Personal care services are provided to help a child with a disability or chronic condition benefit from special education. Personal care services include a range of human assistance provided to persons with disabilities or chronic conditions, enabling them to accomplish tasks that they would normally do for themselves if they did not have a disability. An individual may be physically capable of performing Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and Health Maintenance Activities (HMAs) but may have limitations in performing these activities because of a functional, cognitive, or behavioral impairment. PCS includes direct intervention (assisting the client in performing a task) or indirect intervention (cueing or redirecting the client to perform a task). ADLs, IADLs, and HMAs include, but are not limited to, the following:
ALDs
Bathing
Dressing
Eating
Locomotion or Mobility
Personal Hygiene
Positioning
Toileting
Transferring
IADLs
Escort
Medication Assistance
Money Management
Telephone use or Other Communication
Personal Care services are billed using our documentation and Medicaid billing system, MSB. The service providers oversee documentation and maintain records for personal care.
When documenting services within these settings, documentation can be set up in one of two ways:
Scheduled start and stop time with the student(s)
All-day appointment and then use a student sign-out sheet in the classroom to designate minutes when/where other support staff remove the student from these classrooms to provide services.
These minutes should be indicated in the “Time Away from Student” field in Service Logs to ensure minutes are removed from the documentation of services.
Should a teacher need a “sign-out sheet” for his/her classroom, templates are available here. In addition, documentation responsibilities will fall within the scope of the teacher’s responsibility.
The teacher will ensure all documentation for students receiving services within the school day is accounted for. This requires that all staff members within the team must document for at least one student.
Special Education Teachers should remember the following:
In order to bill Medicaid for PCS, PCS activities must be in the IEP/ARD (PLAAFPs, IEP Goals and Objectives, Accommodations pages, PCS Supplement, and/or in the minutes of the ARD) and furthermore indicate “medical necessity.” All these areas of the ARD/IEP need to be in alignment or “tell the same story.”
The Vision Impairment provider can review the visually-impaired student’s classroom documents and/or the PCS provider’s notation of the specific type of PCS provided to be sure that she agrees that the VI specialist is providing PCS in that she is assisting the student with the performance of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) because the student is not able to perform the age-appropriate tasks due to his/her disabilities. Services provided by Orientation & Mobility Specialists often meet the definition of PCS for visually-impaired students.
We bill direct services through MBS. All sessions are documented as well through informal session notes and data sheets.
During the initial ARD meeting, a licensed healing arts professional determines whether a student requires specialized transportation services from the data in the student’s Full and Individual Evaluation. After confirming a student requires specialized transportation, the ARD committee then confirms whether a student needs monitoring for a bus aide. All decisions the ARD committee makes are recorded in the student’s most current IEP.
Bus drivers record on a paper Trip Log their daily trips for specialized transportation services. Bus drivers and bus monitors or aides are required to sign a weekly trip log indicating they were present for the services provided. On the occasion a bus driver is absent, the substitute for the day records the Trip Log information and indicates that they substituted for the original bus driver.
The logs are collected by the transportation director and then submitted back once a week to MSB for Medicaid billing.
The nursing department must document all services performed for all populations of students. MSB will receive monthly data for the identified special education students. This data file is imported into MBS and reviewed for Medicaid reimbursement potential. There are times when nursing services are delegated to a campus professional. The campus professional can document those services directly in MBS or submit paper documentation to MSB for processing.
For Medicaid purposes, a school’s use of electronic records and signatures for SHARS is permissible. As long as the records are accessible to an investigator or auditor and can be reviewed as needed, maintaining the records in electronic format is acceptable from the perspective of documentation adequacy or other audit issues related to Medicaid.
SHARS providers must recognize the potential for misuse or abuse
SHARS providers must apply relevant administrative procedures, standards, and law
SHARS providers must ensure system and software products are protected
The individual whose name is on the alternate signature method and the provider bears the responsibility for the authenticity of the information attested to in the record
SHARS providers must check with their respective legal counsel regarding alternative signature methods and associated legal concerns
The Texas Education Agency (TEA) advises that it has no additional requirements regarding submitting electronic data or using electronic signatures. The requirement that records are accessible and can be made available to an auditor or a reviewer as needed is, per TEA, sufficient for its purposes.
All software products used by the district meet the below electronic signature policy criteria.
A unique user ID and an alphanumeric password consisting of at least eight characters
Apply electronic signature at the time-of-service documentation and at each instance of service delivery
Staff members will not share username/password information
System will allow access to staff members' historical records
System allows immediate access to records by state or federal agencies and others who are authorized by law
Staff members are required to maintain professional responsibility for their service delivery and their documentation
The individual whose name is on the electronic signature and the school district bears the responsibility for the authenticity of the information attested to in the record
In addition, through our service documentation and Medicaid billing system, any provider documenting services electronically acknowledges the electronic signature procedure before submitting his or her first session for billing. All providers submitting electronic documentation through the MBS are required to agree to the terms and conditions for electronic signature as per TEA requirements. An MSB representative, or his/her designee, is required to train all providers on the requirements of electronic data submission and electronic signatures during their annual provider training.
According to federal rule 42 CFR §300, on an annual basis, the parents/guardians of ILTEXAS' Special Education student population will receive a notification that outlines our participation in the SHARS program and the rights of the parent/guardian. This notification is presented during the annual ARD meeting, along with an opportunity to consent, deny, or withdraw from the program. If the parent/guardian does not attend the Annual ARD meeting, then a phone call will be made to bring the parent along. If a phone call fails, an email will be sent with all the pertinent information.
Within two business days of the IEP/ARD committee meeting, the consent form status needs to be updated in the MBS.
ILTEXAS does not authorize any billing for students who do not have parental consent on file per TEA’s requirements. ILTEXAS uses Project Education (SPED) to track which parents have signed parental consent forms. The Campus Coordinator (ARD/IEP meeting facilitator) informs parents about the SHARS program at the annual ARD meeting. Any parent that has not yet signed a Medicaid Consent form can do so at each ARD meeting or reach out to the district ahead of time.
The Medicaid to Schools Program requires districts to participate in Random Moment Time Study (RMTS). This program aims to determine how often providers perform “direct medical services” to students throughout the school day. The state randomly selects participants who provide direct services to special education students each quarter. The selected participant will receive an email from STAIRS/Fairbanks notifying the participant that they have been selected for RMTS. As the moment approaches, the participant will be provided a specific date and time for which they will answer the time study. The time study consists of three basic questions about what the provider did during the selected moment. Each provider needs to understand what the Medicaid program recognizes as a “medical” service to appropriately respond to the moment and differentiate between a direct medical service and an educational/instructional service. Responding to the random moment in a more informed way assists in the accuracy of the time study.
ILTEXAS expects to maintain a 100% participation each quarter which is defined by those participants who are selected that they respond within the timelines specified.
All participants must receive training annually on this program. Training on RMTS is provided in a multitude of ways:
MBS Documentation Workshops
Video Training
Staff Meetings.
To educate our providers on the RMTS Program and what Medicaid determines as “medical” versus “educational,” MSB Consulting Group has created a video each selected participant will watch before responding to their RMTS. The training video is available by clicking here: https://vimeo.com/847438153. After viewing the video, providers will fill out this online form for tracking and auditing purposes.