Medicaid Administrative Claiming

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Medicaid Administrative Claiming

• Train-The-Trainers
• Workshop

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Welcome to Medicaid Administrative Claiming (MAC)
(Fill In Your District Name)

• The Medicaid Administrative Claiming program is
  being implemented in (Fill In Your District Name)
  through a partnership between
• The Department of Human Services (DHS)
• The (Fill In Your District Name)
• Local School Districts
• Multnomah Education Service District (MESD) (If
  applicable)

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Building Trainer Responsibilities

• Attend a two hour MAC train-the-trainers
  workshop.
• Following direction from District MAC
  Coordinator, schedule training with staff who
  have been chosen to take the MAC survey each
  survey period.
• Provide staff training using training
  tools/materials provided for you by (Fill In).
• Require staff to sign the training sign in sheet.
  Following the training, return the sign in sheet
  to your District MAC Coordinator.
• Be available as the first contact on the survey
  date.
• Follow-up with any questions or concerns you have
  with your District MAC Coordinator.

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Resource Materials

• Medicaid Administrative Claiming Power Point
  Presentation
• Directions to access the MAC survey
• School-Based Medicaid/OHP Administrative Claiming
  Coding Guide
• Claimable Categories Activity Codes
• Sample MAC Survey Form
• Questions Relating to the Activity Codes
• Mac Provider Manual Version 2.0
• Section 5 Activity Codes FAQs

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What is Medicaid?

• Medicaid is a health care program under the
  Oregon Health Plan (OHP) which provides medical
  assistance to low-income children and families at
  little or no cost. OHP health care benefits
  include
• Medical
• Dental
• Mental Health
• Chemical Dependency Services

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What is Medicaid Administrative Claiming ?

• Medicaid Administrative Claiming is a survey
  method of identifying and accounting for the time
  spent by public school staff on medically related
  activities, that otherwise would be the financial
  responsibility of the State.
• Schools provided administrative services that
  have been found to be necessary for the proper
  and efficient administration of the State
  Medicaid plan.

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Important Facts

• You do not need to know who is Medicaid/OHP
  eligible
• You do not need to know all about Medicaid/OHP
• It is the activity you are doing that is being
  measured, not the outcome of the activity
• The time study determines your time spent on
  eligible and non-eligible activities

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MAC Activities

• Examples of these MAC activities include
• discussing access to health care with a
  student/family
• assisting in early identification of children who
  could benefit from health services provided by
  Medicaid
• contacting pregnant and parenting teens about the
  availability of Medicaid prenatal, and well baby
  care programs and services
• providing referral assistance to families where
  Medicaid services can be provided

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Where do MAC activities take place?

• MAC activities may take place anywhere school-age
  children, their families and school personnel are
  together. For example
• in the classroom
• in the lunchroom
• on the playground
• on a field trip
• during a meeting (except for IEP)
• during school conferences

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What school personnel can participate in MAC?

• ESD and School District staff who have routine
  contact with students and families
• School District Administrators
• Principals
• Classroom Teachers
• Classroom Assistants
• School Secretaries
• School Nurses
• School Counselors

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Why would a school district choose to participate
in MAC?

• The MAC process permits the costs of allowable
  administrative activities being performed by
  school staff, but not otherwise reimbursed, to be
  reimbursed under Medicaid.
• Revenue can be used for vital health and social
  services programs
• Strengthens local relationships among planning
  bodies, service providers, and public entities
• Diversifies funding base for needed programs and
  opportunities

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Examples of Projects throughout the State funded
with MAC dollars

• Dental Vans
• Family Advocates working out of the school
• School Nursing, Mental Health, Substance Abuse
  services
• Other health care or social service programs

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How is MAC time reported for Medicaid
reimbursement?

• MAC claiming is reported by district staff
  completing a web-based survey. The survey
  documents services provided by school personnel
  on a normal school day. There are three survey
  periods per school year. Each survey period has
  five survey days within the period. Survey
  periods and dates are selected by DHS.
• September December
• January March
• April June

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How is MAC time reported for Medicaid
reimbursement?

• District staff participate in the survey
• All staff who are chosen through the random
  survey process must be trained prior to taking
  the survey
• Staff must sign in at the training
• Paid time at school is surveyed in the
  predominant portion of 15 minute increments
• Staff time falls into any one of ten activity
  codes

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How is MAC time reported for Medicaid
reimbursement?

• It is recommended you complete the survey on the
  assigned random day, however to accommodate for
  times when you may not be able to complete the
  survey on the assigned day, it is open for 5
  days.
• The survey day, and the next four work days.
  Example If the survey day is Tuesday, October
  12 you would have until Monday, October 18
  (Tuesday, Wednesday, Thursday, Friday, Monday) to
  fill out the survey for the activities you did on
  October 12.

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Ten Activity Codes

• A. School-Related and Educational Activities,
  other
• B1. Medicaid/OHP Outreach
• B2. Non-Medicaid Outreach
• C1. OHP Referral, Coordination, Training
• C2. Non-OHP Referral , Coordination, Training
• D1. OHP Transportation/Translation
• D2. Non-OHP Transportation/Translation
• E1. Medical program planning, policy
  development, and interagency coordination
• E2. Non-medical program planning, policy
  development, and interagency coordination
• F. Direct Medical Services

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Claimable Categories Activity Codes

• When a positive code is used (B1, C1, D1 or E1),
  staff will select the specific code from the
  activity description pop up screen. Example of
  B1 activity descriptions
• B1.1 - Informing children and their families on
  how to effectively access, use, and maintain
  participation in Medicaid/OHP. (Includes
  describing the range of services, and
  distributing OHP literature)
• B1.2 - Assisting the student/family to access,
  apply for, and/or complete the Medicaid/OHP
  application. (Includes transportation and
  translation related to OHP application, and
  gathering appropriate information)
• B1.3 - Checking a student and/or family's OHP
  status.
• B1.4 - Contacting pregnant and parenting
  teenagers about the availability of Medicaid/OHP
  for prenatal and well baby care programs.

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Code A School Related and Educational Activities

• This code should be used for
• any school-related activities such as teaching
  and educational services
• developing, coordinating and monitoring of a
  students education plan or IEP
• discipline or student supervision
• social services and non-health related services

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Code A Activity Examples

• I developed a lesson plan.
• I graded tests.
• I supervised the playground, halls, or lunch
  time.
• I discussed a students educational progress with
  a family at parent-teacher conferences.
• I helped a student to apply for college.
• I assisted in evaluating a textbook.
• I attended an IEP team meeting

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Code B1 Medicaid/OHP Outreach and Facilitating
Medicaid/ OHP Eligibility

• This code should be used for
• informing students/families about OHP
• helping to get information for filling out or
  assisting to fill out the OHP application
• contacting pregnant and parenting teens about OHP
  prenatal and well baby care
• checking a student/family OHP eligibility status

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Code B1 Activity Examples

• I informed a student/family about OHP (B1.1).
• I helped a family fill out the OHP form (B1.2).
• I referred a family to the local DHS office for
  the OHP application (B1.2).
• I talked to a teen parent about OHP prenatal
  and/or well baby care programs and services
  (B1.4).
• I provided necessary forms to a student/family in
  preparation for OHP eligibility determination
  (B1.3).

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Code B2 Non-Medicaid/OHP Outreach and
Facilitating Non-Medicaid/OHP eligibility

• This code should be used for
• Child Find outreach activities
• informing students/families about social,
  vocational, or educational (including special ed)
  programs
• describing the services/benefits of these
  programs
• helping families fill out the necessary program
  forms

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Code B-2 Activity Examples

• I informed a student/family about general health
  information.
• I assisted a student/family to fill out a Free
  and Reduced lunch application.
• I informed a student/family about social service
  and educational programs such as WIC, childcare,
  food stamps, community college, higher education,
  and job training.
• I participated in Child Find for special
  education services.

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Code C1 Referral, Coordination, Monitoring and
Training of Medicaid/OHP Services

• This code should be used for
• making referrals for medical, mental and dental
  health services covered by Medicaid
• coordinating the delivery of medical, mental and
  dental health services covered by Medicaid
• monitoring the delivery of medical, mental and
  dental health services covered by Medicaid
• attending training about MAC and OHP covered
  services and the benefits of those services

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Code C-1 Activity Examples

• I referred a student to medical, dental or mental
  health care covered by Medicaid (C1.1).
• I participated in a meeting/discussion to
  coordinate or review a students need for health
  related services covered by OHP(C1.2).
• I spoke with a students doctor or parent about a
  change in medication (C1.2).
• I monitored and evaluated the medical service
  component of the IEP not done during the IEP team
  meeting (C1.3).
• I gathered information in order to refer a
  student/family to health care (C1.1).
• I participated in a MAC training or training
  about OHP covered service (C1.4).

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Code C2 Referral, Coordination, Monitoring and
Training of Non-Medicaid/OHP Services

• This code should be used for
• participating in or coordinating state mandated
  health screening activities
• making referrals for scholastic, vocational,
  employment and social services
• referring to non-Medicaid/OHP services

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Code C-2 Activity Examples

• I participated in IDEA training or other
  education based in-service training.
• I participated in a meeting/discussion to
  coordinate or review a students need for
  scholastic, employment, vocational and other
  non-health services.
• I referred a student/family to educational or
  social services.
• I helped to coordinate and deliver the state
  mandated vision and hearing screens.

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Code D1 OHP Transportation and Translation

• This code should be used for
• scheduling, arranging or providing transportation
  to OHP covered services
• scheduling, arranging or providing translation
  services that assist the individual to access and
  understand necessary care and treatment

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Code D1 Activity Examples

• Transportation
• I arranged transportation (e.g. bus, taxi,
  transportation brokerage) to take a student to a
  physical therapy appointment (D1.1).
• I drove a child to the hospital for emergency
  medical care (D1.1).
• I arranged a taxi to take a student to a medical
  appointment (D1.1)
• Translation
• I used the assistance of a translator to inform a
  family about medical services for their child
  (D1.2).
• I used the assistance of a sign language
  interpreter to sign with a deaf student about
  his/her medical/physical, mental health condition
  and available services (D1.2).

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Code D2 Non-OHP Transportation and Translation

• This code should be used for
• scheduling, arranging or providing transportation
  to social, vocational and/or other educational
  programs and activities
• scheduling, arranging or providing translation
  services to assist individual to access and
  understand necessary non-Medicaid/OHP services

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Code D2 Activity Examples

• Transportation
• I arranged transportation for a student to go to
  a vocational assessment.
• I arranged transportation for a student to attend
  a recreational program.
• Translation
• I arranged for a translator to assist me with
  tutoring a child in math.
• I arranged for a translator to assist me to
  communicate with a students parent about the
  suspension process.

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Code E1 Program Planning, Policy Development,
Interagency Coordination Related to Medical
Services

• This code should be used for
• develop strategies to assess or increase the
  capacity of school medical/health programs
• work with other agencies and providers to improve
  coordination and collaboration of Medicaid/OHP
  services
• monitoring the delivery of medical services
  system in the schools
• creating and reviewing health policies in the
  schools

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Code E-1 Activity Examples

• I helped develop strategies to increase the
  capacity of the school health programs (E1.1).
• I monitored the medical/health delivery systems
  in the school (E1.3).
• I developed an advisory group of health
  professionals to advise the school on health care
  services in the school (E1.2).
• I participated in an Early Childhood planning
  meeting to discuss the coordination of health
  care in our community and school (E1.1).

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Code E2 Program Planning, Policy Development,
Interagency Coordination Related to Non-Medical
Services

• This code should be used for
• working collaboratively with other agencies to
  identify gaps, overlaps or duplication of
  non-medical/health services, such as vocational,
  social or educational services
• improve coordination, expand access or delivery
  of non-Medicaid/OHP services
• develop strategies to assess or increase the
  capacity of non-medical, dental and mental health
  school programs

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Code E-2 Activity Examples

• I developed strategies to increase the capacity
  of social services in my school.
• I collaborated with a vocational education
  program to expand services to students.
• I coordinated the delivery of social services in
  my school.
• I attended a meeting coordinating the use of the
  school building by a community group for a
  non-health activity.

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Code F Direct Medical Services

• This code should be used for
• providing health/dental/mental health services
  contained in the IEP
• conducting health/dental/mental health
  assessments/evaluations and diagnostic testing
• administering first aid or prescribed injection
  or medication to a student (not dispensing)
• providing speech, occupational, physical
  therapies or counseling services

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Code F Activity Examples

• I provided mental health counseling contained in
  an IEP.
• I administered first aid to a student on the
  playground.
• I completed a psychological evaluation and wrote
  the evaluation report.
• I provided direct speech therapy.

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Coding Details and Guidelines

• Code only paid time and actual work hours
• Paid leave including absences, vacation, and
  personal leave are Code A
• Blank increments on the survey are only used for
  unpaid timeotherwise the survey will default to
  Code A other
• Part-time employees only code the portion of the
  day they are paid

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Who do I contact if I need technical assistance?

• 1) The MAC Trainer in your building
• ________________________________
• 2) The MAC Coordinator for your district
• ________________________________
• 3) The (Fill In) ESD Medicaid Facilitator
• (fill in your contact info here)

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Taking the Survey

• Web address
• http//www.mesd.k12.or.us/mac/
• (If applicable)

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QUESTIONS