Transcript Kansas School District Administrative Claiming

MO HealthNet School
District Administrative
Claiming
Participant Training
Presented by MSBA Medicaid Consortium
Terminology and
Acronyms
School District Administrative Claiming = SDAC
Random Moment Sample = RMS
MO HealthNet Division = MHD
Medicaid (Federal term) = MO HealthNet
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Training and Support
Materials
www.MSBAnet.org/Medicaid/SDAC
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Training Objectives
What is Missouri School District
Administrative Claiming (SDAC)?
Why were you chosen to participate?
What is MO HealthNet?
Who is covered by MO HealthNet?
What documentation is required?
How do you fill out a RMS form?
Review of Activity Codes
WHAT IS SCHOOL BASED
MO HealthNet?
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)
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What is Missouri SDAC?
A means for Missouri school districts to receive
federal reimbursement for MO HealthNet
administrative activities such as:
outreach to the MO HealthNet & HCY
program
referrals made for health services, and
coordination of health services for students.
Why Were You Chosen?
Your school district chose you to
participate because:
as part of your routine job tasks
you provide one or more of the
reimbursable SDAC activities
to children who are MO
HealthNet eligible or potentially
MO HealthNet eligible.
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?
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.
What is MO HealthNet?
Examples of MO HealthNet / HCY Covered Services:
Hospital Services Inpatient and
Outpatient
Dental Services
Immunizations
Physical, Occupational
and Speech Therapy
Hearing Services
Home Health
Lab & X-ray
Prescription Drugs
Physician Services
Medical Supplies and
Equipment
Behavioral Services
Check Up’s
Substance Abuse
Treatment
Vision Services
Who is Covered by MO
HealthNet?
It is important to note that for
Administrative Claiming activities it is
NOT necessary to know which
children are MO HealthNet eligible.
WHAT IS SCHOOL BASED MO
HealthNet?
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
Activity Codes
You should always
include any
paperwork, clerical
work or travel time
associated with a
particular activity as
part of that activity.
What Documentation is
Required?
In order to obtain reimbursement,
staff must document the amount of
time spent on all activities.
Time is documented using a process
called Random Moment Sampling
(RMS).
What is a Random Moment
Sample or RMS?
It is a Federally accepted method .
The RMS system compiles employee
data from each participating school
district in the MSBA Medicaid
Consortium to form a sample pool.
From this pool, names are randomly
selected and paired with random
moments in time to create “random
moment samples (RMS).”
Simple Three-Step Process
Step 1: The school district’s SDAC
Coordinator distributes RMS forms to
selected personnel.
Step 2: Selected personnel complete their
RMS form at their “sample moment.”
Step 3: The completed RMS form is
returned to the district SDAC coordinator.
All three steps are critical to generating a
valid sample.
BEFORE YOU GET STARTED
ASK YOURSELF THREE
QUESTIONS!!!
What were you doing?
Who were you with?
Why were you doing this activity?
CODE 1 A
NON-MO HealthNet OUTREACH
This code should be used when
informing individuals about non-MO
HealthNet programs and how to
access them, or when describing the
range of benefits covered under
these non-MO HealthNet programs
and how to obtain them.
CODE 1 A - Examples
Non-MO HealthNet Outreach
Scheduling and promoting extra curricular
activities, sports programs, after school
programs etc…
Conducting general health education
programs,
Conducting outreach campaigns to
encourage access to social, educational, legal
or other services not covered by MO
HealthNet.
CODE 1 B
MO HealthNet / EPSDT OUTREACH
Performing activities that inform
eligible or potentially eligible
individuals about MO HealthNet &
HCY benefits and how to access
services.
CODE 1 B Examples
MO HealthNet / EPSDT Outreach
Informing children and families about the
benefits and availability of services provided by
MO HealthNet & HCY.
Providing referral assistance to families
where these services can be obtained.
Informing MO HealthNet eligible pregnant
students of the availability of HCY services.
CODE 2 A
Facilitating an Application for
Non-MO HealthNet Programs
This code should be used when assisting
an individual or family to prepare an
application for programs such as TANF,
Food Stamps, WIC, day care, legal aid,
and other social or educational programs
and when referring them to the
appropriate agency to complete an
application.
CODE 2 B
Facilitating MO HealthNet Eligibility
Determination
This code should be used when assisting
children and families to establish MO
HealthNet eligibility by:
making referrals to the Children’s Division
assisting the applicant to complete the
form,or
to collect the required information for the
application process.
CODE 2 B Examples
Facilitating MO HealthNet Eligibility
Determination
Assisting an individual or family to
complete an application for MO HealthNet /
HCY benefits.
Updating forms you receive that relate to
MO HealthNet eligibility when a child’s
circumstances change.
Providing assistance by collecting
required information.
CODE 3
School Related & Educational Services
This code should be used for any other
school-related activities that are not health
related, such as social services, educational
services, teaching services, employment and
job training.
CODE 3 Examples
School Related & Educational Services
Providing classroom instruction
Fulfilling school attendance requirements
Testing, grading papers,
Providing general supervision of students,
Improving the coordination of non-medical
activities.
CODE 4
Direct Medical Services
Use this code when providing direct
health care, treatment, and/or
counseling services including mental
health assessments and evaluations
to an individual or group in order to
correct a medical or
mental health problem.
CODE 4 Examples
Direct Medical Services
Administering first aid, a prescribed injection
or medication to a student.
Providing speech, occupational, physical
and other therapies contained in the IEP.
Performing routine or mandated child health
screens including, but not limited to: vision,
hearing, dental, scoliosis, and HCY screens.
CODE 5 A
Transportation for Non-MO HealthNet
Services
Use this code when performing
activities associated with assisting an
individual to obtain transportation to
services not covered by MO HealthNet
or when accompanying the individual
to such services.
CODE 5 A Examples
Transportation to Non-MO HealthNet
Services
Scheduling or arranging transportation to
social, vocational, and, or educational
programs and activities.
Arranging transportation for field trips,after
school programs, sports programs, etc…
CODE 5 B
Transportation-Related Activities in
Support of MO HealthNet Covered
Services
School staff should use this code when
assisting an individual to obtain transportation
to services covered by MO HealthNet. The
code does not cover the actual transportation,
but rather the administrative activities involved
in arranging and providing the transportation.
CODE 5 B Examples
Transportation-Related Activities in Support
of MO HealthNet Covered Services
Scheduling or
arranging special
transportation to MO
HealthNet covered
services, including
those received at
school.
CODE 6 A
Non-MO HealthNet Translation
School staff should use this code when
performing translation services related
to social, vocational, or educational
programs and activities.
CODE 6 A Examples
Non-MO HealthNet Translation
Face-to-face translation from one language
to another in a classroom or other setting
not related to Mo HealthNet services.
Sign-language for the deaf or the hearing
impaired when the content is not related to
Mo
HealthNet
services.
CODE 6 B
Translation Related to MO HealthNet
Services
School staff should use this code when
assisting an individual to obtain
translation services in order to receive
medical, dental or mental health
services covered by MO HealthNet.
CODE 6 B Examples
Translation Related to MO HealthNet
Services
Arranging for translation services, including
sign language, in order for a student or
family to receive MO HealthNet covered
services.
Explaining medical or other technical
terminology to a family in order for them to
properly understand MO HealthNet covered
services.
CODE 7 A
Program Planning, Policy Development &
Interagency Coordination Related to NonMO HealthNet Services
School staff should use this code when
performing activities associated with the
development of strategies to improve the
coordination and delivery of educational,
vocational and social services to students
and families.
CODE 7 A Examples
Program Planning, Policy Development &
Interagency Coordination Related to NonMO HealthNet Services
Developing strategies to increase the capacity of
after school programs, sports programs etc…
Monitoring the delivery of educational or social
services in schools.
Working with outside agencies to improve the
delivery of educational and social activities.
CODE 7 B
Program Planning, Policy Development &
Interagency Coordination Related to MO
HealthNet Services
School staff should use this code when
performing activities associated with the
development of strategies to improve the
coordination and delivery of Mo HealthNet
covered medical/dental/mental health
services to school age children, and when
performing collaborative activities with other
agencies and/or providers.
CODE 7 B Examples
Program Planning, Policy Development &
Interagency Coordination Related to MO
HealthNet Services
Developing strategies to increase the
capacity of school medical and mental
health programs.
Monitoring the delivery of medical &
mental health services in schools.
Working with outside agencies to
improve the delivery of medical &
mental health services in schools.
CODE 8 A
Non-MO HealthNet Training
School staff should use this code when
coordinating, conducting or participating in
training events and seminars that are
educational, vocational or social in nature.
CODE 8 A Examples
Non-MO HealthNet Training
Participating in, conducting or coordinating
training that improves the delivery of
educational, vocational or social programs
in the school setting.
CODE 8 B
MO HealthNet Specific Training
School staff should use this code
when coordinating, conducting or
participating in training events and
seminars for staff regarding the
benefits of the MO HealthNet / HCY
program, how to assist families to
access such services, and how to
effectively refer students for services.
CODE 8 B Examples
MO HealthNet Specific Training
Participating or coordinating
training which enhances early
identification, intervention,
screening and referral of
students with special health
needs to HCY services.
Participating or coordinating
training which improves the
delivery of MO HealthNet
services.
CODE 9 A
Referral, Coordination & Monitoring of
Non-MO HealthNet Services
School staff should use this code when
making referrals for,coordinating and / or
monitoring the delivery of educational,
vocational or social services to students.
CODE 9 A Examples
Referral, Coordination & Monitoring of NonMO HealthNet Services
Making referrals for educational, social or
disciplinary issues.
Participating in meetings or conferences
regarding a student’s educational
performance.
Monitoring and evaluating the non-medical or
educational components of a student’s IEP.
CODE 9 B
Referral, Coordination & Monitoring of
MO HealthNet Services
School staff should use this code when
making referrals for, coordinating, and / or
monitoring the delivery of medical, dental,
and mental health services to school age
children, including but not limited to
evaluations, screenings, examinations etc…
CODE 9 B Examples
Referral, Coordination & Monitoring of MO
HealthNet Services
Scheduling or coordinating referrals for
medical or mental health evaluations or
examinations,
Gathering information in advance of such
referrals or evaluations,
Participating in meetings, discussions, or
conferences with parents or other staff
regarding a student’s health services,
CODE 9 B Examples
Referral, Coordination & Monitoring of
MO HealthNet Services (continued)
Providing follow-up contact to ensure a
child has received the prescribed health
services.
Monitoring or evaluating the medical
and mental health components of the
IEP, once developed.
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CODE 10
General Administration
School staff should use this code when they
are performing general administrative
activities of the school or local school district.
CODE 10 Examples
General Administration
Reviewing district policy & procedures,
Attending staff meetings,
Breaks,
Vacation,
Sick Days,
Personal time etc…
Thank you for your
participation!
For more information please contact:
MSBA Medicaid Consortium
1-800-221-MSBA (6722)
Or visit our website at
www.MSBAnet.org/Medicaid/SDAC