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Funding For Special Needs Child Care Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. Retrieved May 1, 2011, from.

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Presentation on theme: "Funding For Special Needs Child Care Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. Retrieved May 1, 2011, from."— Presentation transcript:

1 Funding For Special Needs Child Care Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Docu ments/Rules/441-80.pdf

2 Presented by:  Deborah VanderGaast, RN  Owner - Tipton Adaptive Daycare  Home Care Case Manager, Girling Health  Home care services for adults and children with disabilities  Skilled nursing care for acute and chronic health care needs

3 Tipton Adaptive Daycare Category B Family Daycare Home Medicaid Waiver Provider for IMMT & Respite Child Care Assistance Promise Jobs Protective Daycare Skilled Child Care for Children with Special Health Care Needs www.TiptonAdaptiveDaycare.com

4 Providing care for children with special needs in an inclusive environment with their typically-developing peers. Special Needs Child Care

5 Least Restrictive Environment  The Individuals with Disabilities Education Act (IDEA) of 1975 requires that children with disabilities be provided education and services in the least restrictive environment.  Amended in 1997 to include specific guidelines for infants and toddlers  Guidelines state they should receive care and services in “natural environments”

6 Natural Environments  Defined as, “settings that are natural or normal for the child’s age peers with no disabilities”. Smith, Barbara J., & Rapport, Mary Jane K. (1999, September). IDEA and early childhood inclusion. Collaborative Planning Project. Retrieved July 15, 2009, from http://www.nectac.org/~pdfs/topics/inclusion/ideaec.pdf

7 Special Health Care Needs Children and youth with special health care needs (CYSHCN) are defined by the Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) as:  “Those who have or are at increased risk for a chronic physical, development, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally” McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Perrin, J. M., et al. (1998, July). A new definition of children with special health care needs. Pediatrics, 102(1), 137-141.

8 Statistics:  Approximately 20% of American households with children have one or more children with special health care needs (SHCN) [1.]  In 2008, there was an estimated 535,000 children with SHCN living in the United States [2.] [1.]Looman, Wendy S., O'Conner-Von, Susan, & Lindeke, Linda L. (2008, July 11). Caring for children with special health care needs and their families: What advanced practice nurses need to know. The Journal for Nurse Practitioners, 4, 512-517. [2.] Kogan, Michael D., Strickland, Bonnie B., Blumberg, Stephen J., Singh, Gopal K., Perrin, James M., & van Dyck, Peter C. (2008, December). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005-2006. Pediatrics, 122(6), e1149-e1158.

9 Medicaid HCBS Waivers  The Medicaid Home and Community Based Services are designed to allow individuals with disabilities to receive the care they need to remain living in their homes.

10 How the Waivers Were Created  The Medicaid Waivers started in 1981 with a 3- year-old girl in a hospital and the president who was angered when he learned that federal rules prevented her from going home.  Shapiro, J. (2010, November 8). Katie Beckett: Patient turned home-care advocate. National Public Radio. Retrieved April 2, 2011, from http://www.npr.org/templates/story/story.php?storyId=131145687

11 Katie Beckett  [1] Shapiro, J. (2010, November 8). Katie Beckett: Patient turned home-care advocate. National Public Radio. Retrieved April 2, 2011, from http://www.npr.org/templates/story/story.php?storyId=131145687 “Katie Becket, had contracted viral encephalitis, a brain infection, when she was just five months old. She'd gone into a coma for ten days, and when she came out she suffered a paralysis that left her unable to breathe without the help of a ventilator most of the day. After more than two years living in St. Luke's Methodist Hospital in Cedar Rapids, Iowa, the family reached the limit of what its private insurance would pay for Katie's care. Medicaid, the state and federal health insurance for the needy, started picking up the cost of that expensive breathing machine and other care. But Medicaid would pay only as long as the little girl lived in the pediatric intensive care unit at the hospital.” [1]

12  “By what sense do we have a regulation in government that says we'll pay $6,000 a month to keep someone in a hospital that we believe would be better off at home, but the family cannot afford one-sixth that amount to keep them at home?” - President Ronald Reagan, Nov. 10, 1981  Shapiro, J. (2010, November 8). Katie Beckett: Patient turned home-care advocate. National Public Radio. Retrieved April 2, 2011, from http://www.npr.org/templates/story/story.php?storyId=131145687

13 Waivers that fund services that can be provided by day care centers and registered day care centers. Eligible Waivers

14 HCBS Ill & Handicapped (IH) Waiver The IH waiver provides services for persons who are blind or disabled. An applicant must be less than 65 years of age. The following services are available: ● Adult Day Care ● Homemaker ● Consumer Directed ● Interim Medical Attendant Care Monitoring & Treatment ● Counseling ● Nursing ● Home & Vehicle ● Nutritional Counseling Modification ● Personal Emergency ● Home Delivered Meals Response ● Home Health Aide ● Respite  Iowa Department of Human Services. (2006, September). Are Home & Community Based Services Right for You? Retrieved April 1, 2011, from http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf

15 HCBS Intellectual Disability (ID) Waiver The ID waiver provides services for persons with a diagnosis of intellectual disability. The following services are available: ● Adult Day Care ● Personal Emergency ● Consumer Directed Response Attendant Care ● Prevocational ● Day Habilitation ● Respite ● Home & Vehicle ● Supported Community Modification Living ● Home Health Aide ● Supported Community ● Interim Medical Living-Residential Based Monitoring & Treatment ● Supported Employment ● Nursing ● Transportation  Iowa Department of Human Services. (2006, September). Are Home & Community Based Services Right for You?.Retrieved April 1, 2011, from http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf

16 HCBS Brain Injury (BI) Waiver ● Adult Day Care ● Behavioral Programming ● Case Management ● Consumer Directed Attendant Care ● Family Counseling & Training ● Home & Vehicle Modification ● Interim Medical Monitoring & Treatment ● Personal Emergency Response ● Prevocational Services ● Respite ● Specialized Medical Equipment ● Supported Community Living ● Supported Employment ● Transportation  Iowa Department of Human Services. (2006, September). Are Home & Community Based Services Right for You?.Retrieved April 1, 2011, from http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf The BI waiver provides services for persons who have a brain injury diagnosis due to an accident or illness. An applicant must be at least one month of age but less than 65 years of age. The following services are available:

17 B.I. Waiver Requirements:  Those wishing to provide services under the Brain Injury waiver need to submit documentation indicating training or experience with persons with brain injury.  Providers must demonstrate proficiency in delivery of the services included in a consumer’s service plan. Proficiency must be demonstrated through documentation of prior training and experience or a certificate of formal training.  Training classes are available through DHS. To receive training call (515) 281-8061. http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Documents/Provman/ill.pdf

18 Service Plan  All consumers will have a service plan developed by a DHS service worker or Medicaid case manager in cooperation with the consumer.  This plan must be completed prior to implementation of services.  The service plan for consumers aged 20 or under must be developed or reviewed taking into consideration those services that may be provided through the individual education plan (IEP) and EPSDT (Care For Kids) plan(s).

19 Special Needs Child Care  The only Medicaid waiver service that can be accessed for child care while their parents are working is interim medical monitoring and treatment (IMMT)  Children with problem behaviors due to autism or intellectual disabilities cannot use IMMT because their need for additional care and monitoring is a behavioral need and not a medical need.

20 IMMT Services

21 What is IMMT?  I = Interim  M = Medical  M = Monitoring  T = Treatment

22 Legal Definition:  Interim medical monitoring and treatment services are monitoring and treatment of a medical nature requiring specially trained caregivers beyond what is normally available in a day care setting. Iowa Human Services Department. (2009, June 17) Medicaid waiver services, (ch.83). Retrieved July 11, 2009, from http://www.legis.state.ia.us/aspx/ACODocs/DOCS/6-17-2009.441.83.pdf

23 IMMT Eligibility e. To be eligible for interim medical monitoring and treatment services the consumer must be: (1) Under the age of 21; (2) Currently receiving home health agency services under rule 441- 78.9(249A) and require medical assessment, medical monitoring, and regular medical intervention or intervention in a medical emergency during those services; (3) Residing in the consumer’s family home or foster family home; (4) In need of interim medical monitoring and treatment as ordered by a physician. Iowa Human Services Department. (2009) Medicaid waiver services, (ch.83). Retrieved February 5, 2010, from http://www.legis.state.ia.us/aspx/ACODocs/DOCS/6-17-2009.441.83.pdf

24 IMMT Services: ♦ Provide experiences for each member’s social, emotional, intellectual, and physical development. ♦ Include developmental care and any special services for a member with special needs. ♦ Include medical assessment, medical monitoring, and medical intervention as needed on a regular or emergency basis. ♦ May include supervision during transportation to and from school if not available through other sources.  Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

25 Service Times:  The services must be needed to allow the consumer’s usual caregivers to be employed or, for a limited period of time, for academic or vocational training of a usual caregiver; due to the hospitalization, treatment for physical or mental illness, or death of a usual caregiver; or during a search for employment by a usual caregiver.  Iowa Human Services Department. (2009) Medicaid waiver services, (ch.83). Retrieved February 5, 2010, from http://www.legis.state.ia.us/aspx/ACODocs/DOCS/6-17-2009.441.83.pdf

26 Service Locations: Services may not duplicate any regular Medicaid or waiver services provided under the state plan. They may be provided only: ♦ In the member’s home, ♦ In a registered child development home, ♦ In a licensed child care center, or ♦ During transportation to and from school.  Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

27 Service Providers The following providers may provide IMMT services: ♦ Licensed child-care centers ♦ Registered child-care homes ♦ Home health agencies certified to participate in the Medicare program ♦ Supported community living providers under the ID waiver  Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

28 Ratios and Billing Units:  The staff-to-member ratio shall not be less than one to six.  A unit of service is one hour.  A maximum of 12 one-hour units of service is available per day.  Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

29 Respite Services

30 Respite Care  Respite care services are services provided to the member that give temporary relief to the usual caregivers and provide all the necessary care that the usual caregiver would provide during that period. The purpose of respite care is to enable members to remain in their current living situation.  Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

31 Usual Caregiver  The “usual caregiver” is defined as a person or persons who reside with the member and are available on a 24-hour-per-day basis to assume responsibility for the care of the member.  Respite care is not to be provided to members during the hours in which the member’s usual caregiver is employed, except when the provider is a camp. Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

32 Respite Units of Service  A unit of service is one hour for all respite services. A maximum of 14 consecutive days of 24-hour respite care may be reimbursed.  When respite care is provided, the provision of or payment for other duplicative services under the waiver is precluded. Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

33 Respite may be provided by: ♦ A camp certified by the American Camping Association ♦ A child development home registered with DHS ♦ A child-care center licensed by DHS ♦ A group living foster care facility for children licensed by DHS ♦ A home health agency certified to participate in Medicare ♦ A hospital enrolled in Medicaid ♦ A nursing facility enrolled in Medicaid ♦ A preschool ♦ A residential care facility for persons with mental retardation (RCF/MR) ♦ An adult day care provider certified by DIA ♦ An agency with a local public health services contract for similar services ♦ An assisted living program certified by DIA ♦ An intermediate care facility for the mentally retarded (ICF/MR) ♦ Any agency certified to provide care in a member’s home under the ID waiver Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

34 Day Care vs. Home Care  Private duty nurses meet the child’s medical needs and the child’s home is considered a natural environment.  The majority of time is often spent in front of the television rather than engaging in age-appropriate activities with other children.  May not be in compliance with the least restrictive environment requirement and may not be in the child’s best interest Etscheidt, Susan. (2006). Least restrictive and natural environments for young children with disabilities: A legal analysis of issues. Topics in Early Childhood Special Education, 26(3), 167-178.

35 http://www.ime.state.ia.us/ Applying to be a Medicaid Provider

36 How to enroll as a Medicaid waiver provider  The provider application and instructions can be found on Iowa Medicaid Enterprise’s (IME) web site. Any questions regarding the completion of the application can be directed to Iowa Medicaid Enterprise Provider Services 1-800-338-7909 or 515-725-1004 (from Des Moines).provider application and instructions Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm

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39 Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Docu ments/Rules/441-80.pdf

40 Provider Handbook A Medicaid provider handbook that covers provider and member eligibility, waiver service policies, service rate information, and claim submission is available on the Internet either through the IME web site or through the Department’s Policy Analysis Web site at: http://www.dhs.iowa.gov/policyanalysis/Policy ManualPages/MedProvider.htm

41 Provider Online Tools  The IME provides you the opportunity to use the Web Portal through the Internet to Verify Member Eligibility (HIPAA Transaction 270), Check the Status of Your Claims (HIPAA Transaction 276), or submit a Request For Prior Authorization (HIPAA Transaction 278). You must register through EDISS Total Onboarding to use the Web Portal.EDISS Total Onboarding http://www.ime.state.ia.us/Providers/OnlineTools.html

42 Developing A Plan of Care

43 Provider Qualifications:  The provider must be qualified by training or experience to provide medical intervention or intervention in a medical emergency necessary to carry out the member’s plan of care.  This must be determined by the usual caregivers and a licensed medical professional on the member’s interdisciplinary team and documented in the service plan.  Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

44 Member’s Interdisciplinary Team  Primary Physician  Social Workers  Specialists & Therapists  Home Care Nurse  School Nurse  Physical, Occupational & Speech Therapists  Area Education Agency (AEA)  Home and Community-Based Service Providers  Direct Care Providers  Special Education Teachers  Child Care Provider ? “Depending on an individual's age and disability, the exact composition of the interdisciplinary team will vary. An interdisciplinary team consists of the family and professionals who are engaged in supporting the individual.” [1] [1] National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC). (2011). Interdisciplinary teams; Communication services and supports for individuals with severe disabilities: FAQs. Retrieved April 20, 2011, from http://www.asha.org/NJC/faqs-i nterdisciplinary.htm#39

45 Sample IMMT Daycare Plan  SERVICES PROVIDED AT DAYCARE IMMT services funded by the Ill and Handicap Waiver for a ## year-old female with cerebral palsy. Child is wheelchair bound and wears bilateral AFOs. She has a MIC-KEY Gastrostomy Feeding Tube for supplemental feeding QHS PRN for inadequate oral intake and medications. Daycare provider will provide safety supervision at all times, monitor and adjust positioning hourly, monitor oral intake daily, teach and assist with safe pivot transfer from wheelchair to toilet as needed, assist with toileting, hygiene and clothing adjustment as needed, perform stretching and passive range of motion to lower extremities daily, remove AFOs and provide floor time for at least one hour per day, reapply AFOs before returning to wheelchair, assess skin integrity daily, and report client's care and condition to client's mother daily. Provider will also encourage independent mobility, physical activity, and interactions with peers as appropriate to develop age-appropriate social and self-care skills.

46 Tipton Adaptive Daycare 118 Parkview Court Tipton, IA 52772 Phone / Fax: 563-886-3143 Mrs.V@tiptonadaptivedaycare.com DAYCARE PERSONAL CARE PLAN FOR CHILD WITH SPECIAL NEEDS Child's Name: Date of Birth: Social Security #: Street Address: City, State, Zip: Home Phone Number: Parent(s)/Guardian(s) Name(s): Parent(s)/Guardian(s) Cell Phone #: Parent(s)/Guardian(s) Email: Parent(s)/Guardian(s) Employer(s): Employer Address: Employer Phone Number: Medical/Psychiatric Diagnosis:Cerebral Palsy Allergies: Penicillin, Sulfa, Augmentin Safety Precautions: wheelchair precautions, fall precautions, supervision at all times Activity Restrictions: Provide assistance for partial weightbearing, transferrs, and wheelchair mobility on uneven surfaces. MEDICATIONS TO BE GIVEN AT DAYCARE MEDICATION:STRENGTH:DOSE:FREQUENCY:ROUTE:SCHEDULED TIMES / PRN INDICATORS: Ibuprofen100mg/5ml10 mlQ 6-8 hrs PRNPO / GTas needed for pain ADDITIONAL PRESCRIPTION MEDICATIONS TAKEN AT HOME MEDICATION:STRENGTH:DOSE:FREQUENCY:ROUTE:SCHEDULED TIMES / PRN INDICATORS: Miralax 2 ozDailyGTQAM for constipation SERVICES PROVIDED AT DAYCARE IMMT services funded by the Ill and Handicap Waiver for a ## year-old female with cerebral palsy. Child is wheelchair bound and wears bilateral AFOs. She has a MIC-KEY Gastrostomy Feeding Tube for supplimental feeding QHS PRN for inadequate oral intake and medications. Daycare provider will provide safety supervision at all times, monitor and adjust positioning hourly, monitor oral intake daily, teach and assist with safe pivot transfer from wheelchair to toilet as needed, assist with toileting, hygene and clothing adjustment as needed, perform stretching and passive range of motion to lower extremeties daily, remove AFOs and provide floor time for at least one hour per day, reapply AFOs before returning to wheelchair, assess skin integrity daily, and report client's care and condition to client's mother daily. Provider will also encourage independant mobility, physical activity, and interactions with peers as appropriate to develop age-appropriate social and self-care skills. PARENT SIGNATURE:___________________________________________________________ DATE:_______________ CHILD CARE PROVIDER SIGNATURE:_____________________________________________ DATE:_______________ Deborah VanderGaast, RN, Owner/Operator Physician: Clinic Name: Address: City, State, Zip: Phone: Fax: PHYSICIAN SIGNATURE:___________________________________________________ DATE:____________________ Care plan will expire one year from date of physician signature. Updates in orders and medications will be attached to care plan.

47 Tipton Adaptive Daycare Weekly Personal Care and Medical Monitoring Record NAME:MONTH: ____________________20_____ Orders from Care Plan: IMMT services funded by the Ill and Handicap Waiver for a ## year-old female with cerebral palsy. Child is wheelchair bound and wears bilateral AFOs. She has a MIC-KEY Gastrostomy Feeding Tube for nightly supplemental feeding and medications. Daycare provider will provide safety supervision at all times, monitor and adjust positioning hourly, monitor oral intake daily, teach and assist with safe pivot transfer from wheelchair to toilet as needed, assist with toileting, hygiene and clothing adjustment as needed, perform stretching and passive range of motion to lower extremities daily, remove AFOs and provide floor time for at least one hour per day, reapply AFOs before returning to wheelchair, assess skin integrity daily, and report client's care and condition to client's mother daily. Provider will also encourage independent mobility, physical activity, and interactions with peers as appropriate to develop age-appropriate social and self-care skills. DATE: Care Provided:Time MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY Monitor and adjust positioning hourly9 am 10 am 11 am 12 pm 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm Assess skin integrity daily % of breakfast eaten % of AM snack eaten % of lunch eaten % of PM snack eaten Pivot transfer to/from toilet PRN A x I x Toileting, clothing adjust, hygene PRN A x I x Floor time to Time AFOs removed Time AFOs applied Stretching and PROM to L.E. Report client's care and condition to mother Time In: Time Out: Provider Initials: X = done, INT = Intact without erythema or ecchymoses, Note = see note on back, A = assisted, I = independent w/supervision

48 Sample Protective Daycare Plan  SERVICES PROVIDED AT DAYCARE Protective daycare services funded by the Department of Human Services for ## year-old female with risk for behavior disorders and risk for injury related to altered family process: mental illness. Child requires adult supervision at all times. Provider will provide continuous supervision, age appropriate activities, and homework supervision daily, homework assistance as needed, redirection to appropriate activities as needed, develop and implement behavior modification plans as needed for maladaptive behaviors, report absences to child's social worker immediately, communicate child's progress to parent as needed, give written or oral progress report to social worker monthly, and keep written record of incidents as needed.

49 Required Documentation

50 What are the basic documentation requirements that Waiver providers must meet? Information necessary to support each item of service reported on the Medicaid claim form. For instance: 1) Full name of child receiving service 2) Name of the service provided 3) First and last name of the staff providing services 4) Full date and time frames/duration of service delivery 5) Signature of staff providing the service 6) Activities during respite 7) Documentation of Medical Monitoring and Treatment on care plan Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm

51 Respite Client Records Providers shall maintain the following information that shall be updated at least annually: ♦ The member’s name, birth date, age, and address and the telephone number of each parent, guardian, or primary caregiver. ♦ An emergency medical care release. ♦ Emergency contact telephone numbers such as the number of the member’s physician and the parents, guardian, or primary caregiver. ♦ The member’s medical issues, including allergies. ♦ The member’s daily schedule which includes the member’s preferences in activities, food preferences, or any other special concerns. Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

52 Medications: Procedures shall be developed for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications administered. Home health agencies must follow Medicare regulations for medication dispensing. ♦ All medications shall be stored in their original containers, with the accompanying physician or pharmacist’s directions and label intact. ♦ Medications shall be stored so they are inaccessible to members and the public. ♦ Non-prescription medications shall be labeled with the member’s name. ♦ In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription. Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

53 Policies shall be developed for: ♦ Notifying the parent, guardian, or primary caregiver of any injuries or illness that occur during respite provision. A signature by the parent, guardian, or primary caregiver is required to verify receipt of notification. ♦ Requiring the parent, guardian, or primary caregiver to notify the respite provider of any injuries or illnesses that occurred before respite provision. ♦ Documenting activities and times of respite. This documentation shall be made available to the parent, guardian, or primary caregiver upon request. ♦ Ensuring the safety and privacy of the person. Policies shall at a minimum address fire, tornado, flood and bomb threats. Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

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55 Information included on the notice of decision: ♦ Services authorized ♦ Units of service ♦ Rates for services ♦ Providers authorized ♦ Start and end date for each service authorized ♦ Information about client participation, if any Iowa Department of Human Services. (2011, March 18). Employees’ manual: Title 16, chapter K. Medicaid Waiver Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/policyanalysis/policymanualpages/manual_documents/master/16-k.pdf

56 Provider Quality Management Self-Assessment TO: Iowa Medicaid Habilitation, Remedial Services and HCBS Waiver Providers (Excluding Individual CDAC) The Department of Human Services has implemented a quality management process for providers of each of the services identified below. As a provider enrolled for one or more of these services you are required to complete the 2010 Provider Quality Management Self-Assessment. Failure to complete the self-assessment may jeopardize your status as a Medicaid provider of these services.  http://www.ime.state.ia.us/docs/935_InformationalLetter.pdf

57 Which Self-Assessment to Use:  There are five versions of the self-assessment  Sole Proprietor (Individual that has no direct service or subcontracted employees, and services are provided by the owner); enrolled only for Respite and/or Interim Medical Monitoring and Treatment (IMMT) Services  Provider enrolled only for Support Services (agency CDAC, IMMT, Respite, Adult Day Care)  This form is setup as a Microsoft Word template and is to be completed electronically and submitted as directed in the form instructions.  http://www.ime.state.ia.us/HCBS/ReviewTools.html

58 Billing for Medicaid Services

59 441—80.2(249A) Submission of claims. Providers of medical and remedial care participating in the program shall submit claims for services rendered to the Iowa Medicaid enterprise on at least a monthly basis. All nursing facilities and providers of home- and community-based services shall submit claims for services after end of the calendar month in which the services are provided. Providers of home- and community-based waiver services, including home health agencies, shall submit claims on Form 470-2486, Claim for Targeted Medical Care. Providers are encouraged to submit claims electronically whenever possible. PROCEDURE AND METHOD OF PAYMENT Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. 441 Iowa Admin Code Chapter 80. Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis /PolicyManualPages/Manual_Documents/Rules/441-80.pdf

60 Time Limits  441—80.4(249A) Time limit for submission of claims and claim adjustments.  80.4(1) Submission of claims. Payment will not be made on any claim where the amount of time that has elapsed between the date the service was rendered and the date the initial claim is received by the Iowa Medicaid enterprise exceeds 365 days. Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. 441 Iowa Admin Code Chapter 80. Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis

61 Electronic Billing  As a medical provider are you interested in increasing your cash flow? Would you like to do away with the burden of filling out paperwork and the expense of mailing your paper claims? Then now may be the time to consider filing your Medicaid claims electronically.  Iowa Medicaid Enterprise (IME) supports the electronic submission of claims. Through electronic submission, you are able to submit claims more accurately. You also receive your Medicaid payments sooner than if you submitted paper claims.  Effective July 1, 2005, the Iowa Medicaid Enterprise (IME) has contracted with a new company to process Medicaid claims currently being processed by ACS, the current fiscal agent.  As part of this change, there is a new clearinghouse to receive electronic claims transactions. The new clearinghouse is EDI Support Services (EDISS To begin the enrollment process for electronic claims to IME all offices must complete these steps:  Fill out the appropriate EDI paperwork Complete claims registration forms (837P, 837I, or 837D) along with the EDI Enrollment form If you will be using PC-ACE Pro32, the PC-ACE Pro32 Software Sublicense Agreement will need to be completed as well All forms must be filled out completely and signed in ink by the provider http://www.ime.state.ia.us/Providers/BillingInstructions.html

62 Paper Billing  Submit Claim Forms to: IME Claims P.O. Box 150001 Des Moines, IA 50315

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66 Iowa Department of Human Services. (2011). Chapter 80: Procedure and method of payment. Retrieved May 1, 2011, from http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Docu ments/Rules/441-80.pdf

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70 What are the Healthcare Provider Taxonomy Codes (HPTC)?  The Healthcare Provider Taxonomy code set divides health care providers into hierarchical groupings by type, classification, and specialization, and assigns a code to each grouping.  All codes are alphanumeric and are 10 positions in length.  Iowa Medicaid assigns the taxonomy code(s) that most closely represents the provider’s education, license, or certification. Centers for Medicare & Medicaid Services. (2003, October 3). What are the Healthcare Provider Taxonomy Codes (HPTC)? Where may I obtain a copy of the codes?. Retrieved April 20, 2011, from https://questions.cms.hhs.gov/app/answers/detail/a_id/2356/~/what-are-the-healthcare-provider-taxonomy- codes-%28hptc%29%3F-where-may-i-obtain-a

71  Taxonomy codes are assigned to you when you apply to be a Medicaid provider.  The Healthcare Provider Taxonomy code set is available at no charge from the Washington Publishing Company’s website: http://www.wpc-edi.com/codes/taxonomy http://www.wpc-edi.com/codes/taxonomy

72 Sample Taxonomy Code: 385HR2060X  Respite Care, Mental Retardation and/or Developmental Disabilities, Child: A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental retardation and/or developmental disabilities as respite for the regular caregivers.

73 Sample Taxonomy Code: 385HR2065X 385HR2065X Respite Care, Physical Disabilities, Child - 385HR2065X  Respite Care, Physical Disabilities, Child: A facility or distinct part of a facility that providers short term, residential care to children, diagnosed with complex or profound disabilities as respite for the regular caregivers.

74 Q: How long does a provider have to submit a bill/claim for delivered services?  A: Service providers have 12 months to bill from the time the service was provided. The service had to be authorized in the service plan and approved in ISIS and could not have been provided prior to the ISIS approval date. Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm

75 Q: If my claim has been denied, what are some initial things I should check? A: Providers should cross reference their claim form with the service plan and information received from the Targeted Case Manager authorizing their services in ISIS. Check to see whether:  the provider number is correct  the procedure code on the claim form and the service plan match  the service is billed according to the time spans authorized on the service plan  the correct number of units are billed according to what was provided and authorized on the service plan  the correct rate was billed according to the service plan authorization  the service plan was approved at the time when the provider billed  the bill was not submitted too early (services provided in one month cannot be submitted for payment until the following month)  the child was hospitalized or entered a facility (if so, the DHS Income Maintenance Worker must have been notified so necessary changes can be made in the payment system) Iowa State University. (2007). Frequently Asked Questions from Service Providers. Child Welfare Research and Training Project for the Iowa Department of Human Services. Retrieved April 5, 2011, from http://www.dhs.state.ia.us/rts/Lib_Res/1FAQs.htm

76 Resources

77  Available free online at http://nrckids.org/SPINOFF/CSN/CSN.htmhttp://nrckids.org/SPINOFF/CSN/CSN.htm  Print copy can be ordered from American Academy of Pediatrics for $24.95 plus shipping and handling  Children with Special Needs Standards from Caring for Our Children, 2nd Ed.  This document is a compilation of the 101 standards on providing child care to children with special needs.

78 Child Care Nurse Consultants  Healthy Child Care Iowa supports Child Care Nurse Consultants (registered nurses) who are experts in child health, child care, and child safety. Child Care Nurse Consultants work with child care and early education businesses. Businesses may call or send questions to a child care nurse consultant about health and safety policies, health programs, health of personnel, and specific child health or safety issues. Healthy Child Care Iowa has a toll free talkline for child care providers, (800) 369-2229.

79 Locating Regional Child Care Consultants

80  Resources for Children With Special Needs  All Kids Count: Child Care and the ADA (DBTAC Rocky Mtn. ADA Center) All Kids Count: Child Care and the ADA  Children and Youth with Special Health Care Needs Knowledge Path (The Maternal & Child Health Library at Georgetown University) Children and Youth with Special Health Care Needs Knowledge Path  Children with Diabetes (Family Support Network) Children with Diabetes  Developmental Behavioral Pediatrics Online (AAP) Developmental Behavioral Pediatrics Online  Diabetes in Children and Adolescents (Maternal and Child Health Library Knowledge Path) Diabetes in Children and Adolescents  The Division for Early Childhood (of the Council for Exceptional Children) The Division for Early Childhood  Family Village: A Global Community of Disability-Related Resources Family Village: A Global Community of Disability-Related Resources  Family Voices Family Voices  Healthy Kids, Healthy Care: Children with Special Needs Healthy Kids, Healthy Care: Children with Special Needs  National Center on Birth Defects and Developmental Disabilities National Center on Birth Defects and Developmental Disabilities  The National Dissemination Center for Children with Disabilities The National Dissemination Center for Children with Disabilities  http://nrckids.org/RESOURCES/list.htm#Consultants

81 Resources on Facebook  National Dissemination Center for Children with Disabilities (NICHCY)  SpecialQuest Birth-Five: Early Childhood Inclusion Training Resources  Centers for Disease Control (CDC)  Grant Wood Area Education Agency (AEA)  Disability Rights Iowa  Iowa Compass


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