implications of evaluation results At the parents’ or district’s discretion,
including related services personnel as appropriate Whenever appropriate, the child with a disability
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In developing each child’s IEP, the IEP team must consider: The strengths of the child The concerns of the parents The results of the most recent evaluation The academic, developmental, and functional needs of the child The need for assistive technology
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The IEP must include a statement of the child’s present levels
(PLAAFP), including how the child's disability affects the child's involvement and progress in the general education curriculum (i.e. the same curriculum as for nondisabled children).
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The IEP must include a statement of measurable annual goals, including academic and functional goals designed to meet the child’s needs that result from the child’s disability to enable the child to be involved in and progress in the general curriculum.
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The IEP must include a statement of measurable annual goals, including academic and functional goals designed to meet each of child’s other education needs that result from the child’s disability. The IEP includes a statement of measurable annual goals, including benchmarks and short-term objectives.
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The IEP must include a statement of the: special education and related services supplementary aids and services program modifications supports for school personnel that will be provided to the child, or on behalf of the child, and that will enable the child to advance appropriately toward attaining the annual goals.
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Point of Clarification: The special education and related services and supplementary aids and services provided to the child must also enable the child:
curriculum and to participate in extracurricular and other nonacademic activities; and
and nondisabled children.
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Examples of supplementary aids and services include:
software, or a communication system;
supplementary aids
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Examples of program modifications include: A modification is a change in what is being taught to or expected from the student. Shortening an assignment so the student is not doing the same amount of work as other students is an example of a modification. Other examples include getting assistance or consultation from the student’s special education case manager, having an aide in the classroom, or using a special curriculum.
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Examples of supports for school personnel:
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The IEP must include a statement of the pupil's need for and the specific responsibilities of a paraprofessional. Points of Clarification: Federal law requires that the IEP is accessible to each general education teacher, special education teacher, related service provider and another other service provider, including paraprofessionals, responsible for its implementation and these providers are informed of:
and
provided for the child based on the IEP
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The IEP must include the projected start date for the beginning of the services and modifications. The IEP must also include the anticipated frequency, location, and duration of needed services and modifications.
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The IEP includes an explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class and in extracurricular and nonacademic activities. Point of clarification: Each district must ensure that to the maximum extent appropriate, children with disabilities are educated with children who are nondisabled and that special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only if the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.
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During grade 9, the IEP must address the student’s needs for transition from secondary services to postsecondary education and training, employment, community participation, recreation, and leisure and home living Measurable postsecondary (transition) goals must be based on age-appropriate transition assessments, which is part of the evaluation process during or before grade 9. Transition-aged students’ IEPs must include appropriate measurable postsecondary goals related to training or education, employment, and, where appropriate, independent living skills
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The IEP includes a statement of when periodic reports on the progress the child is making toward meeting the annual goals (such as through the use of quarterly
provided. The IEP includes a statement of how the pupil’s parents will be regularly informed by such means as periodic report cards, at least as often as parents are informed of their nondisabled student’s progress. Parents must be informed of the pupil's progress toward the annual goals and the extent to which that progress is sufficient to enable the pupil to achieve the goals by the end of the year.
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The evaluation, IEP, progress reports and other due process forms document how FAPE is provided to the child and the extent to which a child is benefitting from special education. Evaluation and IEP progress data, along with information from IEP team members, including parents, are pivotal in determining if a reevaluation is warranted or if the IEP should be reviewed or revised due to lack of expected progress or new/changing needs of the child.
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What happens next for FAPE when a student is not exiting, graduating or aging
…the whole cycle starts over at the beginning!
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Progress Reports inform present levels for reevaluation and/or PLAAFP for next IEP
Resource Links Handout MDE’s Special Education web page
Online training resources, compliance & assistance Q & A, due process forms, special education complaints, and more! https://education.mn.gov/MDE/dse/sped/
MDE’s Division of Compliance & Assistance Help
mde.compliance-assistance@state.mn.us
MDE’s Division of Special Education
mde.special-ed@state.mn.us
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Concerns? What if?
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Rachael Arndt, Compliance Specialist Rachael.arndt@state.mn.us
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”Sharing Information”
It takes a team
April 18, 2019 Spring Forum
PCA Services
*ADL’s: Eating, Toileting, Grooming, Dressing, Bathing, Transferring Mobility, & Positioning *HEALTH RELATED FUNCTION *REDIRECTION OF BEHAVIOR Physical aggression towards self or
Increased vulnerability due to cognitive deficits or socially inappropriate behavior Resists care or is verbally aggressive causing care to take longer than normally expected; MUST HAVE 1 ADL OR LEVEL 1 BEHAVIOR TO BE BILLABLE
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Student “The reason we do this” DHS IEP Representative MDE IEP Representative Third Party Coordinator Qualified Professional (PCA Supervisor) Designated Person to Verify Services Personal Care Assistant Schools Business Manager/ Office Special Ed Director
IEP Case Manager
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Wanda
It’s all in the Documentation Miriam
Organization for documentation:
○ Time Studies gotten, monthly PCA Logs with school, teacher, student and date of birth. ○ Para’s hired, date, school, when email is sent to do training and the date I received the certification. Then kept in binders of current and past para’s. Collection of documentation:
○ Keeping blank copies of all documents needed on drive for easy access for Case
○ After creating the PCA Logs from the TIme Studies sent in keep a copy. Then send a copy to the teachers to complete monthly logs. The organization and collection of documentation is key and very important. We are going to be going into detail of what is needed, who is involved and how we communicate all of this. We are sharing examples and things that have worked for us. It is important to find what works for you.
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The Process of Billing PCA Services
Students with MA & PCA services
student.
throughout the day.)
start billing.
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Miriam
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Documentation of the IEP Team . . . What’s the Story
Evaluation Report - Shows student has needs IEP - Present levels, goals/objectives, para description
○ Para Support section or ○ Modifications/Adaptations section
○ Condition or diagnosis that creates the need ○ Covered tasks to be provided ○ Frequency ○ Method of delivery (hands on, cueing and constant supervision, observe/intervene/redirect/monitor) ○ Staff who will provide ○ Staff who will supervise tasks
Behavior Plan Staff Debriefing All documentation should tie together
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Documentation Requirements of Qualified Professional
The sharing of… PCA Plan of Care:
A PCA care plan is a written description of medically necessary PCA services a child will need during the school day with specific instruction of how the services should be provided. A copy of the most current PCA plan of care must be available to the person providing the PCA services.
Components of a PCA plan of Care must include:
Start and end date of the plan of care Child’s name, student identification number, date of birth, name of parent, guardian or responsible party, and emergency contact information List of special instructions or procedure required to meet the child’s specific requests or needs A clear summary including the diagnosis, condition, sign, or symptom Identify the ADL’s, level 1 behaviors or health–related tasks the child will need Steps to address safety and vulnerability issues of the child or youth Date, name and signature of the Qualified Professional
PCA Supervision:
The QP must complete an initial evaluation of the PCA through direct observation of the PCAs work within the first 14 days of starting to provide services to the child or youth. The QP must complete periodic evaluations as follows: At least every 90 days for the first year of service to the child, then every 120 days in the second and succeeding years that the same person is providing the PCA services to the same child.
The QP evaluation must include review and documentation of the following:
adequacy of the tasks and activities in the PCA plan of care to meet the needs of the child or youth
knowledge of the care plan, when to notify the QP of concerns or changes in the condition or behavior of the child or youth, and when emergency actions and contacts are required
tasks and activities to meet the needs of the child or youth as trained
care assistants communication with the QP and emergency contacts made, if any
revision of the PCA care plan or additional training of the person providing PCA services
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Documentation Requirements of Personal Care Assistant
The sharing of… Time Study:
Once the 10-day study is complete, schools must calculate the average daily time for each task, and the total daily time for all PCA services. Include the following in the time study documentation:
who provided the PCA service during the time study
Times
service
child is receiving the same task at the same time (shared care)
PCA Activity Log/Record:
The activity record must correspond to the current PCA plan of care and be reviewed by the QP. Documentation for PCA services must include the following:
task or service
youth absent from school)
shortened day
by the most recent time study of PCA services
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Time Studies, Care Plans, Logs & Supervision Documentation Link to SharePoint
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SPECIAL EDUCATION: THIRD PARTY REIMBURSEMENT (TPR) How to Use TPR Funds
School districts may use TPR revenue as follows:
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OPTIONS Notes 1) Administrative costs of Third Party Reimbursement: x
Do not report in SEDRA Use UFARS Finance Dimension 372, program 400. 2) Training and technical assistance to improve services that may be billed to MA: x
Do not report in SEDRA. Use UFARS Finance Dimension 372, program 400. 3) Benefits to Students: EXPENDITURES that would NOT be eligible for state or federal special education aid:
ACTE-SpEd or similar costs. These are program costs where the unreimbursed cost is NOT billed through the Tuition Billing process. Do not report in SEDRA. Use UFARS Finance Dimension 372, program 400.
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Dellynne
This lists the four categories for which third party revenue may be used: billing costs, training and technical assistance to meet the criteria for billing, and, to address the needs of special education students. Notes on the correct finance and student reporting codes are also listed. MDE Special
Education, TPR MDE School
EXPENDITURES typically eligible for STATE Special Education Aid (Fund Source Code A), providing direct services to children with disabilities:
See code sheet called Medical Assistance SEDRA State Expenditures Code Sheet for all eligible costs. Enter in SERDA as Funding Source Code (small case) “i”
TPR funds used in this way are included in the state aid on the comprehensive aid report. The unreimbursed cost is NOT tuition billed back to the resident district. Use UFARS Finance Dimension 372, program 401-420 EXPENDITURES typically eligible for FEDERAL Special Education Aid (Fund Source Code B):
See code sheet called Medical Assistance Unreimbursable Federal Expenditures Code Sheet for all eligible costs. Enter in SERDA as Funding Source Code (small case) “m” TPR funds used in this way are included in the state aid on the comprehensive aid report. The unreimbursed cost is NOT tuition billed back to the resident district. Use UFARS Finance Dimension 372, program 401-420
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Revenue always goes back to Special Education
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Where do we get the information?
The DHS online Manual
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CON VERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_ 151385
MN Statute # 256B.0659 SharePoint ~ Contact: Julie Neururer MDE IEP Representative julie.neururer@state.mn.us 651-582-8660 DHS IEP Representative jenny.m.roth@state.mn.us 651-431-2622 IEP Rates Specialist jesusa.williams@state.mn.us
651-431-2538
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Wanda Lane (3rd Party Billing Facilitator) Paul Bunyan Ed. Co-op Carrie Walsh (SpEd Business Asst.) North Star & Raleigh, Duluth Edison . Dellynne Monson (Admin Assistant) SWWC Service Cooperative Melanie Adema (MA Billing Specialist) River Bend Education District
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The Team
Heather Murphy (3rd Party Billing Facilitator) School District 622 Miriam Wagar (MA Claims Processor) Bemidji Area Schools