MEDICAID ADMINISTRATIVE CLAIMING Staff Training

1. MEDICAID ADMINISTRATIVE CLAIMINGStaff Training

2. 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.

3. 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

4. MAC Claiming Formula • 1. Cost pool • X • 2. Medicaid eligible percentage • X • 3. Percent of allowable time (survey) • = • Your school’s total claim

5. 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

6. 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 what’s recorded. MAC SurveyHow It Works • 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

7. MESD Online Medicaid Administrative Survey

8. MESD Online Medicaid Administrative Survey

9. 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.

10. 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.

11. 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 student’s education plan or IEP • Discipline or student supervision • For social services and non-health related services

12. Code A: Activity Examples • I developed a lesson plan • I graded tests • I supervised the playground, halls, or lunch time • I discussed a student’s educational progress with a family at parent-teacher conferences • I helped a student to apply for college • I assisted in evaluating a textbook

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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 student’s need for health related services covered by OHP • I spoke with a student’s 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

19. 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

20. 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 student’s 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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 provider’s services – code C1

29. 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.

31. 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 time—otherwise will default to code A: other • Part-time employees survey only paid time worked on the day of survey

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

33. Local MAC Coordinator and Contacts

34. Questions