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MO HealthNet School District Administrative Claiming New Coordinator Orientation Training (SDAC) PowerPoint PPT Presentation


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MO HealthNet School District Administrative Claiming New Coordinator Orientation Training (SDAC) August/September 2013 Presented by the MSBA Medicaid Consortium. MSBA Medicaid Consortium Contact and Website Information. Kim Ratcliffe- (800) 221-MSBA(6722) Ext 362 (Executive)

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MO HealthNet School District Administrative Claiming New Coordinator Orientation Training (SDAC)

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Mo healthnet school district administrative claiming new coordinator orientation training sdac

MO HealthNet

School District Administrative Claiming

New Coordinator Orientation Training

(SDAC)

August/September 2013

Presented by the MSBA Medicaid Consortium


Msba medicaid consortium contact and website information

MSBA Medicaid Consortium Contact and Website Information

Kim Ratcliffe- (800) 221-MSBA(6722) Ext 362 (Executive)

Colleen Mahon- (800) 221-6722 Ext 340 (Business)

Collin Swearingen-(573)673-2013 (SDAC, Direct Services)

Brenda Wright- (660)651-1534 (SDAC)

Lisa Helm- (573)795-0510 (Direct Services)

Darcy Frazee- (800)221-6722 (Claims Adjustments and Finance)

Ashley Branstetter- (800)221-6722 (Direct Services)

E-mail addresses for the above: [email protected]

http://www.msbanet.org/school-district-administrative-claiming.html


Agenda

Agenda

What is SDAC?

Coordinator Roles and Responsibilities

Complete walk through of the entire SDAC process


Terminology and acronyms

Terminology and Acronyms

Medicaid (Federal term) = MO HealthNet (MO term)

MO HealthNet Division = MHD

Department of Social Services = DSS

Centers for Medicare and Medicaid Services = CMS

School District Administrative Claiming = SDAC

Random Moment Sample = RMS


What is mo healthnet

What is MO HealthNet?

MO HealthNet is a federally funded, health insurance program for low income and needy people.

For children under age 21, the federal program is called Early & Periodic Screening, Diagnosis and Treatment or EPSDT Program.

In Missouri, EPSDT is referred to as the Healthy Children and Youth program or HCY.


Who is covered by mo healthnet

Who is Covered by MO HealthNet?

Children in families who are eligible for cash assistance under Temporary Assistance to Needy Families (TANF), and Supplemental Security Income.

Children for whom adoption assistance or foster care payments are made.

Certain other low-income children may be eligible.

Children with certain disabilities.


Examples of mo healthnet epsdt covered services

Examples of MO HealthNet / EPSDT Covered Services


What is school district administrative claiming sdac

What is School District Administrative Claiming (SDAC)?

Outreach to MO HealthNet & HCY

Assistance with the MO HealthNet Application Process

Referring Students for Health Services

Coordination with other Health Care Providers

Arranging for Special Transportation

MO HealthNet / Medical Training

FOR ALL CHILDREN POTENTIALLY ELIGIBLE FOR MO HealthNet


What is sdac

What is SDAC?

SDAC allows a school to become an “administrative arm” of the MO HealthNet Division.

“The purpose of administrative claiming is to encourage the development of a framework of activities that result in each MO HealthNet participant having information and assistance to access needed health care services from a qualified provider.”

(MO HealthNet School District Administrative Claiming Manual, Section 4)


Five tab template

Five Tab Template

Districts are to provide all reports on approved Excel Template

1-Instructions

2-Personnel Roster–due quarterly 6-8 weeks prior to quarter

3-Cost Data-due month after the sampled quarter ends

4-PPR (Provider Participation Rate)-due month after the sampled quarter ends

5-Quarterly Certification of Expenditures Instructions-due after your Cost Data/PPR have been validated


Personnel roster job classifications

Personnel Roster: Job Classifications

Speech-Language Pathologists/Assistants

Audiologists/Assistants

Occupational Therapists/Assistants

Physical Therapists/Assistants

Social Workers

Psychologists

Counselors

Diagnosticians

Physicians

Registered Nurses/Licensed Practical Nurses/School Health Aides

Interpreters

Orientation and Mobility Specialists

Bilingual Specialists

Administrators for Special Education

Student Services Personnel

Augmentative Specialists

Dietitians

Respiratory Therapists

Liaisons for Special Education

Other school district staff who routinely engage in MO HealthNet reimbursable administrative activities


Quarterly personnel rosters

Quarterly Personnel Rosters

Name the Excel File:

School District name

Six-Digit DESE code

Personnel Roster

Quarter

Example: Missouri R-I, 000-000, Personnel Roster, Q4-13.xls


Rms general directions

RMS General Directions

“Description”—remarks should answer all the following questions:

Who were you with?

What were you doing?

What was the immediate intended result?

Activity Code: Select proper activity code based upon “Activity Description”

Position Section: Check one. If not in list, type in position name next to “Other_____”


Rms general directions1

RMS General Directions

It is important to note that for Administrative Claiming activities it is NOT necessary to know which children are MO HealthNet eligible.


Rms general directions2

RMS General Directions

Review of RMS Observation Form

10% of all forms from your district are to be reviewed

Coordinator on their own must verify the sampled staff accurately completed the observation form.

Coordinator can mark a form reviewed by clicking “Mark Reviewed” in therapylog and then confirming by clicking okay that they have completed this step.


Rms general directions3

RMS General Directions

Validation of RMS Observation Form

10% of all forms from your district are to be validated

Coordinator must verify by phone or in person that the sampled staff accurately completed the observation form.

Coordinator validates a form by clicking “Mark Validated” in therapylog and then confirming by clicking okay that they have completed this step.


Reporting of salary and benefits

Reporting of Salary and Benefits

Staff whose costs are captured in the school district’s federally approved unrestricted indirect cost allocation plan will not be included in the sampling process.

Salary and associated expenses paid to employees from federal sources cannot be included in computing the cost base for SDAC billings.


Reporting of salary and benefits1

Reporting of Salary and Benefits

Staff whose salaries are comprised of both federal funds and general funds may be included in time studies although their associated cost must be adjusted accordingly.

All federal funds must be removed from the reporting process.


Reporting of salary and benefits2

Reporting of Salary and Benefits

Full-time employees, part-time employees, and contracted employees who participate in SDAC activities will be included in the cost pool.

Contracted employees who “only” provide direct services should not be included.


Reporting of salary and benefits3

Reporting of Salary and Benefits

Report ACTUAL costs including salary AND benefits in Cost Data

Provide report on the Five Tab Template with the personnel roster that was submitted prior to the quarter starting.


District cost data do s and don ts

District Cost Data - Do’s and Don'ts

BACK OUT FEDERAL FUNDS

Report Actual Costs

Note employees that are replaced, contracted, and those who are federally funded

Include all board paid benefits

INCLUDE FEDERAL FUNDS

Report annual salaries divided by 4.

Add additional employees

Report only Health Insurance or Retirement benefits


Provider participation rate ppr form spreadsheet

Provider Participation Rate(PPR Form) Spreadsheet

PPR is due quarterly at same time as Cost Data (within 30 days after the end of the reported quarter)--Do not send prior to the end of the quarter being reported

List all MO HealthNet and non-MO HealthNet providers the district referred students to forany and all medical services.


Provider participation rate ppr form spreadsheet1

Provider Participation Rate (PPR Form) Spreadsheet

The PPR will be calculated by dividing the

number of MO HealthNet providers by the number of any and all providers referred to for each district. This percentage will then be applied to the MO HealthNet claimable activity related to referral, monitoring and coordination.


Quarterly salary and ppr spreadsheets

Quarterly Salary and PPR Spreadsheets

Name the Excel File:

School District name

Six digit DESE county district code

Name of documents in the file

Quarter (Time period document is reporting)

Example: Missouri R-I, 000-000, Salaries-PPR Q3-13.xls


Quarterly certification of state expenditures

Quarterly Certification of State Expenditures

The school district will include a quarterly certification stating that sufficient state funds are available to comply with MO HealthNet federal matching requirements. A copy of this form can be downloaded from therapylog once your cost data and ppr have been validated by MSBA.


Sdac quarterly cycle

SDAC Quarterly Cycle

Staff participants(future quarter)

1. Personnel RosterSubmit list of SDAC participants 4-6 weeks in advance of the next quarter

HOW MUCH Salaries/expenses/Quarterly Cert(past quarter)

Activity(current quarter)

2. Random Moment Sampling (“RMS”)

Observation Forms are assigned to randomly selected staff in the pool of employees, requesting a description of activity during their “random moment.” RMS forms are completed and submitted electronically through Therapylog.com

3. Cost Data/Provider Participation Rate

After close of the sampling quarter, submit that quarter’s cost data within 30 days, to request partial federal reimbursements for the participating staff salaries


Student roster file

Student Roster File

Student Roster Files (school enrollment K-12 all student file) must be updated by the school district annually and submitted to the MSBA Medicaid Consortium in early September

Standard Excel format (ONLY)


Student roster file1

Student Roster File

Student Roster File (student enrollment file) needs to be submitted via therapylog.com (Shown at Regional SDAC Training):

FieldNameExample

FirstJohn

LastSmith

SSN*999999999 (not MOSIS number)

DOB10/01/1999 (Month/Day/Year)

*Some schools no longer have or may have limited SSN’s. If you do not have a SSN for a child, please leave the cell blank. Not having a SSN is acceptable, but it may effect the percentage of match for MO HealthNet eligibility if the name and DOB do not match the child’s birth certificate.


Student roster file2

Student Roster File

Name the File:

School District name

Six-Digit DESE code

Student Roster

2013 - 2014

Example:

Missouri R-I, 000-000, Student Roster, 2013-2014.xls


Sdac participation steps

SDAC Participation Steps

ACTIVITY

FREQUENCY

1. Contact MO HealthNet to Request/Submit Interagency Agreement

Start-up

2. Enroll on www.msbanet.org to request agreement

Start-up

3. Coordinator attends Regional SDAC Training

Yearly

4. Upload completed Personnel Roster into Therapylog.com

Quarterly

5. Conduct SDAC training for participants on Personnel Roster

At Least Yearly

6.Upload completed Salary/Benefits/PPR into Therapylog.com

Quarterly

7. Upload or fax completed Certification of Expenditures

Quarterly

8. Upload completed Student Roster into Therapylog.com

Yearly

9.Maintain Audit Files (Keep for 5 years)

Quarterly


Sdac audit record

SDAC Audit Record

Master Audit File (Keep Indefinitely):

Interagency Agreement

MSBA Agreement

Any communications received from MHD/OIG (Audits/Reviews)

Methodology (All versions)


Sdac audit record1

SDAC Audit Record

Yearly Audit File for Annual Documents (Keep for 5 years):

Copy of the Student Roster used to generate MEV rate.*

MO HealthNet MEV letter.*

Verification of DESE calculated indirect cost rate. (Obtain copy from district bookkeeper/ CFO.)

*INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.


Sdac audit record2

SDAC Audit Record

Yearly Audit File for Annual Documents (Kept for 5 years):

Record of Training

Date of group SDAC training with names of attendees and instructors and signatures of participants; or,

Certificate of Verification of online training.

Copies of all training materials given to staff.*

*INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.


Sdac audit record3

SDAC Audit Record

Required Quarterly Documents (Keep for 5 years):

Copy of Personnel File*

Copies of all paper RMS forms

Copies of all electronic RMS forms*

*INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.


Sdac audit record4

SDAC Audit Record

Copy of cost file detailing salaries, benefits, and PPR.*

Support Documentation to your cost file.

Certified expenditures are separately identified and supported in the district accounting system.

Documentation of any federal revenues removed from costs for specific individuals on the personnel roster.

Quarterly Certification of Expenditures*

*INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.


Sdac audit record5

SDAC Audit Record

Completed quarterly invoice.*

Receipt of payment from MHD (may be downloaded from vendor payment web site.)

Any notification of required actions resulting from an audit review. (File in every application quarter resulting from action.)

*INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.


Sdac audit record6

SDAC Audit Record

Demo of Therapylog.com quarterly audit file feature….

This feature is available from Q3-09 forward.


Closing remarks

Closing Remarks

Questions?


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