Catastrophic 2007-2008 by chenmeixiu


									   Arkansas Catastrophic
   Occurrences 2010-2011

Maureen Bradshaw
State Coordinator Behavior Consultants

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)
Catastrophic Points

  The act of submitting a claim - does not ensure
   that it is a ―catastrophic claim‖ which will be
  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.

This session will cover                              88    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
            Student‘s Individualized Education Program
   • Fourth Step: Funding Considerations/Submissions of funds
This 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
  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
   Identifying the Student who may be a
             “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
Extraordinary….Beyond normal and routine               11

 Extraordinary: Beyond what is usual, ordinary or
 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.
Experiences in Arkansas & Nationally shows          12

    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
    We can objectively determine that a student
     has ―severe & profound impairments in a
     number of domains‖ by using the
     ABILITIES Scale.
ABILITIES Scale                                                              13

  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)
ABILITIES Index measures the severity of a student’s disability
   in each of the following nine areas                  14

   1. audition (A)
   2. behavior and socials skills (B)
   3. intellectual functioning (I)
   4. limbs (L)
                                           Refer to rubric to
   5. intentional communication (I)
   6. tonicity (T)
                                         accurately report level
   7.integrity of physical health (I)       of functioning
   8. eyes (E)
   9. structural status (S)

How to Score: ABILITIES                                      15

  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.
 Objective Data
Hearing Impaired
 Hearing loss         Nurse
must be listed as
   decibels         completes
Interpreters must   use scores
   be qualified:    from recent
 Scores must be      evaluation

Same for
Vision           Nurse
List Vision    completes
Scores            OR
obtained         scores
from File or   taken from
from Vision      recent
Consultant     evaluation
Integrity of Physical

 Recommend be           Student’s who
                        are rated as a 4
completed by the
                        or 5 should
                        have a Health
                        Care Plan
 Communication       19

pathologist should

 SLP Rates
with others


 Functioning       22

    Scores for
  should come
   from recent
 evaluation and
     be rated
according to the
  rubric on the

Information for
Limbs, Tone &
   should be
provided by an
   OT or PT
What do the scores mean?                         25

      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
 (exception: Severe Medical or health issues
   with no impairments in any other domains)
       Higher ABILITIES Score
The More Likely a Catastrophic Student   27
Deciding who to submit into the registry                    28

 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.
Multiple Areas of Severe/Profound Impairment
              Likely -Submit
No multiple areas of severe-profound
   Not Likely - Should not submit      30
2008-2009 Reimbursement by disability
category                                30 a
Question which needs to be answered

Is the student a “Catastrophic” student because
his/her complex needs require costs above what is
considered normal and usual costs for special
Is the student a “Catastrophic” student because
decisions were made to spend money when other less
costly options may have been available?
      Second Step:
   Demographics Data
      to document
  services provided by
   a Para and/or nurse
   & why services are
    Complete form
    with Accurate
      & Student
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 Demographic Form
(C ) Educational Interpreters scores                           34

 For services of an Educational Interpreter
   • Student needs to meet the definition of a ―catastrophic
   • Scores need to be provided to show the interpreter is a
     qualified provider
How and where to submit ABILITIES &
Student 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                              36

 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 review                                           37

 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 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.
Review of the IEP - Student’s Program                       39

 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
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.‖

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.

Appropriateness 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
 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

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.
The IEP Team needs to make specific considerations regarding
          behavioral & Social issues for students.

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.
Another Example: Communication Domain

       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
     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
Special Factors-Communication:

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

Ensuring 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,

Qualified Providers
      LEA‘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.
        Catastrophic funds can be used for:
 “Intensive Preparation” & Professional Development
          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
ARLEARN                                                   Slide 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
Catastrophic funds for Related Services                              51

  (34 CFR § 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

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
Paraprofessionals 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.
Paraprofessional as a related service                       54

 1. Identify the specific reasons why paraprofessional
  supports are being considered based on student‘s needs.
 2. Determine what personnel can best meet those
 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)
Paraprofessional 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
Access to qualified teachers,                             56
           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,
 Students without disabilities receive instruction
  primarily or exclusively from certified educators,
  whereas some students with disabilities receive their
  instruction primarily or exclusively from
Catastrophic Submission Points                                               57

 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:
FUNDING CONSIDERATIONS                                                     58
 • 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
 • Costs must be justified and documented on the basis of valid
   IEP services delivered by qualified personnel.
Catastrophic Occurrences Funding
Considerations, continued                             59

 • 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
 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
 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.
A 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.
CATASTROPHIC 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.
        Considerations When Filing
     A Catastrophic Claim, continued                                      61

• 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
• 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 Filing
   A Catastrophic Claim, continued                              62

• To access Personal Care Assistance provider status
   − Consult the Medicaid in the Schools (MITS) website at
   − Complete the Medicaid Service Provider Application and
     Agreement. Send to Tony Boaz at MITS. Do NOT send to
   − 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.
  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

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?
    • 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
           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
           How was the amount claimed as an expenditure determined
           for these services for this student?
           Are these services required in the student‘s IEP?
 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.

 Review questions and answers which are presently
  posted on the grants and data web site.

 Submit additional questions to:
 Donald Watkins, Grants & Data
Most Important: Submit the claim

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