Occupational and Physical Therapist Professional Development

1. Occupational and Physical Therapist Professional Development ACCESS Updates and Pending Changes to Service Documentation Wednesday, September 3, 2014

2. Agenda • Review the requirements for the ACCESS Program • Explain the changes in the Evaluation/Re-Evaluation Claiming • Introduce the template for the new screens under development • Tips for Service Documentation • Review Collateral Service Documentation • Review Progress Note Documentation • Review the Error Reports • Review the EasyTrac History Screen and tracking of Medicaid Parental Consent • Review the 150 day cycle – no more retroactive submissions • Review how claims are submitted and the 15 minute increment • Questions and Answers

3. ACCESS Program Claiming Requirements • The student must be identified as Chapter 14. • The student must be Medicaid Eligible. • The Medicaid Parental Consent must be signed Yes and on file. The One Time Consent form if signed Yes will cover services moving forward. • The service provider must be registered with the ACCESS office and meet the criteria to be credentialed with an ACCESS Provider number. • The services must be provided by the service provider submitting the claim. Absolutely No Intern services are to be claimed. • There must be Medical Authorization on file to cover the dates of services. • There must be an IEP in place recommending the service and covering the date of service to be claimable. Note: The EasySystem is a Full Electronic Documentation system and all services should be documented regardless of claiming status.

4. Medical Authorization Form

5. Changes to the Evaluation and Re-evaluation Claiming • The state has removed collateral services from their EasyTrac screens as they are not claimable services. SDP has been removing these service minutes from the total time before submitting an eligible claim for processing. • The state screens for evaluations are separate from the daily service logging screens and capture services as a total time for the Evaluation/Re-evaluation. We are developing a screen to work toward this but that still allows for full electronic documentation of services. • Only evaluations and re-evaluations that have an ongoing health related service in the IEP are claimable when they meet all other eligibility criteria. • The IEP is the claiming date for the Initial Evaluation. There is discussion throughout the state to make the re-evaluation date the claiming date. This date would disallow any services provided after the re-evaluation report date. • All services require Medical Authorization to be claimable. This authorization is obtained by submitting pages from the IEP to a CRNP for sign-off. Physician prescriptions may also be used to cover the Medical Authorization requirement. • SDP is developing a screen to track Medical Authorization in the EasySystem.

6. Sample Medical Authorization Tracking Screen

7. Sample Evaluation/Re-evaluation Logging Screen

8. Sample Screen Areas Covered/Assessed

9. Tips for Recording Services • Make daily entries of the services provided to assure the accuracy of the data. Be sure to be as timely as possible so that the student record is always current. • Pay close attention to the type of service and the time required to perform the activity. Enter accordingly. • Separate services into correct categories. Be careful not to duplicate or overlap services. Do not combine everything into one date if a report was written over the course of several days. Testing should always come before the final written report is documented and the dates should match the test forms. • At the end of the month, review all services to assure your service entries have been recorded correctly. • Maintain a caseload of students for whom you are currently part of the team. Once all services have been completed and the monthly summary recorded, a student may be removed from your caseload. • Utilize the Green Checkmark/Yellow Yield Sign/Red Stop Sign to review actual IEP dates. and Medical Parental Consent. Only use the dates that have a final document attached to them. • If you are not sure how to document a particular item, contact the ACCESS team for assistance. • A written report should be available for presentation to an auditor for all evaluations/re-evaluations claimed under ACCESS.

10. Pending New Evaluation/Re-evaluation Explanations • Initial Evaluation/Assessment This service type is used when the student receives a full evaluation/re-evaluation and is placed in Special Education with a health related service. Note: An evaluation report that can be presented under audit must be readily available. • Re-evaluation/Re-assessment This service type is used when the student has been evaluated and is found to be in need of continued special education health related services. • 504 Evaluation This service type is used when the student has been evaluated and is found Non-Exceptional (not eligible for special education services) but there is an accommodation plan (504 plan) recommended to meet the needs of the student. • Evaluation - No IEP Services Recommended This service type is used when the student is not in need of ongoing health related services. • Evaluation Stopped (Explanation Required) This service type is used when the evaluation process cannot be completed. It is usually used when a child is retained in Early Intervention Service for an additional year, the child moves out of district before the final Special Education determination is made or for children that are deceased or have some other extenuating circumstance.

11. Changes in Collateral Service Documentation • Collateral services are no longer claimable under the School Based ACCESS Program. • Several services that were formerly collateral services have been reclassified as direct service for the purpose of evaluation/re-evaluation. These include, but are not limited to, classroom observation, consult with medical personnel and writing the evaluation report.

12. What is a Progress Note? • The written record that supplies the details of how the student utilized their treatment plan.

13. Why Do We Use Progress Notes? • Progress notes are vital to good clinical treatment. • Charts the students’ journey through the continuum of care. • Improve and enhance the treatment process by helping the direct service provider track the students’ progress in treatment while staying focused on the treatment plan. • Good progress notes also assist other program staff to participate intelligently in the students’ treatment process. • Review of progress notes is the best way to refresh ones memory when sitting with the IEP team to discuss the students’ progress. • If the primary direct service provider is not available to provide support to the student, the chance that another direct service provider will be able to provide meaningful assistance may be dependent on the quality of documentation in the progress notes

14. How? • Essential that the direct service provider is able to give a complete picture of the student’s progress and/or lack of progress. • Progress note should always include documentation of development with the use of suggested activities or strategies during daily routines. • Notes should explain everything that happened with the student

15. WARNINGS: • A series of notes that only reports the student’s attendance and indicating that they had “good participation” are clinically useless. • Additionally, if notes consistently say that service provider worked on the exact same activity for service after service, it may seem like they are not individualizing services to the student’s needs

16. Error Reports – What Do They Mean? • Duplicated Services - This report advises the service provider that they have already claimed for the service in a previous claiming cycle. • IEP Date Did Not Match – This report notifies the service provider that the IEP date that was entered for the outcome does not match the Event Date of the IEP. This date is the date of the IEP, not the date the final version was finalized. • Multiple IEPs – This report advises the service provider that the IEP date and outcome have been entered multiple times. • No Parental Authorization – This report notifies the service provider that the parent has not given permission for claiming to be submitted. • Missing Parental Authorization – This report notifies the service provider that the parent consent has not been submitted to the ACCESS office for programming in the EasySystem to allow claiming to occur. • Expired Parental Authorization – This report advises the service provider that the Medicaid Parental Consent on file has expired and does not cover the date of service for claiming. The correct version of the Medicaid Parental Consent must be submitted for the error to be corrected. • No IEP Meeting – This report notifies the service provider that the outcome has not been entered to allow the student’s record to be completed and the claiming cycle to begin. • Psych No Service Minutes – This report notifies the service provider that the IEP date entered does not have any services associated with it for claiming.

17. Easy Trac History Screen and Tracking of Medicaid Parental Consent

18. Overview of the Claiming Process Begin Here

19. 15 minute increments • Services eligible for reimbursement under the school based ACCESS program are reimbursed in 15 minute increments. • Services under the 15 minute increment, round down to 0 and are not claimed. • Services over 15 minutes are claimed in 15, 30, 45 or 60 minute intervals. • If a service is over one interval, but under the next, i.e. 40 minutes, the service is rounded down to 30 minutes and the remaining minutes are left unclaimed.

20. Individual vs. Group • Services are to be logged as listed in the IEP. If the IEP lists that the student is to receive 30 minutes of group therapy, then the session is to be recorded as group for the ACCESS program. A note should be made in the Description of Service/Daily Note box indicating if the session was not a group session and why.

21. Why is the ACCESS team here today? • To update staff on changes to the program. • To advise staff of pending changes that will be effective in the near future. • To make sure everyone is on the same page regarding the logging of services and how it effects claiming. • To reiterate how important timely and accurate documentation is for the student record and the successful claiming of services under the School Based ACCESS Program. • To offer assistance to staff in need of retraining. • To review the types of error reports so that staff understand what needs to be done. • To remind staff that we cannot claim for services without their correct use of the EasySystem.