Minnesota Health Care Program (MHCP) Billing

Comprehensive guide to understanding Minnesota Health Care Program (MHCP) billing for covered special education services. Learn about the billing process, required documentation, and maximizing revenue through third-party reimbursement. Explore eligibility criteria, covered IEP services, and how schools/districts can access MHCP funds for eligible children.

• MHCP Billing
• Special Education Services
• Minnesota
• Covered IEP Services
• Eligibility

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1. Minnesota Health Care Program (MHCP) Billing Everything You Need to Know About MHCP Billing for Covered Special Education Services August 2017

2. Topics Overview MHCP Billing Process and Required Documentation Data Entry into SpEd Forms (to be covered in the afternoon SpEd Forms Training) Questions & Answers

3. Its the Law!!! Minnesota Statutes 125A.21, subd. 2(a) Third Party Reimbursement: Beginning July 1, 2000, districts shall 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. Districts must maximize their attempts to collect MHCP revenue.

4. Minnesota Health Care Program Funds Are Available Schools/districts can get MHCP reimbursement for covered IEP services provided to eligible children. Services must meet all MHCP requirements and be documented in writing. Staff who meet MHCP qualifications to provide services can help their schools/districts get MHCP funding. MHCP revenue is used to offset non-reimbursable special education costs (which frees up general education revenue!).

5. Eligible Children Are under age 21, Are enrolled in a MHCP, Have covered IEP services included in a current IEP/IFSP, and Receive covered services on service dates billed.

6. Covered IEP Services Physical Therapy Occupational Therapy Speech/Language Pathology and Audiology Mental Health Services Nursing Services Personal Care Assistant (Paraprofessional) Services Assistive Technology Devices Special Transportation Oral Language Interpreter Services Sign Language Interpreter Services

7. Additional Information Re: Covered IEP Services Must be medically necessary Are authorized by the IEP/IFSP team Are reflected in the Evaluation Summary Report Are included on the IEP/IFSP Must meet all MHCP IEP service requirements Must be documented in writing Must be provided by staff who meet MHCP IEP service qualifications

8. Physical Therapy (PT) Occupational Therapy (OT) Covered services: Individual and group therapy Specialized maintenance therapy IEP evaluations (provided by a physical therapist or occupational therapist) Covered providers: Physical Therapist Occupational Therapist Physical Therapy Assistant or Certified Occupational Therapy Assistant (CODA) working under the direction of a PT or OT at least every sixth treatment session

9. Speech-Language-Hearing Therapy Covered services: Individual and group therapy Specialized maintenance therapy as provided by a speech and language pathologist Telemedicine IEP evaluations Covered Providers: Educational speech & language pathologist Masters in speech/language pathology, licensed by MN Board of Teaching, and, either a Certificate of Clinical Competence (CCC) or has completed the required education and work experience to obtain the CCC Speech & language pathologist Master s and CCC Audiologist Clinical fellowship licensee Master s degree and completing the supervised clinical fellowship under MN Statutes 148.511-148-5196

10. Mental Health Services Covered services in SCRED schools: IEP evaluations as provided by a School Psychologist Must result in an IEP Assessments must be included in the Buros Mental Health Yearbook

11. Nursing Services Face-to-face nursing care and simple medication administration Provided by Licensed Practical Nurse (LPN) Registered Nurse (RN) Public Health Nurse (PHN) Licensed School Nurse (LSN) Medication management and IEP evaluations Provided by a RN, PHN, or LSN Note: Per MDE, RN s do not meet criteria to complete evaluations to determine special education eligibility

12. Physicians Orders Orders or prescriptions are required at least annually or upon modifications to the IEP for all nursing services that require a physician s order/prescription under the nurse s license (scope of practice). Orders/prescriptions that are required for IEP services: must be obtained by the school district from a physician, nurse practitioner or physician assistant, must include dated signatures, must be obtained each school year can cover a period of time of up to one year if the time period is stated on the order; otherwise the date of the signature must be used as the begin date for billing, must be in place at the time service is billed. Physician s orders, referrals, or prescriptions are not required for the following services: physical therapy occupational therapy speech, language and hearing therapy mental health services nursing services that do not otherwise require orders or prescriptions assistive technology devices special transportation oral language interpreter services The school nurse will facilitate this process after being notified by the case manager that the student is MCHP eligible.

13. IEP Evaluations Covered Evaluations Health-related initial evaluations, ongoing assessments to determine progress, re-evaluations Provided by a PT, OT, Speech/Language Pathologist, Nurse, Audiologist, School Psychologist, Mental Health Professional Includes administering tests face-to-face; interpreting test results and writing reports Must result in an IEP/IFSP with covered services and/or determine need for continued IEP services

14. IEP Evaluations Evaluations Not covered: Meetings with families and staff to discuss results and make recommendations.

15. Personal Care Assistant (Paraprofessional) Services A child who qualifies for PCA services must Be dependent in at least one activity of daily living, OR Have a level one behavior Level one behavior - self injurious, causes physical injury to others, destroys property In addition they must receive a covered service: Activities of daily living Health-related functions through hands-on assistance Redirection and intervention for behavior Supervised by a qualified professional (QP): PT, OT, speech language pathologist, mental health professional,RN, PHN, LSN, physician, developmental disabilities specialist (DCD teacher) or social worker

16. Personal Care Assistant (Paraprofessional) Services Activities of Daily Living Eating - assisting with hand washing, applying orthotics, transfers, food preparation, and feeding Toileting - assisting with elimination and diapering, transfers, mobility, positioning, feminine hygiene, use of toileting equipment and supplies, cleansing, skin inspection, adjust clothing assist with re-dressing Grooming - assisting with personal hygiene, basic hair care, oral care, shaving, applying cosmetics and deodorant, eyeglass and hearing aid care

17. Personal Care Assistant (Paraprofessional) Services Activities of Daily Living Dressing - assisting with choosing, applying or changing clothes, applying orthotics and prosthetics or special clothing (TED hose) Bathing - assist with basic personal hygiene and skin care for bathing or showering; includes transfers, positioning, assist with soap, rinsing, drying, skin inspection, applying lotion or other products Transferring - assisting with moving from one seat/bed to another; using a lift, pivoting, standing by to assist and two person lifts

18. Personal Care Assistant (Paraprofessional) Services Activities of Daily Living Mobility: assisting with ambulation; includes assisting with using a wheelchair, walker, cane Positioning: assisting with positioning, repositioning or turning for necessary care and comfort; includes relieving pressure areas, positioning with pillows, wedges, or bolsters whether in a chair, bed, sofa or wheelchair

19. Personal Care Assistant (Paraprofessional) Services Health-Related Tasks Tasks that do not require the skill of a nurse Range of motion and passive exercise to maintain muscle function and strength Assist with self-administered medication (cueing child to take medication; handing child medication that has been set-up; opening medication; assuring child takes medication) Must be trained by a nurse Must demonstrate competency to safely assist with self- administered medication PCAs do not dispense or administer medication

20. Personal Care Assistant (Paraprofessional) Services Health-Related Tasks Intervene for seizures including monitoring and observing while the child is having a seizure Continuous monitoring for seizures is not covered Tracheostomy suctioning and ventilator care CLEAN procedures only (PCAs do not provide sterile procedures) Supervised by a nurse Delegated and trained by a nurse, respiratory therapist or physician Specialized training for procedures, tasks and equipment and ventilator care Individual training on specific needs of child

21. Personal Care Assistant (Paraprofessional) Services Intervene and Redirect Behavior Intervention and redirection for behavior that is medically necessary, related to the child s disability and fits into one of these categories 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; physical injury to others; destruction of property

22. Personal Care Assistant Supervision Within 14 days or sooner as determined by the QP through direct observation of the PCA s work Every 90 days in 1st year; every 120 days after 1styear Provided by a qualified professional (QP) within the scope of practice Licensed registered nurse, public health nurse, licensed school nurse; physician Mental health professional; social worker Physical therapist; Occupational therapist Speech-language therapist; Audiologist Qualified developmental disabilities specialist

23. Personal Care Assistant Training Persons who provide PCA services Take the DHS Individual PCA Training before providing PCA services Take and pass the test Print the certificate of completion and give a copy to the district Are trained on the specific needs of each child for whom the PCA provides services Are trained on tracheostomy suctioning and ventilator care as appropriate

24. Assistive Technology (AT) Devices Covered Devices: Purchased or rented; repairs covered Augmentative communication devices Hearing amplification devices Mobility devices Positioning devices Hardware/software essential to a covered device Additional Requirements: Medically necessary Cannot be purchased or used by a school or program - device belongs to the child Need for the device must be in the IEP/IFSP/IIIP Must be purchased or rented and delivered to the child before billed * As of 7/1/2013, electronic tablets are covered; before billing check to be sure coverage policy development is complete.

25. Assistive Technology SCRED provides assistance to make AT decisions Contact the SCRED Services Coordinator that provides support to your service area

26. Special Transportation Covered Only if All Requirements are Met: Child has a physical or mental impairment that prevents him/her from safely accessing and using a common carrier (taxi, bus, car, van). Child requires a special adaptation or a one-on- one aide, nurse, or PCA while being transported (aide cannot also be the driver). Need for covered IEP special transportation is identified in the IEP/IFSP/IIIP Child is transported to another MHCP covered IEP service on the same day.

27. Special Transportation Provided by a district in a district owned vehicle or a contracted school transportation agency vehicle Includes getting a child to and from the vehicle, waiting for the vehicle with the child and transporting the child Not covered: Services of bus supervisors and monitors Services provided in taxis, cars and non-school owned buses and vans

28. Oral Language & Sign Language Interpreter Services Covered When: Provided to a child with limited English proficiency in conjunction with another covered IEP service. Provided to a parent in order to obtain and relay information regarding the child during a covered IEP service or evaluation Provided by: A person who speaks the language (or signs) and is employed by or has a contract with the school/district to provide language interpreter services. See requirements for competent interpreters in Technical Assistance Guide.

29. Service Not Covered List in the IEP Services Technical Assistance Guide services section (E) Not a complete list Review list carefully Never assume that a service is covered if not listed as not covered; when in doubt ask DHS

30. The MA Billing Process 1. It is the responsibility of the special education case manager to determine if the special education student is eligible for MHCP. There is an assigned person in each district to check the MHCP Eligibility website. This is the due process secretary in most districts. 2. The case manager will determine whether the student receives any of the billable services. 3. Obtain parental consent to bill MHCP. After initial consent is obtained, the yearly issuance of procedural safeguards is the only ongoing requirement.

31. The MA Billing Process (continued) 4. After the meeting, the case manager or other knowledgeable person should discuss with the parent(s) the district s request to access MHCP to bill for services. See SCRED Desk Reference MHCP Billing Script for this purpose. 5. If the student receives nursing services, the case manager will contact the school nurse to obtain a Physician s Order (for nursing services). 6. Case managers or district-assigned MA billing point person will notify the appropriate service providers (i.e., speech and language, OT, PT, Nursing, etc.) when a student is MHCP eligible. 7. For each student that is MHCP eligible, case managers will complete a MA Billing/ICD-10-CM code Checklist. The qualified service provider will assign an ICD-10-CM Code to each eligible service.

32. The MA Billing Process (continued) 7. For each student that is MHCP eligible, service providers and case managers (or MA Billing Site Contacts in some districts) need to fill out the activity logs and data collection forms (AKA: IEP/IFSP Services Record in SpEd Forms) on a monthly basis and submit to assigned person in their district. Complete one record per student even if there are multiple paras. Multiple paras can use the same record. Make only one entry for the total time served. Make separate entries when the group size changes. Note: Data entry should occur for all MHCP eligible students regardless of whether parental consent has been obtained since we can back bill for services if we receive consent at a later date.

33. The MA Billing Process (continued) 8. For students who receive special transportation, the trip log is completed. The child/student s need for IEP special transportation must be included in the IEP/IFSP in order to bill MHCP. Special Transportation is billable per trip from home-to- school and school-to-home each day that the child receives another billable service. For example if the child receives speech therapy twice a week, we can bill for transportation on those two days, but not on days when child is not receiving billable services. If a student has a paraprofessional every day, then transportation could be billed each day.

34. The MA Billing Process (continued) 9. For billable special education evaluations, each evaluator must also complete the activity log and data collection form. 9. In the case of billing for assistive technology (AT), the need for AT must be established in the Evaluation Summary Report (ESR) and the IEP. Identifying the need for AT must include: a. The child s diagnosis or condition. b. A description of the child s functional status. c. The objectives of the device. d. A description of how the device will be evaluated.

35. Billing Service documentation must be complete and accurate Cannot submit claims without service documentation and ICD-10-CM Code(s) Service documentation and attendance records must match Change: Districts may only bill within the current school year Districts, not billing agents, are responsible for all MHCP service, billing, rates information, and data requirements

36. Treatment Plans IEP/IFSP must include frequency, duration and scope of services to be provided and billed to MHCP Description of the reason for special transportation, assistive technology, and interpreter services must be included on the IEP/IFSP If IEP/IFSP do not include goals and objectives, treatment plans can be considered additions to the IEP/IFSP for DHS audits

37. Documentation Written documentation of actual services provided is required Who got the service; who provided the service; how many children participated; how long did the service take; describe the service; describe results; describe plan for next session Written documentation of supervision is required Different services require different supervision documentation Timely documentation is required Keep all documentation for 5 years Remember to complete MHCP billing on at least a monthly basis Adjust MHCP billing if services change during the year, if the student is exited from special education service, or moves out of the school district

38. Final Reminder Billing MHCP is a legal requirement. It is not an optional activity! (and the revenue is a great benefit to your district!)