Transcript SHARS (Parent Consent Form):

SHARS:
A.R.D. Documentation and SHARS
Compliance
Areas of Concern
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6.
What is SHARS?
Service areas with Documentation issues
ARD Documentation
Medical Necessity
Alignment – PLAAFP, IEP, Supplement
Parental Consent to release information
(one-time)
1. What is S.H.A.R.S.?
S.H.A.R.S. stands for School Health And
Related Services.
It is a program that was created by the federal
government, that allows a district to bill
Medicaid for “direct medical services”
provided to “eligible” students by district
employed service providers or contracted
service providers.
1. What is S.H.A.R.S.?
• What are Direct Medical Services?
• Direct Medical services are services (other than
transportation on the bus) that a district is allowed to
bill through the SHARS program.
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Audiology
Speech
Occupational Therapy
Physical Therapy
Counseling
Pyschological Services
• Assessment and
Evaluations
• Nursing Services
• Nursing Meds
• Personal Care Services
• PCS - Transportation
• Transportation
1. What is S.H.A.R.S.?
• Who Qualifies?
• What criteria must a child meet in order for the district to bill
Medicaid under the SHARS program?
– The child must:
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be enrolled in a public school’s special education program;
be 20 years of age or younger;
have an ARD/IEP documenting the medical necessity for services
have a disability or chronic medical condition; and
Medicaid eligibility.
• The services the child receives at school do not affect the type or
amount of Medicaid services the child receives outside the school.
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Source – TMPPM
2. Service areas with Documentation issues
• Personal Care Services – PCS supplement
• Personal Care Services Transportation Aide (Bus
monitor) – PCS supplement
• Nursing – Skilled Nursing supplement
• Nursing Meds – Routine Oral Medication
Administration – Skilled Nursing supplement
• Transportation – Transportation supplement
3. ARD Documentation – Personal Care Services
• Individual Education Plan
– PCS - Must state needs of the child, including
necessary supervision, monitoring, re-direction,
prompting and cueing, as well as when and where
it’s needed (this includes bus monitor)
3. ARD Documentation – Personal Care Services
What is Personal Care Services?
There is an entire 8 page section in the SHARS F.A.Q. that covers PCS in
tremendous detail. This is the sentence that summarizes best what
PCS is:
• “PCS include a range of human assistance provided to persons with
disabilities and chronic conditions which enables them to
accomplish age-appropriate tasks that they would normally do for
themselves if they did not have a disability or chronic condition. “
In other words.” You are doing something for the student that they
cannot do for themselves due to their disability or chronic medical
condition”
3. ARD Documentation – Personal Care Services
• Personal care services are provided to help a child with a disability
or chronic condition benefit from special education.
– Performed on a continuing basis or on episodic occasions provided in a
one-on-one or group setting basis
– May have limitations in performing these activities because of a
functional, cognitive and/or behavioral impairment.
– Assistance may be in the form of “hands-on assistance” (actually
performing a personal care task for a person) or “cueing” the person
so that the person performs the task by him/herself.
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3. ARD Documentation – Personal Care Services
• Activities of Daily Living (ADLs)
– Basic human functioning
• eating, bathing, dressing, toileting (including diapering), transferring,
maintaining continence, and mobility services
• Instrumental Activities of Daily Living (IADLs)
– Societal functioning
• complex life activities and include personal hygiene, light housework,
essential household chores, laundry, meal planning and preparation,
transportation, grocery shopping, communication by telephone or other
media, medication management, managing finances, getting around and
participating in the community, and limited exercises to increase range of
motion and flexibility
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3. ARD Documentation – Personal Care Services
• Goal is not to teach or habilitate, but complete the activity.
• Level of assistance is greater than typical child of same age.
• Need for assistance is related to disability/chronic condition that
affects function.
• Supports
– Total or partial physical assistance
– Prompting or cueing the student to complete the task
– Redirection, monitoring, and observation that are medically necessary
and an integral part of completing a personal care service
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3. ARD Documentation – Personal Care Services
3. ARD Documentation – Personal Care Services
• When documenting the need for PCS in the ARD
you must state that the “student requires
personal care services” as well as answer the
following 4 questions:
(1) Is the service provided on an individual basis or group
or both
(2) examples of PCS
(3) when/where are the PCS needed
(4) the reason(s) for PCS, such as medical necessity, etc.
3. ARD Documentation – Personal Care Services
An example of the correct way to document Personal Care
Services is shown below:
Doug requires personal care services (1) on a one-on-one basis
as well as a group setting when necessary. Doug requires (2)
constant monitoring and re-direction of behavior (3) throughout
the school day while in the classroom, cafeteria, transition
periods between classes and during bus escort between place of
residence and school. (4) Doug has been diagnosed as ED and
can exhibit behaviors that are dangerous to himself or others
without direct supervision.
3. ARD Documentation – Personal Care Services
• PCS is a summary of information found in the students IEP
• There is not a need to create specific goals and objectives for
PCS. The goals and objectives created for other areas such as,
Language, Math, Functional Skills should reflect the areas
addressed in the PCS Supplement
3. ARD Documentation – Personal Care Services
• Toileting, diapering, and escorting do not justify a teacher billing for
an entire day
– At most 2 hours per day
– Must select monitoring, cueing, prompting, redirections and
observation which are continual services to be justified for billing all
day
• Unless a student has a position (e.g., one provider or a rotation of
providers) assigned to work with only him/her throughout the day,
then PCS is delivered in a group setting
• Adaptive P.E., Sign Language Interpretation, Braille Instruction,
Community/Vocational Training, Visual Impairment Assistance, Art &
Music Therapy
3. ARD Documentation – Personal Care Services
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CONTINUOUS
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INTERMITTENT
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There are two ways to document personal care services (PCS): continuous and noncontinuous
These services can be provided in an individual setting (one-on-one) or group setting (more
than one).
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Student 1
Student 2
Student 3
An example of continuous, group PCS: Lifeskills classroom with multiple students per
teacher/aide who require assistance for daily living skills throughout the school day.
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Student 4
Student 5
An example of non-continuous, group PCS: Two or more students with one teacher/aide
that may require assistance in the lunch room at the same time.
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Student 6
An example of a non-continuous, individual PCS: Susie is a paraplegic and requires
bathroom assistance periodically throughout the school day.
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Student 7
An example of a continuous, individual PCS: Johnny has bipolar disorder but is
mainstreamed; however, in the event of a breakdown, Johnny has an aide with him at all
times throughout the school day to observe/monitor his behavior.
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In order to bill for individual (one-on-one) PCS, the need for the individual (one-on-one)
PCS must be stated in the student’s ARD/IEP.
3. ARD Documentation – Personal Care Services
• Why do we document?
– Documentation is necessary in the event that the district is selected
for an audit
• Keep in mind that the person conducting the audit more than likely
has little-to-no experience with:
– Special Education
– Medical Services
– Educational Environment
• Explain what is happening so anyone can read it.
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3. ARD Documentation – Personal Care Services
• Special Education Teachers & Aides
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Self-Contained Classrooms
Certain Resource/Inclusion Classrooms
Community Based / Vocational Classrooms
PPCD
Behavior Unit / Classrooms
Visual Impairment Specialists (Direct)
Orientation & Mobility Specialists (Direct)
Sign Language Interpreters
Adaptive P.E. Coaches
Bus Aides/Monitors
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3. ARD Documentation – Personal Care Services
• Personal Care on the Bus – Aide/ Monitor
• The student needs the monitoring, observation, redirecting,
prompting, cueing and/or assistance due to the student’s disability
or chronic medical condition.
• The need for a monitor needs to be justified and documented in the
student’s IEP.
– PCS Supplement – Necessary!
– TR Supplement (Doug doesn’t agree with this at all and I advise against
it when I am at schools)
– Deliberations
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3. ARD Documentation – Nursing Services
• Individual Education Plan
– Nursing – must identify disability/chronic medical
condition that leads to the need for the service
• There is a difference between regular nursing
procedures and routine oral medication
3. ARD Documentation – Nursing Services
• Nursing Services – Medication Administration
• Children who have health problems that go untreated may be prevented
from reaching their full academic potential. Many students who have a
chronic illness or disability must receive medication during the school day.
• IDEA mandates that school districts provide health-related services to
students with disabilities if it is required in their Individualized Healthcare
Plan (IHP)2. These “services” frequently include the administration of
medication.
• Routine Oral Medication – Pills, liquids, or inhalers only
– “Student requires the administration of routine oral medication as
prescribed by a physician due to (DISABILTY or CHRONIC MEDICAL
CONDITION).”
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3. ARD Documentation – Nursing Services
• Nursing services are skilled nursing tasks, as defined by the Texas
Board of Nursing (BON), that are included in the student’s IEP.
• A district can receive Medicaid reimbursement for any nursing
service that is determined by the ARD/IEP committee to be needed
in order for a Medicaid-eligible student to fully participate in school.
• Due to the wide variation in individual needs, it is impossible to
develop an all-inclusive list of nursing services.
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3. ARD Documentation – Nursing Services
•Assessment - Personal Care Services
Needed
•Assessment - Nursing Services
Needed
•Blood Pressure
•Blood Sugar Check
•Catheterization
•Chest Percussion Therapy (CPT)
•Cough Assist
•Diaper Change
•Diaper Rash Cream
•Dressing Change
•E-Cylinder O2 tank check
•Empty Ostomy
•Exit Site Care
•Gastrostomy Care
•G-tube Feeding
•G-tube Flush
•G-tube Medication and Flush
•G-tube Site Care
•G-tube Vent
•Ileostomy Care
•Insulin Injection or Pump
•Inhalation Therapy
•Insulin Pump Injection Site Change
•Insulin Pump Refill
•J-Tube Feeding
•J-Tube Flush
•Ketone Check
•Nebulizer Treatment
•Non-Routine Medication
Administration
•O2 Continuous
•O2 Refill
•Oxygen Saturation Check
•Passy Muir Trach Valve Replacement
•Peak Flow Check
•Routine Oral Medication
Administration
•Suctioning
•Suctioning with Neb treatment
•Trach Suctioning
•Trach Tube Replacement
•Trach Valve Replacement
•Tracheostomy Care
•Vagal Nerve Stimulator
•Ventilator Monitoring
3. ARD Documentation – Transportation
• Individual Education Plan
– Transportation – Physical adaptation tied to
medical need
3. ARD Documentation – Transportation
• A specially adapted vehicle is one that has been physically modified
due to the
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addition of a wheelchair lift;
addition of seatbelts, lap restraints, harnesses;
addition of child protective seating;
addition of air conditioning; and/or
addition of windows being covered or blacked out.
• IEP documentation explains that
– the student requires specific physical adaptation(s) of a vehicle in
order to be transported; and
– the justification why the student needs the specialized transportation.
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3. ARD Documentation
• PLAAFP
– Currently the area of documentation causing the
most problems.
– ARD facilitators will make comments talking about
the child’s progress without fully explaining the
necessary supports that make the progress
possible.
3. ARD Documentation
• Deliberations
– Optional – comments must be in alignment with
other areas of documentation, such as the IEP,
Supplement and PLAAFP
4. Medical Necessity
• Need for service must be linked to an
identified Medical Disability or Chronic
Medical Condition.
– If the child is only LD – we shouldn’t be delivering
any services other than instructional services
– If the child is Speech only – we should only be
delivering speech therapy.
5. Alignment – PLAAFP, IEP, Supplement
• The biggest problem we see is that the areas
of documentation are not in alignment with
each other. Often times they contradict each
other. An auditor will always choose the
documentation that allows him to “recoupe”
revenue.
5. Alignment – PLAAFP, IEP, Supplement
• All 3 areas should:
TELL THE SAME STORY
6. Parental Consent
• As of March 18, 2013, the consent law has
changed
– Signed consent to release information is one time:
PK-12, unless the parent revokes it
– Annual notification must be sent to parents, but
does not need to be returned or signed.