Provider Notice issued 09/09/02

Fee-for-Service Chapter U-200 and the SBHS Web site

Chapter U-200 Handbook for LEAs Fee-for-Service Program, Policy and Procedures

Revisions have been made to the School-Based Health Services (SBHS) Chapter U-200 Handbook for Local Education Agencies for the Fee for Service Program, Policy and Procedures. The revisions include:

• The addition of an evaluation form

• The addition of a SBHS Glossary of Terms

• U202.4 Federal Reimbursement mailing schedule for remittance advices has changed. Remittance advices regarding rejected claims are now sent weekly instead of monthly. This was changed so LEAs could re-submit the claim in a timelier manner. Remittance advices regarding allowable claims are still mailed monthly.

• U-203 Covered Services now includes School Health Aide. The addition of School Health Aide in section U-210.10 gives the service description, staff qualifications, and claimable services. School Health Aide services are claimable effective July 1, 2002, using the W7123 procedure code.

• U-204 Non-Covered Services list has been expanded

• U-205.1 Student Eligibility Verification information and detailed directions have been added

• U-205.2 Student Medical Record requirements have been further detailed

• U-205.3 Case Documentation requirements have been detailed and clarified. A sample activity log has been added as Appendix U-4.

• U-205.4 Billing Records requirements have been detailed and clarified. A sample transportation log will be added as Appendix U-6. (The transportation log example is not included at this time. It will be added later.)

• U-205.5 Practitioner Credential Records added a sample verification statement as Appendix U-5

• U-210 The group size limitation of 6 has been eliminated for occupational therapy (U-210.7), physical therapy (U-210.8), psychological services (U-210.9), social work (U-210.11), and speech/language therapy (U-210.12).

• U-210 Time spent in Individualized Education Program (IEP)/IFSP meetings has been eliminated for claiming.

• U-210.10 School Health Aide has been added as a covered service

• U-210.13 Transportation Services has been clarified regarding the specific circumstances under which each form of transportation is claimable.

Compact disks (CDs) containing Chapter U-200 will be distributed at the Informational Workshops to be held in Carterville, Springfield, Moline, and Lisle in September 2002. The revised U-200 document is now available at: https://www.illinois.gov/hfs/MedicalPrograms/sbhs/Pages/default.aspx, the Department of Public Aid SBHS Web site. Additional reference materials recently added to the Web site include School-Based Health Services terms and definitions, and a listing of SBHS abbreviations and acronyms.

Rounding of Units of Service

In Appendix U-1, page 5, of Chapter U-200, is found the explanation for coding time in 15-minute increments. Seven minutes of face-to-face service must be provided in order to claim one unit. 1 unit = 15 minutes. When the service time is greater than one unit 7 minutes, enter 2 units. When the service time is less than one unit 7 minutes, round down to the lesser unit, enter one unit. (3 hrs = 12 units; 3 hrs, 15 min = 13 units; 3 hrs, 20 min = 13 units; 3 hrs, 22 min = 14 units)

Calculating Costs for Units of Service

Effective October 1, 2002, the Department will require that the costs for each service provided by your LEA be determined using a standardized cost calculation methodology. A draft of the Department's proposed methodology is attached.

Consultation with a Parent, Documentation and Reporting

U-210 describes direct services as face-to-face, health-related services provided to a student, group of students, or parent/guardian on behalf of the student. Consultations must include the student or parent/guardian on behalf of the student to be claimable. Individualized Education Program (IEP)/IFSP meetings are not claimable as Fee-for-Service. Activities performed by the practitioner following a provided direct service including documentation, consultation with a parent, and reporting are considered time necessary for the billable service to occur, but such time is not a claimable event. (For example, a practitioner provides 30 minutes of direct service to a child and then later spends 15 minutes reporting the progress made to the child's parents.) The costs of such follow-up time are built into the cost of the face-to-face claimable time as calculated in the attached draft Fee-for-Service Cost Form.

School-Based Health Services Web site

Do visit our Web site noted above. If you have any questions about this notice, or any information on the Web site, please call or email me. My staff is here to assist you and your staff with the school-based health services program.