MEDICAID ADMINISTRATIVE CLAIMING Staff Training

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MEDICAID ADMINISTRATIVE CLAIMINGStaff Training
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Medicaid Administrative Claiming Is

• A method of identifying and accounting for the
  time spent by public school and related staff on
  medically related activities.
• Reimbursement is then claimed for the time spent
  doing those activities Many are already being
  done by school staff.
• Staff do not need to know who is Medicaid/OHP
  eligible, nor do they need to become Medicaid
  experts.

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Why a School District Would Participate

• Staff are already doing the activities
• Reimbursement for these activities is available
• It takes staff approximately 10-15 minutes to
  complete survey and document activity
• Revenue can be used for vital health and social
  service programs in the school
• Diversifies funding base for needed programs and
  opportunities

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MAC Claiming Formula

• 1. Cost pool
• X
• 2. Medicaid eligible percentage
• X
• 3. Percent of allowable time (survey)
• Your schools total claim

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Training Requirements

• All staff who are to be surveyed must be
  knowledgeable prior to taking the survey
• All staff in cost pool must be trained face to
  face at a minimum of once per year prior to
  taking the survey
• Staff must sign in at training
• Trainers ensure adequate time for training and
  are the first line for technical assistance for
  staff

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MAC Survey How It Works

• Paid time at school is surveyed in 15-minute
  increments.
• Staff time falls into any one of the ten activity
  codes.
• Predominant portion of a 15-minute increment is
  whats recorded.

• Individual staff does the survey one day per
  survey period
• There are three survey periods during school year
• Surveys dates are randomly selected by DHS

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MESD Online Medicaid Administrative Survey
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MESD Online Medicaid Administrative Survey
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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.

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Ten Activity Codes

• 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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Coded 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
• For 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

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

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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
• Participated in child find activities

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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
• Coordinating the delivery of medical, mental and
  dental health services
• Monitoring the delivery of medical, mental and
  dental health services
• 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
• I participated in a meeting/discussion to
  coordinate or review a students need for health
  related services covered by OHP
• I spoke with a students doctor or parent about a
  change in medication
• I monitored and evaluated the medical service
  component of the IEP
• I gathered information in order to refer a
  student/family to health care
• I attended a MAC training or training about OHP
  covered service

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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 Medicaid/OHP Translation and
Transportation

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

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Code D2 Non-Medicaid/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 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
• I monitored the medical/health delivery systems
  in the school
• I developed an advisory group of health
  professionals to advise the school on health care
  services in the school
• I attended an early childhood planning meeting to
  discuss the coordination of health care in our
  community and school

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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
• Providing speech, occupational, physical
  therapies or counselling services

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Using Code C1 Versus Code F

• Administering first aid, or administering an
  insulin injection who does it, and then who
  monitors it is the question to ask
• Providing direct mental health treatment
  following DSM IV protocols code F
• Coordinating with a community-based mental health
  provider for monitoring follow-up of the
  providers services code C1

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Survey Documentation Protocols

• When a positive code is used (B1, C1, D1 or E1),
  staff will need to document activity.
• Documentation is in form of numeric system that
  associates an activity narrative with a number.
• It is not necessary for staff to provide a
  written narrative account of activity.
• If more than one time increment is the same
  activity narrative, list the number once.

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Coding Details and Guidelines

• Code only paid time and actual work hours
• Paid leave including absences, vacation, etc. Are
  code A (supervisor may need to complete survey)
• Blank increments on survey are only used for
  unpaid timeotherwise will default to code A
  other
• Part-time employees survey only paid time worked
  on the day of survey

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Good Information Remember

• Staff do not need to know who is Medicaid/OHP
  eligible
• It is the activity of staff that is being
  measured, not the outcome of the activity

• Staff do not need to know all about Medicaid/OHP
• Time study determines staff time spent on
  eligible and non-eligible activities

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Local MAC Coordinator and Contacts

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Questions