Minnesota Department of Human Services

1. Minnesota Department ofHuman Services Medical Assistance Individualized Education Program (IEP) Services March 2007 Minnesota Infinite Campus Interchange

2. IEP Services Technical Assistance Guide • All information about medical assistance eligible individuals and providers, billing, coverage policy, rates, settle-up • Go To: Individualized Education Program (IEP) Services Web page • www.dhs.state.mn.us/provider/iep • Under “Quick Links” • DHS #443 • Updated regularly • Must have a current copy Section K – IEP Services Technical Assistance Guide

3. Other IEP Web Page Information • News and latest additions • NPI Information • Quick links for IEP service providers • Forms & documents • IEP TA Guide • Settle-up documents • Family Brochures • Provider enrollment information • Billing and information resources • MN-ITS information • Paper claims instructions • Payment and claim cut-off calendar Section K – IEP Services Technical Assistance Guide

4. Eligible Children • Under age 21 • Enrolled in Medical Assistance or MinnesotaCare • Major programs MA, RM, LL, EH • Eligible on dates services provided • Verify eligibility monthly • MN-ITS Eligibility Verification • Enhanced touch-tone automated phone Eligibility Verification System • Receive covered services • On dates billed • Current IEP, IFSP, or IIIP Section C – IEP Services Technical Assistance Guide

5. Eligible Providers • Public schools and school districts • Tribal schools • Charter schools • Education districts • Intermediate districts • Service cooperatives • Special education cooperatives • State academies Section D – IEP Services Technical Assistance Guide

6. Enroll as MHCP Provider • Complete application and sign agreement • Each district must enroll separately • Consolidated/unconsolidated districts • May need new MHCP provider number • Contact Provider Enrollment Section D – IEP Services Technical Assistance Guide

7. NPI Numbers • National Provider Identifier • One unique number for billing all payers • Federally assigned 10 digit number • Replaces current 9 digit MHCP number • Required by May 23, 2007 • CMS Web site • http://www.cms.hhs.gov/NationalProvIdentStand/01_overview.asp • Or access from IEP Services Web page

8. IEP Services • Carved out of managed care • Bill services directly to DHS • MEDICALLY NECESSARY • Included in IEP, IFSP, IIIP • Example: Is it covered by MA? • Cannot be a factor in decision • Provided by qualified service providers • Meet all requirements for service • Documented before billed Section E – IEP Services Technical Assistance Guide

9. Physical Therapy Occupational Therapy Speech Language Hearing Therapy Mental Health Services Nursing Services Personal Care Assistant Services Assistive Technology Devices Special Transportation Oral Language Interpreter Services Section E – IEP Services Technical Assistance Guide Covered Services

10. Billing • Qualified billers • Schools and districts • Billing agents • Fees must be related to cost of processing the billing • Cannot be a percentage of amount billed or collected • Cannot depend on collection of payments • Use correct provider ID numbers Section F – IEP Services Technical Assistance Guide

11. Third Party Liability • Medicaid is the payer of last resort for all other liable parties • Exception: schools and districts • Obtain payment or a denial of coverage from liable parties • Exceptions: special transportation and PCA services • Use DHS TPL letter or submit claims • Cannot change the letter • Send copies of responses to Genie

12. Billing • Electronic claims • Web based MN-ITS • Directions for completing claims in IEP TA Guide • Paper claims • Required for AT devices & claims with no response from private health plans • Directions for completing claimswww.dhs.state.mn.us/provider/iep • Mail in DHS 1863 envelopes • Payment & claim cut-off calendar • IEP Web page

13. Physical Therapy Occupational Therapy Speech/Language/ Hearing Therapy Mental Health Services Nursing Services PCA/Para Services Assistive Technology Devices Special Transportation Oral Language Interpreter Services T1018 U1 T1018 U2 T1018 U3 T1018 U4 T1018 U5 T1018 U6 T1018 U7 T1018 U8 T1013 Billing Codes

14. Physical Therapy Occupational Therapy Speech/Language/ Hearing Therapy Mental Health Services Nursing Services PCA/Para Services Assistive Technology Devices Special Transportation Oral Language Interpreter Services 1 per day per child 1 per day per child 1 per day per child 1 per day per child 1 per day per child 1 per day per child 1 per complete device 1=1mile 1=15 minutes Billing Units

15. Billing Units

16. Use Caution • Common billing errors • All claims • Units and days in date span don’t match • Wrong modifier • COB information missing • No rate • Paper claims • Missing units • Missing attachments • Missing contact information • Missing charge

17. Remittance Advice • Claims invoice • Paid claims • Denied claims • Suspended claims (on supplement page) • Ignore supplemental page except suspended claims

18. Rates • Cost-based rates: • Physical therapy, occupational therapy, speech language hearing therapy, and mental health, nursing, PCA services • Formula • 1. Total Salaries + Benefits ÷ Total Employment Hours • 2. Item 1 X Direct Medical Assistance Service Hours • 3. Item 2 ÷ Medical Assistance Encounters • 4. Item 3 X District’s Unrestricted Indirect Cost Percentage • 5. Rate = item 3 + item 4 Section G – IEP Services Technical Assistance Guide

19. Rates • Special transportation • One statewide rate - $2.21 per mile • Oral language interpreter services • $12.50 per 15 minute unit Section G – IEP Services Technical Assistance Guide

20. Payments • Current year payments - Interim rates • Interim rates are based on a previous year’s costs • Federal share – 50% • Schools and districts responsible for the non-federal share (50%) and administration fee (currently 4%) • Excess administration fees collected returned • Remittance Advice • Payment “invoice” • In MN-ITS mailbox (90 days worth) • Not organized by date – can be sorted by date • Include finance officer as a MN-ITS user Section G – IEP Services Technical Assistance Guide

21. Settle-up • Reimburse actual costs • PT, OT, Speech/hearing, mental health, nursing, PCA • Previously paid claims reprocessed and paid at settle-up rate • Document actual cost data and retain for 5 years • Rate calculation • Uses actual cost data reported to MDE and DHS & unrestricted indirect cost percentage • Requirements • Bill, receive payment, report accurate cost data • OR, settle-up and new interim rates = $0.00

22. Record Keeping and Documentation • Keep a record that includes: • Medical diagnosis or condition • Results of evaluations/assessments • Treatment Goals/Care Plan • Complete copies of current: IEP, IFSP, IIIP, Individual Health Plan, Individual Behavior Plan, Individual Treatment Plan • Document actual services provided for all services • trip logs, activity/progress logs, PCA checklists • Required orders & Physician’s Statement of Need • Documentation of supervision or direction • Keep all documentation for 5 yrs Section H – IEP Services Technical Assistance Guide

23. Auditing and Monitoring • Written documentation required • If it is not written down, it was not done!! • State and federal audits of services billed • no set schedule • complaints - 24 hours notice • required documents and service documentation for services billed • PERM-Payment Error Rate Measurement program Section I – IEP Services Technical Assistance Guide

24. DHS Contacts • IEP services policy and billing: • Genie Potosky, Coordinator • (651) 431-2622; genie.potosky@state.mn.us • Bob Ries, Provider Trainer • (651) 431-2714; bob.ries@state.mn.us • IEP services rates: • Jesusa Williams • (651) 431-2538; jesusa.williams@state.mn.us • Provider Call Center: (651) 431-2700 1-800-366-5411