1. Putting the Pieces Together Independent Contractors Working in Schools

2. At the conclusion the presentation, you will: Understand options for meeting the legal requirements for working with private agencies who provide developmental or mental health services to students in schools. Have a framework for implementing practices in your district Know colleagues you can call for additional assistance

3. Pieces of the Puzzle Memo of Understanding is no longer legally permissible. State Medicaid billed for school based services. Parents want their agency to work at school. Federal Medicaid may not cover our costs.

4. Timelines Communicate with stakeholders Board Policy Establish referral procedures Cost Analysis: employee costs vs. contract costs Contract rates

5. Who will work on the puzzle? Communications with stakeholders At the IEP team meeting, communicate to parents your desire to serve students using school based resources Send a letter to private providers in your area, or meet with them to discuss how you will work with them next year.

6. Continued... Communicate with stakeholders Plan a way to communicate your plans to principals, teachers, and related service staff. Options might include: written documents, meetings, host a webinar, principal meetings. Anticipate conflict due to change in previous practices!

7. Board Policy Critical piece of the puzzle! Study model Board Policies Policy needs to be read at a Board meeting 3 times before adopting Policy should be in place before school starts next fall Board Policy Reduces contention With stakeholders Provides direction Three readings provide the public with opportunities to react

9. Who are the Independent Contractors? SLP, OT, PT PSR – Who qualifies for service IBI – Who qualifies for service DT – Who qualifies

10. Positive Behavior Supports and General Ed. Interventions PBS should be operating in all schools. Before spending funds to provide 1:1 support, explore multiple options for building a relationship with the student and his/her family. Implement and document strategies for improving student behavior in general education.

11. Referral to Placement A 1:1 aide, provides a very restrictive LRE Exhaust general ed. interventions. Exhaust special ed. interventions Insure that PSR, IBI, and DT are available only to students with a significant disability.

12. PSR Referral Process Conduct an evaluation to determine whether or not the student has an emotional disturbance Collect information from multiple sources, including the private agency. Evaluation must include an in depth Functional Behavior Analysis (FBA) and Social History Behavior Improvement Plan must be based on the findings of the FBA and include specially designed instruction.

13. IEP for other funding categories If the student has an IEP in a different funding category that also accurately describes the disability, then the student must demonstrate: DSM-IV diagnosis AND Obtain a CAFAS score of 80+

14. Activity Matrix WHO is providing support WHAT level of support is needed WHEN 1:1 is required HOW support is provided WHERE support is occurring

15. Medicaid and PSR The student must qualify for: Medicaid IEP If the funding category is E.D., then the school can bill Medicaid for PSR services If the funding category is any category besides E.D., the student must have a DSM- IV diagnosis and a CAFAS score of 80+.

16. Options for Providing Services PSR Qualifications: Must have a B. A. degree in a human service area IDAPA recommends 21 hours of continuing ed. in related subjects each year Serves students with a mental health condition or an emotional disturbance Hire PSR workers as district employees and bill Medicaid Contract with an agency

17. Hiring a District PSR Hire as non-certified staff Determine rate of pay for PSR (or IBI) (recommended: $16.00 to $17.00 per hour) There will be a pool of qualified workers available to work during school hours District can hire staff of their choice Work with parents to insure success

19. Contracting with an Agency When? The district is not able to provide the service. How? Look at model contracts: be specific as to the services to be delivered Considerations for Directors: compare the cost of a contract with employment costs (salary, health benefits, taxes, PERSI, FICA, Workmens Compensation = 33% to 35%) Possible Medicaid reimbursement – 70% of rate

20. What if it doesn’t work? What is the District’s obligation? Complaint procedure How to avoid a sticky situation. Change is difficult – some people will complain!

21. Addressing IBI, PSR, DT on Student’s IEP How to list services on the Service Page for Medicaid reimbursement. Be sure to include a statement of need in the P.L.O.P. to justify the related service. Develop goals and objectives (as required) to match the Social History/Functional Behavior Assessment/Behavior Improvement Plan. How does it impact Child Count?

22. Questions and Answers ? ? ? ? ?