MHMR Mental Health Mental Retardation

1. Time Study Training MHMR Mental Health Mental Retardation

2. Housekeeping • Training duration is approximately 4 hours • Short breaks will be provided • Questions will be taken throughout • Attendance certificates will be sent via e-mail to all participants that are given credit for attending and participating in the training

3. New News - Changes in 2010 • The various trainings for Time Study, MAC, TAFI and Direct Service have been combined • Once the Program Contact has been trained it is good for the full FFY (Oct-Sept) • There is no longer a final survey, polling questions are inserted through the training to ensure the information is understood • Webinars have proven to be an effective training methodology and will continue to be used • There are some requirements that must be monitored in order to accurately credit training Participation level, Polling Questions Answered, Log In & Out times • HHSC will contact anyone that does not appear to have fully participated to gain understanding

4. New FacesRoles Time Study 512-491-1715 Ray Wilson - Manager Beverly Tackett – Lead Alexandra Young MAC 512-491-1411 Dan Huggins - Director Yvonne Moorad – Lead Serena Lee TAFI 512-491-1347 Dan Huggins - Director Yvonne Moorad – Lead Serena Lee New FacesOld Friends

5. AGENDA • Time Study & Coding Process • MAC & Direct Service Financial Process • TAFI Reporting Process • Questions/ Wrap up Note: Must be present for entire training to obtain credit

6. Purpose of Time Study • A statistically valid methodology that reflects how time is allocated among functions • Determine the amount of time spent on the MHMR Program in assisting individuals to access medically necessary Medicaid funded services • Necessary for determination of interim rates and final reimbursement for MR service coordination and MH rehabilitation and case management

7. Purpose of Time Study Cont. • Necessary for participation in Medicaid Administrative Claiming (MAC) • Assist the State in carrying out the Medicaid State plan • Time Study participants include personnel who are in direct contact with the service population

8. Who Are the Players ? • MAC Coordinator • Assistant MAC Coordinator • Time Study Participants • Signing Supervisors • Skilled Professional Medical Personnel (SPMP) is no longer a recognized distinction for MAC

9. What Are Their Roles? • MAC Coordinator & Asst. MAC Coordinator • Identifies personnel who spend a portion of their time performing administrative activities • Provide Participant and Signing Supervisor time study training • Provide ongoing technical assistance to Participants and Signing Supervisors to ensure coding accuracy throughout the fiscal year • Conduct Quality Assurance checks

10. What Are Their Roles? (cont.) • Participant • Document their activities on Worker Day Logs (WDL) • Determine which activity took the majority of time in each 15 minute increment • Code the time using uniform time study codes • Sign the WDL within 7 days from the last date on the WDL • Signing Supervisor • Review WDL to ensure that all information and coding is complete and accurate • Discuss identified errors with the participant • Supervisors cannot alter the WDL • Sign the WDL within 7 days from the last date on the WDL and after the participant has signed

11. Requirements • Time Study Periods (Federal Fiscal Quarters) 1st Quarter - October, November, December 2nd Quarter - January, February, March 3rd Quarter - April, May, June 4th Quarter - July, August, September • Time study begins the 1st day of the mid-month of the quarter or with approval by HHSC the alternative mid-month begins the 1st Monday of the mid-month • The minimum duration is 3 working days • 4th Quarter both the mid-month and alternative time studies start on the 2nd Monday of July

12. Requirements (cont.) • 1500 Valid Worker Day Logs (WDL) or 1 Month • Personnel included in the time study document their activities on WDL • One WDL is one person coding 100% of their activities for one workday, whatever the duration • 100% of the paid workday must be time studied including breaks, meals and paid leave • Do not leave gaps on the time log

13. Sample of Time Study Log

14. Sample of Time Study Log – Swing Shift

15. Who’s Included? • Persons sharing the same job functions that spend 5% or more of their normal required job duties annually performing MR Service Coordination, MH Case Management and/or Rehabilitation • Persons sharing the same job functions that spend 10% or more of their normal required job duties annually performing MAC reimbursable activities • Contract staff or First line supervisors who do either of the above

16. Who’s Not? • Clerical staff that support time studied staff but do not meet the other requirements • Generally, First-line supervisors or above • Staff that provide agency wide administrative functions (e.g., payroll, human resources) • Staff that only provide ICF-MR, HCS, MR direct service, MH vocational service, and non-Medicaid residential direct service

17. Participant Participant List • Personnel are grouped by similar job functions • Job functions are assigned to a cost pool to be used later in coding the claim • Random Sampling is prohibited – Everyone must time study

18. POLLING QUESTION

19. Let’s Get Started ! TIME STUDY CODES

20. Medicaid Covered Services • Physicians’ services • Hospital review • Clinic services for children under 21 • Limited maternity care clinics • Lab and X-ray services • Home health care • THSteps/EPSDT screens and services • Medically needed oral surgery and dentistry for adults (not routine dentistry) • Pharmacy services (prescription drugs) • Rehabilitative mental health and mental retardation services • Family planning • Services provided by licensed clinical psychologist, licensed clinical social workers, and licensed professional counselors

21. Medicaid Covered Services cont. • Comprehensive Care Program (CCP) services for children under 21 • School Health and Related Services (SHARS) • Targeted Case Management for pregnant women and children under 1 • Hearing aids and related audiologists’ services • Diagnostic assessment services for person with mental retardations and mental illness • Optometry and eyeglasses • Emergency medical services • Private duty nursing for children under 21 • Intermediate care facilities for the mentally retarded • Physical therapy • Rehabilitation services for chronic medical conditions • Hospice services • Day Activity and Health Services (DAHS)

22. Code 1: Facilitating Medicaid Eligibility Determination Code 2: Facilitating Non-Medicaid Eligibility Determinations Code 4: Medicaid Outreach Code 5: Outreach Non-Medicaid Code 6: Referral, Coordination, and Monitoring of Medicaid Svc. Code 8: Referral, Coordination, and Monitoring of Non-Medicaid Services Code 9: Medicaid Transportation and Translation Code 10: Medicaid Provider Relations MHMR Time Study Codes

23. MHMR Time Study Codes Code 11: Program Planning, Development, & Interagency Coordination Code 13: Direct Medical Service Code 14: Non-Medicaid, Other Educational & Social Services Code 15: General Administration Code 16: MR Service Coordination & MH Case Management Code 17: Rehabilitation Services Code 18: Home & Community Based Services (HCS) Code 21: Intermediate Care Facility - MR (ICF-MR) Code L: Lunch Code O: Off Codes 3, 7, 12, 19 and 20 are no longer used

24. Time Study Codes & Cost Pools MHMR Centers state wide have three distinct cost pools with corresponding Time Study codes to facilitate the claiming process Reimbursable Non Reimbursable Direct Service Codes 1, 4, 6, 9, 10, 11Medicaid Codes 2, 5 & 8 Non-Medicaid Codes 13, 14, 16, 17, 18 & 21 Code 15 is allocated among all codes used

25. Explanation: Informing and/or assisting families in becoming eligible for Medicaid including related paperwork, travel and clerical activities Examples: An intake worker assisting a family in completing the Medicaid application. A clerk putting together the packet of Medicaid eligibility forms. A bilingual interpreter obtaining insurance information at Medicaid eligibility intake Facilitating Medicaid Eligibility Code 1

26. Explanation: Informing and/or assisting families in becoming eligible for non-Medicaid services Examples: A Social Worker explaining WIC rules to a group of women at the local shelter A Case Coordinator verifying Medicaid eligibility for a family prior to apply for IHFS A MH Worker assisting a consumer enroll in literacy classes Facilitating Non- Medicaid Eligibility Code 2

27. Explanation: Extending Medicaid services or benefits to a wider section of population (potential recipients) about eligibility Examples: A Nurse speaking at a community function about early detection of health problems A Case Manager talking to a parenting group about mental illness and signs to look for in adolescents Explaining Medicaid services to inmates at a correctional facility Medicaid Outreach Code 4

28. Explanation: Extending services or benefits of programs not funded or covered by Medicaid to a wider section of population. Include related paperwork, clerical activities, or staff travel to perform these activities Examples: Scheduling a community event promoting alcohol and drug awareness Traveling to a homeless shelter to provide information about area food banks Printing brochures to hand out at the high school PTA meeting on gangs Non-Medicaid Outreach Code 5

29. Explanation: Coordinating and monitoring the completion of prescribed services, termination of services, & referral to other Medicaid svc providers to provide continuity of care Arranging for any diagnostic services which may be required as the result of a condition identified during an evaluation Gathering information that may be required in advance of these referrals or evaluations Examples: Scheduling a physician or dental appointment for a consumer Linking individuals with mental illness to crisis intervention Writing the DMR report Initial treatment planning for an individual prior to the determination of eligibility for MR Service Coordination Referral, Coordination, & Monitoring of Medicaid Covered Services Code 6

30. Examples: Making referral to Section 8 Housing A Non-MR Service Coordinator transitioning a individual from state hospital to the community Intakes & funding for In Home Family Support (IFSP) Referral to an indigent care program Explanation: Screening and making referrals for, coordinating and/or monitoring the delivery of Non-Medicaid services, or medical services not covered by Medicaid. Referral, Coordination, & Monitoring of Non-Medicaid Covered Services Code 8

31. Explanation: Assisting a consumer to obtain and/or accompanying the individual to services covered by Medicaid Obtaining translation services for the purpose of accessing Medicaid services(Including Braille, ASL, alternative languages, or due to illiteracy) Transportation provided to eligible individuals in some covered Medicaid programs is an integral part of those services and would not be Code 9 Examples: Accompanying a consumer to the doctor’s office to translate from Spanish to English the medical information between the doctor and patient Transportation from a consumer’s home to a Medicaid service & back home Waiting for a consumer to have lab work completed then transporting them home Medicaid Transportation & Translation Code 9

32. Explanation: Performing activities to secure and maintain the pool of eligible Medicaid providers Use only for external providers, not contractors that you subcontract with for Medicaid Services Notice:Code 10 Clarification available on the HHSC web site: http://www.hhsc.state.tx.us/medicaid/programs/rad/AcuteCare/TS/Code10Clarification.pdf Examples: Developing and maintaining the recruiting materials for potential Medicaid providers Explaining Medicaid policy and regulations to an adaptive equipment vendor Recruiting new Medicaid providers (HCS physicians, etc.) Medicaid Provider Relations Code 10

33. Explanation: Use by staff whose job description includes program planning, policy development or interagency coordination; including paperwork, data analysis, staff travel and clerical activities. Examples: Implementation of the Planning and Network Advisory Committee (PNAC) decisions regarding Medicaid Services Developing Medicaid policy based on critical incident data Inter-agency utilization review meetings on Medicaid services Program Planning, Development & Interagency Coordination Code 11

34. Explanation: Use by staff providing client care, treatment and/or counseling services to correct or improve a specific condition Used when there is no specific activity code for a direct service (Medicaid or Non-Medicaid) and the indirect services required to perform the activity i.e., travel or documentation Examples: QA of any direct service without a specific MAC code Calling in a prescription that is an ancillary function to the doctor’s appointment Time spent providing Rehab Services other than crisis intervention services without authorization Direct Medical Services Code 13

35. Explanation: Use for any activities which are not health related, such as employment, job training and social services, as well as Non-Medicaid health related. Examples: Transportation to apply for Section 8 Housing assistance Providing client’s family case-management like activities IHFS reports and administrative activities Appearing in court on behalf of consumer trying to maintain custody of her children Non-Medicaid, Other Educational & Social Services Code 14

36. Explanation: Paperwork/clerical not directly supporting other activity Paid time off & breaks Data entry/billing Staff meetings or board meetings Processing payroll & personnel documentation Examples: Attending or presenting training Maintaining inventory & ordering supplies Chart audits of multiple services Activities related to conducting Death Review Activities to expand non-Medicaid provider base General Administration Code 15

37. Explanation: Used by staff that provide MH Case Management & MR Service Coordination to eligible individuals There are four subdivisions to document costs: MR Service Coordination 16-A: MR – Adult and Child MH Case Management 16-B: MH – Routine – Adult Case Management 16-C: MH – Routine – Child and Adolescent Case Management 16-D: MH – Intensive – Child and Adolescent Case Management Examples: Consumer specific consultation regarding the provision of Case Management A Service Coordinator talking with a State School resident about to be placed in the community about Medicaid services available to them A Case Manager meeting with the consumer to write their Case Management Plan No Show to scheduled appointment MR Service Coordination & MH Case Management Code 16

38. Explanation: Used only by staff authorized to provide Medicaid Rehabilitative Services There are seven subdivisions to document costs: 17-A Day Program for Acute Needs 17-B Crisis Intervention Services 17-C Med Training & Support - Individual 17-D Med Training & Support – Group – Adult 17-E Med Training & Support – Group – Child & Adolescent 17-F Psychosocial Rehab Services – Individual 17-G Psychosocial Rehab Services – Group 17- J Skills Training & Development – Individual 17-K Skills Training & Development – Adult Group 17-L Skills Training & Development – Child Group Examples: A therapeutic team member: Attending a Rehabilitative Services staffing on a specific consumer Providing Group training on paying bills and talking with your landlord Meeting with an adolescent and their parents to review overdose precautions of the child’s medications Working with a consumer to learn safe cooking practices Rehabilitative Services Code 17

39. Explanation: Used only by staff authorized to provide HCS Medicaid covered services Examples of these services are: Adaptive Aids Counseling and Therapies Dental Treatment Respite Includes: Texas Home Living Svcs. Examples: Assist with housekeeping as a HCS Companion Care in someone's home Providing respite care for a consumer in their home Provide training to a consumer which will allow them to obtain or sustain paid work Assist a consumer with the process of purchasing a wheel chair ramp for their house Home & Community Based Service (HCS) Code 18

40. Explanation: Used only by staff authorized to provide ICF-MR Medicaid covered services A few examples of these services are: Dietary Direct Care Contact Physical Therapy Psychology Services Skills Training Day Programming Examples: Conducting a QA review of the ICF-MR program Psychologist conducting follow-up sessions with ICF-MR clients Vocational training at a sheltered workshop Intermediate Care Facility(ICF-MR) Code 21

41. Explanation: Un-Paid Lunch Explanation: Off duty and/or comp time used Un-paid time that may occur during your normal scheduled work day Code L Code O LUNCH OFF

42. POLLING QUESTION

43. Time Study Contacts Time Study 512-491-1715 Beverly Tackett (Lead) Alexandra Young TimeStudy@hhsc.state.tx.us Time Study Web site: http://www.hhsc.state.tx.us/medicaid/programs/rad/AcuteCare/TS/SharsTimeStudy.html

44. Need a chocolate break? 15 minutes Coming Next MAC/Direct Service Please be back on time