School Nurse Organization of Minnesota Annual Conference

1. School Nurse Organization of Minnesota Annual Conference November 2, 2013 Janet Lowe, RN, LSN, CPNP, MA

2. Connecting School Nurses to Reimbursement Impact Influence Outcomes

3. Connecting School Nurses to Reimbursement Reimbursement Impact Influence Outcome Background Regulations Best Practices FAQ Resources

4. Connecting School Nurses to Reimbursement: Impact

5. Connecting School Nurses to Reimbursement: Impact • Reimbursement • Increases Revenue • School Nurse Positions

6. Connecting School Nurses To Reimbursement: Influence • School Nurses are an Integral Part of the Health Care Delivery • Increases Access to Health Care

7. Reduces Health Related Barriers to Learning Increases Achievement Increased Graduation Rates Connecting School Nurses to Reimbursement: Outcomes

8. Where To Begin?

9. Medicaid • Federal and State • 1965 – Social Security Act • Reimbursement for Health Care Services

10. Q3 = Reimbursement • Qualified Children/ Youth • Qualified Providers • Qualified Covered Medicaid Services

11. Qualified Providers • Licensed School Nurses • RNs, LPNs • Advanced Practice Registered Nurses • CNPs

12. Qualified Services • Federal Regulations • State Medicaid Regulations

13. Covered Services • Individualized Education Program (IEP) Plan Health Related Services • (34C.F.R.300.154) • (MS256B.0625) • School Nursing Service

14. Covered IEP Health Related Nursing Service (IEP Technical Assistance Guide, DHS) • Face to face nursing care within nurse’s scope of practice • Examples, but not limited to: • Catheterization, tube feeding, suctioning, ventilator care • Nursing assessment and diagnostic testing such as glucose testing • Vital signs • Health counseling

15. Covered IEP Health Related Nursing Service (IEP • Activities of Daily Living when the IEP indicates a one on one nurse is required at school • Medication administration – • Complex – IV, injection, nebulizer, or gastrostomy tube • Simple – administration of prescription medications related to the child’s disability and in the IEP

16. Covered IEP Health Related Nursing Service • Medication Management • Review of medication and adherence to regimen, and one of the following: • Evaluation for adverse reactions • Education about medication • Contacts with the physician

17. Covered IEP Health Related Nursing Service • IEP Evaluations • Health related • Result in an IEP • Includes: • Pre-IEP evaluations • Ongoing assessments to determine needs • Re-evaluations • Face to face Health Assessments, interpreting test results and writing reports

18. Medicaid – Reimbursement in MNfor IEP Health Related Services - Over 200 Million

19. Other Requirements • Enroll as a Provider (DHS) • Must provide notification/consent one time • District • MA consent • Must obtain denial through MDE, or private insurance company, for students with a combination of MA and private insurance

20. Covered Services • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) (42C.F.R.441.50-441.62) MN- Child and Teen Checkups (CTC) (MS256B.0625) • Immunizations • Enroll as a Public Health Nursing Clinic

21. Childhood Immunizations (MS256B.0625, Subd. 39) • Must enroll in the pediatric vaccine administration • Budget Reconciliation Act of 1993. Medical assistance shall pay for administration of the vaccine to children eligible for medical assistance. • Medical assistance does not pay for vaccines that are available at no cost from the pediatric vaccine administration program.

22. Public Health Nursing Clinic • Be department of, or operate under the direct authority of a unit of government. Examples of a unit of government include county, city, or school district • Eligible Providers • Public Health Nurses (PHN) • Licensed registered nurses, supervised by a PHN, practicing in a PHNC

23. Public Health Nursing Clinic • Covered Services • Health Promotion and Counseling • Medication Management: Review of current medications and adherence to the prescribed medication regime. Education on proper medication use and contact with the prescribing physician when necessary • Nursing Assessment Treatment and Diagnostic Testing

24. Erickson, C., Splett, P., Mullett, S., & Heiman, M. (2006). The healthy learner model for student chronic condition management— Part 1. Journal of School Nursing, 22, 310-318.

25. Diabetes Chronic Disease Management

28. Public Health Clinic (PHC) • Covered Services • Preventive health services • Early periodic screening, diagnosis, and treatment services, also known as Child and Teen Checkups or C&TC • Dental services • Tuberculosis case management and directly observed therapy • Eligible Providers • Advanced practice registered nurses (APRN)• Nurse practitioners (NP)

29. Covered Services • Nurse Practitioner Services • Advanced Practice Registered Nurse (APRN) (MS256B.0625)

30. Best Practices in the Development of a Reimbursement Program • Administrative Support • Superintendent • Board of Education

31. Collecting Data on Health Care Services Provided in Your School • Chronic Disease Management • Asthma, Diabetes, Hearing Conditions, ADHD • Medications • Treatments

32. Best Practices in the Development of a Reimbursement Program • Strategic Goals and the Racial Equity Policy • Achievement • Alignment • Sustainability

33. Best Practices in the Development of a Reimbursement Program • Inter-Department Support • Finance • Legal • Purchasing • Technical Department

34. Best Practices in the Development of a Reimbursement Program • Work Across Disciplines • OT • PT • Speech and Language and Audiology • Social Workers • School Psychologists

35. Best Practices in the Development of a Reimbursement Program • Adhere to Standards of Practice • Develop Policies and Procedures

36. Documentation Name, student ID Date of Service Duration of Service Description of Service Progress Plan SOAP Subjective, Objective, Assessment, Plan DAP Data, Assessment, Plan DARP Data, Assessment, Response, Plan CCC Concept, cueing, clicking Best Practices in the Development of a Reimbursement Program

37. Best Practices in the Development of a Reimbursement Program • Secure Data • Electronic • Firewalls, encryption, security • Retrievable for Audits  

38. Best Practices in the Development of a Reimbursement Program • Build the Infrastructure for an Audit • Internal Audits

39. Other Areas for Reimbursement for School Nurses in Minnesota • Electronic Data Reporting System (EDRS) – State Special Education funds • Minnesota Department of Education • Local Collaborative Time Study (LCTS) • MN Department of Human Services • Other Grants, or other

40. Affordable Health Care Act • Coordination of Health Care Services • Prevention • Outcome Based

41. The Time is Now You can Make an IMPACT INFLUENCE and be an Advocate OUTCOMES For Students!! Tell Your Story

42. Questions from School Nurses • IEP Health Related Nursing Services • “If the nurse has listed direct time and it is very little, can she track and charge for more time. For instance, the nurse put in 15 min. a month for seizure care and management but she is needing to go to the classroom every time the student has a seizure and it is more often than when they wrote the IEP.”

43. Questions from School Nurses • “Do the physician orders need to order medication management in order to bill medication management.”

44. Questions from School Nurses • Is adding nursing as a related service limited by the category of disability? • For example, can nursing only be on an OHD? What about LD, speech, and other categories?

45. Questions from School Nurses • How do you document nursing services on the IEP?

46. Resources • Minnesota Department of Human Services, IEP Technical Assistance Guide • Minnesota Department of Education, Ruth Ellen Luehr, TPL denials, sharepoint • Centers for Medicare and Medicaid (CMS) http://www.cms.gov/ • National Alliance for Medicaid in Education (NAME) http://medicaidforeducation.org/ • National Association of School Nurses http://www.nasn.org/ School Nursing: A Comprehensive Text, available for ordering June 23, 2012 Contact apyles@nasn.org bookstore • Erickson, C., Splett, P., Mullett, S., & Heiman, M. (2006). The healthy learner model for student chronic condition management— Part 1. Journal of School Nursing, 22, 310-318.