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ADMINISTRATIVE LETTER NO.: 15
POLICY CODE: IHBA
TO: Superintendents of Schools and Directors of Special Education
FROM: Susan A. Gendron, Commissioner
DATE: October 21, 2005
SUBJECT: EF-S-04A, State Agency Client Admission/Discharge Notice & EF-S-04B, State Agency Client Billing Form
The EF-S-04A, State Agency Client Admission/Discharge Notice and the EF-S-04B, State Agency Client Billing Form are available on the State of Maine Department of Education website at http://www.maine.gov/education/forms/specservices.htm These two forms are to be used to report the admission or discharge of state agency clients to/from each school administrative unit and when billing the Department of Education for special education and related services provided to state agency clients by either a school administrative unit or a private special purpose school. These forms will provide verification that a student is a state agency client in the school administrative unit and authorize payment for special education and related services provided to special education children only.
The EF-S-04A, State Agency Client Admission/Discharge Notice, should be completed and mailed by each school administrative unit to the Department of Education, Office of Special Services, no later than October 1, 2005, for all state agency clients enrolled as of the start of the school year. All state agency clients residing in the unit must be enrolled in the appropriate school, regardless of whether they will actually be attending school in the unit or at a private special purpose school, and regardless of method of payment. If you have no state agency clients, it is not necessary to send in this form until the end of the month if a state agency client enrolls in your unit during that month.
The EF-S-04B, State Agency Client Billing Form, should be sent to the Department of Education, Office of Special Services, on a monthly basis, for services provided to eligible students by your unit. BILLS FOR SEPTEMBER WILL BE DUE ON OCTOBER 18, 2005. Any bill received more than thirty (30) days after the due date will be returned to the billing party and will not be paid. State law allows for transportation to be billed as a related service to state agency clients when this isspecified in thestudent's IEP. (Table 4, Code 38)
The initial submission of both the EF-S-04A & B must be signed by the Superintendent (or Director, if a Special Purpose Private School) and dated. All subsequent submissions should be submitted electronically.
The enclosed instructions provide specific information as to when the EF-S-04B is due. The Office of Special Services will verify that the students reported for billing were reported on the EF-S-04A prior to authorizing payment and will notify the school administrative unit or private school of any problems with processing the payment.
The initial submission of the EF-S-04A will verify enrollment of all state agency clients as of the beginning of the school year. The EF-S-04A should be amended any time a change occurs in the status of any state agency client included in the original report or if new state agency clients enroll in the unit. A copy of the amended form must be sent to the Office of Special Services at the end of the month in which any changes occur. If no changes occur during the month, you do not have to send an amended EF-S-04A.
Students who are eligible state agency clients are defined as follows:
A. Department of Human Services - Any student who is in the care or custody of DHS, residing in a foster home, group home, or emergency shelter in the unit, and for whom special education and/or related services are being provided;
B. Department of Behavioral and Developmental Services (formerly Department of Mental Health and Mental Retardation and Substance Abuse Services) - Any student who is placed in a facility or with a person other than the child's parent, legal guardian, or relative, with the approval of a designated employee of the Department of Behavioral and Developmental Services, whose placement was made for other than educational reasons and for whom special education and/or related services are being provided; *
C. Department of Corrections – Any student who is in the custody or under the supervision of the Department of Corrections, including but not limited to: a juvenile on conditional release; an informally adjusted juvenile; and a probationer or a juvenile on aftercare status from the Maine Youth Center who is placed, for reasons other than educational reasons, pursuant to a court order or with the agreement of an authorized agent of the Department of Corrections, outside the juvenile’s home; and
D. Residents of state institutions - Any student residing in a state institution who is attending either a public school or a private special purpose day school, and for whom special education and/or related services are being provided.
If there is a question about the eligibility status of any student, school administrative units should contact the appropriate state agency to determine whether the student qualifies as a state agency client within the meaning of this governing statute. For further assistance, please contact Nancy Connolly, Office of Special Services, at 624-6650.
* Reflects changes in Department of Mental Health and Mental Retardation and Substance Abuse Services name and their policy regarding who is an eligible state agency client.