Steve Sisolak Richard Whitley Governor Director State of Nevada Department of Health and Human Services MSM 2800 – School Based Child Health Services (SBCHS) Updates Division of Health Care Financing and Policy Gladys Cook and Julie Lindesmith 12/13/2019 Helping people. It’s who we are and what we do.
Agenda 1. General proposed changes (chapter wide) Names/terms • Removal of Individualized Education Program (IEP) • requirement Chapter structure • 2. Service/Section specific proposed changes There will be opportunity for questions and comments throughout the presentation. Agenda
Acronyms ABA- Applied Behavior Analysis MDC- Multidisciplinary Conference • • ACD- Assistive Communication Devise MSM- Medicaid Services Manual • • ADLS- Activities of Daily Living NCU- Nevada Check-Up • • APRN- Advance Practice Registered Nurse NRS- Nevada Revised Statues • • ASD- Autism Spectrum Disorder OPR- Ordering, Prescribing, Referring • • CFR- Code of Federal Regulations PA- Physician’s Assistant • • DHCFP- Division of Health Care Financing and Policy PCA- Personal Care Assistant • • DHHS- Department of Health and Human Services PCS- Personal Care Services • • DME- Durable Medical Equiment POC- Plan of Care • • DPBH- Division of Public and Behavioral Health QIO- Quality Insurance Organization • • EPSDT- Early and Periodic Screening, Diagnostic and SBCHS- School Based Child Health Services • • Treatment SEA- State Education Agency • FASD- Fetal Alcohol Spectrum Disorders • SFASP- School Functional Assessment Service Plan • FERPA- Family Educational Rights and Privacy Act • SHS- School Health Services • IADLS- Instrumental Activities of Daily Living • SPA- State Plan Ammendment • IDEA- Individuals with Disabilities Education Act • TPL- Third Party Liability • IEP- Individualized Education Program • IFSP- Individual Family Service Plan • LEA- Local Education Agency • LRI- Legally Responsible Individual • Acronyms
Chapter Wide Changes 4
Name/Term Changes • School Based Child Health Services (SBCHS) is now School Health Services (SHS) • School districts replaced with Local Education Agency (LEA)/ State Education Agency (SEA) • Parent replaced with Legally Responsible Individual (LRI) 5
Removal of IEP Requirement • Most IEP language has been removed from the chapter and been replaced with Plan of Care (POC). 6
Chapter Structure • Consistent order for listed services 7
Service/Section Specific Proposed Changes 8
2800 Introduction • Added POC language • Added Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Code of Federal Regulations (CFR) 440.40(B) • Removed Individuals with Disabilities Education Act (IDEA) and IEP language • Updated Nevada Check-Up (NCU) manual reference 9
2801 Authority • Split authorities into Federal and State • Updated State Plan Amendment (SPA) page(s) 10
2802 Definitions- Added • 504 Accommodation Plan • Activities of Daily Living (ADLs) • Applied Behavior Analysis (ABA) • Autism Spectrum Disorder (ASD) • By or Under Direction of • Fetal Alcohol Spectrum Disorders (FASD) • Individual Family Service Plan (IFSP) • Instrumental Activities of Daily Living (IADLs) • Legally Responsible Individual (LRI) • Medical Necessity • Medical Team Conference (with Interdisciplinary Team) • Personal Care Assistant (PCA) • Personal Care Services (PCS) • Plan of Care (POC) • Preventive and Diagnostic Services • School Functional Assessment Service Plan (SFASP) • State Education Agency (SEA) • Third Party Liability (TPL) • Treatment Services 11
2802 Definitions- Removed • Removed definitions • Counseling Services • Parent- replaced by LRI • Multidisciplinary Conference (MDC)- Replaced by Medical Team Conference • Present Levels of Educational Performance • Progress Monitoring • Related Services • Review and Revision of IEP • Special Education • Support Services 12
2802 Definitions- Revised • Revised definitions • Assistive Communication Devise (ACD) • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) • Local Education Agency (LEA) • Short-Term Objectives/Benchmark 13
2803.1 Policy Overview • Added POC language • Added categories • Screening and Diagnostic Services • Treatment Services 14
2803.1A Screening and Diagnostic Services • New Section • Refers to Chapter 1500, Healthy Kids Program services that will now be covered in SHS • Services that can be covered without a POC because they are screening and assessment services 15
2803.1B Treatment Services • New Section • Refers to all services that will be included in SHS except those from 2803.1A Preventive and Diagnostic 16
2803.1C Coverage and Limitations • Previously Section 2803.1A • IEP development meeting changed to medical team conference • Added the language to “3. Covered Services” to make it more inclusive of preventive services • Rearranged services to match order described later in the chapter • Updated the MSM Sections referenced 17
2803.1C Coverage and Limitations Added Covered Services • Added to Covered Services (2803.1C3) • Screening, diagnostic, and treatment services • Mental Health and alcohol/substance abuse (replaced psychological counseling) • Personal Care Services (PCS) • Applied Behavior Analysis (ABA) • Dental services • Optometry services • Case management • Services delivered by telehealth 18
2803.1C Coverage and Limitations Changes to Non-Covered Services • Added • Medical necessity requirement • Reference to Ordering, Prescribing, Referring (OPR) section • Removed • Dental or related services (these will now be covered) • Treatment of obesity (this will now be covered) • Any examination and laboratory tests for preventable diseases (this will now be covered) 19
2803.1D Provider Responsibility OPR and Under the Direction Of • Previously Section 2803.1B • Replaced “Medical or Treatment Services” Section with “Ordering, Prescribing, and Referring (OPR)” Section. • The OPR Section was newly drafted 20
2803.1D Provider Responsibility POC and Medical Team Conference • Replaced “Reserved for Future Use” Section with “Plan of Care (POC)” Section • POC Section is newly drafted language • Replaced “Individualized Education Program (IEP)” Section with “Medical Team Conference (with Interdisciplinary Team)” Section 21
2803.1D Provider Responsibility- Assessments, Records, and Non-Discrimination • Removed Sections • IEP Assessment/Evaluation • Assessment • Records Section- added statement that documentation must be completed as appropriate for the service being provided as detailed in the corresponding MSM chapter • Made Non-Discrimination Section more general and reference back to MSM 100 22
2803.1D Provider Responsibility TPL and Katie Beckett Recipients • Third-Party Liability (TPL) • Pay & Chase will only apply to IEP services • Medicaid will pay for services if the third-party insurance does not pay in a school setting • Katie Beckett Recipients • Replaced Parental Notification and Consent Section • Parental Notification and Consent was removed as it is a Family Educational Rights and Privacy Act (FERPA) regulation not a Medicaid regulation. 23
2803.1F Authorization Process • Previously Section 2803.1D • POC serves as prior authorization • Added OPR refence 24
2803.2 Provider Qualifications Overview • Licensed replaced with qualified as not all services require a license (example PCS). 25
2803.2 Provider Qualifications Details • Added sections with qualification specification for each type of provider A. Physician, Physician’s Assistant (PA) & Advanced Nurse Practitioner Services B. Mental Health and Substance Abuse C. Nursing D. Physical Therapy E. Occupational Therapy F. Speech Therapy and Audiology G. PCS H. ABA I. Dental J. Optometry K. Case Management L. Telehealth 26
2803.3 Screening, Diagnostic Services and Treatment • Newly drafted language • Based off MSM Chapter 1500, Healthy Kids Program 27
2803.4 Physician, Physician’s Assistant & Advanced Nurse Practitioner Services • Defined the list of covered services in 2803.4A as examples, not an exhaustive list • Added new and established patient visited to covered services • Added Limitations Section (2803.4B) 28
2803.5 Mental Health and Alcohol/Substance Abuse Services • Replaced Psychological Counseling • Based off MSM Chapter 400, Mental Health and Alcohol and Substance Abuse Services • Added Limitations Section 29
2803.6 Nursing Services • Added that nursing services must be under the order and supervision of a physician, or Advanced Practice Registered Nurse (APRN) • Added Limitations Section (2803.6B) 30
2803.7 Physical Therapy Services • Added Limitations Section (2803.7B) 31
2803.8 Occupational Therapy Services • Added Limitations Section (2803.8B) 32
2803.9 Speech Therapy and Audiology Services • Added Limitations Section (2803.9B) 33
2803.10 Audiological Supplies, Equipment, Medical Supplies and Other DME • Added Limitations Section (2803.10B) 34
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