maureen bradshaw state coordinator behavior consultants [email protected] arkansas...
TRANSCRIPT
Maureen Bradshaw State Coordinator Behavior Consultants
Arkansas Catastrophic Arkansas Catastrophic Occurrences 2010-2011Occurrences 2010-2011
Review Review
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)2
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Catastrophic Points 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 8
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
expended.
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This session will cover 8This session will cover 8
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 9
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
First Step First Step Identifying the Student who may be a Identifying the Student who may be a
“Catastrophic Claim”. “Catastrophic Claim”.
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
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Extraordinary….Beyond normal and routine
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.
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Experiences in Arkansas & Nationally showsExperiences 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 ScaleABILITIES Scale
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)
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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: ABILITIESHow to Score: ABILITIES
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.
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Hearing Impaired
Hearing loss must be listed as decibels
Interpreters must be
qualified: Scores must be
provided
Objective Data
Nurse
completes
Or
use scores from recent evaluation
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Same for Vision
List Vision Scores obtained from File or from Vision Consultant
Nurse complete
s OR
scores taken from
recent evaluatio
n
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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
Speech-language pathologist should
complete
Intentional Communication 19
SLP Rates both
Communicating with others
IntentionalCommunication
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And understanding
others
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Scores for cognitive
functioning should come from recent evaluation
and be rated according to the rubric on
the form
Intellectual Functioning
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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?What do the scores mean?
According to state and national data 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)
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HIGHER SCORES
ASSOCIATED WITH HIGH COSTS 26
Higher ABILITIES Score
The More Likely a Catastrophic Student
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Deciding who to submit into the registry Deciding who to submit into the registry 2828
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
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.
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Multiple Areas of Severe/Profound Impairment
Likely -Submit29
No multiple areas of severe-profound
Not Likely - Should not submit 30
2008-2009 Reimbursement by disability 2008-2009 Reimbursement by disability category category 30 a30 a
Is the student a “Catastrophic” student because his/her complex needs require costs above what is considered normal and usual costs for special education?
orIs the student a “Catastrophic” student because decisions were made to spend money when other less costly options may have been available?
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Question which needs to be answered
Second Step: Complete
Demographics Data to document
services provided by a Para and/or nurse & why services are
needed
Complete form with
Accurate & Student Specific
Information
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Student Demographic Form: Para & Nurse 33
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.
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 & How and where to submit ABILITIES & Student Demographic FormStudent 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
• 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 When can forms be submitted 3636
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 reviewOn site review 3737
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
On Site ReviewsOn 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.
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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.”
Review of the IEP - Student’s Program 39
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 IEPAppropriateness 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
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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.
Example42
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.
The IEP Team needs to make specific considerations regarding behavioral & Social issues for students.
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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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Another Example: Communication Domain
Special Factors-Communication: 45
All Students should have a method to communicate with peers and adults
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 ProvidersEnsuring 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 ProvidersQualified ProvidersLEA’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.
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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
Catastrophic funds can be used for: Catastrophic funds can be used for: “Intensive Preparation”“Intensive Preparation” & Professional Development& Professional Development
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ARLEARN www.arlearn.org ARLEARN www.arlearn.org Slide 50Slide 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 ServicesCatastrophic funds for Related Services (34 CFR (34 CFR §§ 300.34 Related Services) 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 Related Services
(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
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Paraprofessionals as a Related ServiceParaprofessionals as a Related Service
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.
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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, continueParaprofessional as a Related Service, continue
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.
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Access to qualified teachers,Access to qualified teachers, FAPE & Improved outcomes 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 PointsCatastrophic 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 OCCURRENCESCATASTROPHIC OCCURRENCESFUNDING CONSIDERATIONSFUNDING CONSIDERATIONS 5858
• The Catastrophic Occurrences Program provides student-specific 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 Catastrophic Occurrences Funding Funding Considerations, Considerations, continued continued 5959
• 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 $15,000 after offsets to be considered for the reimbursement
CONSIDERATIONS WHEN FILING ACATASTROPHIC 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 pro-rated 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 FILINGA 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 VI-B 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 ACATASTROPHIC 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.
• 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 FilingA Catastrophic Claim, continued 61
• 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.
Considerations When FilingA Catastrophic Claim, continued 62
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 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?
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 claimMost Important: Submit the claim
