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Q&A on the Memorandum of Agreement between the DOE and the UFT on Medicaid reimbursement for speech and language services

Questions Answered

The UFT and the Department of Education on Nov. 18 signed an agreement that addresses the challenging working conditions that speech teachers have faced when documenting their work with children with speech and language delays in the Special Education Student Information System. Paving the way for New York City to receive tens of millions of dollars more in Medicaid reimbursements from the federal government, the agreement provides a pathway for the DOE to bill Medicaid for speech therapy delivered by speech teachers with speech language pathology licenses. The UFT drafted the following Q&A to answer speech teachers' most common questions about the agreement.

General Questions

1. Which speech teachers are affected by this agreement?

All speech teachers are affected. This includes speech teachers who are certified teachers of the speech and hearing handicapped (TSHH) and teachers of students with speech and language disabilities (TSSLD) who don’t have speech language pathology (SLP) licenses as well as those who do have SLP licenses. It also affects speech teachers who are serving as Speech Evaluators.

2. What Medicaid-reimbursable services are covered by this agreement?

The agreement allows the New York City Department of Education to seek Medicaid reimbursement for speech and language related services and initial speech evaluations.

3. Will all work performed in SESIS outside the regular workday be considered when distributing the proceeds of the SESIS settlement or only work in SESIS Encounter Attendance?

All work performed in SESIS outside of the contractual workday during the time frame, excluding lunch, will be counted.

4. Will the DOE identify Medicaid-eligible students?

 No. The DOE believes that all students should be treated the same regardless of their Medicaid eligibility. Also, the eligibility status of students changes frequently.

All speech teachers

1. What provisions of the agreement affect all speech teachers?

Under the agreement, all speech teachers

  • will continue to receive no less than 155 minutes per week, during the regular workday, for SESIS-related work;
  • may not be assigned to other duties (such as exam scoring or coverage/proctoring for other classes) that would prevent them from providing IEP-mandated services except in extraordinary circumstances;
  • will receive a laptop computer or tablet with internet access as soon as possible, but no later than 90 days from UFT approval of the agreement if full-time and as soon as possible for F-status providers;
  • will have 20 hours of per session work per year available to them if their caseload is 30 students or less and 40 hours of per session work per year available to them if their caseload is more than 30 students, with supervisor approval (which may not be unreasonably denied) through November 2017 and 10 hours of per session per year available to them if their caseload is 30 students or less and 20 hours of per session work per year available to them if their caseload is more than 30 students starting in December 2017;
  • will be able to work these additional per session hours at home to complete encounter attendance if they choose; and
  • will receive a proportional share of the $33 million settlement of the SESIS arbitration based on the number of hours of SESIS work performed outside the regular workday.
  • will benefit from the resolution of issues discussed at Labor Management Committee meetings including
    • materials and space for speech assessments and services;
    • configuration of the 155 minutes;
    • standardized reevaluation forms;
    • sample session notes, progress reports and reevaluation reports; and
    • provision of Clinical Fellowship Year support and mentoring for those who need it.

In addition, the DOE has agreed to complete a SESIS system upgrade no later than Nov. 1, 2017. This system upgrade will include the following changes that we have identified as priorities:

  • recognition of the employee;
  • pre-population of the service type, group size, service location, language and start time (if prescheduled);
  • adjustments to the provider’s caseload within 24 hours;
  • generation of service reports without unnecessary columns;
  • adjustments to the hours field to reflect hours within the regular school day;
  • functions that will allow providers to record their absence or non-attendance for all scheduled encounters;
  • ability to view the last Encounter Attendance entry for the student; and
  • ability to modify Encounter Attendance entries that have not been certified.

Lastly, the UFT Speech and Language Resource Center will remain open to support members, help provide Clinical Fellowship Year supervision and mentoring, and deliver citywide training.

Teachers of speech and hearing handicapped and teachers of students with speech and language disabilities who are New York State licensed speech language pathologists (SLP speech teachers)

1. Will I be required to provide a copy of my license to the DOE for use in Medicaid billing?

Yes. Consistent with advice provided to school districts by New York State’s School Supportive Health Program, the agreement requires SLP Speech Teachers to provide a copy of their New York State Speech Language Pathology license to the DOE. The DOE will provide directions to SLP Speech Teachers on how to comply with this requirement. You should receive this information in the near future. It will also be posted on the DOE website, and the UFT will post it on the UFT Speech Chapter website.

2. Does the agreement require me to register or enroll with any other government entity?

Yes. All SLP Speech Teachers will be required to apply for a National Provider Identification number and a Billing or Non-Billing Medicaid Identification number if they do not already have proof of registration or enrollment. The DOE will provide directions to SLP Speech Teachers on how to comply with these requirements. You should receive this information by email in the near future. It will also be posted on the DOE website, and the UFT will post it on the UFT Speech Chapter website.

3. Will my duties and responsibilities change? If so, how?

In addition to your current responsibilities, SLP Speech Teachers will be required to complete referrals for speech therapy services within 10 school days of the student’s date of first service provided in accordance with the student’s IEP mandates, except in extraordinary circumstances. The referral documents medical necessity and is required prior to initiation of a Medicaid-reimbursable service. Referrals must also be completed for a change to an existing service in order for the service to be Medicaid reimbursable. To be clear, the need for a referral is a Medicaid requirement. The presence or absence of a referral has no bearing on a speech teacher’s ongoing obligation to serve the child in accordance with his or her IEP.

4. How will this agreement benefit me?

In addition to the provisions applicable to all speech teachers, SLP Speech Teachers receive a $5,000 salary differential after they provide their National Provider Identification and Medicaid or Non-Medicaid Billing numbers. This salary differential becomes part of the SLP Speech Teacher’s base salary from that point forward and is subject to collective-bargaining increases unless the parties agree otherwise. To be eligible for the differential, the SLP Speech Teacher must maintain his or her SLP license in good standing. The differential will be pro-rated for F-status SLP Speech Teachers.

The DOE will reimburse SLP Speech Teachers for the triennial fee for renewing their state SLP license.

5. How does this agreement protect my license?

In the very unlikely event that you were to face any legal issues as a result of the DOE billing Medicaid for your speech services, this agreement protects you.  It requires that the city provide you with an attorney in any administrative or legal proceedings that result from the DOE/city submitting a claim for Medicaid reimbursement so long as you were not in violation of any federal, state or city rule or regulation and were acting in accordance with applicable policies of New York City and the DOE. You would also be indemnified by the city if for some reason it became necessary.

In addition, the agreement protects employees who report compliance concerns in a manner consistent with the city DOE’s Medicaid Compliance Plan. The agreement provides that compliance concerns can be reported anonymously. Employees who make reports consistent with the Medicaid Compliance Plan or refuse to take actions that a Medicaid compliance officer or official has agreed are a violation of laws or regulations are protected from retaliation, administrative disciplinary proceedings, a letter to file or discontinuance.

6. How can I make sure that claims submitted for services I have provided meet all of the requirements for Medicaid claiming?

The City of New York/DOE is the billing provider and, as such, is responsible for ensuring that all claims meet the requirements for Medicaid reimbursement. As a provider of Medicaid-reimbursable services, SLP Speech Teachers fulfill their responsibilities if they accurately complete all encounter-attendance fields, including session notes, for the students they serve.

7. Must the information recorded in SESIS Encounter Attendance regarding services provided to the student match the service recommendations (frequency, duration and location) in the student's IEP?

The Encounter Attendance entry will match the service recommendations in the IEP only if all aspects of the service delivery on the date in question matched the service recommendations. If they did not (i.e., the group size, location or duration of the session on the day in question did not match the group size, location or duration in the IEP), the provider must enter the details for the service as it was actually provided. The provider always and only enters into SESIS Encounter Attendance the service (group size, location, frequency and duration) that is actually provided. If you are directed to do otherwise, you should report it to the DOE's Medicaid Compliance Officer immediately. You will learn more about the Medicaid Compliance Office at the DOE's Medicaid Compliance Training.

8.  After the DOE begins to use our SLP license for Medicaid reimbursement, will we still be considered teachers?

Yes. You will still be covered by the DOE-UFT teachers’ contract. In addition, all personnel employed by public school districts in New York State to provide speech and language services must hold state certification as teachers of the speech and hearing handicapped or teachers of students with speech and language disabilities. The fact that the New York City public schools are using your SLP license to seek Medicaid reimbursement for the services you provide does not affect the requirement for state teaching certification.

9.  When this agreement goes into effect, will the DOE be able to seek reimbursement for services prior to the effective date of the agreement?

The DOE can only seek reimbursement for services provided prior to the effective date of this agreement if a written referral is in place for the services.

Teachers of speech and hearing handicapped and teachers of students with speech and language disabilities who Are not New York State-licensed speech language pathologists (speech teacher providers)

1.  How will this agreement benefit me?

Speech Teacher Providers will receive all of the benefits in the agreement for all Speech Teachers listed in Section B of this Q&A.

2.  Is my job at risk because the DOE cannot seek Medicaid reimbursement for my services?

Nothing has changed with respect to your current job protections or the job responsibilities and duties you are obligated to fulfill.

Speech teachers who have speech language pathology licenses who are working as Teachers Assigned (Speech Evaluators)

1. Will I be required to provide a copy of my license to the DOE for use in Medicaid billing?

Yes. The state School Supportive Health Program advises school districts to maintain a copy of each provider’s credentials on file. The agreement requires Speech Evaluators who have SLP licenses to provide a copy of their New York State Speech Language Pathology license to the DOE. The DOE will provide directions to Speech Evaluators on how to comply with this requirement.

2. Does the agreement require me to register or enroll with any other government entity?

Yes. All Speech Evaluators who have SLP licenses will be required to apply for a National Provider Identification number and a Billing or Non-billing Medicaid Identification number if they do not already have proof of registration or enrollment. The DOE will provide directions to Speech Evaluators on how to comply with these requirements.

3.  Will my duties and responsibilities change? If so, how?

You will be required to complete documentation necessary for the DOE to seek Medicaid reimbursement for initial speech evaluations and any speech services recommended as a result of the evaluation.

4. How will this agreement affect me?

In addition to the provisions applicable to all speech teachers, Speech Evaluators will receive a $5,000 salary differential per year after they provide their National Provider Identification and Billing or Non-Billing Medicaid Identification numbers. This salary differential is part of the Speech Evaluator’s base salary and is subject to collective-bargaining increases unless the parties agree otherwise. To be eligible for the differential, the Speech Evaluator must maintain his or her SLP license in good standing.

The DOE will reimburse Speech Evaluators for the triennial fee for renewing their state SLP license.

5.  Will I continue to work as a Teacher Assigned?

Yes. The agreement defines Speech Evaluators as Teachers Assigned governed by the provisions of the collective-bargaining agreement between the UFT and the DOE covering teachers who conduct initial speech evaluations as part of their assignment.