Program Overview Administration of the SBAP

1. Program Overview Administration of the SBAP The School-Based ACCESS Program (SBAP) is a partnership between the PA Department of Education (PDE) and the PA Department of Public Welfare (DPW). Leader Services is the statewide contractor selected by PDE to perform the day-to-day operations of the SBAP. All SBAP claims must be submitted to DPW by the designated PDE contractor for the school-based programs.

2. Chapter 1 PROVIDER PARTICIPATION RULE #1 School entities must be actively enrolled as SBAP providers in the PA Medical Assistance Program. RULE #7 Salaries for service providers must be partially or fully funded by state and/or local dollars.

3. School Based ACCESS Programhttp://www.leaderservices.com/services/ds.asp Direct Services Leader Services assists school districts nationwide in recovering funds from Medicaid for providing federally-mandated health-related services to children. The list of eligible services varies by state but generally includes: Speech therapy Physical therapy Nursing Personal care assistance Physician services Audiology Interpreter services Orientation and mobility Psychiatric services Psychological services (includes Evaluation, Therapy and Counseling services) and others. Schools provide encounter information, which Leader accumulates, processes, and submits for reimbursement. As part of this process, Leader develops extensive training materials and programs, provides annual and as-needed training opportunities, assists in eligibility verification, provides pre-printed claim forms and digital logs, collects claim information and enters it into Leader's custom claim software, submits claims electronically to federal agencies, provides management reports to schools and LEAs, performs quality assurance reviews, and a multitude of other tasks. Leader Services currently facilitates direct services claiming programs in the following states, and is exploring implementing programs in other states throughout the country: California Iowa Minnesota Oklahoma Pennsylvania Washington

4. Typical Schedule Blue Text = TSS role (BHRS) Black Text = Aide role Typical Daily Schedule for student who requires intensive assistance Student’s name: John Smith DOB: 9/9/99 Diagnosis: Autism & ADHD Note: Please note that the daily schedule must relate to the one-on-one services specified in the IEP, and a copy must be kept in the student’s ACCESS file. The following sample is a typical schedule for this student. The schedule may vary depending on the school’s scheduled activities and/or special programs. Time & Description of activity 8:40 - 9:00 a.m. John will be met at the bus stop and escorted to his locker and then his first class. He will be reminded to look straight ahead when walking and encouraged to interact with other students. John will be queued to independently open his locker and gather his class work for the day. 9:00 -11:45 a.m. Classroom Procedures: John will be prompted to pick up his pencil and focus on what the teacher is saying. The periods that John is able to focus, the aide will step back and out of sight. The aide will remain only a few feet from John to queue and prompt as needed. When John finishes an assignment he will be praised and given a sticker for his notebook. If John becomes disruptive during class, the aide will remove him from the classroom. The aide and instructional classroom aide will take John to Room 3 where John’s aide will begin to use calming techniques. If John cannot be calmed, the instructional support aide will summon the nurse while the aide remains with John. 11:45 a.m. – 12:15 p.m. An aide will assist John from class to the lunchroom, walk him through the lunch line and find him seating. John will be prompted three times to pick up the fork and eat his lunch. If after three attempts John cannot stay focused, the aide will spoon-feed him. 12:15 - 3:00 p.m. Following lunch, the aide will escort John back to his classroom and the above classroom procedures will be followed. 3:00p.m.- 3:30 p.m. John will be escorted to his locker; the aide will prompt him to put his homework assignments into his book bag and then he will be escorted to the bus stop. The aide will escort John onto the bus, seat him and remain with him until the bus is ready to leave.

5. Typical Daily Notes Blue Text = TSS role (BHRS) Black Text = Aide role Date 1/8/07 Daily Notes John was very distracted today and required many verbal prompts to stay in his seat and focus on the teacher. I had to verbally queue multiple times just to get him to pick up the pencil and be quiet. I tried moving him to another part of the classroom and that seemed to settle him down for a short period. During spelling, it was more of the same, where I had to redirect his attention repeatedly and remind him that he would not get a sticker if he didn’t focus on his lesson. John was impatient at lunch, probably because he was very hungry. He ate part of his lunch on his own, but I spoon-fed him the remainder and he ate everything on his tray. Although he was more distracted than usual, his peer interaction at lunch today was good. During social studies period, John became overly anxious and I removed him from the classroom. However, he began to calm down almost immediately, so we went back into the classroom. I took him for physical therapy today and he was very cooperative during the session; even the therapist was surprised. John was less hyper after the therapy; he was able to focus on his spelling words with minimal prompting. Although he didn’t finish the assignment, I rewarded him with a sticker (his first one of the day). He was so excited to go home today, he wouldn’t stop clapping and jumping up and down. Total Daily Time: 6 hrs. 50 min.

6. School Based ACCESS Programhttp://www.leaderservices.com/services/ds.asp Administrative Claiming The school environment offers advantages and opportunities to reach children and families to inform, encourage, and assist them to access needed health care services, including enrolling in the Medicaid program. Schools have the responsibility to identify, evaluate, and accommodate the physical and mental health needs of all children who may be at-risk for poor school outcomes. Schools have become an important link for children and families to vital health care services. Federal law allows for reimbursement for allowable administrative activities required for provision of these services. These activities generally include: Public awareness and information Facilitating access to programs Identification and referral Care planning and coordination Client assistance to access services Family notification Available federal funding has important economic implications for local education agencies. Many education agencies do not realize that additional revenue may be generated for these administrative activities, thereby missing out on an important revenue stream. To identify the costs of allowable administrative activities, Leader Services facilitates the required time study of certain staff’s activities. The time study information is converted into a financial cost report and, through the state Department of Education, a quarterly claim is submitted to Medicaid on your behalf. Leader Services currently facilitates administrative claiming programs in the following states, and is exploring implementing programs in other states throughout the country: California Pennsylvania

7. School Based ACCESS Programhttp://www.leaderservices.com “Since the inception of SBAP in 1992, LEAs have recovered more than $576 million in federal Medicaid reimbursement.” 00-01 01-02 02-03 03-04 04-05 05-06 $35,884,960 $49,141,523 $62,258,677 $79,861,594 $96,280,296 $111,044,450

8. Allowable Expenses for SBAP dollars Following is a sample list of acceptable uses of SBAP dollars: Personnel 􀁹 New professional special education positions (teachers, therapists), including salaries and benefits; 􀁹 Special education classroom instructional aides, including salaries and benefits; 􀁹 Personal care aides, including salaries and benefits; 􀁹 School-based ACCESS Coordinators, including salaries and benefits; 􀁹 Nurses, including salaries and benefits for the percentage of time spent working with special education students; 􀁹 Clerical support staff for SBAP record keeping, including salaries and benefits; 􀁹 Clerical support staff for the special education program for the time spent in direct student support (typing, filing, mailing of IEPs, ERs, invitations to IEP meetings, including salaries and benefits; 􀁹 Substitutes for special education classes for teachers attending IEP meetings or trainings. Student and Curriculum Specific 􀁹 Field trips that are tied to the curriculum; 􀁹 Speakers and programs brought into the school; EXPENDITURE SAMPLES 􀁹 Programs above the ESY provided by the district, such as swimming lessons, and additional community-based programs; 􀁹 IEP Writer programs and support/training needed for implementation; 􀁹 Tests; 􀁹 Software; 􀁹 Adaptive reading equipment; 􀁹 Instructional materials; 􀁹 Books; 􀁹 Workbooks; 􀁹 Teacher manuals. SBAP Program Costs 􀁹 Copiers; 􀁹 Printers; 􀁹 Computers; 􀁹 Fax machine; 􀁹 File cabinets; 􀁹 Paper supplies. 􀁹 Equipment maintenance; 􀁹 Internet access for purposes of accessing Leader’s Web-based programs; e.g., SBAP Billing Program and IEP Writer Program. Training 􀁹 CPR and First-Aid training; 􀁹 Conferences and workshops for special educators and administrators; 􀁹 Inclusion conferences and workshops for regular educators; 􀁹 Parent training for special education; 􀁹 Manuals or other materials required for training programs. Property 􀁹 Student computers; 􀁹 Staff computers used for writing IEPs, ERs, lesson or treatment plans, or record keeping; 􀁹 Specialized furniture for students; 􀁹 Treatment room furniture; 􀁹 Furniture needed for computer use; 􀁹 Televisions and VCRs (with closed-caption capability); 􀁹 Portable stair climbers; 􀁹 Wheelchairs; 􀁹 Computer networking; 􀁹 Swimming pool lifts; 􀁹 Therapy equipment.

9. Conclusions 1. SBAP has been taking a substantial amount of money from the DPW Medical Assistance budget without demonstrating treatment efficacy. 2. SBAP focuses exclusively on school issues, does not address home or community issues, and does not use parentassessment of progress to evaluate treatment effectiveness.

10. Conclusions 3. SBAP does not offer sufficient clinical expertise to be effective in the treatment of mental illnesses and behavioral disorders in children. 4. SBAP providers have “divided loyalty” – they work for the school and are more likely to be told to withhold information from parents regarding in-school occurrences and issues.