1. IESBVI Medicaid Billing for Part C Developmental and Orientation & Mobility Services Presenter: Jim Donoghue Medicaid Consultant Iowa Department of Education (515) 281-8505 jim.donoghue@iowa.gov August 16, 2013

2. 2 End Point of Today’s Session Items for You to Know  will bill for Developmental & O and M that you already provide  Early Access/Medicaid policies  expectations of you: a) when this will start; b) when/ how to identify the students; c) start to learn where/ how to document; d & e) communicate with IFSP teammates & Gwen, Pam, DE

3. 3 Medicaid Background Remarks  What is Medicaid?  What does Medicaid have to do with Education Services?  What does Medicaid have to do with IESBVI?

4. 4 What do I need to know about Developmental Services? EA Procedure Manual : SI includes: 1) design of learning environments & activities that promote acquisition of skills…;2) curriculum planning.. that leads to achieving the outcomes in the IFSP; 3) providing families with information, skills, & support..; & 4) working..to enhance development. NOTE: Resources Families Receive

5. 5 What do I need to know about Developmental Services? (cont’d 2) ITP Medicaid Manual : Services include: 1) designing activities that help the child to..;2) modeling and teaching family members or care providers..;3) working with the child Covered services: 1)screening; 2) assessment; 3) developmental services to an individual..4) in a group..or 5)by contract provider

6. 6 What do I need to know about Developmental Services? (cont’d 3) ITP Medicaid Manual: cont’d: screening: brief assessment to identify presence of condition or developmental delay; identifies child’s potential eligibility for service & need for further evaluation; documented decision and rationale

7. 7 What do I need to know about Developmental Services? (cont’d 4) assessment: comprehensive eval to determine child’s developmental level of functioning; from informed clinical opinion… through objective testing, includes 1) review pertinent records; 2) evaluate child’s level of functioning in six areas; 3) assess unique strengths and needs; 4) identify appropriate services; written narrative of evaluation and results

8. 8 What do I need to know about Developmental Services? (cont’d 5) direct services to individual, in a group, or by contractor: type and level of treatment direct outcome of assessment; services may be provided directly or through case consultation (monitor, supervise, teach & train professionals, paras, & parents in home or community providing general information and making recommendations)

9. 9 What do I need to know about Developmental Services? (cont’d 6) ITP Medicaid Manual 6 procedure codes, particularly 96111 Developmental Assessment, Extended,1 hour unit 96152 Health and Behavior Intervention, Individual, 15 minute unit

10. 10 What do I need to know about Orientation and Mobility? ITP Medicaid Manual : Vision services include: identification of range, nature and degree of vision loss; 2) consultation with child and parents ; 3) evaluation of effectiveness of a vision aide; and 4) orientation and mobility services

11. 11 What do I need to know about Orientation and Mobility? ITP Medicaid Manual (cont’d.) : O & M: Services provided to eligible blind or visually impaired children by qualified personnel to enable those children to attain systematic orientation to & safe movement within their environments in home & community; Code 97139 Unlisted Therapeutic Procedure 15 minute unit

12. 12 What do I need to know about Orientation and Mobility? EA Procedure Manual : O & M includes teaching children the following as appropriate: 1)spatial & environmental concepts and use of information received by the senses to (such as sound, temperature, vibrations) to establish, maintain or regain orientation and line of travel;..

13. 13 What do I need to know about Orientation and Mobility? EA Procedure Manual (cont’d.): 2) to use long cane or a service animal to supplement visual travel skills or as a tool for safely negotiating environment for children with no available travel vision;3) to understand & use remaining vision & distance low vision aids;& 4) other concepts, techniques and tools. NOTE: Resources Families Receive

14. 14 End Point of Today’s Session (cont’d 2) Expected of You to Know  a) when this will start: Oct 1;  b) when and how to identify the students involved: You will receive a list of students for whom you need to document; c) where and how to document: See example;

15. 15 End Point of Today’s Session (cont’d 3) Expected of You to Know  d) what communications are expected of you with IFSP team: If shared visit, agree who will bill for specific time block  e) what communications are expected of you with Gwen or Pam if there are challenges: If challenges, make timely contact

16. 16 If questions…. If you have any questions after today’s presentation, please contact Jim Donoghue at (515) 281-8505, fax (515)242-5988, jim.donoghue@iowa.gov or jim.donoghue@iowa.gov Thank you for your interest.