Fringe Benefit Rate Calculation 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. Leading for educational excellence and equity, every day for every one. | education.mn.gov 28
MA Rate Worksheet Leading for educational excellence and equity, every day for every one. | education.mn.gov 29
MA Rate Worksheet (2) Leading for educational excellence and equity, every day for every one. | education.mn.gov 30
Indirect Cost Rate 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. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 31
Reporting Revenue from Third Party 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. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 32
Use of Third Party Revenue (section 125A.21, subdivision 3) 1. Retain an amount sufficient to compensate the district for its administrative costs of obtaining reimbursements; 2. regularly obtain from education- and health-related entities training and other appropriate technical assistance designed to improve the district's ability to access third-party payments for individualized education program or individualized family service plan health-related services; or 3. reallocate reimbursements for the benefit of students with individualized education programs or individualized family service plans in the district. Leading for educational excellence and equity, every day for every one. | education.mn.gov 33
MA Funds – 3 options per 125A.21 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. Leading for educational excellence and equity, every day for every one. | education.mn.gov 34
Equipment reimbursed with Third Party Revenue Assistive technology (equipment) may be purchased with state and local funds and the district will receive third party revenue reimbursement. Pieces of equipment purchased through third party revenue reimbursement, in 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. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 35
Special Education Equipment and Inventories https://education.mn.gov/MDE/dse/sped/caqa/fis/058269 • What is equipment? • What are “sensitive items?” • What is the minimum purchase price of an item that requires it to be included on the LEA’s inventory? • What kinds of special transportation equipment are eligible special education expenditures? • What elements are required on the LEA’s equipment inventory form? • How often is an LEA required to complete a physical inventory of equipment? • Why must LEAs complete property records and physical inventories? • How should an LEA dispose of equipment that is no longer needed for special education purposes? 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 36
What is Equipment? 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 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 37
What are “sensitive items?” 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) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 38
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 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 39
What kinds of special transportation equipment are eligible special education expenditures? • • Special or adapted buses. Locks. • • Lifts. Handrails. • • Ramps. Walkers. • • Special seat restraints. Wheelchairs. • • Security devices (harnesses, tethers, Air-conditioning and other climate braces, brackets, restraints, seatbelts, control methods, including tinted vests). windows. • Curb-cuts. • Car seats or other special seats. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 40
What elements are required on the LEA’s equipment inventory form? a) The description of the property. g) The location of the property. b) The serial number or other h) The use of the property. identification number. i) The condition of the property. c) The funding source of the property. j) Any disposition date including date of d) The name of the entity that holds disposal and sale price of the property. title. e) The acquisition date and cost. f) The percentage of federal/state participation in the cost of the property. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 41
How often is an LEA required to complete a physical inventory of equipment? LEAs are required to conduct a physical inventory at least once every two years. The results must be signed and dated by an authorized agent with 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 or obsolete and should dispose of it appropriately. Authority: 2 C.F.R. § 200.313 (d)(2) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 42
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) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 43
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: 1. The LEA shall establish a Uniform Finance Accounting and Reporting Standards (UFARS) unique Course Code for the purpose of tracking the receipt(s) and expenditures of the sale of a piece of equipment that was federally funded. 2. The LEA will notify the Division of School Finance in writing of the equipment sale. The notice shall 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. 3. The LEA shall receipt the funds from the sale of the equipment with the appropriate UFARS Source Code and established Course Code. 4. The LEA may use a general journal entry to transfer $500 or 10 percent of the proceeds, whichever is less, for the LEA’s selling and handling expenses. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 44
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: 5. The remaining funds from the sale of the equipment must be used only for the purpose of the 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. 6. The LEA must expend the funds from the sale of the equipment in the same fiscal year as the sale. 7. The LEA needs to be aware that these expenditures shall not be included in the calculation of the Maintenance of Effort requirement of the Individuals with Disabilities Education Act (IDEA). 8. The LEA must submit an “Activity Report” to the MDE Division of School Finance at the end of the fiscal year to document expenditures. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 45
How should an LEA dispose of equipment that is no longer needed for special education purposes (3)? Procedures for Disposition of Equipment less than $5,000: 1. If current per-unit fair market value is less than $5,000, the LEA may keep, sell, or otherwise dispose of the equipment with no further obligation. 2. A record of the date, reason, and method of disposal or sale must be maintained with the equipment inventory. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 46
Devices Purchased with State Funds Procedures for Disposition of Equipment: • The LEA may keep, sell, or otherwise dispose of the equipment with no further obligation. • A record of the date, reason, and method of disposal or sale must be maintained with the equipment inventory. Authority: 2 C.F.R. § 200.313 (e)(1 - 4) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 47
SEDRA – UFARS Code Sheets (https://education.mn.gov/MDE/dse/schfin/sped/fund/) Leading for educational excellence and equity, every day for every one. | education.mn.gov 48
Special Education Cross Subsidy 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: • Total State SpEd costs • Minus state SpEd aid • Minus GenEd revenue attributed to students who spend the majority of their day in the SpEd classroom/resource room (this is called the GenEd to Defray). 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 49
Cross Subsidy Legislative Report 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. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 50
Sample Cross Subsidy District Report found on the MFR 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 51
Concerns? Questions? What if? 52
Thank you! Special Education Funding and Data Team mde.spedfunding@state.mn.us 53
Time and Effort Laura Waldoch | Special Education Fiscal Monitor April 18, 2019
Why do we need time and effort? Why do we need to document time and effort? • To support payroll expenditures from special education funding sources • Both state and federal funds • Supports eligibility 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 55
Federal Requirements Federal time and effort records must: • Be supported by a system of internal controls • Be accurate, allowable, and properly allocated • Be incorporated into official records • Show total activity Uniform Grant Guidance 2 C.F.R. §200.430(i) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 56
Substantive Support Support records must: • Include all activities • Comply with accounting policies established by the school’s policy • Support the distribution of the employee’s salary or wages among specific activities or cost objectives Uniform Grant Guidance 2 C.F.R. §200.430(i) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 57
Budget Estimates are Insufficient 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) 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 58
Time & Effort vs. Time Study Time & Effort Time Study • When done correctly, supports all • Only supports the payroll during time periods throughout the school the duration of the time study. year paid with special education funds. 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 59
Time & Effort Example-Nurse 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 60
Time & Effort Example-Speech 4/15/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 61
Concerns? Questions? What if? 62
Thank you! Laura Waldoch laura.waldoch@state.mn.us 651-582-8404 4/15/2019 63
Related Services Third Party Forum April 18, 2019
Speech Language Pathology and Audiology 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. 65
Speech Language Pathologist and Audiologist Licensure The following providers can perform speech or audiology services: • Audiologist: A person who has a master’s degree or doctoral degree, meets the requirements under MS 148.511-148.5198 and is licensed by the Minnesota Department of Health (MDH) • (Educational) speech and language pathologist : A person who meets the requirements in MS 256B.0625, subd. 26, holds a 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 • Speech and language pathologist (SLP): A person who has a master’s degree or doctoral degree in speech-language pathology, meets the requirements in MS 148.511-148.5198 and is licensed by MDH • Clinical fellowship licensee : A person who has a master’s degree and is completing a supervised clinical fellowship in speech- language pathology or audiology according to the requirement in MS148.511-148.5196 (This program is available for a limited time.) 3/21/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 66
Speech Language Pathology Assistant (SLPA) 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. 67
SLPA Duties Under the Supervision of an SLP 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 of a foreign language. 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. 3/21/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 69
Communication Disorders & Audiology A language disorder is impaired comprehension An articulation disorder is the atypical production of and/or use of spoken, written and/or other symbol speech sounds characterized by substitutions, systems. The disorder may involve (1) the form of omissions, additions or distortions that may interfere language (phonology, morphology, syntax), (2) the with intelligibility. content of language (semantics), and/or (3) the function of language in communication (pragmatics) in A fluency disorder is an interruption in the flow of any combination. speaking characterized by atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. Audiological Services include the identification of This may be accompanied by excessive tension, hearing loss that may include recommendations for struggle behavior, and secondary mannerisms. amplification. 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. 3/21/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 70
SLP & Audiology Covered Services MHCP covers the following services: • Individual and group speech and language pathology services provided by a speech and language pathologist, an educational speech or language pathologist who meets the requirements, or a clinical fellowship licensee • Audiology services provided by an audiologist • Specialized maintenance therapy provided by a speech-language pathologist and that is specified in the child’s IEP or IFSP and is 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 • Some telemedicine services provided by a speech-language pathologist (Telemedicine is billable when the service is the service provided is just as effective as if it was provided face to face) • Face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered). 71
Kepro approved documentation 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 72
KEPRO Approved Documentation - Anxious about math test w/out Wangen sitting next to him - /r/ sentences - distortion on a few bleeds and prevocalic /r/ sounds. helped fix a voiced /th/ "the" - Worked on r words: 18/22 - Imitating /m/ IP words X8, /b/ IP words X 8; combining 2-3 words in spontaneous speech X3; signing m own 73
Concerns? Questions? What if? 74
Nursing - Licensure MN Statute148.171 Minnesota Nurse Practice Act Professional Nursing - ● Registered Nurse (RN) - licensed by the Board of Nursing. 2,3 or 4 year Degree in Nursing ● Public Health Nurse (PHN)- licensed as an RN and has Public Health Certification by the Board of Nursing. 4 year (Baccalaureate Degree) in Nursing with public health practicum ● RN/Licensed School Nurse(LSN) - licensed as an RN and has Public Health Certification by the Board of Nursing AND as a School Nurse by the Board of Teaching and licensed. Has a Baccalaureate Degree in Nursing or higher Practical Nursing - ● Licensed Practical Nurse (LPN)- licensed by the Board of Nursing. Works under the direction / delegation of the Professional Nurse. Average of 1 year training Unlicensed Assistive Personnel - (UAP) ● Not licensed as a nurse - PCA, MA, NA 75
Nursing - Scope in schools 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 of practice (Nurse Practice Act), including evaluation and assessments. ● Only the LSN can bill for interpreting health data and writing the evaluation report 76
Nursing - Billable Services ● Catheterization, tube feeding, suctioning and ventilator care (MD ordered) ● Complex medication administration (rectal, via G-tube, IV) ● The simple administration of prescription medications (oral) ● Medication management ○ “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 ● Activities of daily living when the IEP indicates a one-on-one nurse is required at school *Billable activities include administering face-to-face assessments, interpreting test results and writing reports. 77
Nursing - Non Billable Services ● Medical care such as illness and injury care, health education and mass screening ● Administering medications for treating acute episodic illnesses, such as ear infections - (chronic vs acute) ● Services including medication administration that require the skill of a nurse when delegated to or provided by someone who is not a nurse (This does not include PCA services - assisting with self administration of meds) ● Training and supervision of practical nurses and unlicensed assistive personnel (UPA), including health assistants and personal care attendants (PCA) ● Supplies including bandages, gauze, gloves, cotton balls, cotton swabs, masks, etc. ● Consultation and teaching with parents and school staff 78
Nursing - Point of Discussion When to include the LSN? Best Practice (all) vs Statute (need) vs Capacity (staffing) ● Determine need through review similar to how you would determine whether PT or OT or Speech would be included on the evaluation team. ● If there is a student with a medical condition that might impact learning, a nurse should conduct an assessment. The Evaluation Report will specify the health condition and the nursing services that may be needed. 79
Nursing - How to get started? ● Work with the IEP team to learn who is up for consideration to be evaluated for Special Education ● If the student has a chronic health condition or requires ordered treatments in order to be at school, ask to be included on the evaluation team ● Conduct a health assessment to determine if nursing services are needed and complete the IEP Evaluation Report ● If nursing services are needed, place language on the IEP (grid and/or accommodations section) ● Can bill for the assessment and evaluation time ● Can bill for required nursing services as stated in the Evaluation Report and on the IEP 80
Concerns? Questions? What if? 81
Occupational Therapy Description According the Minnesota Board of Occupational Therapy Practice: ● The practice of occupational therapy (MS. 148.6402) means the use of purposeful activity to 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 ● Occupational therapy” means the use of purposeful activity to maximize the independence and 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, or an adverse environmental condition. 82
Occupational Therapy The following providers can perform occupational therapy services: • Occupational Therapist (OT): a person licensed by the Minnesota Board of Occupational Therapy Practice. Occupational therapy regulations require OT license renewal every two years. Continuing education requirements of 24 contact hours for OT for every two-year cycle. • Occupational Therapy Assistant (OTA) : a person licensed by the Minnesota Board of Occupational Therapy Practice. Occupational therapy 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 • Occupational therapist (OT): A person who meets the qualifications in MS 148.6401-148.6450 and is licensed by the MN Department of Health. • Occupational therapy assistant (OTA): A person who meets the qualifications for an occupational therapy assistant under MS 148.6401- 148.6450 and is licensed by the MN Department of Health. 83
Expired Licenses Who monitors licenses? ● State licenses should be monitored ● Have a procedure in place for tracking these licenses 84
Supervision of a Occupational Therapy Assistant Supervision requirements: b) Face-to-face collaboration between the occupational therapist and the occupational therapy assistant shall occur, at a minimum, every two weeks, during which time the occupational therapist is responsible for: 1. planning and documenting an initial treatment plan and discharge from treatment; 2. reviewing treatment goals, therapy programs, and client progress; 3. supervising changes in the treatment plan; The OT should be present on the initial treatment session with the OTA. • The OT determines the frequency and manner of supervision of an OTA performing treatment procedures based on the condition of the child, the complexity of the treatment procedure and the proficiencies of the OTA. 85
Covered Occupational Therapy Services Covered Services • Individual, group and specialized maintenance therapy • Specialized maintenance therapy that is specified in the child’s IEP or IFSP and is 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 • Administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered) 86
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. ● Include activity/activities worked on and what change was made ● Include any specialized therapeutic techniques that were used ( what makes this session different than what a teacher/paraprofessional would do?) ● Include any measurable data that was collected ● May include a plan for next session(s) 87
Sample Occupational Therapy Note-Short note • S was seen in class today while working on a classroom project. S 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. 88
Physical Therapy 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, or alleviating a physical or mental disability. Physical measures shall include but shall not be limited to 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. 89
Physical Therapy The following providers can perform physical therapy services: ● Physical Therapist: a person licensed by the Minnesota Board of Physical Therapy who practices physical therapy as defined 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. ● Physical Therapist Assistant : a person licensed by the Minnesota Board of Physical Therapy who provides physical therapy 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. ● PT and PTA License Renewal: licenses must be renewed every year. Continuing education requirements of 20 contact hours, 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) . 3/21/2019 Leading for educational excellence and equity, every day for every one. | education.mn.gov 90
Supervision of a PTA Supervision and Direction of a PTA Direction means the actions of a PT who: • Instructs the PTA in specific duties to be performed • Monitors the provision of services as the PTA provides the service • Provides on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session of each child or youth when treatment is provided by a PTA • Meets all other supervisory requirements The PT must document supervision and direction. 91
OT & PT Covered Services MHCP covers the following OT & PT services: • Individual, group and specialized maintenance therapy provided by OTs and PTs or OTAs (under the direction of an OT) and PTAs (under the direction of a PT) • Specialized maintenance therapy provided by a OT/OTA or PT/PTA that is specified in the child’s IEP or IFSP and is 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 • Some telemedicine services provided by an occupational therapist or physical therapist. • Administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered). MHCP Authorization Requirements ● The Individualized Education Program (IEP) team authorizes services included in an IEP or Individualized Family Service Plan (IFSP). 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. 92
KEPRO Audited documentation OT 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 on his left side. R demonstrated multiple instances of purposeful arm 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 on vertical surface. During activity student on average would hold button with 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 time. Student required HOH at beginning of session for modeling. 93
KEPRO Audited Documentation PT 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. 94
Concerns? Questions? What if? 95
Social Work Licensure 148E.050 LICENSING; SCOPE OF PRACTICE. § Requirements. The practice of social work must comply with the requirements of subdivision 2, 3, 4, or 5.§ Subd. 2.Licensed social worker. A licensed social worker may engage in social work practice except that a licensed social worker must not engage in clinical practice.§ Subd. 3.Licensed graduate social worker. A licensed graduate social worker may engage in social work practice except that 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.§ Subd. 4.Licensed independent social worker. A licensed independent social worker may engage in social work practice 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.§ Subd. 5.Licensed independent clinical social worker. A licensed independent clinical social worker may engage in social work practice, including clinical practice. 96
SSW Scope and licensure requirements 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. 97
What is Mental Health Practitioner? 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 children. A mental health practitioner for an adult client must have training working with adults. *All school social workers meet the criteria of a mental health practitioner or mental health professional. 98
What is a Mental Health Professional? 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. 99
Covered Evaluations/Assessments Difference between billable Mental Health diagnostic assessment and IEP evaluation: • Evaluation to determination IEP/IFSP eligibility • School Psych or Mental health professional or clinical trainee • Diagnostic Assessment to Diagnose and treat • Mental health professional or clinical trainee 100
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