1. School Nurse Organization of Minnesota Annual Conference November 2, 2013 Janet Lowe, RN, LSN, CPNP, MA

2. Connecting School Nurses to Reimbursement ImpactInfluenceOutcomes

3. Reimbursement Impact Influence Outcome Background Regulations Best Practices FAQ Resources

4. Connecting School Nurses to Reimbursement: Impact

5. Reimbursement Reimbursement Increases RevenueIncreases Revenue School Nurse Positions School Nurse Positions

6. Connecting School Nurses To Reimbursement: Influence School Nurses are an Integral Part of the Health Care Delivery School Nurses are an Integral Part of the Health Care Delivery Increases Access to Health Care Increases Access to Health Care

7. Connecting School Nurses to Reimbursement: Outcomes Reduces Health Related Barriers to Learning Reduces Health Related Barriers to Learning Increases Achievement Increases Achievement Increased Graduation Rates Increased Graduation Rates

8. Where To Begin?

9. Medicaid Federal and State Federal and State 1965 – Social Security Act 1965 – Social Security Act Reimbursement for Health Care Services Reimbursement for Health Care Services

10. Q 3 = Reimbursement Q ualified Children/ Youth Q ualified Children/ Youth Q ualified Providers Q ualified Providers Q ualified Covered Medicaid Services Q ualified Covered Medicaid Services

11. Qualified Providers Licensed School Nurses Licensed School Nurses RNs, LPNs RNs, LPNs Advanced Practice Registered Nurses Advanced Practice Registered Nurses CNPsCNPs

12. Qualified Services Federal Regulations Federal Regulations State Medicaid Regulations State Medicaid Regulations

13. Covered Services Individualized Education Program (IEP) Plan Health Related Services Individualized Education Program (IEP) Plan Health Related Services (34C.F.R.300.154)(34C.F.R.300.154) (MS256B.0625)(MS256B.0625) School Nursing ServiceSchool Nursing Service

14. Covered IEP Health Related Nursing Service (IEP Technical Assistance Guide, DHS) Face to face nursing care within nurse’s scope of practice Face to face nursing care within nurse’s scope of practice Examples, but not limited to: Examples, but not limited to: Catheterization, tube feeding, suctioning, ventilator careCatheterization, tube feeding, suctioning, ventilator care Nursing assessment and diagnostic testing such as glucose testingNursing assessment and diagnostic testing such as glucose testing Vital signsVital signs Health counselingHealth counseling

15. Covered IEP Health Related Nursing Service (IEP Activities of Daily Living when the IEP indicates a one on one nurse is required at school Activities of Daily Living when the IEP indicates a one on one nurse is required at school Medication administration – Medication administration – Complex – IV, injection, nebulizer, or gastrostomy tubeComplex – IV, injection, nebulizer, or gastrostomy tube Simple – administration of prescription medications related to the child’s disability and in the IEPSimple – administration of prescription medications related to the child’s disability and in the IEP

16. Covered IEP Health Related Nursing Service Medication Management Medication Management Review of medication and adherence to regimen, and one of the following:Review of medication and adherence to regimen, and one of the following: Evaluation for adverse reactions Evaluation for adverse reactions Education about medication Education about medication Contacts with the physician Contacts with the physician

17. Covered IEP Health Related Nursing Service IEP Evaluations IEP Evaluations Health relatedHealth related Result in an IEPResult in an IEP Includes:Includes: Pre-IEP evaluations Pre-IEP evaluations Ongoing assessments to determine needs Ongoing assessments to determine needs Re-evaluations Re-evaluations Face to face Health Assessments, interpreting test results and writing reports Face to face Health Assessments, interpreting test results and writing reports

18. Medicaid – Reimbursement in MN for IEP Health Related Services - Over 200 Million

19. Other Requirements Enroll as a Provider (DHS) Must provide notification/consent one time District MA consent Must obtain denial through MDE, or private insurance company, for students with a combination of MA and private insurance

20. Covered Services Early and Periodic Screening, Diagnosis, and Treatment Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) (42C.F.R.441.50-441.62) (EPSDT) (42C.F.R.441.50-441.62) MN- Child and Teen Checkups (CTC) (MS256B.0625) Immunizations Immunizations Enroll as a Public Health Nursing Clinic Enroll as a Public Health Nursing Clinic

21. Childhood Immunizations (MS256B.0625, Subd. 39) Must enroll in the pediatric vaccine administration Budget Reconciliation Act of 1993. Medical assistance shall pay for administration of the vaccine to children eligible for medical assistance. Medical assistance does not pay for vaccines that are available at no cost from the pediatric vaccine administration program.

22. Public Health Nursing Clinic Be department of, or operate under the direct authority of a unit of government. Examples of a unit of government include county, city, or school district Eligible Providers Public Health Nurses (PHN) Licensed registered nurses, supervised by a PHN, practicing in a PHNC

23. Public Health Nursing Clinic Covered Services Health Promotion and Counseling Medication Management: Review of current medications and adherence to the prescribed medication regime. Education on proper medication use and contact with the prescribing physician when necessary Nursing Assessment Treatment and Diagnostic Testing

24. Erickson, C., Splett, P., Mullett, S., & Heiman, M. (2006). The healthy learner model for student chronic condition management— Part 1. Journal of School Nursing, 22, 310-318.

25. Diabetes Chronic Disease Management

28. Public Health Clinic (PHC) Covered Services Preventive health services Early periodic screening, diagnosis, and treatment services, also known as Child and Teen Checkups or C&TC Dental services Tuberculosis case management and directly observed therapy Eligible Providers Advanced practice registered nurses (APRN) Nurse practitioners (NP)

29. Covered Services Nurse Practitioner Services Nurse Practitioner Services Advanced Practice Registered Nurse (APRN)Advanced Practice Registered Nurse (APRN)(MS256B.0625)

30. Best Practices in the Development of a Reimbursement Program Administrative Support Superintendent Board of Education

31. Collecting Data on Health Care Services Provided in Your School Chronic Disease Management Chronic Disease Management Asthma, Diabetes, Hearing Conditions, ADHDAsthma, Diabetes, Hearing Conditions, ADHD Medications Medications Treatments Treatments

32. Best Practices in the Development of a Reimbursement Program Strategic Goals and the Racial Equity Policy Achievement Alignment Sustainability

33. Best Practices in the Development of a Reimbursement Program Inter-Department Support Finance Legal Purchasing Technical Department

34. Best Practices in the Development of a Reimbursement Program Work Across Disciplines OT PT Speech and Language and Audiology Social Workers School Psychologists

35. Best Practices in the Development of a Reimbursement Program Adhere to Standards of Practice Develop Policies and Procedures

36. Best Practices in the Development of a Reimbursement Program Documentation Name, student ID Date of Service Duration of Service Description of Service Progress Plan SOAP Subjective, Objective, Assessment, Plan DAP Data, Assessment, Plan DARP Data, Assessment, Response, Plan CCC Concept, cueing, clicking

37. Best Practices in the Development of a Reimbursement Program Secure Data Electronic Firewalls, encryption, security Retrievable for Audits

38. Best Practices in the Development of a Reimbursement Program Build the Infrastructure for an Audit Internal Audits

39. Other Areas for Reimbursement for School Nurses in Minnesota Electronic Data Reporting System (EDRS) – State Special Education funds Electronic Data Reporting System (EDRS) – State Special Education funds Minnesota Department of EducationMinnesota Department of Education Local Collaborative Time Study (LCTS) Local Collaborative Time Study (LCTS) MN Department of Human ServicesMN Department of Human Services Other Grants, or other Other Grants, or other

40. Affordable Health Care Act Coordination of Health Care Services Coordination of Health Care Services Prevention Prevention Outcome Based Outcome Based

41. The Time is Now You can Make an IMPACT OUTCOMES For Students!! INFLUENCE and be an Advocate Tell Your Story

42. Questions from School Nurses IEP Health Related Nursing Services “If the nurse has listed direct time and it is very little, can she track and charge for more time. For instance, the nurse put in 15 min. a month for seizure care and management but she is needing to go to the classroom every time the student has a seizure and it is more often than when they wrote the IEP.”

43. Questions from School Nurses “Do the physician orders need to order medication management in order to bill medication management.”

44. Questions from School Nurses Is adding nursing as a related service limited by the category of disability? For example, can nursing only be on an OHD? What about LD, speech, and other categories?

45. Questions from School Nurses How do you document nursing services on the IEP?

46. Resources Minnesota Department of Human Services, IEP Technical Assistance Guide Minnesota Department of Human Services, IEP Technical Assistance Guide Minnesota Department of Education, Ruth Ellen Luehr, TPL denials, sharepoint Minnesota Department of Education, Ruth Ellen Luehr, TPL denials, sharepoint Centers for Medicare and Medicaid (CMS) Centers for Medicare and Medicaid (CMS) http://www.cms.gov/ National Alliance for Medicaid in Education (NAME) National Alliance for Medicaid in Education (NAME) http://medicaidforeducation.org/ National Association of School Nurses National Association of School Nurses http://www.nasn.org/ School Nursing: A Comprehensive Text, available for ordering June 23, 2012 Contact apyles@nasn.org bookstore apyles@nasn.org Erickson, C., Splett, P., Mullett, S., & Heiman, M. (2006). The healthy learner model for student chronic condition management— Part 1. Journal of School Nursing, 22, 310-318.