WSR 08-15-129

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed July 22, 2008, 9:12 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 07-03-057.

Title of Rule and Other Identifying Information: The department is amending WAC 388-537-0100 School-based healthcare services for children in special education -- Purpose; and new sections WAC 388-537-0200 School-based healthcare services for children in special education -- Definitions, 388-537-0300 School-based healthcare services for children in special education -- Client eligibility, 388-537-0350 School-based healthcare services for children in special education -- Provider qualifications, 388-537-0400 School-based healthcare services for children in special education -- Covered services, 388-537-0500 School-based healthcare services for children in special education -- Noncovered services, 388-537-0600 School-based healthcare services for children in special education -- School district requirements for billing and payment, 388-537-0700 School-based healthcare services for children in special education, and 388-537-0800 School-based healthcare services for children in special education -- Program monitoring/audits.

Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), or August 26, 2008, at 10:00 a.m.

Date of Intended Adoption: Not sooner than August 27, 2008.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on August 26, 2008.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by August 19, 2008, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: In response to an audit conducted by the Centers for Medicare and Medicaid Services, the amendment and new sections bring this chapter into compliance with federal medicaid regulations, and delineates essential requirements for the delivery of school-based healthcare services. The department is changing the name of this chapter to School-based healthcare services for children in special education, amending WAC 388-537-0100 and adding new sections to chapter 388-537 WAC. The new sections solidify requirements for: (1) Provider qualifications; (2) healthcare services covered under this program; (3) the appropriate documentation for program audits and monitoring; and (4) requirements for billing and payment. The changes make it easier for the school districts to comply with program rule, thus providing qualified service to the children in special education.

Reasons Supporting Proposal: To ensure continuing federal participation in the state's payments for school-based healthcare services.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.500.

Statute Being Implemented: RCW 74.09.500, 42 C.F.R. 440.110.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of social and health services, governmental.

Name of Agency Personnel Responsible for Drafting: Jonell Blatt, HRSA, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1571; Implementation and Enforcement: Chris Bess, HRSA, P.O. Box 45530, Olympia, WA 98504-5530, (360) 725-1668.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department is not required to prepare a small business economic impact statement when it adopts rules that simply conform to and/or comply with a federal statute or regulation. Instead, according to RCW 19.85.061, the following statement applies:


42 C.F.R. 440.110 is the specific federal statute or regulation under which the rule is conforming; and according to RCW 74.04.015 programs administered by the department must conform to federal requirements with respect to eligibility for the receipt of federal grants or funds.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Jonell Blatt, P.O. Box 45504, Olympia, WA 45504-5504 [98504-5504], phone (360) 866-3545, fax (360) 586-9727, e-mail blattj@dshs.wa.gov.

July 16, 2008

Stephanie E. Schiller

Rules Coordinator

4004.2
AMENDATORY SECTION(Amending WSR 01-02-076, filed 12/29/00, effective 1/29/01)

WAC 388-537-0100   ((School medical services for students in special education programs)) School-based healthcare services for children in special education -- Purpose.   (1) ((The medical assistance administration (MAA) pays school districts or educational service districts (ESD) for qualifying medical services provided to an eligible student. To be covered under this section, the student must be eligible for Title XIX (i.e., either the categorically needy or medically needy programs).

(2) To qualify for payment under this section, the medical services must be provided:

(a) By the school district or the ESD; and

(b) To the eligible special education student as part of the student's individualized education program (IEP) or individualized family service plan (IFSP).

(3) To qualify for payment under this section, the medical services must be provided by one of the following service providers:

(a) A qualified Medicaid provider as described under WAC 388-502-0010;

(b) A psychologist, licensed by the state of Washington or granted an educational staff associate (ESA) certificate by the state board of education;

(c) A school guidance counselor, or a school social worker, who has been granted an ESA certificate by the state board of education; or

(d) A person trained and supervised by any of the following:

(i) A licensed registered nurse;

(ii) A licensed physical therapist or physiatrist;

(iii) A licensed occupational therapist; or

(iv) A speech pathologist or audiologist who:

(A) Has been granted a certificate of clinical competence by the American speech, hearing, and language association;

(B) Is a person who completed the equivalent educational and work experience necessary for such a certificate; or

(C) Is a person who has completed the academic program and is acquiring supervised work experience to qualify for the certificate.

(4) Student service recommendations and referrals must be updated at least annually.

(5) The student does not need a provider prescription to receive services described under this section.

(6) MAA pays for school-based medical services according to the department-established rate or the billed amount, whichever is lower.

(7) MAA does not pay individual school practitioners who provide school-based medical services.

(8) For medical services billed to Medicaid, school districts or ESD, must pursue third-party resources)) The department of social and health services (DSHS) pays school districts for school-based healthcare services provided to children in special education in accordance with the individuals with disabilities education act (IDEA). The services must:

(a) Address the physical and/or mental disabilities of a child;

(b) Be prescribed or recommended by a physician or other qualified healthcare provider within his or her scope of practice under state law; and

(c) Be included in the child's individualized education program (IEP).

[Statutory Authority: RCW 74.08.090. 01-02-076, 388-537-0100, filed 12/29/00, effective 1/29/01. Statutory Authority: RCW 74.04.050 and 74.08.090. 00-01-088, 388-537-0100, filed 12/14/99, effective 1/14/00.]


NEW SECTION
WAC 388-537-0200   School-based healthcare services for children in special education -- Definitions.   The following definitions and those found in WAC 388-500-0005 apply to this chapter:

"Assessment" - For purposes of this chapter an assessment is made-up of tests given to an individual child by qualified professionals to evaluate whether a child is determined to be a child with a disability and in need of special education and related services. Assessments are a part of the evaluation and re-evaluation processes.

"Child with a disability" - For purposes of this chapter, a child with a disability means a child evaluated and determined to need special education and related services because of a disability in one or more of the following eligibility categories:

Autism;

Hearing impairment (including deafness);

Mental retardation;

Serious emotional disturbance (emotional behavioral disability);

Speech or language impairment;

Traumatic brain injury;

Visual impairment (including blindness);

Orthopedic impairment;

Traumatic brain injury;

Other health impairment (multiple disabilities); or

A developmental delay for children ages three through eight, with an adverse educational impact, the results of which require special education and related direct services.

"Direct healthcare services" - Services provided directly to a child either one-on-one or in a group setting.

"Educational staff associate (ESA)" - A public school employee who is required to hold an ESA certificate.

"Evaluation" - Procedures used according to WAC 392-172A-03005 through 392-172A-03080 to determine whether a student has a disability, and the nature and extent of the special education and related services needed.

"Individualized education program (IEP)" - A written statement of an educational program for a student eligible for special education. (See WAC 388-172A-03090 through 388-172A-03135.)

"Individualized education program team (IEPT)" - A group of individuals responsible for developing, reviewing, or revising an IEP. (See WAC 392-172A-03095).

"Qualified healthcare provider" - See WAC 388-537-0350.

"Re-evaluation" - Procedures used to determine whether a student continues to be in need of special education and related services. (See WAC 392-172A-03015.)

"Related services" - Developmental, corrective, and other supportive services required to assist an eligible student to benefit from special education. For purposes of this program, related services include: physical therapy, occupational therapy, speech-language therapy, audiology services, psychological assessments, counseling, and nursing services.

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NEW SECTION
WAC 388-537-0300   School-based healthcare services for children in special education -- Client eligibility.   Children in special education must be receiving Title XIX Medicaid under a categorically needy program (CNP) or medically needy program (MNP) to be eligible for school-based healthcare services. Eligible children enrolled in a managed care organization (MCO) receive school-based healthcare services on a fee-for-service basis.

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NEW SECTION
WAC 388-537-0350   School-based healthcare services for children in special education -- Provider qualifications.   The department pays school districts to provide certain healthcare services (see WAC 388-537-0400) to eligible clients (see WAC 388-567-0300). These services must be provided by qualified healthcare providers who meet Washington state and federal requirements and operate within the scope of their practitioner's license:

(1) Audiology services delivered by:

(a) A licensed audiologist; or

(b) A school-based audiologist who:

(i) Meets the education and work experience necessary for a state professional license;

(ii) Holds a valid school audiologist educational staff associate certificate; and

(iii) Limits their audiology services to the school setting.

(2) Counseling services delivered by:

(a) A licensed independent social worker;

(b) A licensed advanced social worker;

(c) A licensed mental health counselor; or

(d) A school-based social worker or mental health counselor who:

(i) Meets the education and work experience necessary for a state professional license;

(ii) Holds a valid school social worker or school counselor educational staff associate certificate; and

(iii) Limits their counseling services to the school setting.

(3) Nursing services delivered by:

(a) A licensed registered nurse;

(b) A licensed practical nurse; or

(c) A noncredentialed school employee who is delegated certain limited healthcare tasks by a registered nurse and, trained and supervised according to professional practice standards.

(4) Occupational therapy services delivered by:

(a) A licensed occupational therapist; or

(b) A certified occupational therapy assistant supervised by a licensed occupational therapist in accordance with professional practice standards.

(5) Physical therapy services delivered by:

(a) A licensed physical therapist; or

(b) A licensed physical therapist assistant.

(6) Psychological services delivered by:

(a) A licensed psychologist; or

(b) A school-based psychologist who:

(i) Holds a masters degree in school psychology;

(ii) Holds a valid school psychologist educational staff associate certificate; and

(iii) Limits their psychological services to the school setting.

(c) A school-based psychologist who:

(i) Holds a doctoral degree in psychology;

(ii) Holds a valid school psychologist educational staff associate certificate; and

(iii) Limits their psychological services to the school setting.

(7) Speech therapy services delivered by:

(a) A licensed speech-language pathologist;

(b) A speech-language pathology assistant, who has graduated from a speech-language pathology assistant program, and is supervised by a speech-language pathologist with a certificate of clinical competence (CCC) in accordance with professional practice standards; or

(c) A school-based speech-language pathologist who:

(i) Meets the education and work experience necessary for a state professional license;

(ii) Holds a valid school speech-language pathologist educational staff associate certificate; and

(iii) Limits their speech therapy services to the school setting.

(8) For services provided under the supervision of a physical therapist, occupational therapist or speech-language pathologist the following requirements apply:

(a) The nature, frequency and length of the supervision must be provided in accordance with professional practice standards and adequate to assure the child receives quality therapy services.

(b) At a minimum, supervision must be one-on-one communication between the supervisor and the supervised professional.

(c) Documentation of supervisory activities must be on record.

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NEW SECTION
WAC 388-537-0400   School-based healthcare services for children in special education -- Covered services.   Covered services include:

(1) Evaluations, when the child is determined to be a child with a disability and in need of special education and related services;

(2) Direct healthcare services including:

(a) Audiology;

(b) Counseling;

(c) Nursing;

(d) Occupational therapy;

(e) Physical therapy;

(f) Psychological assessments;

(g) Speech-language therapy.

(3) Re-evaluations, to determine whether the child continues to need special education and related services.

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NEW SECTION
WAC 388-537-0500   School-based healthcare services for children in special education -- Noncovered services.   Noncovered services include, but are not limited to the following:

(1) Attending meetings;

(2) Charting;

(3) Equipment preparation;

(4) Instructional assistant contact;

(5) Parent consultation;

(6) Parent contact;

(7) Planning;

(8) Preparing and sending correspondence to parents or other professionals;

(9) Professional consultation;

(10) Report writing;

(11) Review of records;

(12) Set-up;

(13) Teacher contact;

(14) Test interpretation;

(15) Travel; and

(16) Observation.

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NEW SECTION
WAC 388-537-0600   School-based healthcare services for children in special education -- School district requirements for billing and payment.   To receive payment from the department for school-based healthcare services, a school district must:

(1) Have a current, signed core provider agreement with the department;

(2) Meet the applicable requirements in chapter 388-502 WAC; and

(3) Bill according to the department's published school-based healthcare services billing instructions.

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NEW SECTION
WAC 388-537-0700   School-based healthcare services for children in special education -- School district documentation requirements.   (1) The school districts must maintain sufficient documentation to support and justify the paid claims, to include, at a minimum:

(a) Professional assessment reports;

(b) Evaluation and re-evaluation reports;

(c) Individualized education program (IEP); and

(d) Treatment notes for each date of service the provider billed to the department.

(2) All provider licenses and other credentials must be current and on file with the school district and available for review upon request.

(3) All records must be easily and readily available to the department upon request.

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NEW SECTION
WAC 388-537-0800   School-based healthcare services for children in special education -- Program monitoring/audits.   (1) School districts must participate in the monitoring process.

(2) The department monitors school-based healthcare services as established by the school-based healthcare services program manager and in compliance with the department's monitoring policy and plan.

(3) The department conducts audits of school-based healthcare services in accordance with chapter 388-502A WAC.

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Washington State Code Reviser's Office