1. PublicConsultingGroup.com October 2008 Michigan Staff Pool List Review

2. Page 2 MI Staff Pool List Update – October 2008 Agenda  Description of Cost Pools  Case Management Staff Requirements  Case Management Activities  Personal Care Services  Personal Care Service Staff Requirements  Personal Care Service Activities  January – March 2008 Staff Pool List Process  Questions

3. Page 3 MI Staff Pool List Update – October 2008 Cost Pool List Descriptions  AOP – Eligible providers include  Administrators  Counselors  Early Identification/Intervention Personnel  Program Specialist  Teacher Consultants  Speech-Language Pathologist – Non ASHA CCC  Psychologist – Non State Licensed and not supervised by a State Licensed Psychologist  Social Worker – Masters Degree – Non State Licensed and not supervised by a State Licensed  Social Worker – Non Master level – All must be in AOP  Registered Nurse

4. Page 4 MI Staff Pool List Update – October 2008 Cost Pool List Description (cont.)  Direct Service – Eligible providers include  Audiologist  Occupational Therapist and Occupational Therapy Assistants  Orientation and Mobility Specialist  Physical Therapist and Physical Therapy Assistants  Physician  Psychologist – State Licensed  Social Workers – Masters Degree – State Licensed  Speech Language Pathologist – ASHA CCC

5. Page 5 MI Staff Pool List Update – October 2008 Case Manager  Case Manager - to qualify the individual needs to meet one of the following criteria:  RN with a Michigan license  Bachelor Degree with a major in a specific special education area  Earned credit in course work equivalent to the above mentioned degree  Minimum of three years personal experience in the direct care of individuals with special needs

6. Page 6 MI Staff Pool List Update – October 2008 Case Management Activity Examples  Assure that standard re-examination/follow-up of the student are periodically conducted to ensure the student receives needed diagnosis and treatment  Assist families in identifying/choosing appropriate care providers and services  Maintain case records and indicate all contact for student in the same manner as other covered services  Coordinate performance evaluations/assessments, other service needs for student  Prevention of duplicate services  Facilitation/participation in development, review and evaluation of the IEP  Supporting activities that link coordinate needed health services for the student and student progress

7. Page 7 MI Staff Pool List Update – October 2008 Personal Care Services  Personal care services are a range of human assistance services provided to persons with disabilities and chronic conditions, which enables them to accomplish tasks that they would normally do for themselves if they did not have a disability. Assistance may be in the form of hands on assistance or cuing so that the person performs the task by him/her self.  Personal Care Services must be medically necessary and the need for the service documented in the IEP/IFSP. Each Child’s school clinical record must contain a completed, signed and dated monthly activity checklist.  In accordance with 42 CFR 440.167, authorization for Personal Care Services (PCS) may be done by a physician or “other licensed practitioner” operating within the scope of their practice. The state definition of “other licensed practitioner” consisted of Registered Nurse (RN), Registered and Certified Occupational Therapist (OT), Licensed Physical Therapist (LPT), Master of Social Worker (MSW), or ASHA-CCC Speech Language Pathologist (SLP). It is expected that personal care services will be authorized by the appropriate practitioners. (Revised per bulletin MSA 08-36)

8. Page 8 MI Staff Pool List Update – October 2008 Personal Care Service (cont.)  Personal Care Services may be provided when:  The service is medically necessary  The service categories are documented in the IEP/IFSP. The treatment plan should contain the details of the service, frequency and duration and can either be part of the IEP/IFSP or an attached document.  The service is authorized at least annually by a Physician, or other licensed practitioner as stated in policy, in accordance with an individual plan of services  Personal Care Services are not covered if they are:  Provided by a family member. A family member is described by the Centers for Medicare & Medicaid services (CMS) to be “legally responsible relatives” ; thus, spouses of beneficiaries and parents of minor beneficiaries (including stepparents who are legally responsible for minor children).  Not documented in the IEP/IFSP  Educational in focus, such as tutoring, preparation or educational materials or Braille interpretation.  Performed as a group service; however, one or more students may be served one at a time sequentially.

9. Page 9 MI Staff Pool List Update – October 2008 Personal Care Service Activity Examples  Eating Feeding  Respiratory Assistance  Toileting  Grooming  Dressing  Transferring  Ambulation  Personal Hygiene  Mobility/Positioning  Meal Preparation  Skin Care  Bathing  Maintenance continence  Assistance with self administered medication  Redirection and intervention for behavior  Health related functions through hands-on assistance, supervision and cuing

10. Page 10 MI Staff Pool List Update – October 2008 Important Changes and Reminders to SPL  Medicaid eligibility of a student should not be a factor in determining if a provider can be part of the staff pool list  Provider must be a qualified provider for the service and the service must be documented in an IEP/IFSP  Service must be medically necessary and must be documented in an IEP/IFSP  If a provider is not currently billing due to not having any Medicaid eligible students on their caseload, they are still eligible to be part of the staff pool list

11. Page 11 MI Staff Pool List Update – October 2008 Important Changes and Reminders to SPL (cont.)  Providers must be in compliance with the Fee-For-Service School Based Services program  Non-Compliant Providers include: oA provider never submits procedure specific claims for their services. This is intentional on the Providers part oAn ISD/LEA or Provider as a standard practice never includes the service in IEP/IFSP; or oA provider is not appropriately credentialed or supervised; or oA provider is not listed in the Provider Manual as a qualified provider

12. Page 12 MI Staff Pool List Update – October 2008 Important Changes and Reminders to SPL (cont.)  Provider Credentials are an essential part of allowing a Provider to be included on the Direct Service staff pool list  Psychologist – Must have State Licensure to be included on the Direct Service staff pool list or be Supervised by a Psychologist who has a State License  Psychologist who do not meet the above criteria may be included on the AOP staff pool list  Social Worker-Masters Degree - Must have State Licensure to be included on the Direct Service staff pool list or be Supervised by a Social Worker who has a State License  Social Worker-Masters Degree - who do not meet the above criteria may be included on the AOP staff pool list

13. Page 13 MI Staff Pool List Update – October 2008 Important Changes and Reminders to SPL (cont.)  Teacher of the Speech and Language Impairments – Must have their ASHA CCC to be included on the Direct Service staff pool list or be Supervised by an ASHA CCC Speech Language Pathologist  Teacher of the Speech and Language Impairments who do not meet the above criteria may be included on the AOP staff pool list

14. Page 14 MI Staff Pool List Update – October 2008 Going Forward Staff Pool List Process  Starting with this quarter the following changes will be in effect for updating your staff pool list update  Changing a provider from one cost pool to another oDelete provider from current cost pool oAdd provider to the new cost pool oDo not state “move to” – If PCG sees this we will delete the provider from the current cost pool list however we will not add the provider to the new cost pool  Provider placed on the incorrect cost pool list oPCG will remove this provider from the incorrect cost pool list oPCG will not add the provider to the correct cost pool list  Provider information changes oMake the change directly to the document oDocument in Add/Delete/Change column exactly what change was made. EX = LN change from Jones oNever make a replacement by typing over the information of another provider

15. Page 15 MI Staff Pool List Update – October 2008 Reminders  Do not include any providers who are 100% federally funded in any of the cost pools  Be sure to add email addresses for all of your employees, this helps us with follow-up  If you send a revised updated SPL to PCG please make sure that it is clearly marked as REVISED  Return all staff pool list updates along with the calendar by November 13, 2008

16. Page 16 MI Staff Pool List Update – October 2008 Contacts Sandy Pillarspillar@pcgus.com(312)425-0550 Ext. 38