Appendix
A: General Definitions
IEP (Individualized Education Program)
This
is a written plan that specifies the special education programs and health
related services to be provided to meet the unique educational needs of a
student with a disability. The IEP is a
mandated New York State Department of Education document; however, individual
school districts have a right to develop their own IEP form. Many school districts now keep their IEP on a
computer.
All IEPs, however, have certain items in common.
·
First, an area specifying the recommended
service(s).
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Second, the type, frequency and duration of the
services.
·
Third, the goals and objectives of the school
year. For Medicaid purposes the service,
frequency and duration must be on the IEP with the exception of psychological
counseling services which may say as needed and skilled nursing services, which
should be listed on the IEP under other support services, medical alerts or
under related services, whichever is appropriate. An IEP must be done at least once a
year. Therefore, the period of the
service is until the next IEP is implemented.
Most IEPs are not signed by anyone. Signatures are not a requirement for Medicaid
purposes.
IHCP (Individual Health Care Plan) (APPENDIX C, Pg. C-8)
This
consists of the demographics of the student with nursing plan of care
procedures. The plan should be signed by
a registered nurse. A copy should be on
file in the nurse's office. An IHCP may
not exist for the more simple procedures such as administration of medications.
Referral for Medicaid purposes
A
referral is any document that indicates the student may be in need of one or
more health related services. There are two types of referrals:
·
The CSE/CPSE referral is required by SED and
IDEA and starts the process to evaluate a student's needs by the respective
committees.
·
The medical referral relates to a medical
service and is a Medicaid requirement for reimbursement.
Recommendation (Medical Referral)
A
recommendation is advice or counsel by a licensed physician, a registered
physician’s assistant, a licensed nurse practitioner, or a licensed and/or
ASHA certified (updated 2/6/07) speech
language pathologist for health related services indicated on the student’s
IEP. A recommendation must be in writing
and may be required for Medicaid documentation.
It is defined by DOH as
equivalent to an order.
A-1
Order
An order is a prescribed form of service and/or command signed and dated by a licensed physician, a registered physician’s assistant, or a licensed nurse practitioner. An order must be in writing and required by law and Regulations for specific types of Medicaid eligible health services. Orders may be faxed provided that they are signed by the physician and are legible.
Monthly
Service Delivery Documentation
These are notes and/or reports, which demonstrate the attendance of the provider and the student on the day of the service. The service provider must sign this document. In order to bill, there must be two billable services within the calendar month. If there is evidence that all the billable services are not being recorded, the provider should be encouraged to do so. The monthly fees are based on an average number of services provided during the month. If there is a drop in the actual number of services provided the fees may be adjusted downward.
Progress Notes
Progress notes are completed, at a minimum quarterly, by the service provider. They indicate the present level of performance of the student, the progress that the student is making toward meeting projected outcomes of goals, and/or objectives of health related services as specified on the IEP. This may be part of the service delivery documentation. Progress notes are now required, under IDEA and Part 200 of the Commissioner’s Regulations, for each reporting period. An annual review that contains progress notes by appropriate providers qualifies as one progress note.
A-2
Preschool Center
Center Based Claiming Fees
Are student related services that are provided by SED approved schools to operate a preschool program and reimbursed by the county and the state at an SED approved tuition rate.
Individual Based Claiming Fees
A fee for services approved by
SED and provided by Individuals or agencies contracted by the county to provide
individual, preschool related services.
NOTE: In both cases the proper
fees can be verified by reviewing the IEP for individual or center based data
or by review the county
STAC
Medicaid Billable Monthly Related Services
The length of a session/unit is defined by each school
district. A session/unit must be the
same for all students. Medicaid
reimbursement for providing these services requires that a minimum of two
services be provided in a month. However, an exception method for determining
a Medicaid billable monthly service should be followed when the session/unit on
the Individualized Education Program is significantly less than 30 minutes for
occupational therapy, physical therapy and counseling services.
Exception – Where students receive these services in increments of less than 30 minutes, a Medicaid billable monthly service does not occur until the student receives 60 or more minutes of services. For example, if the IEP recommends counseling to be provided in 20 minute increments 3 times per week, the Medicaid billable monthly service would occur after three sessions were provided (3 X 20 = 60 minutes).
The State Education Department requires that Speech-Language Pathology services for all
students must be scheduled at a minimum of two 30 minute sessions per week. Nursing services are defined in 15 minute
sessions/unit. Therefore the exception
above does not apply to speech therapy or nursing services.
§ 365-a. Character and adequacy of assistance
The amount, nature and manner of providing medical
assistance for needs persons shall be determined
by the public welfare official
with the advice of a physician and in accordance with the local medical plan,
this title, and the regulations of the department.
”Medical assistance” shall
mean payment of part or all of the cost of medically necessary medical, dental
and remedial care, services and supplies as authorized in this title or the
regulations of the department, which are necessary to prevent, diagnose,
correct or cure conditions in the person that cause acute suffering, endanger
life, result in illness or infirmity, interfere with such person’s capacity for
normal activity, or threaten some significant handicap and which are furnished
an eligible person in accordance with this title and the regulations of the
department. Such care, services and
supplies, together with such medical care, services and supplies provided for
in subdivisions three, four, and five of this section, and such medical care,
services and supplies as are authorized in the regulations of the department:
[For effective and
termination dates, see notes below. See, also, part (a) below.] services of qualified physicians, dentists, nurses
except that private duty nursing shall be provided subject to section three
hundred sixty-seven-1 of this chapter, and private duty nursing services shall
be further subject to the provisions of section three hundred sixty-seven- of this
chapter, optometrists, and other related professional personnel;
[Eff, June 30, 1994. See, also, part (a) above.] services of qualified physicians, dentists to the extent authorized by paragraph (e) herein, nurses, optometrists, podiatrists and other related professional personnel; care, treatment, maintenance and nursing services in hospitals, nursing homes that qualify as providers in the Medicare program pursuant to title XVIII of the federal social security act.
A-4
T TH STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF
THE STATE OF
DE DEPUTY COMMISSIONER FOR VOCATIONAL AND
EDUCATIONAL SERVICES FOR INDIVIDUALS WITH DISABILITIES
Tel. (518) 474-2714
Fax
(518) 474-8802
March 2005
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TO: |
District Superintendents |
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Superi
Superintendent of Schools |
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Directors of Special Education |
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Organizations, Parents and Individuals
Concerned with Special Education |
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Commissioner’s Advisory Panel for Special
Education Services |
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SETRC Project Directors and Professional
Development Specialists |
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FROM: |
Rebecca H. Cort |
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SUBJECT: |
Special Transportation for Students with
Disabilities |
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At a recent meeting with
representatives of the New York Association for Pupil Transportation, Special
Needs Committee, several concerns relating to the transportation of students
with disabilities were brought to my attention. This memorandum is
intended to provide information to Committees on Special Education (CSEs) and Committees on Preschool Special Education (CPSEs) to assist in developing individualized education
program (IEP) recommendations for students with disabilities with special
transportation needs and communicating with transportation personnel to ensure
IEP implementation.
While most students with disabilities
receive the same transportation services as nondisabled
children, it is the responsibility of the CSE or CPSE to determine whether the
student’s disability prevents the student from using the same transportation
provided to nondisabled students, or getting to
school in the same manner as nondisabled students. In developing
recommendations for special transportation, the CSE/CPSE should consider and
document the needs of the student relating to his/her disability. For
example:
·
Mobility – e.g., nonambulatory wheelchair bound.
·
Behavior – e.g., fearful in noisy environments; self-abusive; runs away; cries
frequently.
·
Communication – e.g., hard of hearing; nonverbal; limited understanding of questions
and directions; non-English speaking.
·
Physical – e.g., needs assistive devices to maintain a sitting position; needs
assistance walking and going up and down stairs.
·
Health needs – e.g., has seizures; fatigue – may fall asleep on bus, requires oxygen
equipment; use of an inhaler.
The IEP must include specific
transportation recommendations to address each of the student’s needs, as
appropriate. It is not appropriate for the IEP to simply indicate, “special transportation needed,” without including the nature
of the special transportation. It is not necessary to include special
transportation goals on the student’s IEP except when instruction will be
provided to enable the student to increase his or her independence or improve
his or her behavior or socialization during travel.
In determining and documenting a student’s special transportation
needs, the CSE/CPSE should consider the following:
q Special seating. Does the student
require special seating on the bus such as seating away from the window,
seating not adjacent to another student, seating in the front of the bus, etc.?
q
Vehicle
and/or equipment needs. Does the student use or require special equipment
such as braces, car seat, walker, lap belt, manual wheelchair, power
wheelchair, safety vest, service animal, stroller, assistive technology device,
medical equipment, adapted buses, or
lifts and ramps, etc.?
q Adult Supervision. Does the student require
additional supervision during transportation that would require specialized
training for the bus driver, a bus with a bus attendant, specialized training
for the bus attendant, a one-on-one bus attendant for a designated purpose,
nursing services, special monitoring, or interpreter, etc.?
q
Type of
transportation. Does the student require accommodations such as door-to-door pick up
and drop off, a small bus with few students, or individual transportation?
q Other Accommodations. Does the student require
other accommodations such as permission to carry personal items or to use
personal electronic devices such as radios?
Transportation personnel with responsibility to provide a program,
service, accommodation, modification or support must be directly informed of
their specific responsibilities to implement a student’s IEP. In addition
to the IEP recommendations, transportation personnel should be informed of any
special information regarding the student that might impact on the health and
safety of the student during transportation, including but not limited to:
o
the reasons a student requires special transportation;
o
health needs that might necessitate ongoing or emergency intervention;
- student behavioral issues or fears that
might raise health or safety concerns; and
- specialized training required for
bus drivers and/or attendants.
We ask Superintendents to share this memorandum with other school
district staff, as appropriate, including Directors of Special Education,
School Psychologists, Guidance Counselors and Directors of Pupil Personnel.
The New York Association for Pupil Transportation (518-463-4937) and the State
Education Department’s Office of Pupil Transportation Services (518-474-6541) have additional information and
resources relating to bus transportation. Questions regarding this
memorandum may be directed to Patricia Geary in the Office of Vocational and Educational
Services for Individuals with Disabilities (VESID), Special Education Policy
and Partnerships Unit at (518) 473-2878.
Cc :
New York Association for Pupil Transportation
THE
STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF
Special Education Program Services and
Reimbursement Bureau:
Thomas Hamel, Chief
[ ] Rate Setting Unit [
] STAC and Special Aids for
Students
http://seddmznt.nysed.gov/psruunit/psruhome.htm with
Disabilities Unit Room
514 EB
[X
] Medicaid Services Unit Phone:
(518) 474-7116 Fax:
(518) 402-5047
http://seddmznt..nysed.gov/medicaid/services.htm http://seddmznt.nysed.gov/stacunit/
Room 304 EB
Phone: (518) 474-3227 FAX: (518) 486-3606
PLEASE SEE
2/6/07 MEMO REGARDING NEW DOCUMENTATION REQUIREMENTS CONCERNING BUS ATTENDANCE
(updated 2/6/07)
January 2002
To: Superintendents
of Public School Districts
Directors of Special Education
Medicaid Contacts - Regional
Information Centers
From: Robert J. Scalise,
Coordinator -
Medicaid Unit
Subject: Medicaid Reimbursement for Special
Transportation
This memorandum provides
information as to the specific documentation required when a school claims
Medicaid reimbursement for special transportation provided to preschool and
school-age students with disabilities.
All special transportation arrangements recommended by the Committee on
Special Education (CSE) and Committee on Preschool Special Education (CPSE) and
identified on the students' individualized education program (IEP) are eligible
for Medicaid funding. Since there is no
mandate for regular transportation for preschool children, any transportation
required by a preschool child with a disability and indicated on his or her IEP
is considered special transportation and eligible for Medicaid
reimbursement.
Determining a Student’s Need for Special
Transportation
Transportation for all
students is mandated pursuant to Section 3635 of the Education Law. Transportation as a special education service
is provided when a student requires specialized transportation equipment,
supports or services because of his/her disability [34 CFR 300.24(b)(15)]. In determining whether to include special
transportation on a student's IEP, the CSE and the CPSE must consider how the
student's disability affects the student's need for transportation. For a preschool child, the CPSE must also
consider the site at which special education services will be provided to the
child if that site is different from the site at which the child receives other
preschool or daycare services. The
process to recommend special transportation should include:
§
Determining if the student's disability prevents the student from
accessing the same transportation provided to non-disabled students or from
getting to school in the same manner as non-disabled students;
§
Determining if a preschool child will be receiving special education
services at a site other than his or her preschool or daycare services; and
§
Documenting specific recommendations on the IEP as to the specialized equipment, supports or services a student needs to travel to
and from or between schools.
Requirements for Claiming Medicaid Reimbursement for Special
Transportation
Claims for Medicaid
reimbursement for special transportation must include the following
documentation:
·
Special transportation must be indicated on the student's IEP;
·
Provider attendance sheets for the Medicaid covered service other than
the transportation must be on file; and
·
School bus rosters must be available.
The bus rosters should include the name of the child transported, when
and where the child is being picked up and the type of special transportation
required. (Please notify your
transportation department that these rosters are necessary documentation for
the claiming of Medicaid services and must be retained for six years from the
date services were paid.)
Counties under the Preschool
Supportive Health Services Program (PSHSP) have been claiming transportation
and may begin claiming Special Transportation at the revised rate, effective
June 1, 2001, using Code #5327, the code they have always used.
NOTE: Handbook #5, page 18 will be
modified to clarify which type of transportation provided to school age
students with disabilities by Public School Districts to programs operated at
Boards Of Cooperative Educational Services would be considered Special
Transportation. The definition of Special Transportation to
the BOCES from the
If you have any questions
regarding the above please contact one of the following:
Robert J. Scalise 518:
474-3227 rscalise@mail.nysed.gov
Michael Albino 518: 473-9050 mca03@health.state.ny.us
cc: Lawrence C. Gloeckler
Rita Levay
Rebecca Cort
Theresa Savo
Thomas Hamel
Richard Billera
Michael Albino