Transcript Catastrophic 2007-2008 - ADE Special Education

Arkansas Catastrophic
Occurrences 2010-2011
Review
Maureen Bradshaw
State Coordinator Behavior Consultants
[email protected]
Documents needed
 Five PDF’s
•

Catastrophic Process & District Responsibilities (1)
Scoring Rubric
 Behavior/Social (2)
 Communication
» Understanding others (3)
» Communicating with others (4)
 Structure (5)
 Two Word Documents
• ABILITIES Form (1)
• Student Demographic Forms (2)
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Catastrophic Points
The act of submitting a claim - does not ensure
that it is a “catastrophic claim” which will be
reimbursed.
The amount of money spent is not the only
indicator of whether a student is a catastrophic
student. There are other factors involved.
Don’t budget based on monies anticipated for
catastrophic reimbursement claims.
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This session will cover
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 What is considered a “catastrophic” claim student, and why is it
necessary to review catastrophic claims?
 Steps involved in The Catastrophic Claim Review Process.
• First Step in the process
− Identification of the students who should be submitted
 ABILITIES Form
• Second Step in the process: Providing Supportive Information
 Student demographic form
• Third Step: On site reviews
− Ensuring catastrophic funds expended are spent to provide
FAPE
 Student’s Individualized Education Program
• Fourth Step: Funding Considerations/Submissions of funds
This session will cover
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 What is considered a “catastrophic” claim student, and
why is it necessary to review catastrophic claims?
 The steps in identification of the students who should be
registered as a possible catastrophic student
 Using the ABIITIES form to identify students to register,
how to complete the form and who should be involved in
providing the information.
 Completion of the student demographic form to describe
in detail the services provided by para’s and nurses.
 What to expect during the on site review
 Accurate submission of funds expended
Why catastrophic claims are reviewed
 1. The state must ensure that reimbursement of
Catastrophic claims is for the provision of FAPE in
accordance with an IEP, and that only allowable program
costs for services provided to eligible students are
reimbursed.
 2. Amount of money requested by districts last year far
exceeded the amount available for reimbursement. Not all
were found to be reimbursable claims.
22 million was requested; 11 million was available to
reimburse legitimate claims/costs
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First Step
Identifying the Student who may be a
“Catastrophic Claim”.
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A catastrophic student is a student who because of
his/her multiple & complex needs
“requires special education & related services which
are unduly expensive, extraordinary, or beyond the
normal & routine costs” (associated with special education and
related services) A.C.A 6-20-2303
Extraordinary….Beyond normal and routine
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 Extraordinary: Beyond what is usual, ordinary or
regular
 Routine: customary, regular, commonplace
 Normal: usual, average, standard
Which is why you would not pro-rate a 1 to 6 class. It is
assumed that a teacher and para are the normal and
routine costs for educating those 6 students. The same
goes for a 1-10 classroom, etc.
Experiences in Arkansas & Nationally shows
 The type of student MOST LIKELY to meet
the standard of being a Catastrophic student
is a student with severe and profound
impairments in a number of functional
domains.
 We can objectively determine that a student
has “severe & profound impairments in a
number of domains” by using the
ABILITIES Scale.
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ABILITIES Scale
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The ABILITIES scale gives an objective,
disability neutral, way for districts to determine
if the student has severe impairments in
multiple domains
ABILITIES Scale: One of the most research-based measurement tools for
identifying severe and profound impairments (Bailey & Simeonsson,1988)
ABILITIES Index measures the severity of a student’s disability
in each of the following nine areas
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
1. audition (A)

2. behavior and socials skills (B)

3. intellectual functioning (I)

4. limbs (L)

5. intentional communication (I)

6. tonicity (T)

7.integrity of physical health (I)

8. eyes (E)

9. structural status (S)
Refer to rubric to
accurately report level
of functioning
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How to Score: ABILITIES
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 For each variable the student is ranked between 0 and 5
• 0 (meaning normal functioning in that domain) and
• 5 (meaning profound disability in that domain)
• It is recommended that specific domains be rated by
professionals who have knowledge about that specific
domain. Ex: OT/PT; SLP; Nurse; SPS, Teacher
• Ratings provided by staff must be based on objective, not
subjective, information.
• During on-site reviews, the reviewer will verify the scores
on the ABILITIES form. Discrepancies will be noted.
Objective Data
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Hearing Impaired
Hearing loss
must be listed as
decibels
Nurse
completes
Or
Interpreters must
be qualified:
Scores must be
provided
use scores
from recent
evaluation
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Same for
Vision
List Vision
Scores
obtained
from File or
from Vision
Consultant
Nurse
completes
OR
scores
taken from
recent
evaluation
Integrity of Physical
Health
Recommend be
completed by the
Nurse
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Student’s who
are rated as a 4
or 5 should
have a Health
Care Plan
Intentional
Communication
Speech-language
pathologist should
complete
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Intentional
Communication
SLP Rates
both
Communicating
with others
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And
understanding
others
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Intellectual
Functioning
Scores for
cognitive
functioning
should come
from recent
evaluation and
be rated
according to the
rubric on the
form
22
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Information for
Limbs, Tone &
Structure
should be
provided by an
OT or PT
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What do the scores mean?
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According to state and national data
The higher the ABILITIES rating, the more
cost likely associated with providing FAPE.
Cost to educate special education students
increases with higher ABILITIES index
scores.
(exception: Severe Medical or health issues
with no impairments in any other domains)
HIGHER SCORES
ASSOCIATED WITH HIGH COSTS
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Higher ABILITIES Score
The More Likely a Catastrophic Student
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Deciding who to submit into the registry
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 Review list of students submitted last year
• If you received reimbursement on a student then this
student should be submitted again this year
• If you did not receive reimbursement on a student do not
resubmit unless regression/or other factors have changed
since last year
• For students who are being submitted for the first time
the LEA should review the ABILITIES form before
deciding to submit.
• The following is provided as a measure of the likelihood
of the student being determined to be a student with
catastrophic needs
28a
Higher scores- likely a Catastrophic Student
 An eligible Catastrophic Occurrences student would
be expected to score at least 4s or 5s on most of the
9 ABILITIES domains.
 Scores of 4 or 5 in two domains:
• NOT likely a catastrophic student - Do not submit
 Scores of 4 or 5 on three or four domains
 MAY BE a Catastrophic Student, but statistically only a
small number of students with ABILITIES this low are
actually determined to be a catastrophic student given the
full definition.
 Scores of 4 or 5 on five or more domains
 Likely a student who is a catastrophic student.
Multiple Areas of Severe/Profound Impairment
Likely -Submit
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No multiple areas of severe-profound
Not Likely - Should not submit
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2008-2009 Reimbursement by disability
category
30 a
Question which needs to be answered
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Is the student a “Catastrophic” student because
his/her complex needs require costs above what is
considered normal and usual costs for special
education?
or
Is the student a “Catastrophic” student because
decisions were made to spend money when other less
costly options may have been available?
Second Step:
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Complete
Demographics Data
to document
services provided by
a Para and/or nurse
& why services are
needed
Complete form
with Accurate
& Student
Specific
Information
Student Demographic Form: Para & Nurse
 Student Demographic form is used to describe:
• Services provided by paraprofessionals/nurses;
− Paraprofessional (A)
− Nurse (B)
• Why the student requires these services for FAPE; and
• Why the costs to provide FAPE for this student “are unduly
expensive and beyond the normal and routine.” (D)
 Information needs to be accurate, current, and specific to the
student.
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Student Demographic Form
(C ) Educational Interpreters scores
 For services of an Educational Interpreter
• Student needs to meet the definition of a “catastrophic
student”
• Scores need to be provided to show the interpreter is a
qualified provider
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How and where to submit ABILITIES &
Student Demographic Form
 Once completed the document need to be saved according to
the following format
 LEA# (number) name of form (ABILITIES or Student
Demographic) then student first name and last initial.
 Completed forms are to be emailed to
• [email protected]
• With the following subject line:
− Catastrophic ABILITIES & Student Demographic
and LEA# (number)
− It is recommended that your get confirmation of
delivery. Forms cannot be faxed or mailed
When can forms be submitted
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 Registry will open on November 19, 2010 & Close on February
1st 2011.
 ABILITIES & Student Demographic can be submitted
immediately (as soon as a district submits an on site review can
be scheduled). All ABILITIES & Student Demographic forms
need to be received by 4:00pm on February 1st 2011
 Final submission is May 2nd 2011
On site review
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 On site Reviews are scheduled once the ABILITIES and
Student Demographic Forms are received.
 Reviews are conducted by BIC’s & ESO staff
 Reviews scheduled with LEA supervisors but only an
estimate of when rather than exact date may be given
 Reviewers will need the following when they arrive
• A copy of the student’s IEP
• A copy of the ABILITIES form
• A copy of the Student Demographic form
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On Site Reviews
On site reviews are conducted to:
Verify information submitted on the claim.
• See if evidence-based educational practices
listed on the IEP are evident and implemented in
the environment
• Verify that staff know, understand, & are able
to discuss the evidence base in a child’s
particular IEP.
• Verify staff demonstrate the required skills and
training to implement the IEP as written and
provide FAPE.
Review of the IEP - Student’s Program
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Reviewers do not ‘second guess’ the IEP team. Reviewers
take the information provided by the district staff and
check to see if it is accurately documented on the IEP and
the catastrophic claim form, and the ‘claimed’ services
are implemented/observable in the educational
environment.
IEPs are reviewed according to the standards set forth in
IDEA to :
1) determine if the weaknesses identified on the ABILITIES
form are reflected in the Present Level of Performance
(PLOP) and are addressed in the IEP;
2) ensure that the services outline on the IEP are
implemented in the environment and are based on “peer
reviewed research.”
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Present level of functioning
[§300.320 (a)(1)]. The child’s “present levels” statement is,
in essence, a comprehensive description of a child’s abilities,
performance, strengths, and needs. It is no exaggeration to
say that a fully developed, well-written “present levels”
statement is the foundation upon which the rest of the IEP
can be developed to specify appropriate goals, services,
supports, accommodations, and placement for the child.
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Appropriateness of the IEP
If the statement of present levels of academic and
functional performance does not consider the unique
needs of the student or establish a baseline to establish
goals and monitor progress, then the entire IEP likely will
be deficient, since problems with the description of needs
at the onset can affect the whole document (LRP) 20USC
1414(d)(1)(A)(i)(I)
It is reasonable to expect that a rating of a 4 or 5 on the
ABILITIES form would be reflected as an area of
weakness on the PLOP.
information on the ABILITIES is compared to
Present Level of performance on the IEP
Example
Behavior rated as severe on the
ABILITIES Index/Scale should be
documented in the IEP’s PLOP statement
and be addressed in the IEP with behavior
goals and/or a behavior support plan based
on peer reviewed research.
Reviewers should see the plan being
implemented in the classroom.
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The IEP Team needs to make specific considerations regarding
behavioral & Social issues for students.
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IEP team must design appropriate interventions and designate
needed supports for a student whose behavior impedes his or her
learning or the learning of others.
Another Example: Communication Domain
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If a student is listed as severe/profound in
communication on the ABILITIES Scale, this should be
reflected on the IEP’s PLOP statement as an area of
weakness.
Addressed in the IEP through Alternative or
augmentative forms of communication, example:
PECs, DynaVox,
yes/no switches, etc.
Reviewers would expect to see augmentative devices or
other alternative communication modes/equipment in
use.
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Special Factors-Communication:
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All Students should have a method to communicate with
peers and adults
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What to expect: on site reviews
 Reviews will need IEP, ABILITIES & Student Demographic form
 IEPs Present Level of Performance will be compared to the areas of
weakness identified on the ABILITIES form.
 The IEP will be reviewed to see if areas rated as a 4 or 5 on the
ABILITIES are addressed when appropriate in the IEP.
 Example: If Behavior is listed as severe on the ABILITIES form,
then it should be mentioned in the PLOP as interfering with the
student’s education and be addressed in the IEP.
 The reviewer would also expect to see the behavior goal or behavior
plan being carried out in the classroom by staff who are
knowledgeable about the disability and the student’s individual
needs.
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Ensuring FAPE- Qualified Providers
 An appropriately written IEP is worthless if personnel have
not seen it or do not have the skills to implement it as written.
• All staff working with the student should be familiar with
the IEP and demonstrate the skills necessary to implement
the IEP as written.
• Teachers, substitute teachers, paraprofessionals, OT’s, PTs,
SLP, School psychology specialists, counselors, bus drivers,
etc.
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Qualified Providers
LEA’s have the Responsibility of ensuring that
the training personnel receive is reflected in the
educational environment and instructional
practices of the teacher & staff.
That all school personnel have the knowledge
and skills necessary to deal appropriately with
all student with disabilities.
It is not enough for teachers to attend training,
LEA’s need to ensure that they implement the
training in their classroom.
Catastrophic funds can be used for:
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“Intensive Preparation” & Professional Development
This type of intensive training would include
Training on the nature and needs for all of the specific
disabilities they are charged with educating…to include
training in:
•Specific “Methodologies” and instructional techniques,.
•Behavior management/interventions
•Social supports
•Communication supports
•Self Help skills
ARLEARN www.arlearn.org
Slide 50
 Upcoming training: to address behavior & communication
• November 22, Pivotal Response Treatment, Nonprofit Center, Rogers

• December 1, Signs and Symptoms of Abuse-AR LEARN Conf. Center, Conway

• December 2, Signs and Symptoms of Abuse- Dawson Coop

• December 3, Signs and Symptoms of Abuse-Southeast AR Coop

• December 9, Lessons Learned from State Compliance Investigations, Airport
Holiday Inn, Little Rock

• December 10, Twelve Legal Pitfalls IEP Teams Must Avoid, Airport Holiday Inn,
Little Rock

•
•
•
•
December 15, Pivotal Response Treatment, Cox Creative Center, Little Rock
February 7-10 2011 Pivotal Response Training Hands on Training SARRC
March 21-24 Discrete Trial Training Hands on Training SARRC
Regional Social Skills training and Autism training on ARLEARN.org
Catastrophic funds for Related Services
(34 CFR § 300.34 Related Services)
Related services means transportation and such
developmental, corrective, and other supportive services as
are required to assist a child with a disability to benefit from
special education, and includes
• speech-language pathology
• audiology services, interpreting services,
• psychological services,
• physical and occupational therapy,
• recreation, including therapeutic recreation,
• early identification and assessment of disabilities in children
• counseling services, including rehabilitation counseling,
• orientation and mobility services,
• medical services for diagnostic or evaluation purposes.
school health services and school nurse services,
• social work services in schools,
• and parent counseling and training
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Related Services
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 (1) must determine if the services are required to provide educational benefit
 (2) Must determine the intensity of services required
 (3) must determine “who” is qualified to provide the identified service
 (4) must determine what if any training is required of assigned personnel
 (5) must ensure duties assigned are appropriate to the role & responsibilities
of the appointed staff
 (6) must ensure duties are clearly described & appropriately supervised
 (7) must have considered all available options
(Mueller& Murphy, 2001)
 Related Services must be accurately listed on the IEP to be claimed
• Names (where applicable)
• Services provided: Time/amount
Paraprofessionals as a Related Service
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 The same questions that guides the determination of all
special education and related services available under the
IDEA guides the need for paraprofessional services:
Are the services of a paraprofessional “required to assist a
child with a disability to benefit from special education?”
 Though paraprofessionals can be valuable members
of a support team, researchers have found than an
over-reliance and dependency on paraprofessionals
can do more harm than good when including special
needs students in general education.
Paraprofessional as a related service
 1. Identify the specific reasons why paraprofessional
supports are being considered based on student’s needs.
 2. Determine what personnel can best meet those
needs.(teacher-para-other)
 3.Discuss intensity of services required.
• 1:1 assistance frequently or intermittently
• (full time or as needed)
 4. Consider options to using a paraprofessional

Mueller& Murphy, 2001)
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Paraprofessional as a Related Service, continue
55
There should be a match between the supports to be provided
and the skills of the person designated to provide the supports.
If a student needs extensive modifications or a behavior support
plan, then a paraprofessional probably can’t meet those needs.
The student may not be receiving FAPE if the person providing
the services/supports does not have the required skills.
Too often the least qualified personnel are put in the position
of providing the majority of instruction and related services to
students presenting the most complex learning & behavioral
challenges (Brown, Farrington, Knight, Ross & Ziegler, 1999)
Students with the most severe needs require staff with high
levels of skills and training which usually means certified
staff.
Access to qualified teachers,
FAPE & Improved outcomes
 One of the few investigations examining student
outcomes concluded that paraprofessionals were not
as effective as teachers and did not improve student
performance (Gerber, Finn, Achilles, & Boyd-Zaharias,
2001)
 Students without disabilities receive instruction
primarily or exclusively from certified educators,
whereas some students with disabilities receive their
instruction primarily or exclusively from
paraprofessionals.
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Catastrophic Submission Points
 Ensure that the required information, including “Projected Student
Costs” has been entered and saved as part of the Catastrophic
Occurrences Student Registry.
 Review the ABILITIES form outcomes to ensure that the ratings
represent a student with “catastrophic needs.”
 Ensure that the “Student Demographics form” is completed to
document the special education and related services needed by this
student are above the normal and usual and the reasons why.
 Review the IEP to ensure that it is complete and appropriate for the
individual student and the student’s unique needs, and that the IEP
addresses all areas of identified weakness.
 Ensure that the teacher has the knowledge and skills needed and that
this is reflected in the instructional methods and materials employed in
the education environment by all the instructional staff.
 Lastly Submit the claim if it appears to meet the established standards,
ensuring accurate information and reflecting the following funding
considerations by the May 2nd date:
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CATASTROPHIC OCCURRENCES
FUNDING CONSIDERATIONS
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• The Catastrophic Occurrences Program provides studentspecific reimbursement for a student with disabilities whose
special education and related services costs are
− unduly expensive
− extraordinary, or
− beyond the routine and normal costs associated with special education and
related services (A.C.A. 6-20-2303)
• Costs are allowable only when they are incurred specifically
as a result of the needs of the individual catastrophic
student.
• Costs must be justified and documented on the basis of valid
IEP services delivered by qualified personnel.
Catastrophic Occurrences Funding
Considerations, continued
59
• The appropriation of State funds for the Catastrophic
Occurrences Reimbursement Program is $11,000,000
• Catastrophic Occurrences reimbursement is available fully
for the first $15,000 of allowable costs, 80% up to $50,000,
and 50% up to $100,000. If the total state reimbursement
amount exceeds $11,000,000, each district’s reimbursement
amount will be prorated
• Reimbursements are calculated after all revenue offsets are
applied, including the per student average amount of Title
VI-B funds, Medicaid and other funds received (Title VI-B
amounts will be preloaded by Grants & Data)
• The Total Catastrophic Occurrences Claim must be at least
CONSIDERATIONS WHEN FILING A
CATASTROPHIC CLAIM, continued
60
 Pro-rated teacher’s salaries & benefits will be deducted from the
Total Claims included for each Catastrophic Occurrences student
(All Object 61110 and/or Fund/Source 1000 expenditures will be
carefully reviewed).
 All expenditures from Title VI-B and Title VI-B ARRA
(Fund/Source codes 6702 and 6721) will be deducted from the Total
Claims included for each Catastrophic Occurrences student—except
6702 expenditures equaling the Title VI-B per child allocation will be
allowed.
 Medicaid (6750), ARMAC (6752), Catastrophic (2265), and other
Salary or Operating fund (Fund 1 or 2) expenditures (except prorated teacher’s salaries & benefits) may be included when
submitting Catastrophic Occurrences expenditures that help meet
the IEP of eligible students.
 The portion of the Medicaid match for each eligible Catastrophic
Occurrences student can be counted as an allowable cost.
CONSIDERATIONS WHEN FILING
A CATASTROPHIC CLAIM , continued 60a
• Education Service Cooperatives cannot file claims for
reimbursement of Catastrophic Occurrences, but the
resident district of children ages 3-5 can apply for
reimbursement on behalf of the ESC if all requirements
for Catastrophic Occurrences are met.
• All expenditures from Title VI-B Pre-school and Title VIB ARRA-Preschool (Fund/Source codes 6710 and 6723)
will be deducted from the Total Claims included for each
Catastrophic Occurrences student—except 6710
expenditures equaling the Title VI-B, Section 619 per
child allocation will be allowed.
CONSIDERATIONS WHEN FILING A
CATASTROPHIC CLAIM, continued
60c
• The availability of additional Medicaid and third party providers for
health-related services must be considered.
• 80% of the 450 students with claims for nurses, personal care aides,
medical equipment or supplies submitted in 2009-10 were Medicaid
eligible, but……Only 46% of those eligible reported Medicaid offsets.
• 19 districts listed personal care aides, only 4 reported Medicaid offsets
• Bottom line, districts aren’t billing as they should for these services.
Districts are reminded that they are required to access all means of
revenue/reimbursement (especially Medicaid) prior to filing for
catastrophic reimbursement.
• ADE-SEU will be checking to verify that districts are complying with this
requirement prior to awarding catastrophic funds.
Considerations When Filing
A Catastrophic Claim, continued
61
• Additional Medicaid is available for districts for
health-related services, particularly for personal,
medically necessary services authorized by a
physician and “hands on” assistance with Activities of
Daily Living (ADL’s) that a student is incapable of
performing
• Examples of Common Personal Care Services
− Eating – tube feedings, cutting food, hand over hand assistance, and complete
assistance with feeding are all examples of reimbursable personal care services
− Bladder/bowel – catheterization, diaper changes, changing soiled clothing,
assisting a student to the restroom, assisting a student in the restroom, and
assisting a student with hand washing after using the restroom are all examples
of reimbursable services
− Personal hygiene – assisting a student comb hair, brush teeth, wash face and
hands are all examples of reimbursable personal care services
− Positioning a student, assisting with a transfer, assisting a student with
ambulation (getting safely from point A to point B), and performing range of
motion exercises are examples of reimbursable personal care services
Considerations When Filing
A Catastrophic Claim, continued
62
• To access Personal Care Assistance provider status
− Consult the Medicaid in the Schools (MITS) website at
http://www.armits.org/
− Complete the Medicaid Service Provider Application and
Agreement. Send to Tony Boaz at MITS. Do NOT send to
Medicaid.
− Complete the Prior Authorization form and contact MITS to assist
in review of the paperwork
− Identify the Paraprofessionals working with the students with the
highest level of need, related to personal care services, and complete
the training to certify them as Certified Personal Care Aides.
CATASTROPHIC CLAIM HINTS
 Review the CATASTROPHIC OCCURRENCE REGISTRY
USER’S GUIDE , FY 2010-11, found on MySPED under the
Support tab
NEW
Projected costs for each student in the Catastrophic
Occurrences Student Registry MUST be entered and saved in the
Registry at the time student demographic information is provided by
February 1, 2011
 Final costs--each student listed in the Catastrophic Occurrences
Student Registry that is submitted for reimbursement MUST have
final cost entered and saved in the Registry and submitted by
May 2, 2011
NEW
The Superintendent’s certification for Catastrophic
Occurrences Students Claimed must be faxed to 501-682-4313 to the
attention of Betsy Farris at Grants & Data by May 2, 2011
CATASTROPHIC CLAIM HINTS,
continued
NEW
Questions that have been added to the projected
costs for each student in the Catastrophic Occurrences
Student Registry that MUST be answered include:
• Under the Instruction Costs tab, Special Education AideIs this a self contained 1:6 setting?
How many aides are in this classroom?
What is the Student-Teacher Ratio for this aide?
How was the amount claimed as an expenditure for
the instructional aide for this student determined?
Is an aide required in Student’s IEP?
CATASTROPHIC CLAIM HINTS,
continued
:
• Under the Related Service Costs tab for any/all areas claimed-----
Have you attempted to access Medicaid or other third
party insurance or provider for these services?
For the Personal Care Aide, is this a self contained 1:6
setting?
How many aides are in this classroom?
What is the Student-Teacher Ratio for this aide and/or
services (or number of students transported with this
student)?
How was the amount claimed as an expenditure determined
for these services for this student?
Are these services required in the student’s IEP?
CATASTROPHIC CLAIM HINTS,
Transparency
 Legislative Auditors will likely review expenditures,
documentation and claims submitted for Catastrophic
Occurrences Students
 ADE-SEU must ensure that reimbursement of Catastrophic
claims is for the provision of FAPE in accordance with an
IEP, and that only allowable program costs for services
provided to eligible students are reimbursed.
Questions:
 Review questions and answers which are presently
posted on the grants and data web site.
 Submit additional questions to:
 Donald Watkins, Grants & Data
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Most Important: Submit the claim