Transcript MEDICAID ADMINISTRATIVE CLAIMING Train The Trainers

Medicaid Administrative
Claiming
Train-The-Trainers
Workshop
Welcome to Medicaid Administrative
Claiming (MAC)
• The Medicaid Administrative Claiming program is
being implemented through a partnership
between:
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The Department of Human Services (DHS)
Your ESD
Local School Districts
Multnomah Education Service District (MESD)
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
What is Medicaid
Administrative Claiming ?
• Medicaid Administrative Claiming is a survey
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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.
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
Building Trainer Responsibilities
• Attend a two hour MAC train-the-trainers workshop.
• Following direction from District MAC Coordinator,
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schedule training with staff who have been chosen to
take the MAC survey each survey period.
Provide staff training using training tools/materials
provided by your MAC Coordinator.
Require staff to sign the training sign in sheet. Following
the training, return the sign in sheet according to your
district process.
Be available as the first contact on the survey date.
Follow-up with any questions or concerns you have with
your District MAC Coordinator.
Resource Materials
• Medicaid Administrative Claiming Power Point
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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 FAQ’s
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
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
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
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
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
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
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
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.
Ten Activity Codes
• A. School-Related and Educational Activities,
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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
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.
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 student’s education plan or IEP
discipline or student supervision
social services and non-health related
services
Code A: Activity Examples
• I developed a lesson plan.
• I graded tests.
• I supervised the playground, halls, or lunch
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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.
I attended an IEP team meeting
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
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
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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).
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
Code B-2: Activity Examples
• I informed a student/family about general health
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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.
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
Code C-1: Activity Examples
• I referred a student to medical, dental or mental health
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care covered by Medicaid (C1.1).
I participated in a meeting/discussion to coordinate or
review a student’s need for health related services
covered by OHP(C1.2).
I spoke with a student’s 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).
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
Code C-2: Activity Examples
• I participated in IDEA training or other education
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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.
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
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).
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 nonMedicaid/OHP services
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.
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
Code E-1: Activity Examples
• I helped develop strategies to increase the
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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).
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 nonmedical/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
Code E-2: Activity Examples
• I developed strategies to increase the capacity
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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 nonhealth activity.
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 counseling services
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.
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 time—otherwise the
survey will default to Code A: other
• Part-time employees only code the portion
of the day they are paid
Documentation to Support
Claimable Activities
• When completing documentation to support
claimable Medicaid Administrative Claiming
(MAC) activities, it should be:
– Brief;
– Concise;
– Use descriptive words (For example, use the code
descriptions in the MAC provider manual as your
guide such as referred, coordinated, monitored,
etc.); and
– Only provide information pertinent to the claimable
activity that was performed.
Documentation Examples
• POOR EXAMPLE
A student with diabetes presented signs of low blood sugar, tested
himself and was found to have a low blood sugar level. I referred
student to the RN to assess the blood sugar level and provide an
injection as needed. The nurse assessed the test results and gave
the student the appropriate injection. I monitored the student for
15 minutes to ensure no adverse reactions occurred.
• GOOD EXAMPLE
– C1.1 – I referred a student to the RN to receive an insulin
injection as needed.
– C1.3 – I monitored the student for 15 minutes afterward to
ensure no adverse reactions occurred.
Are Trainings Claimable?
• Participation in some trainings is claimable
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under code C1. The premise for claiming
trainings is that they fit within the
following description:
This code may also be used when
coordinating and participating in training
events and seminars for outreach
regarding the benefits of the
Medicaid/OHP program, how to assist
families to access Medicaid/OHP services,
and how to more effectively refer students
for services.
Examples of Claimable
Trainings
• Participating in a MAC training (Note: This does not include
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instructions on how to complete a survey form or the web-based
survey.)
Attending a seminar on how to effectively provide OHP outreach to
pregnant and parenting teens
Participating in a training to learn how to assist potential OHP
clients in completing an OHP/CHIP application
Participation in the portion of a training that focuses on
recognition of signs & symptoms of specific medical conditions.
Examples of the portion of trainings that may be allowable:
– Training to recognize signs and symptoms of potential suicide
risk
– Training to recognize the signs and symptoms of Autism
– NOTE: Most trainings to identify signs and symptoms are not
claimable in their entirety, such as the portion dealing with the
district policies and protocols.
Examples of
Non-Claimable Trainings
• Participating in a First Aid Training
• Participating in an EPI Training
• Attending a lecture on IDEA Reauthorization:
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How the changes will affect district and health
agencies in disciplining students with disabilities
Participating in a seminar on “Strategies to keep
kids in school and lower problem behaviors for
students on IEP’s”
Bloodbourne Pathogens Training
NOTE: Trainings whose sole purpose are to assist
in the improvement of professional skills or
development are not claimable.
Who do I contact if I need technical
assistance?
• 1) The MAC Trainer in your building:
• ________________________________
• 2) The MAC Coordinator for your
district/ESD:
• ________________________________
• 3) The MESD Medicaid Facilitator:
• Wendy Chase – [email protected]
503-257-1775
Taking the Survey
• Web address:
http://www.mesd.k12.or.us/mac/
QUESTIONS