iesbvi medicaid billing for part c developmental and orientation & mobility services presenter:...

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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

IESBVI Medicaid Billing for Part C Developmental & O and M Services

IESBVI Medicaid Billing for Part C Developmental & O and M Services 2

End Point of Today’s Session

Items for You to Knowwill bill for Developmental & O

and M that you already provideEarly Access/Medicaid policiesexpectations 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

IESBVI Medicaid Billing for Part C Developmental & O and M Services 3

Medicaid Background Remarks

What is Medicaid?

What does Medicaid have to do with Education Services?

What does Medicaid have to do with IESBVI?

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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

EA Proc Manual Sect 1

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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

ITP Medicaid Prov Manual

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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

IESBVI Medicaid Billing for Part C Developmental & O and M Services 8

What do I need to know about Developmental Services? (cont’d 5)

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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)

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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

ITP Medicaid Prov Manual

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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

ITP Medicaid Prov Manual

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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

IESBVI Medicaid Billing for Part C Developmental & O and M Services 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;..

EA Proc Manual Sect 1

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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

IESBVI Medicaid Billing for Part C Developmental & O and M Services 14

End Point of Today’s Session (cont’d 2)

Expected of You to Knowa) 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;

Ia Braille IFSP documentation example

IESBVI IBSSS Billing Log example

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End Point of Today’s Session (cont’d 3)

Expected of You to Knowd) 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

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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

Thank you for your interest.