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Medicaid Administrative Claiming Guide

FFY 2006 (Revised October 2005)

Disclaimers

The Medicaid Administrative Claiming Guide is not intended to be the final word where issues of billing are concerned. Personnel should always refer to the rules and program manuals regarding the provision and billing of services. This would include, but is not limited to, MR Service Coordination, MH Case Management, Rehabilitative Services, Waiver Services, and ICF-MR services. Changes of content between the FFY 2003 Medicaid Administrative Claiming Guide and the FFY 2004 Medicaid Administrative Claiming Guide will be indicated in blue text. Blue text does not mean that information is more important than text in black. The blue text is indistinguishable from the black text if submitted to a non-color printer. Clarifications/corrections made to the original FFY 2004 October 2003 Medicaid Administrative Claming Guide have been updated and made in red text. Red text does not mean that information is more important than text in blue or black. The red text is indistinguishable from the black or blue text is submitted to a non-color printer. Changes of content between the FFY 2004 Medicaid Administrative Claiming Guide and the FFY 2005 Medicaid Administrative Claiming Guide will be indicated in green. Use of the term “Service Coordination” for persons with Mental Retardation includes those consumers receiving Texas Home Living Service Coordination. Green text does not mean that information is more important than text in red, blue or black. The green text is indistinguishable from the black or blue text from other text if submitted to a non-color printer. Changes of content between the FFY 2005 Medicaid Administrative Claiming Guide and the FFY 2006 Medicaid Administrative Claiming Guide will be indicated in pink. Pink text does not mean that information is more important than text in red, blue, black or green. The pink text is indistinguishable from the other color of text if submitted to a non-color printer. Clarifications/corrections made to the Medicaid Administrative Claiming Guide FFY 2006, have been updated and made in teal text. Teal text does not mean that information is more important than text in blue or black. The teal text is indistinguishable from the black or blue text is submitted to a non-color printer.

Issue Date: September 2005 Revised: October 2005

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Table of Contents CHAPTER 1 Introduction to Medicaid Administrative Claiming ............................................. 7

Section 1.1 What is Medicaid Administrative Claiming? .................................................... 7 Section 1.2 Medicaid Administrative Claiming ................................................................... 8

CHAPTER 2 What Needs to Happen Before a Time Study ................................................... 9 Section 2.1 Agreements........................................................................................................ 9 Section 2.2 Required Personnel............................................................................................ 9 Section 2.3 Responsibilities for the Local Agency Medicaid Administrative Claiming

Coordinator......................................................................................................... 9 2.3.1 AGREEMENTS ........................................................................................................... 9 2.3.2 INFORMATION FLOW ................................................................................................ 9 2.3.3 POLICY ................................................................................................................... 10 2.3.4 REVIEWS ................................................................................................................ 10 2.3.5 TRAINING ............................................................................................................... 10 2.3.6 CLAIMS .................................................................................................................. 10 2.3.7 GENERAL................................................................................................................ 10

Section 2.4 Medicaid Administrative Claiming Mandatory Participation Requirements.. 11 2.4.1 MAC MANAGEMENT ............................................................................................. 11 2.4.2 AGREEMENTS ......................................................................................................... 11 2.4.3 MONITORING AND OVERSIGHT............................................................................... 11

2.4.3.1 Department Responsibilities ................................................................... 11 2.4.3.2 Local Agency’s Responsibilities............................................................. 12 2.4.3.3 Maintenance of Records.......................................................................... 12 2.4.3.4 Participation in Department Reviews and Federal Audits ...................... 12

Section 2.5 Implementation Plan........................................................................................ 13 2.5.1 GUIDELINES............................................................................................................ 13 2.5.2 SUBMISSIONS AND REVISIONS ................................................................................ 14 2.5.3 CONTENT................................................................................................................ 14

Section 2.6 Who’s In and Who’s Out................................................................................. 18 2.6.1 PERSONNEL INCLUDED IN TIME STUDIES ............................................................... 18 2.6.2 PERSONNEL EXCLUDED FROM TIME STUDIES......................................................... 19 2.6.3 ADDITIONAL GUIDELINES ...................................................................................... 19

Section 2.7 Training ........................................................................................................... 20 2.7.1 CERTIFICATION OF THE LOCAL AGENCY MAC COORDINATORS AND LOCAL AGENCY

ASSISTANT MAC COORDINATORS.......................................................................... 20 2.7.2 REQUIRED ATTENDANCE OF THE LOCAL AGENCY MAC COORDINATORS AND LOCAL

AGENCY ASSISTANT MAC COORDINATORS ........................................................... 20 2.7.3 TECHNICAL ASSISTANCE FOR THE LOCAL AGENCY MAC COORDINATORS............ 21 2.7.4 LOCAL AGENCY TIME STUDY PERSONNEL............................................................. 21 2.7.5 HELPFUL TRAINING TIPS ........................................................................................ 22

CHAPTER 3 A Basic Description of a Time Study.................................................................. 23

Section 3.1 Defining A Time Study ................................................................................... 23


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Section 3.2 Time Study Worker-Day Logs ........................................................................ 24 3.2.1 USING THE UNIFORM TIME STUDY CODES ............................................................. 25

Section 3.3 What Time Should Be Studied ........................................................................ 26 Section 3.4 Time Study Start Dates and Criteria................................................................ 27

3.4.1 TIME STUDY START DATES.................................................................................... 27 3.4.2 ALTERNATIVE TIME STUDY START DATE .............................................................. 27 3.4.3 MID-MONTH TIME STUDY START DATE ................................................................ 27

Section 3.5 Instructions for Completing the Alternative and the Manual Time Study Log28 3.5.1 GENERAL INSTRUCTIONS CONCERNING THE ALTERNATIVE AND THE MANUAL TIME

STUDY LOG............................................................................................................. 28 3.5.2 ..SPECIFIC INSTRUCTIONS (FROM LEFT TO RIGHT) ON THE MANUAL TIME LOG FORM 30 3.5.3 SPECIFIC INSTRUCTIONS (FROM LEFT TO RIGHT; FRONT TO BACK) ON THE ALTERNATIVE

TIME LOG FORM ..................................................................................................... 31 3.5.4 QUALITY ASSURANCE CHECKS .............................................................................. 32

Section 3.6 Skilled Professional Medical Personnel .......................................................... 32 3.6.1 BACKGROUND AND AUTHORIZATION FOR SPMP................................................... 33 3.6.2 THE STANDARD FOR DETERMINING SPMP ............................................................ 33 3.6.2.1 EMPLOYER-EMPLOYEE RELATIONSHIP ....................................................... 34 3.6.2.2 PROFESSIONAL EDUCATION AND TRAINING ................................................ 33 3.6.2.3 JOB FUNCTION............................................................................................. 34

Section 3.7 Authorization for Directly Supporting Clerical Personnel.............................. 34 Section 3.8 Skilled Professional Medical Personnel Documentation ................................ 35

3.8.1 SPMP..................................................................................................................... 35 3.8.2 SPMP CLERICAL SUPPORT..................................................................................... 36

Section 3.9 The Codes........................................................................................................ 36 3.9.1 CODES 11 AND 12................................................................................................... 36 3.9.2 THE SPMP CODES - 75% MATCH .......................................................................... 37 3.9.3 CODES FOR ALL STAFF (SPMP AND NON-SPMP) - 50% MATCH ........................... 36

CHAPTER 4 Submitting a Claim After the Time Study .......................................................... 38

Section 4.1 A General Description of the Texas Medicaid Administrative Claiming Cost Allocation Plan ................................................................................................. 38

Section 4.2 Time and Expenditure Entry ........................................................................... 39 4.2.1 FOR TIME STUDY PERSONNEL – SPMP AND NON-SPMP....................................... 39

4.2.1.1 Salaries and Fringe Benefits.................................................................... 39 4.2.1.2 Direct Program Support Salaries and Benefits........................................ 40 4.2.1.3 Travel and Training................................................................................. 40 4.2.1.4 Operating Costs....................................................................................... 40

4.2.2 FOR UNSTUDIED PERSONNEL AND PROGRAMS....................................................... 41 4.2.2.1 Salaries and Benefits ............................................................................... 41 4.2.2.2 Travel and Training and Operating Costs ............................................... 41 4.2.2.3 Unallowable Costs .................................................................................. 41

4.2.3 GENERAL ADMINISTRATIVE COSTS........................................................................ 41 4.2.3.1 Salary and Benefits, Travel and Training and Operating Costs.............. 41

Section 4.3 Revenues.......................................................................................................... 42 4.3.1 RECOGNIZED REVENUES ........................................................................................ 42


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4.3.2 UNRECOGNIZED REVENUES.................................................................................... 43 4.3.3 FEDERAL FINANCIAL PARTICIPATION RATE ........................................................... 44

Section 4.4 Determining the Medicaid Percentage ............................................................ 44 4.4.1 OVERVIEW ............................................................................................................. 44 4.4.2 CALCULATING THE MEDICAID PERCENTAGE.......................................................... 44 4.4.3 METHODOLOGY...................................................................................................... 44 4.4.4 MEDICAID PERCENTAGE......................................................................................... 45

Section 4.5 Direct Charge................................................................................................... 45 Section 4.6 Calculating the Claim...................................................................................... 46 Section 4.7 Quarterly Summary Invoice ............................................................................ 46 Section 4.8 MAC Claim Desk Review............................................................................... 46

Chapter 5 Maintenance ........................................................................................................ 48

Section 5.1 Record Keeping and Documentation............................................................... 48 Section 5.2 Reviews ........................................................................................................... 49 Section 5.3 Local Agency MAC Coordinator’s Quarterly Status Report to CEO/ED....... 50 Section 5.4 Annual Self-Evaluation Report ....................................................................... 50 Section 5.5 Annual Report ................................................................................................. 51

Chapter 6 Medicaid Administrative Claiming Time Study Codes ..................................... 53

MEDICAID-COVERED SERVICES....................................................................................... 54 CODE 1: FACILITATING MEDICAID ELIGIBILITY DETERMINATION (ALL STAFF)55 CODE 2: FACILITATING NON-MEDICAID ELIGIBILITY DETERMINATIONS (ALL

STAFF) .................................................................................................................. 56 CODE 3: MEDICAID OUTREACH (SPMP) ....................................................................... 57 CODE 4: MEDICAID OUTREACH (ALL STAFF) ............................................................. 59 CODE 5: OUTREACH NON-MEDICAID (ALL STAFF) ................................................... 61 CODE 6: REFERRAL, COORDINATION, AND MONITORING OF MEDICAID SERVICES

(ALL STAFF) ........................................................................................................ 62 CODE 7: REFERRAL, COORDINATION, AND MONITORING OF MEDICAID SERVICES

(SPMP)................................................................................................................... 66 CODE 8: REFERRAL, COORDINATION, AND MONITORING OF NON-MEDICAID

SERVICES (ALL STAFF)..................................................................................... 67 CODE 9: MEDICAID TRANSPORTATION AND TRANSLATION (ALL STAFF)......... 69 CODE 10: MEDICAID PROVIDER RELATIONS (ALL STAFF)........................................ 70 CODE 11: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY

COORDINATION (ALL STAFF)......................................................................... 72 CODE 12: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY

COORDINATION (SPMP) ................................................................................... 74 CODE 13: DIRECT MEDICAL SERVICES (ALL STAFF) .................................................. 75 CODE 14: NON-MEDICAID, OTHER EDUCATIONAL AND SOCIAL SERVICES (ALL

STAFF) .................................................................................................................. 77 CODE 15: GENERAL ADMINISTRATION (ALL STAFF) ................................................. 79 CODE 16: MR SERVICE COORDINATION AND MH CASE MANAGEMENT SERVICES

(MEDICAID - COVERED SERVICES) ............................................................... 81 CODE 17: REHABILITATIVE SERVICES (MEDICAID - COVERED SERVICES).......... 88


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CODE 18: HOME AND COMMUNITY BASED SERVICES (HCS)/TEXAS HOME LIVING

SERVICES (TXHML)................................................................................................ 90 CODE 19: NO LONGER USED AFTER 09/01/03 ................................................................ 91 CODE 20: NO LONGER USED AFTER 04/01/98 ................................................................. 91 CODE 21: INTERMEDIATE CARE FACILITY - MR (ICF-MR) ......................................... 91 CODE L: LUNCH (ALL STAFF).......................................................................................... 92 CODE O: OFF (OFF DUTY, COMP-TIME USED) ...................................................................... 92

Chapter 7 Forms, Checklists and Examples ........................................................................ 93

MAC and TAFI Contacts List ............................................................................................. 94 Implementation Plan Checklist............................................................................................ 95 Current Manual Worker-Day Logs...................................................................................... 99 Skilled Professional Medical Personnel (SPMP) Survey .................................................. 100 Quarterly Summary Invoice (QSI) Checklist .................................................................... 101 Quarterly Summary Invoice Medicaid Administration ..................................................... 102 Agency Review File Checklist .......................................................................................... 103 Skilled Professional Medical Personnel (SPMP) Review File Checklist.......................... 104 Time and Financial Information (TAFI) Audit File Checklist .......................................... 104 Agency Medicaid Administrative Claiming Annual Report ............................................. 105

Example Annual Report............................................................................................... 108 Chapter 8 Helpful Optional Tools for Medicaid Administrative Claiming....................... 109

Technical Assistance ......................................................................................................... 109 Training Addendum for Supervisors ................................................................................. 110 Internal Quality Validation ............................................................................................... 111 MAC Who’s In and Who’s Out Policy Flowchart ............................................................ 112 SPMP Flowchart ................................................................................................................ 113 MAC Claim Desk Review Form ...................................................................................... 115 Documents-At-A-Glance ................................................................................................... 115

Acronyms Used in the MHMR Service System ......................................................................... 119


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CHAPTER 1 Introduction to Medicaid Administrative Claiming The federal government permits state Medicaid agencies to claim reimbursement for activities performed that are necessary for the “proper and efficient administration” of the Texas State Medicaid Plan. The Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration or HCFA, historically has provided limited latitude to states in determining the activities for which they may seek reimbursement. Over time, CMS has identified a series of activities that must be claimed administratively through Medicaid Administrative Claiming (MAC). Among these are outreach, utilization review, eligibility determination and activities that determine a consumer's need for care. Federal language has made it clear that the range of activities allowable under MAC is not limited to those identified by CMS in the Texas State Medicaid Plan. As the Medicaid authority for Texas, the Texas Health and Human Services Commission (HHSC) has contracted with Early Childhood Intervention (ECI), Texas Department of Health (TDH), Texas Education Agency (TEA), and the Texas Department of Mental Health and Mental Retardation (TDMHMR) and, through them, local agencies. The purpose of these contracts is to assist HHSC in administering the Texas State Medicaid Plan in the most effective manner possible. HHSC establishes all MAC requirements and has contracted with these state and local agencies to implement MAC. The common interest of HHSC and the state and local agencies is to ensure more effective and timely access to care by individuals and the most appropriate utilization of Medicaid-covered services. Promoting activities and behaviors that reduce the risk of poor health and poor outcomes for the state's most vulnerable populations is also a major consideration. Local agencies participating in MAC for the first time must comply with requirements set forth by HHSC and the department before participating in MAC. Current local agencies must review all the requirements of MAC annually and make any necessary changes to ensure HHSC and the department of their compliance on a continual basis.

Section 1.1 What is Medicaid Administrative Claiming? MAC is a reimbursement methodology to draw down federal matching funds (also known as Federal Financial Participation [FFP]) for Medicaid outreach and administrative activities (e.g., paperwork, phone calls) prior to enrollment into health related medical services. For the purpose of MAC, health related medical services include: medical health, mental health (MH), limited dental health, and limited substance abuse treatment. The medical services available within each category are restricted to services covered by the Texas State Medicaid Plan. For a list of the most frequently used medical services see the list of Medicaid covered services in Chapter 6. The FFP rate is 50% with an enhanced FFP rate of 75% available for some services offered by skilled professional medical personnel (SPMP). The following graphically displays and contrasts the differences in Medicaid reimbursement for direct services and MAC.


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DIRECT SERVICES

ADMINISTRATIVE CLAIMING

FUNCTION Provision of and access to health related and other services

Activities that support the provision of health related services

PROVIDER Requires certain service provider qualifications

Potentially all personnel can participate

PAYMENT METHOD Has calculated rates Cost-based reimbursement OBLIGATION TO CMS State plan amendment Cost Allocation Plan (CAP) FEDERAL MATCH FFP 62% FFP 50% or 75% for SPMP

Section 1.2 Medicaid Administrative Claiming For the department, MAC has two purposes: reimbursement of administrative activities and rate setting for MR Service Coordination Services, MH Case Management Services and Rehabilitative Services. Both purposes are addressed through the utilization of time studies. The time study requires personnel to document 100% of their work time in 15-minute increments using specific activity codes. The time study log does not show who received the activity or where the activity occurred. For the reimbursement of administrative activities, the time study is used to determine the claimability of the outreach and administrative activities and to allocate their costs to the appropriate funding source. MAC reimbursement claims are produced by using the Time and Financial Information (TAFI) and are based on the time study codes. The MAC reimbursement claim is filed according to the federal fiscal quarters and is calculated as follows: Total costs for personnel to be claimed X Percentage of allowable time, based on time studies X Percentage of all persons served who are Medicaid recipients X 50% or 75% federal match, as appropriate = Total Claim

For rate setting, the time study captures time spent in indirect and administrative activities that support the provision of MR Service Coordination Services, MH Case Management Services and Rehabilitative Services. The TAFI uses the information collected through the time study to determine the actual costs of providing the services. This information is then used as the cost basis for calculating the rates for the two services. Participating in MAC for the reimbursement of administrative activities is voluntary. Medicaid providers of MR Service Coordination Services, MH Case Management Services and Rehabilitative Services must participate in MAC for rate-setting purposes.

Back to Table of Contents Issue Date: September 2005

Revised: October 2005

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CHAPTER 2 What Needs to Happen Before a Time Study Section 2.1 Agreements HHSC and the department must be assured that the local agency is capable of administering MAC. The agreement between the department and the local agency includes a description of general responsibilities, Medicaid administration, fiscal provisions, amendments, and terms. Agreement continuation will be dependent on maintaining compliance on an ongoing basis with the agreement and the attachments. Local agencies participating in MAC, as a result of the agreement with the department, may enter into sub-agreements with their own contractors or local programs for the performance of reimbursable MAC activities. This is acceptable only when the Medicaid activities the local agencies perform are supported with public funds.

Section 2.2 Required Personnel Each local agency must designate an employee as the Local Agency MAC Coordinator. This single individual is designated within a local agency to provide oversight for the implementation of MAC and to ensure that policy decisions are implemented appropriately. The local agency must also designate a Local Agency Assistant MAC Coordinator to provide back-up support for MAC responsibilities. The local agency must designate a MAC reimbursement claims expert for the TAFI as the Primary TAFI Preparer. The local agency must also designate a Secondary TAFI Preparer to provide secondary support for TAFI.

Section 2.3 Responsibilities for the Local Agency Medicaid Administrative Claiming Coordinator

The core responsibilities listed below have been developed for the Local Agency MAC Coordinator and must be a part of the personnel's job description. The Local Agency Assistant MAC Coordinator’s job description must have their specific MAC job duty responsibilities listed as well. 2.3.1 Agreements

1. Maintains MAC agreements with the department. 2. Ensures the processing of contracts, agreements, or memoranda of understanding with any

contractors participating in MAC. 2.3.2 Information Flow

1. Receives all correspondence and requests for information regarding MAC from the department (e.g., Implementation Plan and MAC Annual Report) or TAFI from HHSC.

2. Ensures that all programs or contractors claiming reimbursement through MAC receive copies of applicable correspondence.


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2.3.3 Policy

1. Ensures agency or program and contractor instructions are clear (and based on information contained in the current Medicaid Administrative Claiming Guide) and consistent with the department MAC policy.

2. Ensures that personnel in the time study, time study formats, the designation of SPMP, authorization of code 11/12 use, methodologies used to determine the percentage of Medicaid recipients, methods for constructing a claim and methods for establishing an audit trail in compliance with the department and HHSC policy.

3. Assists time study personnel and their supervisors, quality assurance (QA) personnel, and other personnel involved in the time study in defining their roles and responsibilities.

4. Disseminates policy or program information to all programs and contractors participating in MAC.

5. Clarifies policy, program or fiscal questions raised by personnel or contractors; refers any requests for assistance or further clarification to the department or HHSC as appropriate.

2.3.4 Reviews

1. Develops guidelines for establishing and maintaining supporting documentation and local agency review files in a manner that is consistent with procedures outlined by the department.

2. Establishes and maintains all required documentation; conducts periodic reviews to ensure that files are current.

2.3.5 Training

1. Attends all required training and successfully completes all competency tests. 2. Identifies training needs among local agency personnel. 3. Ensures that training is provided to maintain compliance with the procedures established in the

current Medicaid Administrative Claiming Guide. 4. Notifies the department MAC Coordinator of needs for statewide or regional training.

2.3.6 Claims

1. Uses the Quarterly Summary Invoice (QSI) Checklist to ensure that MAC reimbursement claims are consistent with current Medicaid Administrative Claiming Guide criteria before they are submitted to the department and HHSC.

2. Ensures that the methodology used to calculate the Medicaid percentage has been properly applied.

3. Obtains any information that may be requested by the department and/or HHSC about the MAC reimbursement claim.

4. Oversees the processing of any MAC reimbursement claim amendments needed to revise the maximum claiming amount.

2.3.7 General

1. Ensures no duplicate billings occur within the local agency. 2. Encourages interdepartmental coordination and cooperate to improve program efficiency and

effectiveness.


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Section 2.4 Medicaid Administrative Claiming Mandatory Participation Requirements

Local agencies participating in MAC must meet all participation requirements. HHSC establishes all MAC requirements to implement MAC. The purpose of MAC is to assist eligible and potentially eligible Medicaid individuals in accessing services covered by the Medicaid program by using activities such as outreach, referral, case coordination, and monitoring. New local agencies must comply with the participation requirements before participating in MAC. Current local agencies participating in MAC must review their present programs, make any necessary adjustments and ensure HHSC of compliance with all participation requirements. The participation requirements include the following components: 2.4.1 MAC Management The Local Agency MAC Coordinator will receive all correspondence and requests for information on MAC for their local agency (e.g., Implementation Plan and MAC Annual Report). The Local Agency MAC Coordinator must ensure all participation requirements are met. The Local Agency MAC Coordinator must ensure that all time study personnel receive thorough and comprehensive training on MAC and the time study codes prior to each time study. The Local Agency MAC Coordinator issues local agency policy and procedures, ensures accurate and verifiable time study logs, ensures accurate claim preparation within designated timeframes, maintains documentation in support of claims, monitors agreement compliance, and coordinates internal and external MAC activities. 2.4.2 Agreements The agreement between the local agencies and the department must be approved and in place prior to participation in MAC. A standard local agreement is included with the agreement between HHSC and .the department. Each agreement with the local agency must be in effect the first day of the quarter in which the initial time study is initiated. Continuation of the agreement will be dependent on maintaining compliance on a continual basis. 2.4.3 Monitoring and Oversight

2.4.3.1 Department Responsibilities The department is responsible for ensuring that the local agencies are complying with the MAC participation requirements. The department is responsible for ensuring that each MAC reimbursement claim submitted from the local agencies is accurate with the necessary back-up documentation before reimbursing the claim. The claim cannot be considered accurate unless each time study participant has accurately completed all time study logs and there is documentation that the participant received the required training prior to participation in each quarterly time study.


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2.4.3.2 Local Agency’s Responsibilities The local agency must follow its approved Implementation Plan, which includes policies and procedures for monitoring and oversight of MAC. The following activities must be examined:

1. Training and follow-up training on the time study codes and detailed documentation of all training.

2. Detailed reviews of each time study log. 3. Follow up interviews and individual training sessions with all local participants in the

time study who submitted an incorrect time study log. 4. Detailed reviews and checks on each claim and back-up documentation submitted to the

department.

The Local Agency MAC Coordinator must take immediate action to correct any findings that impact the accuracy of the time study and claim. For example, if the Local Agency MAC Coordinator finds that certain personnel in the time study are not performing Medicaid administrative activities, MR Service Coordination Services, MH Case Management Services, and/or Rehabilitative Services, the time study logs for those personnel are not to be included in the claim and subsequent time studies. See the policy regarding Who’s In and Who’s Out in Section 2.6 for more details. The Local Agency MAC Coordinator is responsible for the accuracy of the information in TAFI and the accuracy of the claim. (See Sections 2.3.3 and 2.3.6.) It is the TAFI Preparer’s responsibility to ensure the information in TAFI balances to the local agency’s general ledger.

2.4.3.3 Maintenance of Records The Local Agency MAC Coordinator must maintain required documentation to support the development and submission of each claim to CMS. The Local Agency MAC Coordinator will ensure that time study personnel have documentation to support the time study with enough detail to describe the activities performed during the time study. The Local Agency MAC Coordinator will establish and maintain files on each submitted claim that conforms to the Agency Review File content as listed in the Implementation Plan and the current Medicaid Administrative Claiming Guide. The Local Agency MAC Coordinator will complete and enter summary self-evaluation reports of required MAC performance reviews to the Agency Review File on at least an annual basis. The Local Agency MAC Coordinator will conduct periodic reviews (at least annually) to ensure that files are current, complete, accessible, and secure. For the required Agency Review File, SPMP Review File, and TAFI Audit File Checklists, see Chapter 7. 2.4.3.4 Participation in Department Reviews and Federal Audits

1. The department MAC Coordinator must:

a) Ensure that the local agency understands the importance and seriousness of a federal audit and a department review.

b) Assist the federal or state personnel in coordinating the audit/review, obtaining the necessary documentation in advance, scheduling, etc.

c) Compile findings of the audit/review and prepare a written report for the local agency with a copy for HHSC. The report must include a summary of the findings and the corrective


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actions needed.

2. Local Agency MAC Coordinator must: a) Ensure that the local agency cooperates completely with federal audits and department

reviews. b) Ensure that personnel selected for interviews are available to the auditors/reviewers. c) Provide federal and department personnel with the requested documentation in a timely

manner. d) Provide federal and department personnel with a MAC overview with an emphasis on the

training provided to the time study personnel and the local monitoring of the time studies to ensure the time studies are accurate.

e) Accept the findings and must implement corrective actions needed as a result of the review.

f) Provide a written plan of correction (POC) within 14 days of receiving the MAC Report, if required.

g) Submit evidence supporting the POC within 60 days of the end date of the review, if required.

Section 2.5 Implementation Plan

2.5.1 Guidelines Local agencies participating in MAC are required by the Medicaid Administrative Claiming Mandatory Participation Requirements to complete an annual Implementation Plan. The Implementation Plan must be approved by the department MAC Coordinator, prior to reimbursement to local agencies for any claims submitted. The local agency must follow its approved Implementation Plan, which includes policies and procedures for monitoring and oversight of MAC. Continued approval of the Implementation Plan is based on evidence obtained during reviews. The Local Agency MAC Coordinator is responsible for the overall organization and management of MAC at the local level and must ensure that the HHSC mandatory participation requirements and department requirements are met. The Implementation Plan Checklist in Chapter 7 is a good tool for the Local Agency MAC Coordinator and is used for review by the department. Any new local agency wishing to enter into MAC must have an approved plan in place prior to participation in MAC. The Implementation Plan must be descriptive enough so that the local agency can ensure that there is a local system in place that organizes and manages MAC, in a manner acceptable to HHSC and the department. Once approved, Implementation Plans remain in effect for one year, unless a revision must be made. (See Section 2.5.2 for details regarding required revisions.) The effective dates are July 1 through June 30. Implementation Plans are renewable prior to the expiration date, but the effective end date (i.e., June 30) remains the same. (See Section 2.5.3, X. for more information regarding the effective dates and required content.) See Chapter 7 for the Implementation Plan Checklist.


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2.5.2 Submissions and Revisions The Implementation Plan is to be submitted by June 15th of each year. Should the 15th fall on a weekend or a holiday, the Implementation Plan will be due on the next working day. If the Implementation Plan is not received by the June 15th due date, the local agency’s claim will be deferred until the next resubmission quarter. The first page and the signature page of the Implementation Plan must be submitted on local agency letterhead. At a minimum, the signature page must include the name, signature date, and signature of the local agency Chief Executive Officer (CEO) or Executive Director (ED), Local Agency MAC Coordinator, Local Agency Assistant MAC Coordinator, TAFI Preparer, Assistant TAFI Preparer, Chief Financial Officer (CFO), and any other designated personnel with direct responsibility for MAC. Continued approval of the plan is based on the results of MAC reviews. Send all Implementation Plans to:

Department of Aging and Disability Services

Medicaid Administrative Claiming P.O. Box 149030

Austin, Texas 78714-9030 A revised local agency Implementation Plan must be submitted to the department MAC Contract Technician within 30 days of changes in: Key personnel - as indicated in the “Authorizing Signatures” of the Implementation Plan (i.e.,

CEO/ED, the Local Agency MAC Coordinator, Local Agency Assistant MAC Coordinator, TAFI Preparer, Assistant TAFI Preparer, CFO, and any other designated personnel with direct responsibility for MAC);

Local agency name; Local agency physical address, or Substantive changes in how MAC is implemented at the local agency (e.g., how training is done,

who is conducting the training, quality assurance procedures, switch from manual logs to automated logs, etc.).

2.5.3 Content All of the following sections must be addressed in the Implementation Plan. Each section must be addressed completely and in the order presented below. If a section does not apply, there must be documentation in the section explaining why that section does not apply.

I. Local Agency MAC Coordinator The Local Agency MAC Coordinator is responsible for the overall organization and management of MAC at the local level and will ensure all MAC participation requirements are met. The Implementation Plan must include a detailed job description of the Local Agency MAC Coordinator and an organizational chart of the local agency, which identifies where and to whom the Local Agency MAC Coordinator is assigned. The Local Agency MAC Coordinator is


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responsible for all required and necessary revisions and resubmissions of the Implementation Plan. (See Section 2.5.2 for more information regarding revisions of the Implementation Plan.) The name, address, telephone number, fax number, and email address of the Local Agency MAC Coordinator must be listed in the Implementation Plan. The functions of other individuals who are responsible for the time study or preparation of the claim, their functions must be indicated along with their names, addresses, telephone numbers, fax numbers, and email addresses. This would include the Local Agency Assistant MAC Coordinator, the TAFI Preparer, and the Assistant TAFI Preparer at a minimum. II. Service Programs Involved in the Time Study The service programs within the local agency whose personnel will be participating in the time study must be listed. III. Time Study Personnel The Implementation Plan must include a list of each classification of personnel, the approximate number of personnel, and a list of allowable MAC activities. The MAC code specific to the activity and the estimated percentage of time spent on each activity must be indicated. Describe any activities that could be completed by contract personnel in the same manner as above. Personnel hired within 30 days of the of the first day of the next time study are not required to complete that quarter’s time study. The Implementation Plan must indicate whether or not personnel hired within 30 days of a time study will or will not be included in that quarter’s time study. See Section 2.6.3 for more information regarding this policy. If acronyms are used in the job titles or classifications, the Implementation Plan must include a listing of all of the acronyms used with the corresponding complete job title or classifications. IV. Skilled Professional Medical Personnel List any job classifications that qualify for SPMP. Include the number of personnel in each position who will be designated SPMPs. The responsibility for determining if personnel meet the qualifications to participate as an SPMP lies with the Local Agency MAC Coordinator. Assistance can be obtained from the department MAC Coordinator but it is not the responsibility of the department to make this determination for each individual. For qualifications of SPMPs see Section 3.6. For qualifications of SPMP Clerical Personnel see Section 3.7. V. Job Descriptions for Personnel Using Codes 11/12 List any job classifications for personnel that qualify to use Codes 11 and/or 12. Include the number of personnel in each position who are authorized to use Codes 11 and/or 12.


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For personnel to be considered authorized to use Code 11 and/or 12, Medicaid program planning and Medicaid policy-making authority must be integrated into their job description. For the job description to be considered valid, it must be signed by the personnel, their supervisor, have signature dates, and be current as of the quarter of the time study. The responsibility for determining if personnel meet the qualifications to use Code 11 and/or 12 lies with the Local Agency MAC Coordinator. Assistance can be obtained from the department MAC Coordinator but it is not the responsibility of the department to make this determination for each individual.

VI. Training A minimum of two people with a working knowledge of MAC are required to attend all required department training sessions. The two people may be the Local Agency MAC Coordinator, Local Agency Assistant MAC Coordinator, or a local agency staff person who has a working knowledge of MAC. The Local Agency MAC Coordinator is responsible for ensuring that a mandatory training session on the time study codes and how to complete time studies is provided to all participants prior to each time study. The local agency’s MAC training sessions are expected to provide in-depth and comprehensive instruction to participants. This includes providing a basic understanding of the purpose of MAC and its relationship to Medicaid covered services. The training sessions must include completion of time study logs, an exercise in practice coding of program activities, and provide adequate opportunity for a question and answer session. The Local Agency MAC Coordinator must ensure that all time study participants have a thorough understanding of the types of daily activities they perform and how to code them. The Implementation Plan must describe how participants in the time study will be trained, including initial and follow-up training schedules. It must also describe how participants who are submitting incorrect logs will be retrained. The Implementation Plan must describe how staff turnover will be monitored and how this information will be used to ensure new personnel are trained prior to the next time study. The Local Agency MAC Coordinator must have documentation that all participants in the time study received appropriate training prior to participation in each quarterly time study. VII. Time Study Methodology The method used to time study must be listed as described in Section 3.4. The Implementation Plan must describe the process used for distribution, collection, and compilation of the logs, how supervisors will check the logs for accuracy each week, and how the time study logs will be reviewed for errors and inconsistencies. It must include a description of the Local Agency MAC Coordinator’s Quarterly Status Report content. It must describe the procedures used to ensure all personnel have a designated contact person to call when they have questions about the time study codes.


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HHSC suggests, whenever feasible, that personnel keep back-up documentation with enough detail to support time study logs (e.g., daily planners, transportation logs, etc.). The Implementation Plan must document whether this is required of the time study personnel or not. VIII. Fiscal Information A description of how the local agency will ensure that the claim is prepared correctly, checked for errors, submitted to HHSC and the department within the designated timeframes, and how the Medicaid eligibility percentage is calculated must be included. Describe the type of time log, software, and hardware used to develop the claim. The source of funds to be used as "match" must be listed in language that is easily understandable (do not use acronyms). The expense categories included as allowable costs must be listed in the Implementation Plan. Indicate whether accounting is done on a cost or modified accrual basis, and the methodology for determining indirect costs. IX. Agency Review Files Include in the Implementation Plan a list of all documentation to support the claim according to the Agency Review File, SPMP Review File, and TAFI Audit File Checklists in Chapter 7. Provide information on where the files are physically located and secured. The name or names of the persons responsible for maintaining and updating the local agency review files must be provided. X. Effective Dates The Implementation Plan must include the day, month, and year of the effective dates. The Implementation Plan is to be reviewed at least annually by the Local Agency MAC Coordinator for required changes. Implementation Plans are renewable prior to the expiration date, but the end date remains the same. The effective dates are July 1 through June 30.

XI. Authorizing Signatures The signature page must be on local agency letterhead. The Implementation Plan signature page must include the name, signature date, and signature of the agency CEO/ED, the Local Agency MAC Coordinator, Local Agency Assistant MAC Coordinator, TAFI Preparer, Assistant TAFI Preparer, CFO, and any other designated personnel with direct responsibility for MAC. The local agency will be notified when their Implementation Plan has been reviewed and approved. The approved Implementation Plan will be retained by the department for the HHSC Project Coordinator. XII. MAC and TAFI Contacts List The Implementation Plan must include a current listing of key local agency personnel. All information requested on the MAC and TAFI Contacts List must be provided. Any changes to the information on the MAC and TAFI Contacts List requires that an updated MAC and TAFI


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Contacts List be submitted to the department MAC Coordinator. (See Chapter 7 for the MAC and TAFI Contacts List form.)

Section 2.6 Who’s In and Who’s Out To identify allowable Medicaid administrative costs within a given program, personnel who spend a portion of their time performing administrative activities, MR Service Coordination Services, MH Case Management Services, and/or Rehabilitative Services, will participate in the time studies. Generally, time study participants include personnel who are in direct contact with the client or service population. To meet the test of fairness, participants in the time study should be the same personnel whose costs are included in the cost pool being allocated by the time study. Similarly, if the time study is capturing the time (and costs) of a certain class of personnel with similar job functions, then all the personnel in that class, within that cost pool, should be time studied. However, certain classes of personnel within a cost pool may be excluded from the time study and the cost pool. For a detailed description of cost pools see Section 4.1. A decision made by the Local Agency MAC Coordinator to exclude an entire class of personnel in a cost pool from the time study should be discussed with the department MAC Coordinator prior to implementation. Notations should be made in both the Implementation Plan and the Agency Review File for the quarter in which the decision was made, if approved. The Local Agency MAC Coordinators should review current department policy regarding exclusion of personnel prior to any discussion. Time study personnel must be evaluated using these criteria in the order listed. The following policy applies beginning April 1, 2001. 2.6.1 Personnel Included in Time Studies 1. All personnel within a job classification that, on average, spend 5% or more of their time on an

average annual basis performing direct or indirect activities in Rehabilitative Services and/or MR Service Coordination Services or MH Case Management Services, as part of their normal, required job duties, are included in all time studies. This includes “floaters” such as Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), psychologists, Doctors of Medicine (MDs), etc. All personnel within the same job classification (i.e., share the same job function) must time study even if their individual use of these codes is less than 5%.

2. All personnel within a job classification that, on average, spend 10% or more of their time on an average annual basis performing MAC reimbursable activities (i.e., use Codes 1, 3, 4, 6, 7, 9, 10, 11, and 12) as part of their normal, required job duties are included in all time studies. All personnel within the same job classification (i.e., share the same job function) must time study even if their individual use of these codes is less than 10%.

3. Contract personnel, who qualify under #1 or #2, may be time studied under the same conditions and regulations as employed staff. (Note: Contract personnel cannot be considered SPMP in the MAC time study because there is no employer-employee relationship.)


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Both #1 and #2 require a percentage of time be spent in the specific requirement prior to being included in the time study. This is to be reviewed annually and for all personnel who meet the same job classification and job function. This is not to be done on an individual basis. 2.6.2 Personnel Excluded from Time Studies

1. Clerical personnel (e.g., secretarial, stenographic, copying, filing, record management, and clerical services) that support time studied personnel and do not qualify under #1 or #2 are excluded.

2. First-line supervisors and above (of Medicaid time studied programs or MAC) who do not qualify under #1 are excluded.

3. Personnel that provide agency-wide administrative functions (e.g., payroll, personnel, CEO/ED, etc.) are excluded.

4. Personnel that exclusively provide the following specific services are excluded: Intermediate Care Facility for the Mentally Retarded (ICF-MR), Home and Community-Based Services (HCS), MR Vocational direct service personnel, MH Vocational direct service personnel, and non-Medicaid residential direct service personnel.

2.6.3 Additional Guidelines

It will never be possible to anticipate all questions that arise with regard to inclusion or exclusion from a time study sample. Local Agency MAC Coordinators can make determinations on the basis of the purpose and principles of the time study and with technical assistance from the department MAC Coordinator. Department policy requires that personnel within the same job function/job classification who time study meet either the 5% rule under #1 or the 10% rule under #2 as a group, not individually. When it is not obvious whether the 5% rule or the 10% rule will be met, local agencies are to time study the job classifications in question. However, the local agency is not to include those time studies in the TAFI until it is evident that the requirements of the Who’s In and Who’s Out policy will be met on an annual basis. After it becomes apparent that personnel within those job classifications do meet the requirements for the 5% rule or 10% rule, the previous TAFI(s) can be re-opened and those time studies must be entered into the TAFI. Personnel turnover is an issue that must be monitored quarterly. Personnel hired within 30 days of the next time study are not required to complete that time study. Instead that position and the costs associated with that position may be accounted for in a pro forma. (For information and guidelines regarding pro formas see the current TAFI manual.) The local agency is allowed to determine its own policy regarding personnel hired within 30 days of the time study. The local agency may also choose to set a time frame at something less than 30 days. The local agency policy cannot go beyond 30 days. Whichever decisions the local agency makes, the local agency must set policy and follow that policy with all new hires throughout the effective period of the approved Implementation Plan. Direct service or program personnel who perform no reimbursable administrative activities, MR Service Coordination Services, MH Case Management Services and/or Rehabilitative Services (e.g., doctors who provide direct medical services) should be included in the Unstudied Cost Pool. In such cases, the excluded personnel's costs, including salary, benefits, travel, training and his/her proportionate share of overhead and indirect costs, as well as other operating costs, must be placed in the Unstudied Cost Pool to absorb a fair share of overhead expenses. Issue Date: September 2005


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Questions often arise about inclusion of temporary, part-time, unpaid trainees/interns, or volunteer/stipend personnel of the local agency in the time study. Since volunteers receive no pay, there is no cost to the local agency and no basis for claiming reimbursement. The costs of paid part-time or temporary personnel may be included in the appropriate cost pool. Costs for a vacant position that would normally time study will still be included in the MAC reimbursement claim by completing a pro forma log. See current TAFI manual for pro forma instructions and guidelines.

Section 2.7 Training 2.7.1 Certification of the Local Agency MAC Coordinators and Local Agency Assistant MAC

Coordinators

The department requires that the Local Agency MAC Coordinator and Local Agency Assistant MAC Coordinator be certified by the department MAC Coordinator. The Local Agency MAC Coordinator and the Local Agency Assistant MAC Coordinator must complete and pass all required certification tests within prescribed time frames. New Local Agency MAC Coordinators and Local Agency Assistant MAC Coordinators are required to complete and submit the “New MAC Coordinator/Assistant MAC Coordinator Training Test” within 30 days of assignment of MAC responsibilities. New Local Agency MAC Coordinators and Local Agency Assistant MAC Coordinators are required to attend the next MAC Certification Training. If the new Local Agency MAC Coordinator or Local Agency Assistant MAC Coordinator is assigned responsibilities for MAC within 30 days of the next MAC Certification Training, the requirement to take the “New MAC Coordinator/Assistant MAC Coordinator Training Test” will be waived. The department will provide two opportunities for MAC Certification Training per year: Fall – All local agencies must be in attendance; and Spring – Local Agency MAC Coordinators and/or Local Agency Assistant MAC Coordinators

assigned responsibility for MAC after the fall training and local agencies that demonstrated a need for further training as evidenced by their most recent MAC review.

Established Local Agency MAC Coordinators and Local Agency Assistant MAC Coordinators are required to take the certification test annually at the fall MAC Certification Training. If the local agency has demonstrated a need for further training, successful completion of the certification test will be part of the requirement of attendance at the spring Certification Training. 2.7.2 Required Attendance of the Local Agency MAC Coordinators and Local Agency Assistant

MAC Coordinators

A minimum of two people with a working knowledge of MAC are required to attend all required department training sessions (in person and ComNets) as scheduled by the department. This includes the Local Agency MAC Coordinator and/or the Local Agency Assistant MAC Coordinator or at least one additional local agency personnel with a working knowledge of MAC. Failure to attend the required training will result in the following consequences:


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First absence – Local agency will be moved forward on the MAC Review schedule and the interview sample will consist of 20% of the time study personnel as opposed to the usual 10%;

Second absence – Defer payments until the next re-submit period (1st and 3rd quarters), but claim must still be submitted within required time frame (45 days after the end of the quarter);

Third absence – Recoup 5% of next submitted and approved MAC claim; Fourth absence – Recoup 5% of next four submitted and approved MAC claims; and Fifth absence – Removal of MAC Agreement (no payment on MAC) but still have to time study for

rate setting on MR Service Coordination, MH Case Management Services and Rehabilitative Services.

The consequences will progress throughout the life of the local agency and do not “re-set to zero” during periods of attendance. 2.7.3 Technical Assistance for the Local Agency MAC Coordinators

On-going technical assistance concerning implementation and coding issues is available through the department MAC personnel. For efficiency, technical assistance requests should be sent via email to [email protected]. 2.7.4 Local Agency Time Study Personnel

Training time study personnel prior to each quarterly time study is mandatory. If staff are not trained prior to the time study, the staff cannot participate in the time study. The initial training of all time participants and supervisors must be face-to-face. Refresher trainings may be conducted by teleconference. The department holds the signing supervisor accountable for the coding accuracy of the personnel under their supervision and for performing all necessary time log quality assurance checks. Therefore, training of all signing supervisors is required prior to each time study as well. The Local Agency MAC Coordinator is responsible for ensuring that the training includes the following elements, at a minimum: 1. Basic understanding of the purpose of MAC;

a) Activities being reimbursed by MAC are activities that improve consumer access to Medicaid-covered services (e.g., outreach, transportation etc.);

b) MAC dollars partially reimburse funds already spent by the local agency to administer and support the provision of Medicaid services; and

c) Time study data is used to establish reimbursement rates for MR Service Coordination, MH Case Management and Rehabilitative Services.

2. How coding accuracy and inaccuracy impacts the MAC claim and rate setting; 3. Medicaid covered services vs. non-Medicaid services; 4. Accurate completion of the daily logs; 5. Time study start and stop dates; 6. Time frames for completing and submitting completed logs; 7. All MAC Codes; 8. Coding of indirect activities; 9. Coding of personnel travel; 10. An exercise to practice coding of real-life activities; 11. A test to verify time study personnel’s understanding of MAC and coding;


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mailto:[email protected]

12. Opportunity for the personnel to ask questions; and 13. Who they are to contact when they have additional questions during the time study regarding

MAC coding. The Local Agency MAC Coordinator must ensure that all time study personnel and signing supervisors have a thorough understanding of the types of daily activities they perform and how to code those activities. On-going technical assistance from the Local Agency MAC Coordinator to the time study personnel and signing supervisors is necessary to ensure coding accuracy throughout the fiscal year. On-going technical assistance is available to the Local Agency MAC Coordinator from the department MAC personnel. 2.7.5 Helpful Training Tips

1. Having one primary trainer at the local agency decreases the probability of misunderstanding and miscommunication across the local agency.

2. If the local agency is too large to utilize one trainer, it is recommended that the Local Agency MAC Coordinator observe the training sessions throughout the year to ensure individual trainers are not inadvertently introducing error or inconsistencies.

3. It is recommended that training be conducted during the week before the time study, so the information is fresh and more easily recalled.

4. Training personnel in clusters according to their primary job functions is recommended, as it is easier to train around common tasks. In addition, it is easier for personnel to relate to others’ questions and to feel more comfortable when asking position-specific questions.

5. The training of supervisors should include how to review time study logs for accuracy and completeness, verify coding accuracy, and perform all quality assurance checks. (See optional Training Addendum for Supervisors, Chapter 8.)

6. Emphasize that MAC is not a time-efficiency study. The use of Code 15 to indicate breaks, training, meetings, and administrative activities is expected.

7. It is important that personnel do not perform their jobs differently during the time study period. 8. Conduct the training at a location and time convenient for most personnel to attend. It is often

more cost effective for the one trainer to travel to the personnel then for the personnel to travel to the trainer. Having the trainer go to the personnel is also less disruptive of the personnel’s regular job duties.

9. Conduct the training face-to-face as this allows the trainer to determine if the participants are following along and understanding. Teleconferencing discourages participants from asking questions.

10. Coding practice activities are more effective when tailored to specific job functions within the local agency.

11. Personnel need to know that their careful attention to detail during the time study does have a positive impact on their local agency and the consumers that they serve. If the local agency has a plan for the expenditure of MAC dollars, share that plan with the personnel. Keep the personnel informed of the process and how their cooperation has contributed to achieving the local agency’s goals.

Back to Table of Contents


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CHAPTER 3 A Basic Description of a Time Study A time study accounts for the time and activity of a group of people. Personnel who meet the current Who’s In and Who’s Out requirements (as described in Section 2.6) will time study by using a worker-day log (WDL). This WDL method is described in Section 3.2. Personnel will need to know if a consumer is eligible to receive covered services and code according to the rate-setting process for MR Service Coordination Services, MH Case Management Services and Rehabilitative Services. Time study personnel are not required to show with whom or where the activity was performed. For review purposes, personnel may wish to keep back-up documentation, such as brief descriptions of what occurred in each 15-minute period in daily planners. The time study identifies the proportion of administrative time allowable and reimbursable under MAC and time that is directly or indirectly related to covered program services or waivers. This is why accurate coding and consistent QA at the supervisory level is critical. The time study is completed once each quarter for the number of days it takes to generate a sample of 1500 valid WDLs or a maximum of 30 days. Since the time study is only a sample of the personnel’s activities for the entire quarter, it is very important that staff do not alter their regular work activities simply because they are participating in the time study. Modifying work behavior during the time study period causes inaccuracy in reimbursement and rate setting.

Section 3.1 Defining A Time Study In most local agencies, it is uncommon to find time study personnel whose activities are limited to just one or two specific reimbursable functions. Personnel normally perform a number of activities, some of which are reimbursable and some of which are not reimbursable. Sorting out the portion of time that is reimbursable to MAC and to Medicaid and non-Medicaid service programs requires an allocation methodology that is objective and empirical (i.e., based on documented data) and personnel time has been accepted as the basis for determining personnel cost. The federal government has developed an established tradition of using time study as an acceptable basis for cost allocation. While it is difficult to calculate how much of a local agency's expenditures support a certain activity, it is generally accepted that such costs are proportionate to the percentage of time personnel spend on each activity. Time study results are applied to the total administrative cost of the local agency to determine the cost of specific activities (e.g., outreach, Service Coordination, Case Management, etc.). This method of allocating administrative costs through time study has been incorporated into the CAP between CMS and HHSC. A time study is representative and reflects how personnel’s time is distributed across a range of activities. A time study is not designed to show how much of a certain activity personnel perform; rather, it reflects how time is allocated among functions. Thus, a statistically valid time study should be reflective of how time is spent over all days in the same period. For example, a time study conducted during the week of Christmas or New Year's would not be representative of all a personnel's time.


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Local agencies participating in MAC are already claiming reimbursements for activities through the fee-for-service option in Medicaid (e.g., MR Service Coordination Services, MH Case Management Services, Rehabilitative Services, HCS, etc.) and care must be taken to avoid "double-dipping." Personnel whose covered direct and covered indirect service time and associated costs that are already billed to or covered by fee-for-service programs cannot simultaneously be claimed through MAC. Certain administrative activities outside the scope of fee-for-service programs may be reimbursable as administrative costs. Additional time study codes have been added to track the time spent in specific covered services (codes 16 – 18 and 21).

Section 3.2 Time Study Worker-Day Logs One WDL is one person coding the time study for one of his/her workdays, whatever the duration. The WDLs will generally be evenly distributed across all personnel in the time study. A valid WDL accurately and consistently codes the activities completed by personnel during that workday and contains all required information. The WDL method requires that all personnel in the time study complete a daily log over a specific period of time. Personnel are to record the activity that took the majority of time in each 15-minute increment by using the most recent MAC codes. Because the department uses this time study to obtain data used for rate reimbursement of MR Service Coordination Services, MH Case Management Services and Rehabilitative Services, 1500 valid WDLs over a minimum of three working days must be completed. Local agencies unable to complete this number of valid WDLs in less than 30 days will need to time study for 30 days. (See Section 3.4 for more details.) The department recommends that personnel be over-sampled, as past experience has shown the error rate to be about 10%. With errors (e.g., personnel forgetting to complete the time study, non-SPMP using SPMP codes, etc.) 1500 completed WDLs may not equal 1500 valid WDLs. Therefore, most local agencies require a minimum of 1650 WDLs per quarter to ensure a valid sample of 1500 usable WDLs. In the absence of 1500 valid WDLs, a program becomes more vulnerable to review and a potentially invalid claim. Personnel in the time study record their time on a daily log. Chapter 7 contains copies of two manual time study daily logs. For information regarding the automated time study logs contact the department MAC Coordinator at [email protected]. The local agency must receive prior approval from the department MAC Coordinator to convert from the manual log to the automated log. The department MAC Coordinator must approve any local modifications to the manual or the automated time study log forms and/or the designated software prior to implementation. The request to use a modified log must include an original (not photocopy) of the proposed log and a detailed description of the automated hardware and software to be used with the proposed log.


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3.2.1 Using the Uniform Time Study Codes All time study personnel must have a set of the uniform time study codes for reference. Time study personnel must also have a designated contact person (e.g., trained supervisor, Local Agency MAC Coordinator, Local Agency Assistant MAC Coordinator) to rely on regarding questions about coding and/or MAC requirements. Track time as close to the 15-minute intervals as possible; personnel must not wait until the end of the day to fill out the form, nor are they expected to stop what they are doing every 15 minutes and enter a code. Coding should be completed at the end of a specific activity. All (100%) of the paid work day should be time studied, beginning with the time a person begins working and ending at the time the person stops working. The workday includes breaks, meals, and any form of paid leave. If more than one activity is performed during the 15-minute period, record the activity that took the greater amount of time. Select the appropriate code based on the local agency’s training of the time study codes. Time study personnel who are authorized to begin work at 15, 30, or 45 minutes past the hour are to code the blank box or bubbles as Code O until they are scheduled to begin work. For example, Jabba D. Hutt is scheduled to begin work at 7:30 AM and the time log form is set up to start at 7:00 AM. Jabba D. Hutt must code the 7:00 and 7:15 box (or bubble) with Code O. At 7:30 AM Jabba D. Hutt would begin coding his workday. If personnel are granted eight hours of paid holiday time (such as on a national holiday) but are required to work that day, use the appropriate activity codes for work performed and record Code 15 for the hours of paid holiday the personnel took that day. If personnel are granted “compensatory time” for hours worked, when some or all of those hours are taken off, the time is coded as Code O. In simpler terms, participants must code the work as they actually perform it, and code O when they are not working. The total local agency cost of the holiday time and the authorized additional work time is then captured by the time study. Do not leave gaps on the time log. Each line or box must be coded appropriately according to the work performed during all paid work hours. Work activities that occur after the scheduled workday (on-call, etc.) are to be coded on the next available code line or box. SPMP may use all core codes. Three codes (Codes 3, 7 and 12) are reserved for SPMP only, because they require skilled professional medical knowledge and skills. All other codes are “All Staff” codes. If the performance of an administrative activity does not require the use of professional medical training or skills, an "All Staff" code would be used. For more specific information regarding codes, see Chapter 6.


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Section 3.3 What Time Should Be Studied The primary principles to be remembered are these: A time study is a sample of a local agency’s daily activities as performed by its personnel. A time study is designed to reflect the administrative costs of the local agency and its personnel. Samples should be drawn from as representative a base of time and personnel as feasible. All personnel whose costs are included in the SPMP and non-SPMP Cost Pools (with the exception

of clerical and supervisory personnel who provide exclusive support to these personnel) must time study during the sample period. All personnel who meet the current MAC Policy concerning Who’s In and Who’s Out (as described in Section 2.6) must participate in the time study sample. Random sampling of the time study personnel is prohibited.

The corollary to the first and second principle is that only paid time should time studied, since what is being allocated is the cost of that paid time. Salaried personnel must record all of the time that is actually worked each day regardless of their regularly assigned working hours. For example: The Supported Housing Team Leader is scheduled to work 8:00 AM – 5:00 PM. On August 20th, during the annual budget-planning crunch, the Team Leader works until 8:00 PM. On August 20th, the Supported Housing Team Leader must record all of her activities from 8:00 AM to 8:00 PM. Unpaid time spent by personnel does not cost the local agency anything so that time is not to be included in the time study sample. Thus, unpaid time spent by personnel after their paid shift catching up on paperwork or uncompensated work taken home by a conscientious worker is not to be time studied. If personnel are authorized to work and are paid for the extra hours, then any activity performed during these extra hours should be coded to the appropriate time study function. Personnel who are on-call record only the time they are actually working. Example: Chubacca works a regular 8-5 workday five days a week. Once every two months he works the crisis on-call duty over the weekend. On 5/23 (Friday), Chuy codes his 8-5 workday as usual. His last unit of coding is a Code O at 5:00 PM. At 7:15 PM, he responds to a crisis call. Chuy would Code O for 5:15, 5:30, and 5:45 and then enter 7:00 PM as his next unit of time and code it as Code O. His next unit of time would be 7:15, and he would use Code 17-B. The crisis event takes one hour. Chuy would use Code 17-B for units 7:15 – 8:15. For the two remaining units (8:30 and 8:45), Chuy would use Code O. Compensatory time is handled similar to "flex-time" and is annotated as Code O on the time study log form. This prevents activities documented during compensatory time from being entered into the time study forms as well. The MAC time study is not intended to be a staff productivity or efficiency study. Participants should be trained to code their regular breaks and lunch periods.


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Section 3.4 Time Study Start Dates and Criteria 3.4.1 Time Study Start Dates MAC follows federal fiscal quarters (1st quarter = October – December; 2nd quarter = January – March; 3rd quarter = April – June; 4th quarter = July – September). A minimum of three days, but no more than 30 days, is sampled each quarter. Local agencies currently use one of two start dates, depending on specific criteria, which are explained in detail below. It is the Local Agency MAC Coordinator’s responsibility to verify quarterly the total number of time study participants to determine whether the Alternative or the Mid-Month time study will be used. The Local Agency MAC Coordinator documents the days selected for time study each quarter. 3.4.2 Alternative Time Study Start Date The Alternative Time Study start date method requires the local agency to review exactly how many days their local agency must time study in order to meet the 1500 valid WDL requirement. The Local Agency MAC Coordinator must review the total number of time study participants to decide the total number of days that must be time studied. If the local agency is able to complete 1500 valid WDLs in fewer than 30 days, the time study begins on the first Monday of the middle month of the federal fiscal quarter. The local agency must time study until they have completed the required number of WDLs (no more than 30 days and no fewer than three days). Note this applies to 1st, 2nd and 3rd quarters only; 4th quarter is different so please read carefully. During the 4th quarter (July, August and September), both the Alternative and the Mid-Month Time Studies start on the second Monday of July. The time study requirements concerning the length of the time study remain the same depending on the choice that was selected. Any local agency that participates in the time study for less than 30 days must ensure that the local agency will get the required 1500 valid WDLs. 3.4.3 Mid-Month Time Study Start Date If a local agency does not have enough time study participants to complete the required 1500 valid WDLs in less than 30 days, then they must select the Mid-Month Time Study start date and time study for 30 days. The Mid-Month Time Study starts on the first calendar day of the middle month of each quarter (except 4th quarter) and covers exactly 30 days. This applies to 1st, 2nd, and 3rd quarters only; 4th quarter is different. During the 4th quarter (July, August and September), both the Alternative and the Mid-Month Time Studies start on the second Monday of July. The time study requirements concerning the length of the time study remain the same depending on the choice that was selected.


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Below is a table showing the start dates for the four federal quarters depending on whether the local agency must time study using the Alternative or the Mid-Month Time Study. Special attention should be given to the 4th quarter time study start date. 1st, 2nd, 3rd Qtrs.

Mid-Month

1st day of the middle month (no longer than 30 days from the start date).

1st, 2nd, 3rd Qtrs.

Alternative Start Date

1st Monday of the middle month (no longer than 30 days from the start date and no fewer than three days from the start date).

4th Qtr.

Alternative Start Date and Mid-Month Start Date

2nd Monday of July (no longer than 30 days and no fewer than three days from the start date).

Section 3.5 Instructions for Completing the Alternative and the Manual Time Study Log

3.5.1 General Instructions Concerning the Alternative and the Manual Time Study Log

1. Instructions for completing each item of the log should be carefully followed and must be

included in the training of all time study personnel. 2. Record paid time only. Do not count unpaid time worked after hours. Compensatory time when

taken off, is coded as Code O. 3. Salaried personnel must record all of the time that is actually worked each day (e.g., 8:00 AM to

9:00 PM). 4. Part-time personnel must record all the hours they work each day (e.g., 5:00 PM - 9:00 PM). 5. If participants complete a payroll timesheet, the time recorded must match the time recorded on

the time study log. 6. Personnel who are on-call record only the time they are actually performing work activities. 7. 100% of the participant’s workday must be coded. MAC codes are designed to cover any and all

activities that participants could perform during the workday. 8. Do not divide the standard 24-hour day (midnight of one calendar day to 11:59 PM of the same

calendar day) on more than one time log. Each time log must contain all the activity codes recorded for the participant’s workday represented by that specific time log.

9. Each valid time study log is a stand-alone document. Each log must be completely and accurately filled in with all required identifying information.

10. Complete the log during the course of the day and at the end of each activity (i.e., as close to the time the activity took place as possible) to increase accuracy and ease of recording.

11. Use a current department approved time log. 12. Use the correct type of log. The All Staff manual time study log form in Chapter 7 is to be used

by all personnel who are not SPMP and excludes codes reserved for use by the SPMP. The SPMP manual time study log form, also in Chapter 7, consists of all activity codes and is to be used by


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SPMP personnel. For information concerning the approved automated time study log forms please contact [email protected].

13. Both the time study personnel and the supervisor’s original signatures and signature dates must be in permanent ink regardless of whether the log is tabulated manually or automatically, or daily, weekly, or monthly. Electronic or rubber-stamp signatures and/or signature dates are not permitted.

14. Dates and original signatures of both the time study personnel and his/her supervisor are dated no sooner than the end date on the time study log and no later than 7 days after the end date on the time study log.

15. If the supervisor will be out of the office and unable to sign within 7 days of the end date on the time study log, the MAC Coordinator or another supervisor that is trained and designated to perform the required quality assurance checks must sign off on the time study log for the absent supervisor. In these situations the time study log will be signed by the designee for the absent supervisor. Example: Jabba D. Hutt is the regular supervisor. Jabba D. Hutt takes two weeks off to join forces with the Emperor. George Lucas is designated as Jabba’s replacement. Time study participants would print “ Hutt, Jabba D.” as the supervisor. George Lucas would sign on the supervisor line, “George Lucas for Jabba D. Hutt.”

16. If either the participant or their supervisor fail to sign within 7 days of the end date on the time study log, the reason for the delayed signature(s) must be documented, signed off by either the participant or the supervisor, whomever did not sign within the required timeframe. The documentation must be attached to the log to ensure that it will be included in any review of the log.

17. Given that the supervisor is required to review the accuracy of the time study participant’s completed log, the supervisor’s signature date cannot precede the participant’s signature date.

18. Do not use military time. 19. Time study participants who are authorized to begin work at 15, 30, or 45 minutes past the hour

are to code the blank box or bubbles as Code O until they are scheduled to begin work. Example: Jabba D. Hutt is scheduled to begin work at 7:30 AM and the time log form is set up to start at 7:00 AM. Jabba D. Hutt must code the 7:00 and 7:15 box (or bubble) with Code O. At 7:30 AM Jabba D. Hutt would begin coding his workday.

20. Do not leave blank boxes or bubbles during the workday. Each box should be filled with a numeric code, Code L, or Code O during scheduled work hours.

21. Do not indicate times for boxes or bubbles that are not coded with an activity. 22. Coding of activities must be accurate and consistent. 23. Indicate only one code per 15-minute period. When more than one activity is performed in a 15-

minute period enter the code that accurately represents the activities that were performed for the preponderance of the 15-minute period.

24. All entries must be legible. 25. There should not be any other writing or marks on the log. 26. Do not use white out. 27. Use proper error correction procedures: one line through error, correct the information, initial

the correction, and initial the signature. 28. Supervisors are not to cross out or change codes indicated on the time study logs they do not

agree with. Rather, they should discuss the coding with the participant to see if the codes have been understood and allow the participant to correct any errors, if necessary, by using the accepted error correction procedures.


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3.5.2 Specific Instructions (from left to right) on the Manual Time Log Form 1. All entries must be in permanent ink. 2. Print time study participant’s name (Last, First, Middle Initial) - no nicknames. This should

agree with the information placed in the TAFI 2005. 3. Print time study participant’s full job title. This should agree with the information placed in the

TAFI 2005. Any acronyms used must be on the local agency’s approved MAC acronym list. 4. Enter time study participant’s unique employee identifier - TAFI 2005 software requires the

complete nine-digit number to ensure validation that only one number is assigned to each person. 5. Enter time study participant’s position number - TAFI 2005 software requires a position number

for all personnel (up to nine digits allowed). 6. Enter physical location (local agency option) - Site location or other local agency information

assigned by the local agency MAC Coordinator. 7. Print supervisor’s name (Last, First, Middle Initial) – no nicknames. 8. Indicate participant’s employment status by putting an X to the right of either full-time or part-

time. 9. Indicate participant’s Fair Labor Standards Act (FLSA) status by putting an X to the right of

exempt, non-exempt, or contract. 10. Indicate participant’s SPMP status by putting an X to the right of yes or no. Mark yes only if that

personnel has been evaluated and meet the criteria for SPMP. If personnel are non-SPMP the All Staff form must be used. If personnel are SPMP then the SPMP form must be used.

11. Enter the federal fiscal year and the quarter being time studied (e.g., 1st Qtr. FFY 04): 1st Quarter = October – December; 2nd Quarter = January – March; 3rd Quarter = April –June; 4th Quarter = July – September.

12. Time study participant’s original signature and signature date. The signature date is to be no earlier than the last date on the time log and no later than 7 days after the last date on the time log.

13. Supervisor’s original signature and signature date. The signature date should be no earlier than the last date on the time log and no later than 7 days after the last date on the time log.

14. Add the total number of 15-minute units for each code (e.g., count the number of boxes assigned Code 1 on the log) and enter this number in the appropriate section of the time study log. As required for Code 16 and Code 17, divide these codes into components and document in the appropriate sections that are provided. Total the number of boxes (15-minute increments) not totals of hours. Therefore, a 40-hour workweek is 160 increments (160 boxes). Do not include Codes L or O in the totals. Many errors occur when the codes are not totaled accurately.

15. Enter the month and date to the left of each WDL (e.g., 11/13). 16. Enter the hour and circle am or pm for each 60 minute time increment. 17. Enter the code that accurately represents the activities that were performed for the preponderance

of each 15-minute period. 18. Enter Code O for the time that is not part of the participant’s workday. 19. Enter Code O or use the word “OFF” in place of “O” at the end of each day. It is left to the

agency’s discretion as to whether or not a line must be drawn to the end of the unused portion of that WDL. However, the agency must be consistent across time study participants throughout the Federal Fiscal Year.


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20. When performing the same activity over a period of time, it is acceptable to write the applicable code in the box corresponding to the start time of the activity and to draw an arrow through all the boxes from the start time to the end time of the activity.

3.5.3 Specific Instructions (from left to right; front to back) on the Alternative Time Log Form 1. Use No.2 pencil – except for signatures and signature dates, which must be in permanent ink. 2. Print time study participant’s name (Last, First, Middle Initial) – no nicknames. This should

agree with the information placed in the TAFI 2005. 3. Print time study participant’s full job title. This should agree with the information placed in the

TAFI 2005. Any acronyms used must be on the local agency’s approved MAC acronym list. 4. Print supervisor’s name (Last, First, Middle Initial) – no nicknames. 5. Time study participant’s original signature and signature dates must be in permanent ink. 6. Signature date must be no earlier than the last date on the time log and no later than 7 days after

the last date on the time log. 7. Supervisor’s original signature and signature dates must be in permanent ink. 8. Signature date must be no earlier than the last date on the time log and no later than 7 days after

the end date on the time log. 9. Enter time study participant’s unique employee identifier - TAFI 2005 software requires the

complete nine-digit number to ensure validation that only one number is assigned to each participant.

10. Enter the single digit number that corresponds to the federal fiscal quarter being time studied: 1st Quarter = October – December; 2nd Quarter = January – March; 3rd Quarter = April –June; 4th Quarter = July – September.

11. Enter the double-digit number that corresponds to the FFY of the time study (e.g., 2004 = 04). 12. Enter the time study participant’s position number beginning from left to right - TAFI 2005

software requires personnel position number for all participants (up to nine digits allowed). 13. Indicate full-time or part-time employment status of the time study participant. 14. Indicate FLSA status of the time study participant - exempt, non-exempt, or contract. 15. Indicate SPMP status. Mark yes only if that participant has been evaluated and meets the criteria

for SPMP. If personnel are non-SPMP the All Staff form must be used. If personnel are SPMP then the SPMP form must be used.

16. Revised Form (Required Data if the Time Log is Revised) – Fill in this bubble only if the information on this specific time log has required correction of the original data recorded during the time study. The corrected original time log must be attached to the revised form.

17. Enter time study log start date of this specific log in the following format: mmddyy. (Example: November 13, 2003 = 111303.)

18. Enter time study log end date of this specific log in the following format: mmddyy (Example: February 9, 2004 = 020904.)

19. Site Location (local agency option) - Site location or other local agency information assigned by local agency MAC Coordinator.

20. Enter clock hour to the left of the code line beginning with “00” for each hour of the day the personnel is paid to work (compensated with either pay or authorized time off).


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21. Print AM or PM under the clock hour for each clock hour indicated. It is not acceptable to write in only “A” or “P.”

22. Enter the code that accurately represents the activities that were performed for the preponderance of each 15-minute period.

23. Enter Code O for the time that is not part of the personnel’s workday. 24. Enter Code O at the end of each day (unless three 8-hour days are being placed on one time

study log). 25. Code Line Index Numbers (found to the right of all MAC Codes) - These numbers are used for

reference in QA activities by supervisors and the Local Agency MAC Coordinator. 3.5.4 Quality Assurance Checks Both the participants and the supervisors are required to review and sign the time study logs within 7 days of the end date indicated on the log. The supervisor’s review is to ensure that all information and coding is complete and accurate. When the supervisor identifies a possible error, the supervisor must discuss the possible error with the time study participant. The supervisor is not permitted to modify the log in any manner. The time study participant must make the necessary modifications. Given that the supervisor is required to review the accuracy of the time study participant’s completed log, the supervisor’s signature date cannot precede the participant’s signature date. If the supervisor is out of the office and unable to sign within 7 days of the end date, another supervisor who is trained and designated to perform the required QA review must sign the log. In these situations, the supervisor must sign as the designee for the absent supervisor. Example: Jabba D. Hutt is the regular supervisor. Jabba D. Hutt takes two weeks off to join forces with the Emperor. George Lucas is designated as Jabba’s replacement. Time study participants would print “ Hutt, Jabba D.” as the supervisor. George Lucas would sign on the supervisor line, “George Lucas for Jabba D. Hutt.” If either the participant or their supervisor fail to sign within the 7 days, the reason for the delayed signature(s) must be documented, signed off by either the participant or the supervisor, whomever did not sign within the required timeframe. The documentation must be attached to the log to ensure that it will be included in any review of the log. The time study participant’s and supervisor’s signatures legally certify that the time study log is accurate and complete for use in calculating receipt of federal funds and federal program rate setting. Accurate completion of the time study logs, therefore, has serious implications and requires a high attention to detail. To ensure that all logs meet the standards as set by HHSC and the department, the Local Agency MAC Coordinator is also expected to perform quality assurance checks on each time study log. The department and HHSC hold the signing supervisor and the Local Agency MAC Coordinator responsible for ensuring that all logs meet the requirements of accuracy and completeness.

Section 3.6 Skilled Professional Medical Personnel Federal regulations permit claim reimbursement at the enhanced rate of 75% for those administrative activities that are performed by personnel who have the education, training and job requirements to qualify as an SPMP. Numerous disallowances regarding the reimbursement of costs of SPMP have


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resulted in both CMS and the Departmental Appeals Board (DAB) developing a set of criteria for determining personnel that qualify as SPMPs. Many local agencies participating in Title XIX Medicaid administration employ personnel who may qualify as SPMP. Because of the complex guidelines concerning the claiming of SPMP, reference materials have been developed to provide guidance. Under certain circumstances, the costs of personnel providing direct clerical support to an SPMP may also be reimbursed at 75%. However, claiming reimbursement for administrative activities at the enhanced rate often results in extensive audits by CMS. 3.6.1 Background and Authorization for SPMP Provisions in the Social Security Act in Section 1903 (a)(2) allow for an enhanced FFP rate of 75% for a state's Medicaid costs for the compensation and training of skilled medical professionals. Authorizing regulations are found in 42 Code of Federal Regulations (CFR) 432.50 (b)(1). 42 CFR 432.2 defines SPMP as “physicians, dentists, nurses and other specialized personnel who have professional education and training in the field of medical care or appropriate medical practice and who are in an employer-personnel relationship with the Medicaid agency. It does not include other non-medical health professionals such as public administrators, medical analysts, lobbyists, senior managers or administrators of public assistance programs or the Medicaid program.” 3.6.2 The Standard for Determining SPMP The federal standards for determining SPMP have been developed as a result of key phrases in this definition.

3.6.2.1 Employer-Employee Relationship The first requirement is that an employer-employee relationship must exist between the SPMP and the local agency participating in MAC. Enhanced FFP does not apply to contracts with private organizations or independent contractors. Because contract personnel do not qualify for the enhanced rate, they are reimbursable at 50% FFP. Non-contract personnel holding the same job function as contract personnel also do not qualify for the enhanced rate. 3.6.2.2 Professional Education and Training The second determination for SPMP status is based on two conditions: professional education (including training as part of academic work) and job function. In 1986, CMS implemented regulations in 42 CFR 432.50 that defined professional education as “the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession. This is demonstrated by possession of a medical license, certificate, or other document issued by a recognized National and State medical licensure or certifying organization or a degree in a medical field issued by a college or university certified by a professional medical organization. Experience in the administration, direction or implementation


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of the Medicaid program is not considered the equivalent of professional training in a field of medical care.” Traditionally, physicians, physician assistants, RNs, dentists, dental hygienists, registered dietitians, master level and Ph.D. Psychologists, and Licensed Master Social Workers (LMSW) are considered an SPMP if they meet all of the SPMP requirements. LVNs (completing a two-year or longer program) have also been classified as SPMP. Given that Texas does not offer a two-year LVN degree that is qualitatively different from a one-year degree, Texas is unable to qualify LVNs as SPMPs as of October 1, 2002. 3.6.2.3 Job Function The third condition that determines an individual’s classification as an SPMP is whether the job function meets the basic criteria of an SPMP, as stated in the preamble to the final regulation on this matter. The definition of the SPMP in relation to the individual's job responsibilities is that “the law [Section 1903 (a)(2) of the Act] did not intend to provide 75% FFP merely to any personnel person who has qualifying medical education and training and experience, without regard to his actual responsibilities. Rather, the function performed by the SPMP must be one that requires that level of medical expertise in order to be performed effectively. Consequently, 75% FFP is only available for those positions that require professional medical knowledge and skills, as evidenced by position descriptions, job announcements, or job classification.” 50 Federal Register 46652, at 46656 (November 12, 1985)

The preamble contains examples of functions that meet the basic criteria: Acting as liaison on the medical aspects of the program with providers of services and other agencies

that provide medical care; Furnishing expert medical opinions for the adjustments of administrative appeals; Reviewing complex physician billings; Providing technical assistance and drug abuse screening on pharmacy billings; Participating in medical review or independent professional review team activities; Assessing the necessity for, and the adequate provision of, medical care and services, as in utilization

review.

Section 3.7 Authorization for Directly Supporting Clerical Personnel Federal language described who the qualifying clerical personnel could be and reiterated that these clerical personnel must meet the criteria of directly supporting personnel. According to 42 CFR 432.50(d)(V), “The directly supporting personnel are secretarial, stenographic, and copying personnel and file and records clerks who provide clerical services that are directly necessary for the completion of the professional medical responsibilities and functions of the SPMP personnel. The skilled professional medical personnel must directly supervise the supporting personnel and the performance of the supporting personnel's work.” A supervisory relationship on a day-to-day basis


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between the skilled medical support personnel is not necessary and is not always relevant. If the clerical personnel perform functions directly necessary for the carrying out of the professional's duties, then his/her time is reimbursable at the 75% rate. Utilizing the 75% reimbursement of clerical support personnel does not require that the clerical support personnel complete the time study logs. To utilize the 75% reimbursement of clerical support, the SPMP must complete the time study logs. The local agency has the burden of providing evidence to demonstrate the existence of the immediate and direct connection between the duties of the clerical support personnel and SPMP (i.e., evidence about specific work assignments initiated by the SPMP in an SPMP role).

Section 3.8 Skilled Professional Medical Personnel Documentation Local agencies must provide documentation related to the qualification of time study personnel as SPMP and retain this documentation in the local agency's SPMP Review File (see Chapter 7). 3.8.1 SPMP The following documentation must be included in the SPMP Review File for all personnel that qualify as an SPMP: 1. Copy of qualifying license or certification.

a) Must possess licensure or certification from a recognized National or State licensing or certifying organization as evidence of successful completion of a qualifying professional education. Transcripts or degrees of completed academic work are insufficient.

b) The license or certification must be current as of the time study quarter. c) In instances where photocopies of the license are prohibited by the licensing board, the personnel

must obtain a letter from the licensing board indicating current licensure. d) In instances of the nursing Interstate Compact, the documentation from the licensing board

indicating current licensure and approved use of the interstate reciprocity option must be obtained.

2. Copy of valid job description. a) The job description must indicate use of SPMP education and training in the performance of their

job duties. b) The job description must indicate the specific qualifying SPMP license or certification that is

required to fill the position. If non-SPMP personnel are capable of filling the position, the position cannot be considered as qualifying as an SPMP even if filled by an individual holding a qualifying license or certification.

c) To be considered a valid job description, the job description must include the signatures of personnel filling the position, the signature of their immediate supervisor, signature dates, and be accurate as of the time study quarter.

3. Current Medicaid Administrative Claiming Skilled Professional Medical Personnel (SPMP) Survey (see Chapter 7). a) Survey must be complete and accurate.


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3.8.2 SPMP Clerical Support

The following documentation must be included in the SPMP Review File for each time study personnel that is to qualify as an SPMP Clerical Support: 1. An organizational chart showing the lines of supervision between the SPMP and their supporting

personnel. 2. The job description of the clerical support states that their work is in direct support of an SPMP

carrying out an SPMP function.

Section 3.9 The Codes 3.9.1 Codes 11 and 12 Only personnel who have valid job descriptions indicating Medicaid program planning and Medicaid policy-making authority are permitted to use Codes 11 and 12. The job expectation of Medicaid program planning and Medicaid policy-making must be integrated into the job description. For the job description to be considered valid, it must be signed by the personnel, their supervisor, have signature dates, and be current as of the quarter of the time study Code 12 is further restricted to SPMPs who must use their SPMP knowledge while planning Medicaid programs and establishing Medicaid policy. If an SPMP is involved in Medicaid program planning and decision making that does not require the use of skilled professional medical knowledge or training, then he or she would use Code 11. 3.9.2 The SPMP Codes - 75% Match Only personnel who qualify as SPMP (Section 3.6 discusses how this determination is made) may use three of the Codes (3, 7, and 12). When used by SPMP, these codes can be matched at the rate of 75% only when skilled professional knowledge is required. If an SPMP performs an activity that does not require the use of skilled professional medical knowledge or training, then he or she would use any of the other sixteen activity codes. 3.9.3 Codes for All Staff (SPMP and non-SPMP) - 50% Match Personnel who do not qualify as SPMP or SPMPs that are performing an activity that does not require their skilled professional medical knowledge may use Codes 1, 2, 4, 5, 6, 8, 9, 10, and 11. Only authorized personnel may use Codes 16, 17, 18, and 21. The core set of time study codes (Codes 1-15) is used by all local agencies participating in MAC. The department has added additional codes for current service programs in order to collect data that will be used to establish reimbursement for MR Service Coordination Services and MH Case Management (Code 16) and Rehabilitative Services (Code 17). HCS (Code 18) and ICF-MR (Code 21) are not used


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to set rates for those programs. However, because personnel are required to account for 100% of their paid work time those programs are accounted for with the MAC Codes. See Chapter 6 for coding descriptions and examples. All local agencies participating in MAC allocate their time through the time study codes. These activity codes are based on time study functions that have been reviewed and discussed with regional and national CMS offices. The twenty-one codes are: Code Title MAC

Reimbursement Divided by Medicaid %

1 Facilitating Medicaid Eligibility Determination 50% No 2 Facilitating Non-Medicaid Eligibility

Determinations 0

3 Medicaid Outreach (SPMP) 75% No 4 Medicaid Outreach 50% No 5 Outreach Non-Medicaid 0 6 Referral, Coordination, and Monitoring of

Medicaid Services 50% Yes

7 Referral, Coordination, and Monitoring of Medicaid Services (SPMP)

75% Yes

8 Referral, Coordination, and Monitoring of Non-Medicaid Services

0

9 Medicaid Transportation and Translation 50% Yes 10 Medicaid Provider Relations 50% No 11 Program Planning, Development, and Interagency

Coordination 50% Yes

12 Program Planning, Development, and Interagency Coordination (SPMP)

75% Yes

13 Direct Medical Services 0 14 Non-Medicaid, Other Educational and Social

Services 0

15 General Administration Allocated 16 MR Service Coordination and MH Case

Management Services 0

17 Rehabilitative Services 0 18 Home and Community-Based Services 0 19 Vacant 0 20 Vacant 0 21 Intermediate Care Facility – Mental Retardation 0



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CHAPTER 4 Submitting a Claim After the Time Study

The Elements of a Claim A uniform methodology has been developed for MAC across all participating local agencies. This methodology contains the following elements: Changes in HHSC's CAP; Agreements between HHSC and state agencies as well as agreements between state agencies and

local agencies where the costs of reimbursable MAC activities are supported with state and/or local public funds only;

A uniform set of time study codes approved by HHSC and CMS; A set procedure determining the Medicaid percentage in each local agency; The QSI for documenting the cost of reimbursable activities under Medicaid administration, see

Chapter 7. The rate of FFP, including establishing procedures for identifying SPMP and for appropriately

claiming allowable activities performed by them at the rate of 75% (see Section 4.3). Each of these elements is discussed briefly below. More detailed descriptions will be found in separate sections of this manual. Submitting a Claim for Medicaid Administration The Medicaid Administrative Claim, has four components: cost pool construction; allowable Medicaid administrative time; the FFP; Medicaid eligibility percentage. The claim and all required documentation are to be submitted to HHSC and the department within 45 days of the end of each federal fiscal quarter.

Section 4.1 A General Description of the Texas Medicaid Administrative Claiming Cost Allocation Plan

The computer program developed by the department for claiming reimbursement through MAC is the TAFI 2005. The TAFI 2005 is a web-based, multiple database system incorporating personnel and financial data with time study records. The time study, expenditure and revenue data, and the Medicaid percentage are entered into the TAFI to produce the final two-page “Agency Invoice.” Time data is gathered during a time study based on the approved codes for MAC. Time studies allocate individual salaries and fringe benefits. These allocations are utilized to spread the Travel and Training, Direct Program Support, and Operating Costs of the personnel included in the time study. All costs attributable to personnel who do not time study are entered in an Unstudied Personnel


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section. Thus, all direct costs of the local agency are accounted for in either the Studied or the Unstudied sections of the TAFI. Indirect general administrative costs are entered in a separate section and are allocated to the Studied and Unstudied sections based on the percentage of total Salary/Benefits of that section. Therefore, all costs of the local agency are captured in the TAFI in a single cost area only. Revenues are categorized as Recognized or Unrecognized and entered into the TAFI to follow either the activity by which they are earned or the expense for which they are a reimbursement. For purposes of the Agency Invoice, the costs are collected in four Cost Areas, which are organized by activity function. Revenues are collected in two cost pools and allocated against expenses as directed in Section 4.3.

SPMP (Cost Pool #1) – Compile costs from the TAFI for those activity codes performed by designated SPMPs that are reimbursable at the enhanced rate in this pool. This includes Codes 3, 7, and 12. Non-SPMP (Cost Pool #2) – This area contains costs derived from activities performed by SPMPs and non-SPMPs using Codes 1, 4, 6, 9, 10, and 11. Unstudied (Cost Pool #3) – This cost area collects several types of costs. For time study personnel, there are costs derived from activities coded by both SPMP and non-SPMP which are either non-Medicaid related (Codes 2, 5, and 8) or direct service activities (Codes 13, 14, 16, 17, 18, and 21). Costs for those personnel who were not time studied are to be entered in the Unstudied Personnel section (discussed in Section 4.2) are also included in this cost area. Cost Pool #4 - This pool contains costs for General Administrative services, as well as those costs discussed in the Time and Expenditure Entry section, that cannot be allocated in a more accurate fashion.

Section 4.2 Time and Expenditure Entry Office of Management and Budget (OMB) Circular A-87 (revised), as modified by 1 TAC §355.103, is to be used for assistance in determining the classification and allowable and unallowable status of all expenses.

4.2.1 For Time Study Personnel – SPMP and Non-SPMP

4.2.1.1 Salaries and Fringe Benefits

After the time study logs have been completed for each studied position, enter all salaries and benefits. The coding of the individual’s time study logs drives the allocation of salary and benefit expenses. In this way, the time spent in any one activity will draw only the appropriate percentage of the personnel’s costs.


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Costs that are drawn to Code 15 time will then be reallocated to all the other codes utilized by the personnel based on the percentage of time in Codes 1 - 14, 16 – 18, and 21. For each section, SPMP and non-SPMP, the costs for all personnel will be totaled to provide a basis for calculating an overall percentage figure of time/cost for each activity code. These percentages are then used to allocate the remaining costs for the time studied personnel (e.g., Travel and Training, Direct Program Support, and Operating). At this point, enter the individual time studies into the TAFI. Time studies of SPMP and non-SPMP personnel as defined previously each have a separate section. 4.2.1.2 Direct Program Support Salaries and Benefits Compile the salary and benefits costs for clerical personnel who qualify as “SPMP Clerical” in the SPMP section of the TAFI, as defined in Section 3.7. Salary and benefit costs for those personnel who directly support time studied personnel (SPMP and non-SPMP) and who do not qualify as either “SPMP Clerical” or general administrative personnel are shown in the non-SPMP direct program support section of the TAFI. Time study personnel who coded 100% of the time in Code 15 are allocated here. 4.2.1.3 Travel and Training This includes mileage reimbursements, airfare, per diem, lodging, seminar fees, payments to outside trainers and other directly related costs. Collect travel and training costs assigned to the SPMP and the SPMP Clerical Personnel in the SPMP section of the TAFI. If travel and training costs cannot be directly identified as associated specifically with SPMP, but can be identified as associated with time studied personnel and their direct support personnel, enter these costs with the non-SPMP travel and training costs. Allocate the travel and training costs identified to non-SPMP personnel and their administrative support personnel in the non-SPMP section of the TAFI. If the travel and training costs cannot be identified as associated specifically with time studied personnel, then they should be entered in the General Administrative Cost section, except for those costs which can be identified as specifically associated with Unstudied programs or personnel. 4.2.1.4 Operating Costs Enter operating costs associated with time studied personnel in the appropriate section (SPMP or non-SPMP) of the TAFI. If these costs cannot be tied to a specific person or position, then a percentage of all the salaries and benefits may be determined and used to allocate these costs among the various cost pools including SPMP, non-SPMP, Unstudied Personnel, and Cost Pool


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#4 as necessary. Reliable work papers must be kept when using costs allocations.

4.2.2 For Unstudied Personnel and Programs 4.2.2.1 Salaries and Benefits

Enter salaries and benefits for all personnel who did not time study in the Unstudied Personnel section. These are reported on the “Consolidation Page 1: Unstudied” of the TAFI. (This does not include clerical and direct administrative personnel who do not time study and are captured in the SPMP and non-SPMP Clerical Salaries and Benefits sections of the TAFI. This also does not include those personnel to be included in the General Administrative Costs section.) 4.2.2.2 Travel and Training and Operating Costs

Enter costs for Unstudied Personnel and programs in the Unstudied Personnel section. These costs are reported on the “Consolidation Page 1: Unstudied Personnel” of the TAFI. These may include program operating costs associated with time studied personnel, but are specific costs of providing direct service (e.g., skills training and supplies) and should not be captured in the Medicaid Administrative Claim. 4.2.2.3 Unallowable Costs

As described in OMB Circular A-87 (revised), as modified by 1 TAC §355.103, unallowable costs are entered as a total in the TAFI and appear as an entry under Unstudied Personnel in the Unallowable Operating Costs (UOC) column on the “Consolidation Page 1: Unstudied Personnel” of the TAFI. Do not simply drop these costs from the claim. While they are not allowable to claim for reimbursement for federal programs, they are legitimate expenses of the local agency.

4.2.3 General Administrative Costs 4.2.3.1 Salary and Benefits, Travel and Training and Operating Costs

Costs for personnel who do not time study and who are general administrative personnel (e.g., CEO/ED, Personnel, Business Office, Management Information System [MIS], etc.) are entered in the TAFI and are displayed on the “Cost Pool #4 Dollars” page in the General Administrative section. These personnel support the local agency as a whole, so their costs are allocated across all the appropriate cost areas. Include in this cost area any costs which could not be associated directly with specific time studied and unstudied personnel (e.g., travel and training) that are not captured on an individual basis, as well as any operating costs that could not be reasonably allocated between the costs areas. For the most accurate cost allocation, use this method as seldom as possible to capture non-General Administrative costs.


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Section 4.3 Revenues There are two types of revenue sources for the purpose of the Medicaid Administrative Claim. In determining the share of the costs for which it is willing to pay, the federal government generally expects a local agency to utilize its own income to offset costs, lowering the amount in which the federal government is responsible to participate. These revenues are referred to as Recognized Revenues. Some revenues are not recognized by the federal Medicaid agency as revenue that can be used to offset costs, but rather are designated as the matching funds necessary to draw down the federal support. These funds are designated as Unrecognized Revenues. 4.3.1 Recognized Revenues These are income sources that must be adjusted (offset) against the costs of the local agency, and they are collected in either the Unstudied Cost Pool or Cost Pool #4, based on an analysis of the revenue source. The general rule for determining placement is that revenue must follow the activity by which it is earned or the expense for which it is a reimbursement. Medicaid Fees + Match - This section includes all Title XIX reimbursement and, where required,

the State Matching Funds. To calculate the matching funds, divide the receipts by the Federal Participation Rate to get the total of reimbursements and match. All Medicaid funds are placed in the Unstudied Cost Pool, as they are earned by direct service activities.

Federal Grants + Match - It is important to be aware of which funding sources are federal and

which are state. A federal grant may pass through one or more state agencies, but it is still federal money. A federal grant will always have a Catalog of Federal Domestic Assistance (CFDA) Number and will be listed on the audit report on the “Schedule of State and Federal Assistance.”

Each grant has its own match percentages and contractual requirements. These must be individually analyzed by the local agency preparing the claim. Inputting and adding the match must be done separately for each grant. Placing these funds into the correct cost pool requires determining what expenditures the grant covers.

If the grant funds the entire salary of a time study personnel, then at least the portion of the grant pertaining to the expenses of that personnel must be placed in Cost Pool #4 in order to allocate to all the cost pools, just as those expenditures are allocated. If the grant covers only specific direct service activities of a time study personnel, and/or specifically excludes such activities as fall into Codes 1 - 12, then the grant receipts for the personnel may be placed in the Unstudied Cost Pool.

If the expenditures covered by the grant (e.g., the Department of Housing and Urban Development [HUD] grants for residential costs, grants used to purchase drugs, homeless grants) are collected in the Unstudied Cost Pool, then the grant and the cost of the grant personnel should be placed in the Unstudied Cost Pool as well.

Place grant revenues that are recognized in time studied units and are broad in the nature of the


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expenditures they will cover in Cost Pool #4. If the expenditures are specifically designated within the accounting system, place the expenditures in the Unstudied section as program-specific expenses.

Medicare - Medicare revenues are direct service-related and are placed in the Unstudied Cost

Pool. Insurance - Generally, insurance receipts are entered in the Unstudied Cost Pool. An exception

might be for receipts for casualty insurance (e.g., fire, auto, etc.) which exceeded replacement/repair costs. These would be entered in Cost Pool #4.

Fees - These are typically fees for direct services paid by or on behalf of clients. Place such

revenues in the Unstudied Cost Pool.

If fees are collected for copying client records for outside agencies, place them in Cost Pool #4. Donations to Contractor - Used only by private agencies. Other Revenues - All revenue sources not previously mentioned are generally placed in the

Unstudied Cost Pool, although some are specifically assigned to Cost Pool #4.

Assign miscellaneous revenues, which are one-time, unusual or not readily identifiable and were placed in a miscellaneous account to Cost Pool #4. This includes Interest Income, Other Business Income, and Fundraising Income not specifically designated for a specific Unstudied Cost Pool activity and any other purely administrative income. Place revenues for vocational production, from clients, families or other sources covering residential costs and grants from private foundations in the Unstudied Cost Pool.

4.3.2 Unrecognized Revenues These revenues have no effect on the calculation of the claim and are included solely for purposes of audit and full reporting. Place these revenues in Cost Pool #4. Medicaid Administrative Reimbursement - The reimbursement received for this claim process

is a significant source of unrecognized revenue. The funds have already been reduced for matching purposes in the preparation of the previous quarter’s claim.

Other State Funds - These are General Revenue and grants from state funds from all state

agencies. Local Government Funds - These funding sources include city, county, school districts and other

local taxing authorities. Donations to Public Agencies - All donations to public (legislatively mandated) agencies are

placed in this item.


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Federal Emergency Management Assistance Reimbursement (FEMA) (Title IV-A) - FEMA

funds. Federal Title IV-E Reimbursement 4.3.3 Federal Financial Participation Rate After the results of the time study are multiplied by the cost pool (Section 4.6), they are then multiplied by the FFP rate of either 75% or 50%, depending on whether personnel qualify as SPMP and are performing activities that require this expertise.

Section 4.4 Determining the Medicaid Percentage 4.4.1 Overview The Medicaid percentage is one of the most critical factors in determining the portion of a program's costs that can be claimed to MAC. This one factor, or fraction, is multiplied by most all other factors in the formula for constructing a claim and affects almost every dollar claimed. 4.4.2 Calculating the Medicaid Percentage Federal guidelines require that the methods used to figure this percentage be “statistically valid.” Local agencies claiming reimbursement through Medicaid administration should not expect federal auditors to accept personnel judgment or management decisions as the basis for calculating the Medicaid percentage. Rather, auditors will demand an objective, documented basis for the Medicaid percentage that is used in the claim. The Medicaid percentage must be reflective of the quarter claimed and should be updated regularly. 4.4.3 Methodology The methodology that must be used to determine the Medicaid percentage is to identify, on a case-by-case basis, which individuals are Medicaid eligible and which individuals are not. The Medicaid percentage is a fraction. The numerator consists of all individuals in the local agency or program's caseload or service populations who are actual Medicaid recipients. The denominator of the fraction is the total number of individuals served by the local agency or program during the claim period minus the Medicaid-pending clients. The resulting fraction, or percentage of Medicaid recipients in the caseload, must be current to the quarter of the claim. Thus, a person who would be Medicaid eligible but has neither applied for or been issued a Medicaid card, or whose status is pending is not counted in the numerator. In addition, individuals for whom there is evidence of a pending Medicaid status are to be removed from the denominator. This Medicaid Administrative Claiming Guide uses the term “eligible” to mean the individual has gone through a formal eligibility determination process and the department has determined that he/she is eligible to receive medical assistance.


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The following types of benefit recipients are excluded from the Medicaid eligible portion of the Medicaid percentage calculation for MAC. The program types are: Type Program 23 Specified Low-Income Medicare Beneficiary (SLMB) Type Program 24 Qualified Medicare Beneficiary (QMB) Type Program 30 Medical Assistance for Illegal Aliens Type Program 14 1929(b) Program Individuals receiving services who have the above program types are not to be included in the Medicaid eligible portion of the calculation. However, if they are receiving services for the quarter calculated they would still be included in the total number of clients served portion of the calculation. Consumers receiving services through the ECI grant, receiving services solely due to substance abuse issues (not receiving any sort of MH or MR services), or are contacts via the crisis hotline are also not included in the Medicaid percentage. This is not a complete list of the different types of programs or benefits that are to be excluded from the Medicaid percentage. For specific questions please contact [email protected]. 4.4.4 Medicaid Percentage The Medicaid percentage of the local agency is determined by dividing the total unduplicated clients served for the quarter who are Medicaid eligible (numerator) by the total unduplicated clients served for the quarter (denominator) less those who are pending approval of Medicaid eligibility.

Medicaid-eligible total unduplicated clients served for the quarter Total unduplicated clients served for the quarter – clients pending approval of Medicaid eligibility

For example, if the Medicaid percentage were 15%, the Medicaid Administrative Claim will be about half as large as it would be if the Medicaid percentage were 30% and one-quarter as large as it would be if the percentage were 60%.

Section 4.5 Direct Charge A direct charge is 50% reimbursement for funds expended on MAC and TAFI related business. A direct charge may be made for expenses that are directly related to the preparation of the TAFI and the MAC claim and/or time study by personnel who are otherwise captured in cost pools or by contractors/consultants performing MAC or TAFI related functions. Examples of direct charges can be found in the TAFI manual. If the MAC Coordinator participates in the time study they cannot use the direct charge option for their position.


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Section 4.6 Calculating the Claim The federal portion of the Medicaid Administrative Claim is determined by taking the FFP and Medicaid percentage multiplied by the costs pools (the actual costs incurred for the quarter being claimed). The local agency will certify that there were sufficient non-federal (state, county, or local) funds to match requirements and that the claim only included actual costs incurred for that specific quarter at the time the claim is submitted. In very general terms, the federal share of the claim for Medicaid administration is calculated by: Total Costs for personnel to be claimed X Percentage of allowable time, based on time studies X Percentage of all persons served who are Medicaid recipients X 50% or 75% federal match, as appropriate = Total Claim

Section 4.7 Quarterly Summary Invoice With each MAC claim submitted a QSI and Direct Charge Detail must be included. The QSI documents the amount in the cost pools and the amount being reimbursed. Chapter 7 contains the QSI format and QSI Checklist. If the Medicaid percentage of the current claim is +/- 5% from the claims of the two previous quarters, a letter addressing this variation must be submitted with the current claim. If the total amount of the current claim is +/- 25% from the claims of the two previous quarters, a letter addressing this variation must be submitted with the current claim. Department physical address: Mailing Address: Department of Aging and Disability Services Department of Aging and Disability Services Medicaid Administrative Claiming Medicaid Administrative Claiming 701 W. 51st Street P. O. Box 149030 Austin, Texas 78751 Austin, Texas 78714-9030

Section 4.8 MAC Claim Desk Review The MAC Claim Desk Review is utilized to ensure the integrity and accuracy of all of the data on the QSI. Desk reviews will be completed quarterly for all agencies unless otherwise specified by the department MAC Coordinator and/or HHSC. All data on the QSI will be verified, using the information retrieved from the TAFI for the quarter being reviewed, prior to any authorization of MAC Claims. The QSI and Direct Charge Detail are due to the department 45 calendar days after the end of the FFY quarter. Requests for extensions will be considered on a case by case basis and if granted will not exceed 5 calendar days.


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Upon completion of the department review of the materials sent by the local agency, any discrepancies will be brought to the attention of the local agency. The department will contact the local agency by e-mail requesting explanation, clarification, and/or correction of discrepancies. All return correspondence from the local agency must be in writing on agency letterhead and received by the department within 3 business days of the request. In an effort to expedite the review process, faxes and e-mails will be accepted, but an original signed copy of all revisions/explanations/clarifications must be received by the department within 3 business days of the request for the information. Automatic deferment of the MAC Claim for the reporting quarter will occur for any local agency not satisfying requests for explanation, clarification, or correction of unresolved claim issues. The local agency will receive written notice of MAC reimbursement deferment.



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Chapter 5 Maintenance

Section 5.1 Record Keeping and Documentation MAC is not a fee-for-service activity. Therefore, there is no requirement of additional documentation of client contact beyond the already existing local agency consumer’s records system. The documentation that must be retained for MAC for each federal fiscal quarter: MAC Contract Agency Review File Checklist Time Study Logs Local Agency Implementation Plan Local training materials Time Study personnel list Acronyms used on time logs and in TAFI Annual Self-Evaluation report Annual Report Department policy clarifications, letters, or memos Quarterly Status Report Justification of use of Codes 11 & 12

Implementation Plan Checklist Department notice of approval of Implementation Plan Documentation of training dates, trainers, and participants SPMP Review File Checklist SPMP job descriptions SPMP Surveys Copies of licenses and certifications Clerical support documentation

QSI Checklist Quarterly Summary Invoice Justification of the Medicaid percentage Basis of each cost pool

TAFI Audit File Checklist MAC Review reports (as applicable) Any and all other documentation that is necessary to justify actions taken in the implementation of

the MAC project and the submission of the MAC claim. (See Checklists in Chapter 7, and “Documents-At-A Glance” in Chapter 8 for additional assistance.) Gathering the necessary documentation needed in the event of a review is much simpler to do while the time study is being done and the claim is being developed. Reliable documentation is also essential when personnel who were originally responsible for the time study or the claim leave the local agency and when new personnel must take on these responsibilities.


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The department requires that original and revised records be retained for six years after the submission of each claim. If any claims are resubmitted, the six years starts again with the date the claim is resubmitted.

Section 5.2 Reviews To ensure that the local agencies implement the MAC project according to the federal and state guidelines, the department must conduct a variety of reviews. While the standard MAC certification review is the most common review, the department may be required to conduct follow-up reviews and other types of reviews, as the department or HHSC deem necessary. The standard MAC certification review is comprised of two parts: Desk Review and Personnel Interviews. The materials listed in the Agency Review File Checklist and the SPMP Review File Checklist comprise the bulk of the standard MAC Desk Review. The Desk Review also includes a review of the individual time study logs to ensure that the logs are completed accurately, as indicated in Section 3.2, 3.3, and 3.5. While the review team usually spends more time on the Desk Review items, it is the personnel interviews that stress-out the Local Agency MAC Coordinators. The interview of the Local Agency MAC Coordinator is the longest interview and ensures that the Local Agency MAC Coordinator knows the basic requirements of MAC. The individual time study participant interviews take the bulk of the interview time, not because of their length but because of the number of interviews that need to be conducted. A minimum of 10%, but no less than 10 participants, will be interviewed. The primary focus of the questions is to establish that the personnel can tell the reviewers why they used the codes they did during the quarter being reviewed. The responsibility lies with the time study personnel to justify their use of the codes. The Local Agency MAC Coordinator must ensure that the local agency cooperates completely with federal audits and department reviews. The Local Agency MAC Coordinator must provide federal and department personnel with any documentation that is requested in regards to a MAC audit or review in a timely manner. Personnel selected for interviews must make themselves available to the review team. In cases of illness, death, or previously approved leave, an alternate will be selected by the review team and will notify the Local Agency MAC Coordinator. If any personnel fail to appear for their interview, the personnel’s time study must be placed into unstudied for the quarter being reviewed. There are two potential findings of a standard MAC certification review: 1. Strong Recommendation - items that do not directly affect the accuracy of the claim. Includes

paperwork that has not been completed correctly. (Examples: AM or PM not being appropriately indicated, logs not signed within 7 days of the end date, inaccurate error correction procedures, or having an incomplete SPMP Review File.)

2. Non-Compliance - items that directly affect the accuracy of the claim or items that were cited as a Strong Recommendation or Non-Compliance during any previous MAC review. (Examples: Data entered incorrectly from time logs into the TAFI system, non-SPMP personnel using SPMP codes, or inaccurate coding.)


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The most common Non-Compliance is inaccurate coding. Dependent upon the type of coding errors that are occurring, the local agency may be required to resubmit the MAC claim for the reviewed quarter. There are two potential situations in which a local agency’s claim would need to be resubmitted: 1. The personnel inaccurately coded MAC reimbursable codes and used those codes 10% or more of

their total time. Resubmission - the personnel’s time study must be placed in unstudied for the quarter being reviewed.

2. The personnel inaccurately coded a rate-setting code. Resubmission – using consumer progress notes, correct time study coding. (If unable to correct coding, the personnel’s time study must be placed in unstudied for the quarter being reviewed.)

Note: Refer to the current HHSC TAFI Manual for information on how to resubmit a claim.

If there are any Non-Compliance findings the MAC review team will require the local agency to submit a Plan of Correction (POC) within 14 days of the local agency’s receipt of the formal review report from the department. The local agency’s POC must delineate how the local agency will correct the issue in the current quarter as well as any previous quarters that may have been affected. The POC must also explain how the local agency will keep the error from re-occurring and address any training issues that were identified. Dependent upon the nature of the Non-Compliance and the proposed POC, the local agency’s Implementation Plan may also have to be modified and re-submitted. The POC must be fully implemented within 60 days of the MAC review. Any Non-Compliance will place all pending and future claims on deferred status until the local agency submits evidence that the POC was implemented and all findings were resolved. Evidence of resolution could include copies of revised logs, copies of training logs, and resubmitted TAFI reports. Specific information regarding evidence will be given to the Local Agency MAC Coordinator during the MAC certification review.

Section 5.3 Local Agency MAC Coordinator’s Quarterly Status Report to CEO/ED

The department requires that a written Quarterly Status Report be given to the CEO/ED identifying any progress, problems, improvements, and status of the MAC claim. Additional information can and should be added as the Local Agency MAC Coordinator and the CEO/ED see fit. This status report is required to be completed in writing and must be signed by the CEO/ED every quarter.

Section 5.4 Annual Self-Evaluation Report Local Agency MAC Coordinators are required to review their local agency’s policies and procedures that have been implemented for MAC at least annually. The purpose of this review is to ensure that all the mandatory participation requirements are being covered in the manner as required by HHSC and


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the department. The self-evaluation must be completed in writing every FFY during the 4th quarter and must be signed and dated by the Local Agency MAC Coordinator and the CEO/ED. To conduct the self-evaluation, Local Agency MAC Coordinators must review the MAC process at their local agency. The local agency’s Implementation Plan and the Implementation Plan Checklist (provided in Chapter 7) are the necessary tools for this review. The Local Agency MAC Coordinator must review the effectiveness of the strategies delineated in the Implementation Plan. The Local Agency MAC Coordinator must document any items identified, at this time or throughout the year, as ineffective. Documentation must include an explanation as to why the strategy was not effective. The self-evaluation must contain an explanation of the revised policy and/or procedure and the anticipated outcomes. If the policy and/or procedures have already been implemented, the documentation must include the outcomes thus far. Local Agency MAC Coordinators must also determine if there are any mandatory requirements that are not being completed and document how those items will be addressed during the following FFY.

Section 5.5 Annual Report The report data is used to coordinate and plan activities for MAC. This Annual Report is required from each contracted local agency for any FFY (October 1 - September 30) that a claim was submitted by the local agency. Complete and submit the original Annual Report on official local agency letterhead to Medicaid Administrative Claiming on or before March 15 following any FFY that a claim was submitted by the local agency. Should the 15th fall on a weekend or holiday, the Annual Report will be due on the next working day. If the Annual Report is not received by the due date, the local agency’s claim will be deferred until the next resubmission quarter. Instructions for completing the Annual Report: 1. List the total MAC revenues received during the FFY for which the MAC Annual Report is being

submitted. For the purposes of the MAC Annual Report, the definition of received is as follows: monies received by the local agency are those claims which have been paid by Texas Office of the Comptroller during the four quarters of the FFY being reported. For example, if the Comptroller issues the payment on September 30, 2004, but the money is not direct deposited into the local agency account until October 1, 2004, this payment is still considered paid in FFY 2004. This will be monies actually disbursed by the Texas Office of the Comptroller from October 1 through September 30 of the FFY being reported. Note: This would not include claims submitted but not disbursed by the close of the FFY. Monies reported in the MAC Annual Report should also include any resubmits and/or deferments paid by the Texas Office of the Comptroller during in reporting FFY. Monies should be included in the appropriate quarter(s) in which they were received. Based on the disbursal dates of the payments, this could be as few as one quarter with no more than four quarters being included on the Annual Report. See the Annual Report section of Chapter 7 for the Annual Report format and an example. See the Comptroller’s website at www.window.state.tx.us for monies disbursed by the Comptroller.

2. List the top five priorities (3A – 3E) for use of MAC revenues in the current FFY (e.g., increase


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http://www.window.state.tx.us/

transportation resources, increasing Medicaid eligibility activities, specific outreach campaigns, increased Medicaid provider recruiting, etc.). List the amount of MAC revenues expended for EACH of the top five priorities in the area provided next to the respective priority. In 3F list the amount of any deferred claim (the total amount of the deferred claim) or revised claim and the difference (positive or negative) between the original claim and the resubmitted claim. In 3G, list total unexpended MAC Revenues to be carried forward into the next FFY. In 3H, Total 3A-G. This amount should reconcile back to #2; Total MAC Revenues received during the FFY.

3. List the top five anticipated priorities for use of MAC revenues in the FFY. 4. List the name, title, work telephone number and fax number of the individual who completes the

local agency’s MAC Annual Report. 5. Certify that the financial statement is correct with the CEO/ED, MAC Annual Report preparer, and

Local Agency MAC Coordinator’s signature and date. Technical Assistance: Refer to Page 110.



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Chapter 6 Medicaid Administrative Claiming Time Study Codes

TABLE OF CONTENTS

MEDICAID-COVERED SERVICES....................................................................................... 54 CODE 1: FACILITATING MEDICAID ELIGIBILITY DETERMINATION (ALL STAFF)55 CODE 2: FACILITATING NON-MEDICAID ELIGIBILITY DETERMINATIONS (ALL

STAFF) .................................................................................................................. 56 CODE 3: MEDICAID OUTREACH (SPMP) ....................................................................... 57 CODE 4: MEDICAID OUTREACH (ALL STAFF) ............................................................. 59 CODE 5: OUTREACH NON-MEDICAID (ALL STAFF) ................................................... 61 CODE 6: REFERRAL, COORDINATION, AND MONITORING OF MEDICAID SERVICES

(ALL STAFF) ........................................................................................................ 62 CODE 7: REFERRAL, COORDINATION, AND MONITORING OF MEDICAID SERVICES

(SPMP)................................................................................................................... 66 CODE 8: REFERRAL, COORDINATION, AND MONITORING OF NON-MEDICAID

SERVICES (ALL STAFF)..................................................................................... 67 CODE 9: MEDICAID TRANSPORTATION AND TRANSLATION (ALL STAFF)......... 69 CODE 10: MEDICAID PROVIDER RELATIONS (ALL STAFF)........................................ 70 CODE 11: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY

COORDINATION (ALL STAFF)......................................................................... 72 CODE 12: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY

COORDINATION (SPMP) ................................................................................... 74 CODE 13: DIRECT MEDICAL SERVICES (ALL STAFF) .................................................. 75 CODE 14: NON-MEDICAID, OTHER EDUCATIONAL AND SOCIAL SERVICES (ALL

STAFF) .................................................................................................................. 77 CODE 15: GENERAL ADMINISTRATION (ALL STAFF) ................................................. 79 CODE 16: MR SERVICE COORDINATION AND MH CASE MANAGEMENT (MEDICAID -

COVERED SERVICES)........................................................................................ 81 CODE 17: REHABILITATIVE SERVICES (MEDICAID - COVERED SERVICES).......... 88 CODE 18: HOME AND COMMUNITY BASED SERVICES (HCS).................................... 90 CODE 19: NO LONGER USED AFTER 09/01/03 ................................................................ 91 CODE 20: NO LONGER USED AFTER 04/01/98 ................................................................. 91 CODE 21: INTERMEDIATE CARE FACILITY - MR (ICF-MR) ......................................... 91 CODE L: LUNCH (ALL STAFF).......................................................................................... 92 CODE O: OFF (OFF DUTY, COMP-TIME USED) ...................................................................... 92


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MEDICAID-COVERED SERVICES The purpose of the Medicaid administration project is to ensure the access of eligible individuals to Medicaid services. For clarification, "Medicaid services" refers to services covered under the Texas State Medicaid Plan and are medically related. The following list identifies the services used most frequently by individuals.

physician services hospital services clinic services for children under age 21 limited maternity care clinics lab and x-ray services home health care Texas Health Steps (THSteps) screenings and services dental care for children under age 21 medically necessary oral surgery and dentistry for adults (not routine dentistry) pharmacy services (prescription drugs) mental health and mental retardation services (provided by the department and its contract

local agencies [i.e., Rehabilitative Services, Service Coordination, HCS, and ICF-MR]) family planning services provided to children under age 21 by a Licensed Psychologist, Licensed Master

Social Worker-Advanced Practitioner (LMSW-AP), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), and Licensed Marriage and Family Therapist (LMFT)

Comprehensive Care Program (CCP) services for children under age 21, including services by private duty nurses, physical, occupational, and speech therapies, durable medical equipment, medical supplies, psychiatric hospital care, and dietitian services

School Health and Related Services (SHARS) Targeted Case Management for pregnant women and children under age 1 audiological services diagnostic assessment services for individuals with mental retardation and mental illness when

provided by a physician. emergency medical services private duty nursing for children under age 21 physical therapy rehabilitation services for chronic medical conditions hospice services personal care services in the home day activity and health services (DAHS) nursing facility (NF)

Issue Date: September 2005


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CODE 1: FACILITATING MEDICAID ELIGIBILITY DETERMINATION (ALL STAFF)

All staff should use this code when assisting an individual in becoming eligible for Medicaid. Include related paperwork, clerical activities, or staff travel required to perform these activities. This activity does not include the actual determination of Medicaid eligibility. Examples of activities reported under this code:

Assisting individuals to provide third party resource information at Medicaid eligibility intake;

Verifying an individual's current Medicaid eligibility status; Explaining Medicaid eligibility rules and the Medicaid eligibility process to prospective

applicants of Service Coordination; Assisting an applicant to fill out a Medicaid eligibility application; Gathering information related to the application and eligibility determination for an

individual, including resource information and third party liability (TPL) information, as a prelude to submitting a formal Medicaid application;

Providing necessary forms and packaging all forms in preparation for the Medicaid eligibility determination.

GENERAL CODE CLARIFICATIONS: 1. Activities to assist potential or current consumers in obtaining or maintaining their Medicaid

eligibility is Code 1. 2. Code 1 is to assist individuals in becoming Medicaid eligible. This does not determine the

service array or services provided to an individual. 3. Time spent assisting a consumer and/or family member to complete the Representative Payee

Report is Code 1. 4. Personnel travel, for the purposes of providing a Code 1 activity, is included as Code 1 when

traveling to and from an off-site location, that is not owned, operated, or under arrangement by the local agency.

5. Personnel travel, for the purposes of providing a Code 1 activity, to and from a location that is owned, operated, or under arrangement by the local agency is Code 15.

GENERAL EXAMPLES: 6. Completing an “ability-to-pay fee schedule assessment” when used to help determine

Medicaid eligibility is a Code 1 activity. 7. Assisting individuals with the Medicaid appeal(s) processes (including the Medicaid

Administrative hearing process) is Code 1. 8. Serving as a translator for assisting in obtaining Medicaid eligibility is a Code 1 activity. 9. Transporting a consumer to the Medicaid eligibility office for the purpose of determining

Medicaid eligibility is Code 1. 10. Verifying an individual's eligibility or continuing eligibility for the purpose of developing,

ascertaining, or continuing participation in Medicaid programs is Code 1. 11. Gathering additional information, by personnel, for the Supplemental Security Income

(SSI)/Medicaid application is Code 1.


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12. Filling out the “Mental Status exam” paperwork for the SSI/Medicaid application process is Code 1.

13. Time spent by a Medicaid Eligibility worker filling out a SSI application is Code 1. 14. If the local agency is charging the individual a fee for facilitating Medicaid eligibility

determinations, the local agency must use Code 2 for these activities. 15. Verifying Medicaid eligibility as part of the billing process does not meet the intent of Code

1 (i.e., assisting an individual in becoming eligible) and is not Code 1. Billing activities are Code 15.

ADDITIONAL NORTHSTAR CODE CLARIFICATIONS: 16. The Behavioral Health Organization (BHO) is responsible for helping the individual(s)

become Medicaid eligible. Time spent helping a NorthSTAR consumer to apply for Medicaid would be a Code 2.

ADDITIONAL SERVICE COORDINATION/CASE MANAGEMENT CODE CLARIFICATIONS: 17. A Service Coordinator assisting a Service Coordination consumer in obtaining or

maintaining Medicaid eligibility is Code 1. 18. A Case Manager assisting a Case Management consumer in obtaining or maintaining

Medicaid eligibility is Code 1.

CODE 2: FACILITATING NON-MEDICAID ELIGIBILITY DETERMINATIONS (ALL STAFF) All staff should use this code when helping an individual to become eligible for NON-Medicaid programs. Include related paperwork, clerical activities, or staff travel required to perform these activities. Examples of activities reported under this code:

Verifying an individual's eligibility or continuing eligibility for Medicaid for the purpose of developing, ascertaining, or continuing eligibility for NON-Medicaid programs;

Explaining eligibility rules and eligibility processes for In-Home and Family Support (IHFS) Programs, Temporary Assistance to Needy Families (TANF), food stamps, Women, Infants, and Children (WIC), etc., to prospective applicants;

Assisting an applicant to fill out eligibility applicants for such NON-Medicaid programs as IHFS and food stamps;

Gathering information related to the application and eligibility determination for NON-Medicaid programs for a client;

Providing necessary forms and packaging all forms in preparation for the NON-Medicaid eligibility determination.

GENERAL CODE CLARIFICATIONS:

1. Activities to assist non-Service Coordination consumers in obtaining eligibility for non-Medicaid services must be coded as Code 2 and not to the service being requested.


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2. Personnel travel, for the purposes of providing a Code 2 activity, is included as Code 2 when traveling to and from an off-site location, that is not owned, operated, or under arrangement by the local agency.


GENERAL EXAMPLES:

4. Helping a consumer to become eligible for Substance Abuse Programs (MH), Legal Aid, Day Care, and Social and Educational Programs is Code 2.

5. Indigent care programs (including the application process for drug companies that help pay for necessary medications) and other local financial assistance programs are Code 2.

6. Assisting an applicant to apply for federal grants, such as Partnerships and Transitions Homeless (PATH) is Code 2.

7. When visiting an Institution for Mental Diseases (IMD) or correctional facility and helping the consumer to fill out either a Medicaid or a non-Medicaid application is Code 2. Refer to the current Texas Medicaid and Healthcare Partnership Provider Procedures Manual and Case Management Services for Persons with Severe and Persistent Mental Illness and Persons with Mental Retardation or Relation Conditions manual for further information on IMDs or correctional facilities.

8. Filling out a Children’s Health Insurance Plan (CHIP) application is Code 2. 9. If the local agency is charging the individual a fee for facilitating Medicaid eligibility

determinations, the local agency must use Code 2 for these activities. 10. Facilitating Social Security Disability Insurance (SSDI) eligibility determination is a Code 2

activity. 11. Service Coordinator assisting a non-Service Coordination consumer in obtaining or

maintaining eligibility for non-Medicaid services is Code 2. 12. MH Case Manager assisting MH Case Management consumer in obtaining or maintaining

eligibility for non-Medicaid services is Code 16. Time spent assisting a consumer who is authorized to receive Psychosocial Rehabilitative Services in obtaining or maintaining eligibility for non-Medicaid services would be a Code 17-F.

13. Explaining eligibility rules and eligibility processes for New Generation Medications (NGM) is Code 2.

14. Assisting a person with their Medicare Part D application is Code 2. ADDITIONAL NORTHSTAR CODE CLARIFICATIONS:

15. The BHO is responsible for helping the individual(s) become Medicaid eligible. Time spent helping a NorthSTAR consumer to apply for Medicaid would be a Code 2.

CODE 3: MEDICAID OUTREACH (SPMP) This code should be used only by staff who are SPMP and only when skilled professional medical knowledge is required to identify medically at-risk individuals and persuade recipients or potential recipients to enter care through the Medicaid system. Include related paperwork, clerical activities, or staff travel needed to perform this activity.


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NOT DISCOUNTED: Outreach campaigns directed to the entire population to encourage potential Medicaid eligibles to apply for Medicaid are allowable and the costs do not have to be discounted by the Medicaid percentage. These campaigns are essentially eligibility outreach campaigns. Outreach campaigns directed toward bringing Medicaid eligibles into Medicaid covered services are allowable and the costs also do not have to be discounted by the Medicaid percentage. These campaigns are services campaigns, targeted on specific Medicaid services, such as HCS. A health education program or campaign may be allowable as a Medicaid administrative cost if it is targeted specifically to Medicaid services and for Medicaid eligible individuals, such as an educational campaign on immunization addressed to parents of THSteps children. If the entire campaign is focused on Medicaid the costs need not be discounted. Outreach may consist of discrete campaigns or may be an ongoing activity such as: sending teams of personnel into the community to seek out and identify children with mental retardation and special needs through "child find" activities; contacting individuals with mental illness or their family members about the availability of Medicaid services; establishing a telephone or walk-in service for referring persons to Medicaid services or eligibility offices; and operating a drop-in community center for under-served populations, such as individuals with mental illness, where Medicaid eligibility and service information is disseminated. Certain outreach campaigns may be directed toward bringing specific high-risk populations (for example, individuals with mental retardation or mental illness) into health care services. Report under this code only that portion of time spent on these activities that specifically addresses Medicaid outreach. Report the NON-Medicaid portion of these outreach campaigns under MAC Code 5 (for example, general health education programs). Examples of activities reported under this code:

Designing and implementing strategies to identify individuals who may be at high risk of poor health outcomes because of mental retardation or mental illness;

Designing and implementing strategies to identify mentally retarded children with special needs who may be at high risk of poor health outcomes because of abuse or neglect;

Designing and implementing strategies to respond to emergency health problems effecting groups of individuals with mental illness whom are at high risk for tuberculosis, hepatitis, or Human Immunodeficiency Virus (HIV).


1. Code 3 and title focus on Medicaid outreach by an SPMP. The code description is used to specify that only an SPMP can use the code, if the personnel qualify, and describes qualifying outreach activities. The activity has to be medically related since SPMP knowledge/education is needed to use this code.

2. If the activity does not require SPMP knowledge/education, use Code 4 (All Staff). 3. Visiting residents of an IMD or inmates of a correctional facility and explaining Medicaid

services to them is not a Service Coordination billable activity and is not reimbursable under any MAC Codes. This would be Code 5 when talking to a group or Code 8 if talking to an individual.

4. Medicaid outreach is not skills training. 5. Allocate (split) time spent in outreach activities between those for Medicaid services (Code 3


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GENERAL EXAMPLES:

8. Informing groups of individuals and/or families about the eligibility and availability of Medicaid services prior to the actual enrollment of the individual(s) into covered services, by personnel who qualify as SPMP is Code 3. This activity requires the use of their medically related knowledge/education. If the SPMP knowledge/education is not needed, this would be coded as Code 4 (All Staff).

9. Outreach programs directed toward groups of individuals that require SPMP knowledge to identify medically at-risk individuals and to inform eligible or potentially eligible individuals about Medicaid services and how to access care through the Medicaid system are Code 3.

ADDITIONAL NORTHSTAR CODE CLARIFICATIONS:

10. The BHO is responsible for training and educating the people in the NorthSTAR communities about services that are available and that are provided for MH services. The time spent providing outreach for NorthSTAR services would be Code 5.

ADDITIONAL SERVICE COORDINATION CODE CLARIFICATIONS:

11. Informing individuals who are receiving Service Coordination about Medicaid services is a Code 16 activity.

CODE 4: MEDICAID OUTREACH (ALL STAFF) All staff should use this code when performing activities that inform eligible or potentially eligible individuals about Medicaid and how to access it. This code should also be used when describing the range of services covered under Medicaid, how to obtain them, and the benefits of Medicaid preventive services. Both written and oral methods may be used. Include related paperwork, clerical activities, or staff travel required to perform these activities. NOT DISCOUNTED: Outreach campaigns directed to the entire population to encourage potential Medicaid eligibles to apply for Medicaid are allowable and the costs do not have to be discounted by the Medicaid percentage. These campaigns are essentially eligibility outreach campaigns. Outreach campaigns directed toward bringing Medicaid eligibles into Medicaid covered services are allowable and the costs also do not have to be discounted by the Medicaid percentage. These campaigns are service campaigns, targeted to specific Medicaid services, such as HCS. A health education program or campaign may be allowable as a Medicaid administrative cost if it is targeted specifically to Medicaid services and for Medicaid eligible individuals, such as an educational campaign on immunization addressed to parents of THSteps children. If the entire campaign is


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focused on Medicaid, the costs need not be discounted. Outreach may consist of discrete campaigns or may be an ongoing activity such as: sending teams of personnel into the community to seek out and identify children with mental retardation and special needs through "child find" activities; contacting individuals with mental illness or their family members about the availability of Medicaid services; establishing a telephone or walk-in service for referring persons to Medicaid services or eligibility offices; and operating a drop-in community center for under-served populations, such as individuals with mental illness, where Medicaid eligibility and service information is disseminated. Certain outreach campaigns may be directed toward bringing specific high-risk populations (for example, individuals with mental retardation or mental illness) into health care services. Report under this code only that portion of time spent on these activities which specifically address Medicaid outreach. Report the NON-Medicaid portion of these outreach campaigns under MAC Code 5 (for example, general health education programs). Examples of activities reported under this code include:

Informing individuals and their families about the availability of Medicaid services, such as Service Coordination, HCS, etc.;

Developing and presenting materials to explain HCS and other Medicaid services which are available to Medicaid eligible children;

Assisting the Medicaid agency to fulfill objectives of the THSteps program by: - informing eligibles of the benefits of prevention; - helping individuals and their families use health resources, including their own talents

and knowledge, effectively and efficiently; - ensuring that health problems are diagnosed and treated early, before they become more

serious and the treatment more costly. GENERAL CODE CLARIFICATIONS:

1. Code 4 and title focus on conducting Medicaid outreach that does not require skilled professional medical knowledge and can be used by all time study personnel.

2. Medicaid outreach is not skills training. 3. Allocate (split) time spent in outreach activities between those for Medicaid services (Code 3

or 4) and non-Medicaid services (Code 5). 4. Personnel travel, for the purposes of providing a Code 4 activity, is included as Code 4 when



GENERAL EXAMPLES:

6. Informing groups of individuals and/or families about the eligibility and availability of Medicaid services prior to the actual enrollment of the individual(s) into covered services is Code 4. If SPMP knowledge/education is needed to complete this activity, this would be Code 3.

7. Outreach programs directed toward groups of individuals to inform eligible or potentially eligible individuals about Medicaid services and how to access them are Code 4.

8. Going to a homeless shelter to talk to individuals (not in a group format) about Medicaid


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9. Compiling and distributing brochures for the purpose of Medicaid Outreach are Code 4. Compiling and distributing brochures for the purpose of general advertising and/or fund raising are Code 15.

10. Visiting residents of an IMD or inmates of a correctional facility and explaining Medicaid services to them would be Code 5 when talking to a group or Code 8 if talking to an individual.



ADDITIONAL SERVICE COORDINATION CODE CLARIFICATIONS:

12. Informing individuals who are receiving Service Coordination about Medicaid services is a Code 16-A activity.

CODE 5: OUTREACH NON-MEDICAID (ALL STAFF) All staff should use this code when performing activities that inform eligible or potentially eligible individuals about NON-Medicaid programs and how to access them. This code should also be used when describing the range of benefits covered under the NON-Medicaid programs. Both written and oral methods may be used. Include related paperwork, clerical activities, or staff travel needed to perform these activities. Examples of activities reported under this code:

Scheduling and promoting activities which educate individuals about the benefits of healthy lifestyles and practices;

Any outreach activities in support of programs which are 100% funded by State general revenue (for example, IHFS Program);

General health education programs or campaigns addressed to the general population (i.e., Drug Awareness Recognition Enforcement (DARE), dental hygiene, anti-smoking, alcohol reduction, etc.);

Outreach campaigns directed toward encouraging persons to access social, educational, legal, or other services not covered by Medicaid;

NON-Medicaid portions of general outreach campaigns (see discussion under Codes 3 and 4).


1. Code 5 and title provide a side-by-side choice for all time study personnel with outreach activities for Medicaid (Code 3 or 4) and non-Medicaid (Code 5) programs and services.

2. Allocate (split) time spent in outreach activities between those for Medicaid services (Code 3 or 4) and non-Medicaid services (Code 5).

3. Personnel travel, for the purposes of providing a Code 5 activity, is included as Code 5 when


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GENERAL EXAMPLES:

5. Parent conferences on truancy, drugs, gangs, etc. are Code 5. 6. Outreach programs directed toward groups of individuals that inform eligible or potentially

eligible individuals about non-Medicaid services and how to access them (e.g., local shelters, emergency food assistance, etc.) are Code 5.

7. Informing (not assisting) groups of individuals with regard to federal grants, such as PATH is Code 5.

8. When visiting an IMD or correctional facility and explaining (not assisting) to a group or groups of individuals what Medicaid or non-Medicaid services are available, use Code 5. Use Code 8 when talking to an individual. Refer to the current TMHP Provider Procedures Manual, and Case Management Services for Persons with Severe and Persistent Mental Illness and Persons with Mental Retardation or Relation Conditions manual for further information on IMDs or correctional facilities.



CODE 6: REFERRAL, COORDINATION, AND MONITORING OF MEDICAID SERVICES (ALL STAFF) All staff should use this code when making referrals for, coordinating, and/or monitoring the delivery of medical (Medicaid covered) services. A list of Medicaid covered services are attached. Include related paperwork, clerical activities, or staff travel necessary to perform these activities.

Any linking to crisis prevention and management, monitoring, assessment, and service planning and coordination performed as part of covered Medicaid Service Coordination should be entered in MAC Code 16-A. Examples of activities reported under this code:

Making referrals for and/or coordinating medical or physical examinations and necessary medical evaluations;

Making referrals for and/or scheduling THSteps screens, interperiodic screens, and appropriate immunizations;

Referring individuals for necessary medical health, dental health (under age 21 only), mental health, or substance abuse services covered by Medicaid;

Arranging for any diagnostic or treatment services which may be required as the result of a condition identified during an evaluation or screening;


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Gathering information that may be required in advance of these referrals or evaluations; Working with individuals, their families, other personnel, and providers to identify, arrange

for, and coordinate services covered under Medicaid that may be required as the result of screens, evaluations, or examinations;

The actual referral of a consumer to a Medicaid program for services (Service Coordination, HCS, etc.);

Preparing evaluation summaries and coordinating meetings where the need for referral to services covered by Medicaid will be determined (HCS, Service Coordination, ICF-MR, etc.);

Participating in a meeting to coordinate or review the status of an individual's needs for mental retardation or mental health services covered by Medicaid;

Providing follow-up contact to ensure that a consumer has received the prescribed medical service and to provide feedback whether further treatment or modification of existing treatment are required by personnel other than Service Coordination;

Coordinating and monitoring the completion of the prescribed services, termination of services, and the referral of the individual to other Medicaid service providers as may be required to provide continuity of care;

Providing information to other personnel on the individual's medical services and plans.

GENERAL CODE CLARIFICATIONS: 1. For individuals with Mental Retardation, linking to crisis prevention and management,

monitoring, assessment, and service planning and coordination activities coded under Codes 6, 7, and 8 must be for non-Service Coordination individuals

2. Completing the Adult Uniform Assessment (UA) which includes the initial Texas Recommended Authorization Guidelines (TRAG) and the Texas Implementation of Medication Algorithms (TIMA) is a code 6. Completing the Child/Adolescent Uniform Assessment which includes the initial Child and Adolescent Texas Recommended Authorization Guidelines (CA-TRAG) is Code 6. The ongoing UA to determine amount, duration and scope of services will be Code 16-B, 16-C, 16-D or 17-F.

3. The Licensed Practitioner of the Healing Arts (LPHA) determining medical necessity, initial or ongoing will be Code 6.

4. The Service Coordination Assessment-MR Services and triage of individuals requesting or receiving services are recorded as Code 6.

5. Completing the Inventory for Client and Agency Planning (ICAP), Level of Care/Level of Need (LOC/LON), and the Mental Retardation/Related Condition Assessment (MR/RC) for an individual not currently in an institution are Code 6 activities.

6. Determination of Mental Retardation (DMR) – completing the testing, writing the report, and endorsement are code 6 activities.

7. Completion of the DMR by a licensed psychologist and billing to a third party payor (e.g., private insurance, Medicaid) is a Code 13.

8. Writing the Service Coordination plan for a consumer receiving Service Coordination is Code 16. If the consumer has a Person Directed Plan (PDP), the plan must include elements of the Service Coordination Plan. If the individual is not receiving Service Coordination then use Code 6.

9. Any coordinating and monitoring of Medicaid or non-Medicaid services provided to a non-MR Service Coordination consumer who is currently enrolled in an IMD or correctional


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10. Community placement into or for Medicaid services provided to a non-MR Service Coordination consumer currently enrolled in an institution (i.e., nursing facility, ICF-MR or state school.) within 180 days prior to discharge may be coded as Code 6. If it is in excess of 180 days prior to discharge, then use Code 8.

11. When personnel are contacting non-Service Coordination and/or Service Coordination consumers for the sole purpose of determining whether or not they want to remain on a waiting list, this activity is Code 6. When personnel are contacting non-Case Management and/or Case Management consumers for the sole purpose of determining whether or not they want to remain on a waiting list, this activity is Code 6.

12. Promoting Independence activities, provided within 180 days prior to discharge, to individuals not enrolled in MR Service Coordination are Code 6.

13. Promoting Independence activities, provided more than 180 days prior to discharge, to individuals not enrolled in MR Service Coordination, are Code 8.


15. Personnel travel, for the purpose of providing a Code 6 activity, to and from a location that is owned, operated, or under arrangement by the local agency is Code 15.

16. Permanency Planning provided to a non-MR Service Coordination consumer within 180 days of discharge is Code 6.

17. Permanency Planning provided to a non-MR Service Coordination consumer in excess of 180 days of discharge is Code 8.

18. Transition planning from an ICF-MR or NF to community within 180 days of discharge for a non-MR Service Coordination consumer is Code 6. If in excess of 180 days then is a Code 8.

19. Transition planning from an IMD to community regardless of how many days from discharge for an individual who is a non-MR Service Coordination consumer is Code 8.

20. Diagnostics are Code 6 except for diagnostic services that can be billed to the card which are Code 13. The billable Code 13 diagnostic services include diagnostics provided by a physician and diagnostic services provided to children under the age of 21.

GENERAL EXAMPLES:

21. Referring individuals for a DMR assessment service for persons with the potential diagnosis of MR is Code 6.

22. Referring individuals (under age 21) for dental services is Code 6. 23. Coordinating the delivery of community-based Medicaid covered services for a consumer

who is not a Service Coordination consumer is Code 6. 24. Screening activities provided prior to diagnosis of mental illness by a Licensed Practitioner

of the Healing Arts (LPHA) are Code 6. 25. Prior to the authorization of MH Case Management, time spent identifying needs and

completing intake activities is Code 6. 26. Initial treatment planning for an individual (present or not present) prior to the determination

of eligibility for MR Service Coordination is Code 6. 27. Crisis screening and/or assessment for the need of emergency services as defined in 25 TAC,

Part 1, Chapter 412, Subchapter G Mental Health Community Services Standards is Code


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28. When on “crisis on-call duty,” time spent responding to a call is Code 17-B. Time spent waiting for a call is time not engaged in work related activities and is to be coded in the same manner as time off.

29. Crisis Hotline for all non-NorthSTAR individuals is Code 6. 30. Local agency/authority personnel who coordinate the care for a consumer who is not

receiving MR Service Coordination, as part of the staffing to discuss ongoing treatment for a specific individual is Code 6. All other time study personnel attending the meeting would code their time according to the service they each are representing (for example, Rehabilitative personnel would use the appropriate Rehabilitative Service code under Code 17).

31. Personnel who are representing a non-MR Service Coordination individual at a Community Resource Coordination Group (CRCG), Admission, Review, Dismissal (ARD), or school Individual Transition Plan (ITP) meeting would use the appropriate Codes 6, 7, or 8 – dependent on whether the services being discussed are Medicaid or non-Medicaid.

32. Time spent in a CRCG or ARD when personnel are representing the local agency and are discussing Medicaid services, then Codes 11 or 12 would be applicable if the personnel’s job description reflects “planning and development of a Medicaid program.” When personnel are representing the local agency and discussing non-Medicaid services Code 15 would be used. When the personnel are not qualified to use Codes 11 or 12, then Code 14 would be used.

33. Going to a homeless shelter to talk to individuals (not in a group format) about Medicaid Services is Code 6.

34. Referrals to Medicaid funded substance abuse programs for individuals under 21 is Code 6. 35. Performing an Abnormal Involuntary Movement Scale (AIMS), that is not part of a

physician’s visit, is a Code 6 activity. ADDITIONAL NORTHSTAR CODE CLARIFICATIONS:

36. The BHO is responsible for referring, coordinating, and monitoring those MH services in the NorthSTAR communities. The time spent referring, coordinating, and monitoring those NorthSTAR services would be Code 8.

37. The BHO is responsible for the crisis hotline in the NorthSTAR communities so time spent answering the crisis hotline is to be coded as Code 8.

ADDITIONAL ICF-MR/HCS CODE CLARIFICATIONS:

38. When an individual who is not currently in an institution, is contacted about an available ICF-MR or HCS slot, the completion of the following pre-admission activities are Code 6 whether or not the individual is enrolled in Service Coordination:

ICAP LOC/LON MR/RC


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CODE 7: REFERRAL, COORDINATION, AND MONITORING OF MEDICAID SERVICES (SPMP) SPMP staff should use this code when making referrals for, coordinating, and/or monitoring the delivery of medical (Medicaid covered) services that require the use of skilled professional medical knowledge and training. A list of Medicaid covered services is attached. Staff that use this code must meet the requirements under 42 CFR 432.50 for skilled professional medical personnel. Include related paperwork, clerical activities, or staff travel required to perform these activities. Any linking to crisis prevention and management, monitoring, assessment, and service planning and coordination performed as part of covered Medicaid Service Coordination should be entered in MAC Code 16-A. Examples of activities requiring skilled professional medical knowledge and training included:

Making referrals for and/or coordinating medical or physical examinations and necessary medical evaluations;

Making referrals for and/or scheduling THSteps screens, interperiodic screens, and appropriate immunizations;

Referring individuals for necessary medical health, mental health, dental health (under age 21 only), or substance abuse services covered by Medicaid;

Arranging for any diagnostic or treatment services which may be required as the result of a condition identified during an evaluation or screening;

Gathering any information that may be required in advance of these referrals or evaluations; Working with individuals, their families, other personnel, and providers to identify, arrange

for, and coordinate services covered under Medicaid that may be required as the result of screens, evaluations, or examinations;

The actual referral of a consumer to a Medicaid program for services (Service Coordination, HCS, etc.);

Preparing the evaluation summaries and coordinating meetings where the need for referral to services covered by Medicaid will be determine (HCS, Service Coordination, ICF-MR, etc.);

Participating in a meeting to coordinate or review a consumer's needs for mental retardation or mental health services covered by Medicaid;

Providing follow-up contact to ensure that a consumer has received the prescribed medical service and providing feedback whether further treatment or modification of existing treatment are required by personnel other than Service Coordination;

Coordinating the completion of the prescribed services, termination of services, and the referral of a consumer to other Medicaid service providers as may be required to provide continuity of care;

Providing information to other personnel on the individual's medical services and plans; Coordinating referrals for additional medical evaluation or treatment covered by Medicaid

and following up on these services.

GENERAL CODE CLARIFICATIONS: 1. For individuals with Mental Retardation, linking to crisis prevention and management,

monitoring, assessment, and service planning and coordination activities coded under Codes


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2. Code 7 is restricted to use by qualified SPMP. The activity must be medically related since SPMP knowledge/education is needed to use this code. (Note: Not all LPHA qualify as a SPMP.)

3. If the activity does not require SPMP knowledge/education, use an "All Staff" code. 4. DMR – completing the testing, writing the report, and endorsement are code 6 activities. 5. Completion of the DMR by a licensed psychologist and billing a third party payor (e.g.,

private insurance, Medicaid) is a Code 13. 6. Personnel travel, for the purposes of providing a Code 7 activity, is included as Code 7 when



GENERAL EXAMPLES:

8. Personnel who are representing a non-MR Service Coordination individual at a CRCG, ARD, or school ITP meeting would use the appropriate Codes 6, 7, or 8 – dependent on whether the services being discussed are Medicaid or non-Medicaid.

NOTE: See Code 6 for activities that do not require SPMP knowledge. ADDITIONAL NORTHSTAR CODE CLARIFICATIONS:

9. The BHO is responsible for referring, coordinating, and monitoring those MH services in the NorthSTAR communities. The time spent referring, coordinating, and monitoring those NorthSTAR services would be Code 8.

10. The BHO is responsible for the crisis hotline in the NorthSTAR communities so time spent answering the crisis hotline would be coded as Code 8.

CODE 8: REFERRAL, COORDINATION, AND MONITORING OF NON-MEDICAID SERVICES (ALL STAFF) All staff should use this code when making referrals for, coordinating, and/or monitoring the delivery of NON-medical services, or medical services not covered by Medicaid. A list of Medicaid covered services is attached. Include related paperwork, clerical activities, or staff travel required to perform these activities. Any linking to crisis prevention and management, monitoring, assessment, and service planning and coordination performed as part of covered Medicaid Service Coordination should be entered in MAC Code 16-A. Examples of activities reported under this code:

Making referrals to medical services not covered by Medicaid (e.g. adult dental services); Making referrals for and coordinating access to social and educational services such as child

care, employment, job training, and housing; Making referrals to, coordination, and/or monitoring for the IHFS Program.


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1. For individuals with Mental Retardation, linking to crisis prevention and management, monitoring, assessment, and service planning and coordination activities coded under Codes 6, 7, and 8 must be for non-MR Service Coordination individuals.

2. Promoting Independence activities, provided more than 180 days prior to discharge, to individuals not enrolled in MR Service Coordination, are Code 8.

3. Promoting Independence activities, provided within 180 days prior to discharge, to individuals not enrolled in MR Service Coordination, are Code 6.

4. MR Service Coordination-like activities for non-MR Service Coordination consumers as a part of the Mental Retardation Authority (MRA) function for consumers living in an institution and transferring to another institution is Code 8.

5. MR Service Coordination-like activities provided to a non-MR Service Coordination consumer in a state hospital, jail, or other institution is Code 8.

6. Visiting non-MR Service Coordination consumers who are residents of an IMD or inmates of a correctional facility and explaining Medicaid services to them is not a MR Service Coordination activity and is not reimbursable under any MAC Codes. This would be Code 5 when talking to a group or Code 8 if talking to an individual.


8. Personnel travel, for purposes of providing a Code 8 activity, to and from a location that is owned, operated, or under arrangement by the local agency is Code 15.

9. Permanency Planning provided to a non-MR Service Coordination consumer within 180 days of discharge is Code 6.

10. Permanency Planning provided to a non-MR Service Coordination consumer in excess of 180 days of discharge is Code 8.

GENERAL EXAMPLES:

11. Referral to Salvation Army, Section 8 Housing, Goodwill Industries, housing shelters, food banks, WIC, non-Medicaid funded substance abuse programs is Code 8.

12. Indigent care programs (the referring to or coordinating of services with drug companies that help pay for necessary medications) and other local financial assistance programs are Code 8.

13. Making referrals concerning federal grants, such as PATH is Code 8. 14. Personnel who are representing a non-MR Service Coordination individual at a CRCG,

ARD, or school ITP meeting would use the appropriate Codes 6, 7, or 8– dependent on whether the services being discussed are Medicaid or non-Medicaid.

15. Any coordinating and monitoring of Medicaid or non-Medicaid services provided to a non-MR Service Coordination consumer who is currently enrolled in an IMD or correctional facility is Code 8.

16. Community placement into or for Medicaid services provided to a non-MR Service Coordination consumer currently enrolled in an institution (i.e., nursing facility, ICF-MR or state school) within 180 days prior to discharge may be coded as Code 6. If it is in excess of 180 days prior to discharge, then use Code 8.

17. Intakes and funding planning for IHFS are Code 8. 18. Transition planning from an ICF-MR, NF, or IMD to another ICF-MR, NF or IMD for non-


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19. Transition planning from an IMD to community regardless of how many days from discharge for an individual who is a non-MR Service Coordination consumer is Code 8.

ADDITIONAL NORTHSTAR CODE CLARIFICATIONS: 20. The BHO is responsible for referring, coordinating, and monitoring those MH services in the

NorthSTAR communities. The time spent referring, coordinating, and monitoring those NorthSTAR services would be Code 8.

21. The BHO is responsible for the crisis hotline in the NorthSTAR communities so time spent answering the crisis hotline would be coded as Code 8.

CODE 9: MEDICAID TRANSPORTATION AND TRANSLATION (ALL STAFF) All staff should use this code when assisting a consumer to obtain transportation to services covered by Medicaid; accompanying the individual to services covered by Medicaid or obtaining translation services for the purpose of accessing Medicaid services. A list of Medicaid covered services is attached. Include related paperwork, clerical activities, or staff travel required to perform these activities. Generally, NON-Medicaid transportation and translation activities should be reported under MAC Code 14 (NON-MEDICAID AND OTHER EDUCATIONAL AND SOCIAL SERVICES). Examples of activities reported under this code:

Drive eligible or potentially eligible individuals to the physician’s office for a scheduled physical exam.

Scheduling, arranging, or providing recipient transportation to medical treatment required as the result of an evaluation or examination;

Arranging for or providing translation services that assist the individual to access and understand necessary care or treatment.


1. Code non-Medicaid transportation and translation services to Code 14 (NON-Medicaid, Other Educational and Social Services) by all personnel.

2. Transportation of individuals to covered Medicaid services may be reimbursed under MAC or the TxDot Medicaid Transportation program but not both for the same activity. If you have or utilize the TxDot transportation contract then do not use Code 9. Code 14 would be the correct code to account for the time.

3. Transportation provided to eligible individuals in some covered Medicaid program services is an integral part of those services. For example, transportation is covered in HCS but is not a covered activity in MR Service Coordination or MH Case Management.

GENERAL EXAMPLES:


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4. Transportation to Medicaid services is Code 9. 5. Transportation from one Medicaid service to another Medicaid service is Code 9. 6. Transportation from the consumer’s home to a Medicaid service and back home (round-trip)

is Code 9. 7. Code 9 includes the necessary waiting time when transportation is provided to a Medicaid

service. 8. Transporting a consumer to the pharmacy to pick up the individual’s prescribed medication is

Code 9. If this is an HCS or ICF-MR individual, transporting is not a Code 9 activity. Code 18 must be used for HCS consumers and Code 21 for ICF-MR consumers.

9. Accompanying a consumer to the physician’s office to translate from Spanish to English medically related information between the MD and the individual is Code 9.

10. Serving as a translator on how to access Medicaid services is Code 9. This includes alternative languages, Braille, sign languages, and translation due to illiteracy.


11. Transportation of NorthSTAR and non-NorthSTAR individuals in the same vehicle, to a Medicaid service is Code 9.

12. Transportation of individuals enrolled in NorthSTAR is Code 14. ADDITIONAL SERVICE COORDINATION/CASE MANAGEMENT CODE CLARIFICATIONS:

13. Arranging and scheduling transportation and/or translation must be covered under Code 16 if this activity is being completed for a MR Service Coordination individual or MH Case Management individual.

CODE 10: MEDICAID PROVIDER RELATIONS (ALL STAFF) All staff should use this code when performing activities to secure and maintain the pool of eligible Medicaid providers. Include related paperwork, clerical activities, or staff travel required to perform these activities. Examples of activities reported under this code:

Recruiting new Medicaid providers (HCS, physicians, etc.); Providing technical assistance and support to new providers about Medicaid; Providing information to providers on Medicaid policy and regulations; Developing Medicaid service provider directories.


1. Code 10 and title emphasizes Medicaid service providers. Direct service time study personnel should not use Code 10 when they are completing direct service activities.

2. Code 10 is for time spent with external providers only. For the purposes of MAC, local agencies that subcontract Medicaid services (i.e., Rehabilitative Services, etc.) are to consider those contracts as internal providers for purposes of MAC and time spent training, informing, etc., is not a Code 10 activity. This is a Code 15 activity.


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3. For entities that have both an internal provider function (e.g., physician providing med management services for the MHMR Center) and an external provider role (e.g., private practice that provides med management services post discharge from MHMR services), only those activities that support the development and continuance of the external provider role (e.g., recruiting, technical assistance and training of the provider of aftercare functions) would be Code 10 activities. Activities that support the internal provider function (e.g., technical assistance in the MHMR Center’s client tracking or billing system, training on administering the TRAG) would be Code 15 activities.

4. For entities that have both an internal provider function (e.g., physician providing med

management services for the MHMR Center) and an external provider role (e.g., private practice that provides med management services post discharge from MHMR services), only those activities that support the development and continuance of the external provider role (e.g., recruiting, technical assistance and training of the provider of aftercare functions) would be Code 10 activities. Activities that support the internal provider function (e.g., technical assistance in the MHMR Center’s client tracking or billing system, training on administering the TRAG) would be Code 15 activities.*



GENERAL EXAMPLES:

7. Conducting a local agency meeting to provide an orientation for potential Medicaid contract providers is Code 10.

8. Developing written materials to recruit potential Medicaid providers is Code 10. 9. Developing a comprehensive network of Medicaid providers through a request for

information, request for proposal, and/or an open enrollment process is Code 10. ADDITIONAL NORTHSTAR CODE CLARIFICATIONS:

10. This is a BHO function so time spent doing this activity in the NorthSTAR local agencies is a Code 14.

ADDITIONAL TxHmL SERVICE COORDINATION CODE CLARIFICATIONS:

11. Initial authorization of external provider(s) when initiating a Medicaid contract for services is Code 10.

12. Technical assistance provided to external TxHmL providers is MAC Code 10. 13. Training the providers’ staff on client specific plans, needs, etc. is Code 16-A.


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CODE 11: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY COORDINATION (ALL STAFF) Staff should use this code only when the program planning and policy development is performed by a unit of one or more staff whose tasks officially involve program planning, policy development, and interagency coordination, according to their position descriptions. Include any paperwork, clerical activities, or staff travel required to perform these functions. *Additional clarification added to Code 10 - 7/23/09 Examples of activities reported under this code:

Working with other agencies providing Medicaid services to improve the coordination and delivery of services, to expand their access to specific populations of Medicaid eligibles, and to improve collaboration around the early identification of medical problems;

Containing Medicaid costs and improving services to individuals as a part of the goals of THSteps program;

Reducing overlap and duplication in Medicaid services and closing gaps in the availability of services, especially for medically-at-risk mental health and mental retardation target populations;

Focusing Medicaid services on specific populations or geographic areas; Defining the scope of each agency's Medicaid service in relation to the other; Develop strategies to increase Medicaid system capacity and close Medicaid service gaps;

includes analyzing Medicaid data related to a specific program or specific group; Interagency coordination to improve delivery of Medicaid services; Developing resource directories of Medicaid services.

GENERAL CODE CLARIFICATIONS: 1. Code 11 is restricted to personnel that have system level Medicaid program planning and

policy development job functions listed in their position descriptions. 2. When personnel are at a CRCG and are representing the local agency, it must state in their

job description that they have Medicaid program planning and interagency coordination to use Code 11. Otherwise the personnel must use Code 14.

3. The scope of the Code 11 activity may be agency-wide or inter-agency planning, but not individual service planning. Code 11 includes the development of new Medicaid programs. When staff are discussing both Medicaid and non-Medicaid, staff must split out their time between Code 11 (Medicaid) and Code 15 (non-Medicaid).

4. Utilization Review (UR) is included in Code 11 since it focuses on programs or agency-wide monitoring of trends in Medicaid service utilization (quantity), cost effectiveness in various service settings, etc.

5. Completion of the agency-wide Utilization Management (UM) functions for Medicaid services is Code 11. Time study personnel are looking at the overall picture of services that are being provided throughout the center, even if they are looking at just a few specific individuals. Time study personnel are authorizing services based on the need of the individual and also the availability of services.

6. UR and UM of non-Medicaid services is Code 15. 7. Personnel travel, for the purposes of providing a Code 11 activity, is included as Code 11


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9. UM personnel use Code 11 for UM activities and authorization of Mental Health Services. These individuals must have language in their job descriptions stating that they have decision making authority. Clerical support of the UM unit is to use Code 11 but no additional documentation is necessary.

10. Time spent working with department personnel regarding authorization/UR of Medicaid services for individuals as a result of the UR function is Code 11.

GENERAL EXAMPLES:

11. Program planning and policy development activities based on Rights, Abuse, neglect & exploitation, Safety and Health (RASH) or critical incident data, for Medicaid Services are Code 11.

12. Agency-wide or inter-agency utilization review meetings on Medicaid services are Code 11. 13. Developing or revising Medicaid program service manuals or procedures are Code 11

activities as it relates to existing Medicaid programs and the development of new Medicaid programs.

14. Significant program or system changes that affect more than one Medicaid program (agency-wide) are Code 11.

15. Time spent in a CRCG or ARD when personnel are representing the local agency and are discussing Medicaid services, then Codes 11 or 12 would be applicable if the personnel’s job description reflects “planning and development of a Medicaid program.” When personnel are representing the local agency and discussing non-Medicaid services Code 15 would be used. When personnel are not qualified to use Codes 11 or 12, then Code 14 would be used.

16. Personnel who are representing a non-Service Coordination individual at a CRCG, ARD, or school ITP meeting would use the appropriate Codes 6, 7, or 8 – dependent on whether the services being discussed are Medicaid or non-Medicaid.

17. Coordinating and/or attending the Planning and Network Advisory Committee (PNAC) meetings is Code 15. Implementation of PNAC decisions regarding Medicaid services is Codes 11 or 12. Implementation of PNAC decisions regarding non-Medicaid services is Code 15.

18. Development and implementation of program changes that resulted from the Death Review are Code 11 activities, if the program impacted is a Medicaid covered service. If the program impacted is not a Medicaid Covered service, Code 15 should be used. Activities related to conducting Death Reviews are Code 15 activities.

19. For non-Medicaid services, program planning and development are Code 15.

ADDITIONAL NORTHSTAR CODE CLARIFICATIONS: 20. Planning for NorthSTAR programs is non-reimbursable time under MAC. This time would

be coded as Code 14. ADDITIONAL SERVICE COORDINATION/MH CASE MANAGEMENT CODE CLARIFICATIONS:

21. When MR Service Coordinators or MH Case Managers are at a CRCG, ARD, or school ITP


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Note: See Code 16 for comparison.

CODE 12: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY COORDINATION (SPMP) SPMP staff should use this code when program planning and policy development is performed by a unit of one or more SPMP staff whose tasks officially involve program planning, policy development, and interagency coordination, according to their position descriptions. These activities must require the use of skilled professional medical knowledge and training. Staff using this code must meet the requirements under 42 CFR 432.50 for SPMPs. Include any paperwork, clerical activities, or staff travel required to perform these functions. Examples of activities reported under this code:

Working with other agencies providing Medicaid services to improve the coordination and delivery of services, to expand their access to specific populations of Medicaid eligibles, and to improve collaboration around the early identification of medical problems;

Containing Medicaid costs and improving services to individuals as part of the goals of the THSteps program;

Reducing overlap and duplication in Medicaid services and closing gaps in the availability of services, especially for children;

Focusing Medicaid services on specific populations or geographic areas; Defining the scope of each agency's Medicaid service in relation to the other; Developing strategies to increase Medicaid system capacity and close Medicaid service gaps;

includes analyzing Medicaid data related to a specific program or specific group; Interagency coordination to improve delivery of Medicaid services; Developing resource directories of Medicaid services.


1. Code 12 is restricted to personnel that have system level Medicaid program planning and policy development job functions listed in their position descriptions. Otherwise the personnel must use Code 14.

2. The scope of Code 12 activities may be agency-wide or inter-agency planning, but not individual service planning. Code 12 includes the development of new Medicaid programs.

3. Completion of the overall agency-wide UR function can be Code 12. However, use of skilled professional medical knowledge is required to use this code.

4. UR that requires skilled professional medical knowledge and training is included in Code 12 since it focuses on programs or agency-wide monitoring of trends in Medicaid service utilization (quantity), cost effectiveness in various service settings, etc.

5. The code description specifies that only SPMP can use this code. The activity has to be medically related since SPMP knowledge/education is required to use this code and that the personnel have to qualify as SPMP. If the activity does not require SPMP knowledge/education, use Code 11 (All Staff).

6. Personnel travel, for the purposes of providing a Code 12 activity, is included as Code 12 Issue Date: September 2005


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GENERAL EXAMPLES:

8. Program planning and policy development activities based on RASH or critical incident data, for Medicaid Services are Code 12.

9. Agency-wide or inter-agency utilization review meetings on Medicaid services that require skilled professional medical knowledge are Code 12.

10. Developing or revising new Medicaid program service manuals or procedures requiring skilled professional medical knowledge are Code 12 as it relates to existing Medicaid programs or the development of new Medicaid programs.

11. Significant program or system changes that affect more than one Medicaid program (agency-wide) are Code 12.

12. Assessing the necessity for and the adequacy of medical care and services provided are Code 12.

13. Acting as liaisons on the medical aspects of the program with service providers and other agencies that provide medical care is Code 12.


15. Personnel who are representing a non-Service Coordination individual at a CRCG, ARD, or school ITP meeting would use the appropriate Codes 6, 7, or 8 – dependent on whether the services being discussed are Medicaid or non-Medicaid.

16. Coordinating and/or attending the PNAC meetings is Code 15. Implementation of PNAC decisions regarding Medicaid services is Codes 11 or 12. Implementation of PNAC decisions regarding non-Medicaid services is Code 15.

17. Review of complex physician billings for service utilization data by an SPMP is Code 12. 18. CAUTION: See Code 11 for comparison.


19. Planning for NorthSTAR programs is non-reimbursable time under MAC. This time would be coded as Code 14.

CODE 13: DIRECT MEDICAL SERVICES (ALL STAFF) This code should be used by all staff when providing client care, treatment, and/or counseling services to a consumer in order to correct or ameliorate a specific condition. This code includes the provision of services reimbursed through Medicaid if there is no specific activity code available for this Medicaid service. This code also includes all related paperwork, clerical activities, or staff travel required to perform these activities.


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Examples: Direct clinical/treatment services; Counseling services; Skills training; Administering first aid, emergency care, or prescribed injection or medication to a consumer.


1. Selected covered Medicaid services that could be included in the code have been assigned separate activity code numbers (Codes 16-21). Non-Medicaid program services (i.e., IHFS) are placed in Code 14 (NON-Medicaid, Other Educational and Social Services).

2. Code 13 is to be used when there is no specific activity code given for a direct service (Medicaid or non-Medicaid) and would include the indirect services that are required to perform this activity (such as required documentation of the direct service and personnel travel).

3. Direct services billed to TMHP (Medicaid Card) are Code 13 (including nursing services provided under the personal supervision of the physician).

4. Quality assurance activities (such as ensuring that all forms are complete in a consumer’s record) is a part of the indirect cost of providing that service and are to be coded for the covered service. These activities are usually directed toward individuals receiving services and can include individual client record reviews for appropriate screening activities, quality of services provided to the individual, supporting documentation, etc.

5. DMR – completing the testing, writing the report, and endorsement are code 6 activities. 6. Completion of the DMR by a licensed psychologist and billing a third party payor (e.g.,

private insurance, Medicaid) is a Code 13. 7. Personnel travel, for the purposes of providing a Code 13 activity, is included as Code 13

when traveling to and from an off-site location, that is not owned, operated, or under arrangement by the local agency.


GENERAL EXAMPLES:

9. Code 13 includes quality assurance of any direct service without a specific MAC code. 10. ECI covered service (Direct and Indirect) is Code 13. 11. Substance abuse covered services (direct and indirect) are Code 13 activities. 12. Texas Correctional Office on Offenders with Medical or Mental Impairments(TCOOMMI)

covered services (direct and indirect) that are medically related are Code 13. 13. Diagnosis of mental illness by a LPHA when it is billed to a third party payor (e.g., private

insurance, Medicaid) is Code 13. 14. Counseling provided to Medicaid eligible children (under age 21) by Licensed Master Social

Worker – Advanced Practitioner (LMSW-AP), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), or Licensed Professional Counselor (LPC) is Code 13.

15. Calling in a prescription that is an ancillary function to the doctor’s appointment is Code 13. 16. Medication monitoring over the telephone is Code 13. 17. Physician Medicaid card direct services that would include incidental services, such as

completion of the required documentation are Code 13.


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18. Development and writing of a Behavior Plan are Code 13 activities. 19. Skills training for consumers who do not have Rehabilitative Services in their treatment plan

is Code 13. 20. Time spent providing Rehabilitative Services other than crisis intervention services without

authorization for those services is Code 13. 21. Time spent providing Rehabilitative services and developing treatment plan without

authorization for those services is Code 13. 22. Time spent providing MH Case Management services or developing the MH Case

Management Plan without authorization for those services is Code 13. 23. Medication Training, as defined in the Performance Contract, is Code 13. 24. Family Training, as defined in the Performance Contract, is Code 13. 25. Group Skills Training for Children, as defined in the Performance Contract, is Code 13

ADDITIONAL NORTHSTAR CODE CLARIFICATIONS: 26. MH services (e.g., Rehabilitative Services) provided to HCS consumers in the NorthSTAR

service area are Code 13.

CODE 14: NON-MEDICAID, OTHER EDUCATIONAL AND SOCIAL SERVICES (ALL STAFF) This code should be used for any activities which are not health related, such as employment, job training, and social services, as well as NON-Medicaid health related. This code includes all paperwork, documentation and other administrative activities that directly support the delivery of these services. Examples of activities reported under this code:

Providing information to individuals seeking assistance related to job training, employment, housing, education, or social services;

Assisting a consumer in securing child care; Assisting individuals in legal matters (such as divorces, evictions, child custody, etc.); Court appearance on behalf of clients; Providing tutoring; Conferring with students or parents about school discipline, academic matters, or procedures; IHFS Program services.


1. Code 14 and title focus on non-health and non-Medicaid services, but includes medically related services not covered by Medicaid.

2. Quality assurance activities (such as ensuring that all forms are complete in a consumer’s chart) is a part of the indirect cost of providing that service and are to be coded for the covered service. These activities are usually directed toward individuals receiving services and can include individual client record reviews for appropriate screening activities, quality of services provided to the individual, supporting documentation, etc.


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3. Court appearances for SSI would be a Code 1. 4. Other types of court appearances (e.g., child custody, divorce, subpoena, etc.) would be Code

14. 5. Court appearances related to making recommendations for “community service” rather than

jail time for MR Service Coordination or MH Case Management individuals would be a Code 16 activity.

6. Transportation and translation activities for non-Medicaid services are Code 14. Note: Refer to the program specific manuals and rules for details.

7. Transportation of individuals to covered Medicaid services may be reimbursed under MAC or the TxDot Medicaid Transportation program but not both for the same activity. If the local agency utilizes the TxDot Medicaid transportation contract use Code 14.



10. Provision of Supported Home Living and Site-Based Habilitation Services and staff travel, even if travel is to and from a location that is owned, operated, or under arrangement by the local agency. (Travel is included in Supported Home Living and Site-Based Habilitation Services.)

GENERAL EXAMPLES:

11. Taking a consumer to a Detroit Pistons vs. San Antonio Spurs basketball game is Code 14. 12. Respite services are Code 14. 13. Transportation to non-covered, non-health related activities (such as social activities) of

Medicaid eligible individuals is Code 14. 14. Transportation to apply for or obtain food stamps is Code 14. 15. The pick-up and delivery of medications for individuals who are not present are Code 14. 16. Direct services that are under a federal grant or are subsidized by a federal grant (for

example, PATH) to support a specific service only are Code 14. 17. TCOOMMI covered services (direct and indirect) that are non-medically related are Code 14. 18. Dental care for individuals over 21 years of age (this is medically related but not a Medicaid

service) is Code 14. 19. Non-covered vocational (job) training services are Code 14. 20. Routine monitoring by personnel in a 24-hour acute needs residential program is Code 14. 21. When personnel are at a CRCG and are representing the local agency, it must state in their

job description that they have Medicaid program planning and interagency coordination to use Code 11. Otherwise the personnel must use Code 14.

22. IHFS reports and administrative activities are Code 14. 23. When providing Flexible Community Supports – MR use Code 14. 24. Family Partner doing case management-like activities for the client’s family is Code 14. 25. Case Management provided to a family member to address the family member’s need is

Code 14. 26. Parent Support Group is Code 14.


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ADDITIONAL NORTHSTAR CODE CLARIFICATIONS: 27. Transportation of NorthSTAR and non-NorthSTAR individuals in the same vehicle to a

Medicaid service is Code 9. 28. Transportation of individuals enrolled in NorthSTAR is Code 14. 29. Planning for NorthSTAR program is non-reimbursable time under MAC. This time would

be coded as Code 14.

CODE 15: GENERAL ADMINISTRATION (ALL STAFF) All staff should use this code when engaged in general administrative activities. This code should also be used by all staff when on break or any form of paid leave. It should also be used when engaged in administrative activities. Examples of activities reported under this code:

Training; Establishing goals and objectives of health related programs as part of the local agency's

annual or multiyear plan; Reviewing departmental, local agency, or unit procedures and rules; Attending or facilitating general agency or unit personnel meetings or board meetings; Providing general supervision of staff and evaluation of employee performance; Processing payroll/personnel-related documents; Maintaining inventories and ordering supplies; Developing budgets and maintaining records; Performing administrative or clerical activities related to general building or local agency

function or operations; Reviewing technical literature and research articles.


1. If personnel are granted eight hours of paid holiday time (such as on a national holiday) they record Code 15 for the hours of paid holiday the personnel took that day. If personnel are required to work that day, use the appropriate activity codes for activities performed. This enters the total local agency cost of the holiday time and the authorized additional work time into the time study.

2. If personnel are granted “compensatory time” for the hours he/she worked and then takes off some or all of those hours, the time is coded as Code O.

3. Code 15 includes required activities of agency-wide personnel (Personnel Director, Financial Director, Personnel Development Personnel, etc.).

4. Code 15 includes activities that support local agency operations in general. 5. Code 15 includes paid leave for personnel (vacation, sick time, holidays, jury duty, etc.). 6. Travel time between local agency sites that are owned, operated, or under arrangement by the

local agency and is not the individual’s current residence is Code 15. 7. Travel related to the provision of Code 15 activities is Code 15.


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8. Travel time to and from a location that is owned, operated, or under arrangement by the local agency, but is the individual’s residence is not a Code 15. That travel time is to be allocated

GENERAL EXAMPLES:

9. Staff training is a Code 15 activity. This includes general agency personnel development, orientation to the local agency, Cardiopulmonary Resuscitation (CPR) training, defensive driving, management training, etc.

10. Time spent completing in-service training for Rehabilitative Services, MR Service Coordination, MH Case Management, HCS, ICF-MR, TxHmL, etc is Code 15.

11. Peer review activities are Code 15. 12. Development and data entry for a locally developed MIS system for tracking Medicaid

eligibility and service data for individuals served by the local agency are Code 15 only if this activity is time studied and not direct charged to the MAC claim.

13. Developing and revising the local agency improvement plan are Code 15. 14. Providing required voter registration assistance is Code15. 15. Activities related to abuse and neglect are Code 15. 16. Activities related to provider and consumer complaints, are Code 15. 17. Initiating, conducting, or participating in internal rights investigations and Department of

Family and Protective Services (DFPS) rights investigations are Code 15. 18. Transportation vehicle maintenance is Code 15. 19. Assertive Community Treatment (ACT) Team shift or morning meetings are Code 15. 20. Completing a consumer’s Representative Payee Report as a representative of the local

agency is Code 15. 21. Personnel time when meeting with sales representatives (i.e., drug representatives, supplies

representatives, etc.) is Code 15. 22. Paid time while personnel are sleeping at a service location is Code 15.(this is considered a

long break)). 23. Chart audits of multiple services is Code 15. 24. Assisting a consumer with a “Client Satisfaction Survey” is Code 15. 25. Coordinating and/or attending the PNAC meetings is Code 15. Implementation of PNAC

decisions regarding Medicaid services is Codes 11 or 12. Implementation of PNAC decisions regarding non-Medicaid services is Code 15.

26. Time spent in a CRCG or ARD when personnel are representing the local agency and are discussing Medicaid services, then Codes 11 or 12 would be applicable if the personnel’s job description reflects “planning and development of a Medicaid program”. When personnel are representing the local agency and discussing non-Medicaid services Code 15 would be used. When the personnel are not qualified to use Codes 11 or 12, then Code 14 would be used.

27. Complaints, grievances, criminal occurrence reporting, and client rights investigations would be Code 15.

28. Completion of Client Assessment and Review and Evaluation (CARE) forms is Code 15. 29. Billing, data entry, and generating reports is a Code 15 activity. 30. Breaks are Code 15. 31. Activities related to conducting Death Reviews are Code 15 activities. Development and

implementation of program changes that resulted from the Death Review are Code 11 activities, if the program impacted is a Medicaid covered service. If the program impacted is not a Medicaid Covered service, Code 15 should be used.


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32. Staff travel to or from a location that is owned, operated, or under arrangement by the local agency to provide Supported Home Living or Site-Based Habilitation Services is Code 14. (Travel is included in Supported Home Living and Site-Based Habilitation Services.)

33. Compiling and distributing brochures for the purpose of Medicaid Outreach is Code 4. Compiling and distributing brochures for the purpose of general advertising and/or fund raising is Code 15.

34. Agency-wide utilization review and management for non-Medicaid MR services is Code 15. 35. Quality assurance activities across programs (e.g., ensuring consumer flow through service

system) is Code 15. 36. Activities to expand non-Medicaid provider base are Code 15.

CODE 16: MR SERVICE COORDINATION AND MH CASE MANAGEMENT SERVICES (MEDICAID - COVERED SERVICES) These codes are to be used by all staff that provide MH Case Management and MR Service Coordination type activities to eligible individuals. These codes are used when performing any of the activities covered under the Medicaid Service Coordination program and MH Case Management Services. Service codes (16-A, 16-B, 16-C, and 16-D) should be used when providing MR Service Coordination services and MH Case Management services. These codes include all paperwork, documentation, and other administrative activities that directly support the delivery of Service Coordination and Case Management services and are included within the rates set for these Medicaid covered services. Staff travel associated with these activities is included in the time recorded for each of these services. This code has four subdivisions in order to document MR Service Coordination and MH Case Management costs. The subdivisions are:

MR Service Coordination:

Code 16-A: MR – Adult and Child: This code should be used when providing Service Coordination activities to both adults and children with mental retardation

MH Case Management: Code 16-B: MH – Routine – Adult Case Management: This code should be used when

providing Case Management services to an adult who is authorized to receive Routine Case Management services.

Code 16-C: MH - – Routine – Child and Adolescent Case Management: This code should be used when providing Case Management services to children and adolescents who are authorized to receive Routine Case Management services.

Code 16-D: MH – Intensive – Child and Adolescent Case Management: This code should be used when providing Case Management services to children and adolescents who are authorized to receive Intensive MH Case Management services .

GENERAL SERVICE COORDINATION CODE CLARIFICATIONS:

1. A consumer must be enrolled in Service Coordination (regardless of their Medicaid status)


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2. Time study personnel who are providing Service Coordination must remember to code the time spent completing all necessary paperwork, documentation, correspondence, telephone calls, etc., to Code 16-A.

3. To code a Service Coordination activity under the MAC Code 16-A does not require the authorization or training that is required to bill a Service Coordination contact. Incidental and delegated contacts provided by untrained/unauthorized personnel to a Service Coordination individual are allowable under Code 16-A. If the contact is not incidental to the service or delegated by a Service Coordinator, then Code 8 must be used. For the purposes of MAC, delegated means a Service Coordination activity assigned by a Service Coordinator to non-Service Coordinator personnel for a Service Coordination individual. Note: This applies to the MAC coding only. For billing information please follow guidelines that have been established concerning Service Coordination.

4. Time study personnel should use Code 16-A when providing Service Coordination activities regardless of whether or not the time study personnel is assigned to a Service Coordination unit.

5. Time study personnel who provide Service Coordination should use Code 16-A when assisting individuals, who are receiving Service Coordination services, in completing applications or maintaining eligibility for programs.

6. Personnel travel, for the purposes of providing a Code 16-A activity, is included as Code 16-A when traveling to and from an off-site location, that is not owned, operated, or under arrangement by the local agency.


8. Arranging and scheduling transportation and/or translation is covered under Code 16 if this activity is being completed for a Service Coordination individual.

9. Quality assurance activities (such as ensuring that all forms are complete in a consumer’s record) specific to Service Coordination are a part of the indirect cost of providing that service and are to be Code 16-A. These activities are usually directed toward individuals receiving services and can include individual client record reviews for appropriate screening activities, quality of services provided to the individual, supporting documentation, etc.

10. Any coordinating and monitoring of services that is conducted by a Service Coordinator (for those individuals enrolled in Service Coordination) is Code 16-A. This includes individuals who are currently enrolled in an IMD or inmates of a correctional facility. However, Service Coordination cannot be billed for these individuals.

11. Community placement into or for Medicaid services that are provided to a Service Coordination consumer currently enrolled in an institution (e.g., nursing facility, ICF-MR, state school, etc.) by a Service Coordinator is Code 16-A.

12. Community placement into or for Medicaid services provided to a non-Service Coordination consumer currently enrolled in an institution (e.g., nursing facility, ICF-MR, state school, etc.) within 180 days prior to discharge may be coded as Code 6. If it is in excess of 180 days prior to discharge, then use Code 8.

13. Informing Service Coordination consumers about Medicaid and non-Medicaid services is a Code 16-A activity.

14. Permanency Planning provided to a non-Service Coordination consumer within 180 days of discharge is Code 6.


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15. Permanency Planning provided to a non-Service Coordination consumer in excess of 180 days of discharge is Code 8.

16. Permanency Planning provided to Service Coordination consumer, by a Service Coordinator is Code 16-A.

17. Billing, data entry, and generating reports is a Code 15 activity. 18. Transition planning for a Service Coordination consumer from ICF-MR or NF in excess of

180 days of discharge is Code 16-A. Note: This will be coded 16-A but not billed to Service Coordination.

GENERAL EXAMPLES:

19. Service Coordination personnel meetings regarding consumer specific provision of Service Coordination are Code 16-A.

20. Performing any clerical activities in direct support of the provision of Service Coordination (e.g., reviewing records, filing, etc.) are Code 16-A.

21. Consumer specific staff consultation regarding the provision of Service Coordination is Code 16-A.

22. No-shows (i.e., consumer does not keep the Service Coordination appointment) are Code 16-A.

23. Time spent with a Legally Authorized Representative (LAR) or collateral when providing Service Coordination activities is to be coded under Code 16-A. This also includes the indirect time.

24. When Service Coordinators are at a CRCG, ARD, or school ITP meeting and are representing a Service Coordination individual Code 16-A would be used.

25. When a Service Coordinator is representing a non-Service Coordination individual at a CRCG, ARD, or school ITP meeting, then the appropriate Codes 6, 7, or 8 would be used, dependent on whether the services being discussed are Medicaid or non-Medicaid.

26. Linking to crisis screening and/or assessment for the need for emergency services as defined in 25 TAC, Part 1, Chapter 412, Subchapter G Mental Health Community Service Standards for MR Service Coordination individuals is Code 16-A.


27. Time spent completing NorthSTAR services for MH Case Management is Code 13. ADDITIONAL SERVICE COORDINATION CODE CLARIFICATIONS:

28. Refer to the current Service Coordination Manual and applicable rules for details. 29. Time spent in a CRCG or ARD when personnel are representing the local agency and are

discussing Medicaid services, then Codes 11 or 12 would be applicable if the personnel’s job description reflects “planning and development of a Medicaid program.” When personnel are representing the local agency and discussing non-Medicaid services Code 15 would be used. When personnel are not qualified to use Codes 11 or 12, then Code 14 would be used.

30. Completion of the initial and ongoing Service Coordination assessment is Code 6. 31. Writing the Service Coordination plan for a consumer receiving Service Coordination is

Code 16-A. If the individual is not receiving Service Coordination then use Code 6. 32. When time study personnel complete or revise the Service Coordination Plan for individuals

receiving Service Coordination, the time used for this activity is Code 16-A.


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33. Time study personnel who provide Service Coordination should use Code 1 when assisting non-Service Coordination or Service Coordination individuals in becoming Medicaid eligible.

34. Activities related to waiting list maintenance, when conducted by a Service Coordinator during a Service Coordination contact visit, are Code 16-A.

35. Activities related to waiting list maintenance for a Service Coordination consumer but are not in conjunction with a Service Coordination visit are Code 6.

36. Activities related to abuse and neglect, when conducted by a Service Coordinator or the Service Coordination Supervisor, are Code 15.

37. Activities related to provider and consumer complaints, when conducted by a Service Coordinator or the Service Coordination Supervisor, are Code 15.

38. Providing required voter registration assistance, when provided by a Service Coordinator, is Code 15.

39. When a Service Coordinator initiates, conducts, or participates in internal rights investigations and DFPS rights investigations use Code 15.

40. When a Service Coordinator completes a consumer’s Representative Payee Report as a representative of the local agency use Code 15.

41. When a Service Coordinator assists a Service Coordination consumer with a “Client Satisfaction Survey” use Code 15.

42. Time spent by Service Coordinators involved in complaints, grievances, criminal occurrence reporting, and/or a client rights investigation is Code 15.

43. Service Coordination activities provided to a Service Coordination enrolled consumer are Code 16-A, even if a third party (e.g., TCOOMMI) is paying for the provision of the Service Coordination activities.

44. Transition planning from IMD to community regardless of how many days from discharge for a Service Coordination consumer is Code 16-A.

ADDITIONAL TxHmL SERVICE COORDINATION CODE CLARIFICATIONS;

45. To code a TxHmL Service Coordination activity under the MAC time study does not require the authorization or training that is required to bill a TxHmL Service Coordination contact. Incidental and delegated contacts provided by untrained/unauthorized personnel to a TxHmL Service Coordination individual are allowable under Code 16-A. If the contact is not incidental to the service or delegated by a TxHmL Service Coordinator, then Code 8 must be used. For the purposes of MAC, delegated means a TxHmL Service Coordination activity assigned by a TxHmL Service Coordinator to non-Service Coordinator personnel for a TxHmL Service Coordination individual. NOTE: This applies to the MAC coding only. For billing information please follow guidelines that have been established concerning TxHmL Service Coordination.

46. TxHmL programs report TxHmL Service Coordination activities under MAC Code 16-A. 47. Re-establishing TxHmL program eligibility, when conducted by a TxHmL Service

Coordinator, is MAC Code 16-A. This would include the completion of the ICAP, LOC/LON and the MR/RC.

48. When individuals who are enrolled in the TxHmL program are being discharged or transferred, time spent in regards to those procedures (i.e., linking) is MAC Code 16-A.

49. When a TxHmL Service Coordinator is justifying/recommending services (amount, duration and scope) based on the Individual Plan of Care (IPC) that is a MAC Code 16-A.


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50. Linking an individual to a specific TxHmL provider is MAC Code 16-A. 51. Contacting a TxHmL consumer for the sole purpose of determining whether or not they want

to remain on the waiting list is Code 16-A. 52. When a TxHmL Service Coordination consumer, who was on a waiting list, is contacted

about an available slot, the completion of the ICAP, LOC/LON and MR/RC by the TxHmL Service Coordinator are MAC Code 16-A.

53. When conducted by a TxHmL Service Coordinator, the completion of the initial and on-going Person Directed Plan (PDP) for a TxHmL Service Coordination consumer is a MAC Code 16-A activity.

54. Time Study personnel who provide TxHmL Service Coordination should use MAC Code 16-A when assisting TxHmL individuals in becoming Medicaid eligible.

55. Activities related to UR, when conducted by a TxHmL Service Coordinator or the TxHmL Service Coordination Supervisor is MAC Code 16-A.

56. Activities related to abuse and neglect, when conducted by a TxHmL Service Coordinator or the TxHmL Service Coordination Supervisor is MAC Code 16-A.

57. Activities related to provider and consumer complaints, when conducted by a TxHmL Service Coordinator or the TxHmL Service Coordination Supervisor is MAC Code 16-A.

58. Time spent by TxHmL Service Coordinators involved in complaints, grievances, criminal occurrence reporting and/or a client rights investigation is MAC Code 16-A.

59. When a TxHmL Service Coordinator initiates, conducts or participates in internal rights investigations and DFPS rights investigations use MAC Code 16-A.

60. When a TxHmL Service Coordinator completes a consumer’s Representative Payee Report as a Representative of the local agency use MAC Code 16-A.

61. When a TxHmL Service Coordinator provides required voter registration assistance to a TxHmL Service Coordination consumer the time is a MAC Code 16-A activity.

62. When a TxHmL Service Coordinator assists a TxHmL Service Coordination consumer with a “Client Satisfaction Survey” use MAC Code 16-A.

63. When a TxHmL Service Coordinator is representing TxHmL consumers at a CRCG meeting it would be a MAC Code 16-A activity.

64. Transition planning from an ICF-MR or NF to community for a TxHmL consumer by a TxHmL Service Coordinator is Code 16-A.

65. Transition planning from an IMD to community for a TxHmL Service Coordination consumer is Code 16-A.

66. Activities related to waiting list maintenance, when conducted by a TxHmL Service Coordinator during a Service Coordination contact visit, are Code 16-A.

67. Time study personnel who provide TxHmL Service Coordination should use Mac Code 16-A when assisting individuals, who are receiving Service Coordination services, in completing applications or maintaining eligibility for programs other than Medicaid

GENERAL MH CASE MANAGEMENT CODE CLARIFICATIONS:

68. A consumer must be authorized to receive MH Case Management Services for time study personnel to code the appropriate 16-B, 16-C or 16-D.

69. To code a MH Case Management activity under the MAC time study does not require the authorization or training that is required to bill a MH Case Management contact. Incidental and delegated contacts provided by untrained/unauthorized personnel to a MH Case Management individual are allowable under Code 16. If the contact is not incidental to the


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70. Ongoing UA to determine amount, duration and scope of services is the appropriate Code 16 except for consumers receiving Psychosocial Rehabilitative Services which would be Code 17-F.

71. Time study personnel who are providing MH Case Management must remember to code the time spent completing all necessary paperwork, documentation, correspondence, telephone calls, etc., to the appropriate Code 16.

72. Time study personnel who provide MH Case Management should use the appropriate Code 16 when assisting individuals, who are receiving MH Case Management services, in completing applications or maintaining eligibility for programs.

73. Personnel travel, for the purposes of providing a Code 16 activity, is included as the appropriate Code 16 when traveling to and from an off-site location, that is not owned, operated or under arrangement by the local agency.

74. Personnel travel for the purposes of providing a Code 16 activity, to and from a location that is owned, operated, or under arrangement by the local agency is Code 15.

75. Arranging and scheduling transportation and/or translation is covered under the appropriate Code 16 if this activity is being completed for a MH Case Management individual.

76. Quality assurance activities (such as ensuring that all forms are complete in a consumer’s record) specific to MH Case Management are a part of the indirect cost of providing that service and are to be Code 16. These activities are usually directed toward individuals receiving services and can include individual client record reviews for appropriate screening activities, quality of services provided to the individual, supporting documentation, etc.

77. Any coordinating and monitoring of services that is conducted by a MH Case Manager for those individuals who are enrolled in MH Case Management is Code 16. This includes individuals who are currently enrolled in an IMD or inmates of a correctional facility. However, Case Management cannot be billed for these individuals.

78. Informing Case Management consumers about Medicaid and non-Medicaid services is a Code 16 activity.

79. Billing, data entry and generating reports is a Code 15 activity. GENERAL MH CASE MANAGEMENT EXAMPLES:

80. Case Manager meets face to face with an adult consumer to identify the immediate needs and assist in gaining access to community resources that may address that need. This would be Code 16-B. This would include the documentation of the identified need and the assistance given to address the need.

81. Case Management personnel meetings regarding consumer specific provision of MH Case Management are the appropriate Code 16.

82. Performing any clerical activities in direct support of the provision of Case Management (e.g., reviewing records, filing, etc.) are the appropriate Code 16.

83. Consumer specific consultation regarding the provision of Case Management is the appropriate Code 16.

84. No-shows (i.e., consumer does not keep the Case Management appointment) are the appropriate Code 16.


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85. Time spent with a Legally Authorized Representative (LAR) or collateral when providing Case Management activities is to be coded under the appropriate Code 16 that time is supporting. This also includes the indirect time.

86. Developing Treatment Plans for services other than Case Management are not Case Management and should be coded under the service.

87. When Case Managers are at a CRCG, ARD, or school ITP meeting and are representing a Case Management individual the appropriate Code 16 would be used.

ADDITIONAL CASE MANAGEMENT CODE CLARIFICATIONS:


89. Writing the Case Management plan for a consumer receiving Case Management services and the consumer is present is Code 16. If the consumer is not present, then is a Code 13.

90. When time study personnel complete or revise the Case Management Plan for individuals receiving Case Management and the consumer is present, the time used for this activity is Code 16. If the consumer is not present, then it is a Code 13.

91. Time study personnel who provide Case Management should use Code 1 when assisting individuals in becoming Medicaid eligible.

92. Activities related to abuse and neglect, when conducted by a Case Manager or the Case Manager Supervisor are Code 15.

93. Activities related to provider and consumer complaints, when conducted by a Case Manager or the Case Manager Supervisor are Code 15.

94. Providing required voter registration assistance, when provided by a Case Manager, is Code 15.

95. When a Case Manager initiates, conducts, or participates in internal rights investigations and DFPS rights investigations use Code 15.

96. When a Case Manager completes a consumer’s Representative Payee Report as a representative of the local agency use Code 15.

97. When a Case Manager assists a Case Management Consumer with a “Client Satisfaction Survey” use Code 15.

98. Time spent by Case Managers involved in complaints, grievances, criminal occurrence reporting and/or a client rights investigation is Code 15.

99. Case Management activities provided to Case Management enrolled consumer are Code 16 even if a third party (e.g., TCOOMMI) is paying for the provision of the Case Management activities.

100. Transition planning from IMD to community for a MH Case Management consumer is Code 8.

101. Time spent providing MH Case Management services or developing the MH Case Management Plan without authorization for those services is Code 13.

ADDITIONAL SERVICE COORDINATION/CASE MANAGEMENT CODE CLARIFICATIONS:


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102. Arranging and scheduling transportation and/or translation must be covered under Code 16 if this activity is being completed for a MR Service Coordination individual or MH Case Management individual.

CODE 17: REHABILITATIVE SERVICES (MEDICAID - COVERED SERVICES) These codes are to be used only by staff authorized to provide these Medicaid services. These codes should be used when performing any of the activities covered under Medicaid Rehabilitative Services. Service codes (17-A through 17-K) should be used when providing Rehabilitative Services. This code includes all paperwork, documentation, and other administrative activities that directly support the delivery of Rehabilitative Services and are included within the rates set for these Medicaid covered services. Staff travel associated with these activities is included in the time recorded for each of these direct services. This code has eleven subdivisions in order to document Rehabilitative Services costs. The subdivisions are:

Code 17-A Day Program for Acute Needs Code 17-B Crisis Intervention Services Code 17-C Med Training and Support - Individual Code 17-D Med Training and Support – Group - Adult Code 17-E Med Training and Support – Group – Child and Adolescent Code 17-F Psychosocial Rehabilitative Services - Individual Code 17-G Psychosocial Rehabilitative Services - Group Code 17-H Rehabilitative Counseling and Psychotherapy - Individual Code 17-I Rehabilitative Counseling and Psychotherapy - Group Code 17-J Skills Training and Development – Individual Code 17-K Skills Training and Development - Group


1. Refer to the current Rehabilitative Services Provider Manual and applicable rules for details. 2. Code 17 includes activities that can be billed to Rehabilitative Services (direct provision of

the service face to face) and indirect activities that cannot be billed to Rehabilitative Services.

3. Indirect activities (e.g., paperwork, telephone calls) that directly support the provision of Rehabilitative Services must be coded to that specific Rehabilitative Service are Code 17.




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6. Transportation to a Medicaid service is Code 9. 7. If the local agency has or utilizes a TxDot Medicaid transportation contract, then

transportation time is Code 14, regardless of whether the individual is being transported to a Medicaid or a non-Medicaid service.

8. Quality assurance activities specific to Rehabilitative Services (such as ensuring that all forms are complete in a consumer’s record) is a part of the indirect cost of providing that service and are to be coded for the covered service. These activities are usually directed toward individuals receiving services and can include individual client record reviews for appropriate screening activities, quality of services provided to the individual, supporting documentation, etc.

9. Billing, data entry, and generating reports are Code 15 activities. 10. Crisis services as defined in 25 TAC, Part 1, Chapter 412, Subchapter G Mental Health

Community Services Standards are 17-B regardless of consumers primary diagnosis. GENERAL EXAMPLES:

11. No-shows (i.e. consumer does not keep the Rehabilitative Services appointment) are the appropriate Code 17.

12. Consumer specific staff consultation regarding the provision of Rehabilitative Services is the appropriate Code 17.

13. Rehabilitative Service staffings regarding a specific client are the appropriate Code 17. 14. Documentation of Rehabilitative Services activities is the appropriate Code 17. 15. Completing paperwork necessary in the performance of Rehabilitative Services activities

(e.g., correspondence, etc.) is the appropriate Code 17. 16. Telephone contacts as necessary to the delivery of Rehabilitative Services are the appropriate

Code 17. 17. Performing any clerical activities in support of Rehabilitative Services (e.g., reviewing

records, filing, etc.) are the appropriate Code 17. 18. Rehabilitative Services provided to a Rehabilitative Services enrolled consumer are the

appropriate Code 17, even if a third party (e.g., TCOOMMI) is paying for the provision of the Rehabilitative Services.

19. Training provided to a caregiver related to the caregiver’s mental health or well-being is not Rehabilitative services. (Example: Teaching a caregiver relaxation techniques for the caregiver to use to relax is not Rehab.)

20. Ongoing UA for provider determination of amount, duration and scope of services for consumers receiving Psychosocial Rehabilitative Services is Code 17-F.

21. Crisis services provided outside of a therapeutic team (e.g., by the crisis triage team) are considered to be Crisis Intervention Services which is Code 17-B.

22. Writing the Rehabilitative Treatment Plan with the consumer present is the appropriate Code 17.

23. Writing the Rehabilitative Treatment Plan without the consumer present is Code 13. 24. Time spent providing Rehabilitative Services other than crisis intervention services without

authorization for those services is Code 13. 25. Time spent providing Rehabilitative services and developing treatment plan without

authorization for those services is Code 13. 26. Rehabilitative services, including crisis intervention services, provided to someone who is in

an IMD or jail is Code 17. Issue Date: September 2005


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ADDITIONAL NORTHSTAR CODE CLARIFICATIONS: 27. Time spent completing NorthSTAR services for Rehabilitative Services is Code 13.

CODE 18: HOME AND COMMUNITY BASED SERVICES (HCS)/TEXAS

HOME LIVING SERVICES (TxHmL) This code is to be used only by staff authorized to provide HCS Medicaid covered services. This code includes all paperwork, documentation, and other administrative activities that directly support the delivery of HCS covered services and are included within the rates set for these Medicaid covered services. Staff travel associated with these activities is included in the time recorded for these covered services. Current covered services include:

Adaptive Aids; Case Management; Counseling and Therapies; Residential Assistance;

Supported Home Living; HCS Foster/Companion Care; Residential Support;

Dental Treatment; Minor Home Modifications; Nursing; Respite; Day Habilitation; Supported Employment.


1. Refer to the current HCS Manual and applicable rules for details. 2. Code 18 includes covered HCS direct and indirect services. 3. As of September 1, 2003, HCS will include services and activities previously identified as

Home and Community-based Services – OBRA (HCS-O) services and activities. 4. HCS specific quality assurance activities (such as ensuring that all forms are complete in a

consumer’s record) is a part of the indirect cost of providing that service and are to be coded for the covered service. These activities are usually directed toward individuals receiving services and can include individual client record reviews for appropriate screening activities, quality of services provided to the individual, supporting documentation, etc.

5. HCS covered services include transportation of HCS eligible individuals when this activity is an integral part of the service.

6. Personnel's travel time to provide an HCS service is Code 18. 7. As of 4/1/04, Code 18 includes Texas Home Living Services.



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8. MH services (i.e., Rehabilitative services) provided to HCS consumer in NorthSTAR service area is Code 13. MR Services provided to HCS consumer in NorthSTAR service area would still be coded as Code 18.

CODE 19: NO LONGER USED AFTER 09/01/03 CODE 20: NO LONGER USED AFTER 04/01/98 CODE 21: INTERMEDIATE CARE FACILITY - MR (ICF-MR) This code is to be used only by staff authorized to provide these ICF-MR Medicaid covered services. This code includes all paperwork, documentation, and other administrative activities that directly support the delivery of ICF-MR services and are included within the rates set for these Medicaid covered services. Staff travel associated with these activities is included in the time recorded for these covered services. Current covered services include:

Dietary; Direct Care Contact; Physician Services; Occupational Therapy; Physical Therapy; Recreational Therapy; Psychology Services; Social Work Services; Speech and/or Language Services; Rehabilitation Counseling; Nursing Services; Dental Services; Pharmacy Services; Skills Training; Assessment Services; Laboratory Services; Residential Services; Day Programming; Other Habilitation Services; Other Medicaid Services; Other Adjunctive Therapy Services.


1. Refer to the current ICF-MR Manual and applicable rules for details. 2. Code 21 includes covered ICF-MR direct and indirect services. 3. ICF-MR specific quality assurance activities (such as ensuring that all forms are complete in

a consumer’s record) is a part of the indirect cost of providing that service and are to be


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4. ICF-MR covered service include Day Services which includes Supported Employment. 5. ICF-MR covered services include transportation of ICF-MR eligible individuals when this

activity is an integral part of the service. 6. Personnel travel to provide ICF-MR services is Code 21. 7. Service Coordination-like activities that are provided when a consumer is transferring from

one institution to another institution are Code 8.

CODE L: LUNCH (ALL STAFF) GENERAL CODE CLARIFICATIONS:

1. Personnel who are required and authorized to work during their lunchtime would code for the activity they are completing.

2. Code L is a filler code for non-paid lunch time. CODE O: OFF (Off Duty, Comp-time Used) GENERAL CODE CLARIFICATIONS:

1. If personnel are in an “off-duty” (not paid or not receiving compensatory time) status during part of his/her scheduled workday, record this time using Code O. For example, if personnel attend a school function for his/her child in a non-paid status for two hours during his/her scheduled workday, use Code O to record that time.

2. Code O is a filler code for time study personnel on non-paid time. Paid sleep at the service location would be Code 15 - Long Paid Break.

3. Code O is used as a filler code at local agencies using automated or manual time logs for time study personnel who are "Off Duty" or using Comp-time.

4. Use Code O to account for non-paid time that may occur during your normally scheduled workday. This includes the beginning of the day and at the end of the day.

5. When on “crisis on-call duty,” time spent responding to a call is Code 17-B. Time spent waiting for a call is Code O.



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Chapter 7 Forms, Checklists and Examples


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MAC and TAFI Contacts List

(Complete All Information)

Agency Name: Agency Main Phone # (Switchboard #): Physical (Street) Address: City: State: Zip: Mailing Address: City: State: Zip: Executive Director: Phone #: Fax #: E-mail Address: Deputy Executive Director: Phone #: Fax #: E-mail Address: MAC Coordinator: Phone #: Fax #: E-mail Address: Assistant MAC Coordinator: Phone #: Fax #: E-mail Address: Primary TAFI Preparer: Actual Position Title e.g., Accountant II): Phone #: Fax #: E-mail Address: Secondary TAFI Preparer: Actual Position Title (e.g., Accountant II): Phone #: Fax #: E-mail Address: Chief Financial Officer: Phone #: Fax #: E-mail Address: MIS Contact Person: Phone #: Fax #:

E-mail Address: Board Chair Member Name: Physical (Street) Address: City: State: Zip:


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Implementation Plan Checklist

Name of Local Agency: ___________________________________________

Review Date: ___________________________________________

Any item that is not checked indicates an item was not found in the local agency's Implementation Plan or that it lacked thorough explanation of the procedure. If these requirements do not apply to your local agency, it is necessary to state in the Implementation Plan that it is not applicable to your local agency and why.

I. Local Agency MAC Coordinator

___ Name, address, telephone number, fax number, and email address of the Local Agency MAC Coordinator.

___ Detailed job description of the Local Agency MAC Coordinator.

___ Names, addresses, telephone numbers, fax numbers, email addresses, and functions of other individuals responsible for the time study or preparation of the claim.

___ Organizational chart of the local agency. Identify where and to whom the Local Agency MAC Coordinator is assigned.

II. Service Programs Involved in the Time Study

___ List the service programs within the local agency whose personnel will be participating in the time study.

III. Time Study Personnel

___ List the job titles or classifications of individuals who will be participating in the time study.

___ If acronyms are used in the job titles or classifications, list all of the acronyms with the complete job titles or classifications.

___ Indicate whether or not personnel hired within 30 days of a time study will be included in the time study. (If a time frame of less than 30 days is selected, indicate time frame to be used.)

___ List the approximate number of personnel that will be time studying in each position.

___ A detailed list of activities that are considered allowable MAC activities for each job title or classification.

___ The MAC Code applicable to the specific MAC activity.

___ Estimated percentages of time personnel usually spend on each MAC activity. ___ Any activities that could be completed by contract personnel.

IV. Skilled Professional Medical Personnel ___ List any job classifications that qualify for SPMP. ___ Include the number of personnel in each position who will be designated as SPMP.



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V. Job descriptions for Personnel Using Codes 11 and 12 ___ List any job classifications that qualify. ___ Include the number of personnel in each position who will be authorized to use

Codes 11 and/or 12.

VI. Training

___ The Local Agency MAC Coordinator and/or Local Agency Assistant MAC Coordinator and at least one additional personnel with a working knowledge of MAC must attend all required department MAC training.

___ The Local Agency MAC Coordinator ensures that all time study personnel receive training prior to each time study on the time study codes and how to complete the time study logs.

___

Provide personnel with a basic understanding of the MAC project, the purpose of MAC, and its relationship to Medicaid covered services.

___ Completion of time study logs, practice coding of program activities and an adequate question-and-answer session.

___ Discuss initial and follow-up training schedules.

___ A plan to deal with individuals who, after submitting incorrect logs, will require one-on-one training.

___ Discuss system that will be used to monitor staff turnover and ensure new personnel are trained.

___ The Local Agency MAC Coordinator must have documentation that each personnel in the time study received appropriate training.

VII. Time Study Methodology

___ Method used to time study (Alternative Start Date or the Mid-Month method).

___ Describe the process used for distribution of the logs.

___ Describe the process used for collection of the logs.

___ Who will add the totals.

___ How will supervisors check the logs for accuracy each week.

___ Describe plans for reviewing the logs for errors and inconsistencies.

___ Describe the Local Agency MAC Coordinator’s Quarterly Status Report content.

___ Describe procedures used to ensure all personnel have a designated contact person to call when they have questions about the time study.

___ HHSC suggests, whenever feasible, that personnel keep back-up documentation (daily planners, transportation logs, etc.) with sufficient detail to support time study logs.



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VIII. Fiscal

___ List the source of funds to be used as "match".

___ List the expense categories included as allowable costs.

___ Indicate whether accounting is done on a cost or modified accrual basis.

___ Indicate the methodology for determining indirect cost.

___ Describe how the claim is prepared correctly.

___ Describe the type of time log, software and hardware used to develop the claim.

___ Describe how the claim is checked for errors.

___ Describe how the claim is submitted to the department within the designated time frames.

___ Describe how the Medicaid eligibility percentage is calculated.

IX. Agency Review File

___ List the name or names of the persons responsible for maintaining and updating the Agency Review File.

___ Agency Review File Checklist:

___ Signed original time study logs that have also been signed by the personnel's supervisor per mandated time lines.

___ Signed copy of the approved Annual Implementation Plan in effect for this quarter.

___ Copies of all training materials given to personnel, dated for the quarter they were used.

___ A list of personnel who participated in the time study organized by name, personnel identification number, physical office address, SPMP status, pro forma status, and status as a Service Coordinator.

___ List of all acronyms with the complete job titles or classifications.

___ Annual Self-Evaluation Report of required MAC performance review. (4th Quarter Agency Review File Only)

___ Annual Report. (2nd Quarter Agency Review File of the following year only)

___ MAC/TAFI Memo Binder.

___ Local Agency MAC Coordinator’s Quarterly Status Report to CEO/ED signed by the CEO/ED.

___ A copy of the valid job descriptions for those who use MAC Code 11 and/or 12 indicating Medicaid program planning and Medicaid policy decision-making authority.

___ SPMP Review File Checklist:

___ A copy of the valid job description indicating requirement of SPMP licensure or certification and use of SPMP education and training.

___ A copy of the SPMP Survey.

___ A copy of the appropriate license or certificate as indicated on the SPMP Survey.

___ An organizational chart showing the relationship of SPMP to their direct


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supporting clerical personnel, if the costs of these clerical personnel are being claimed at 75%.

___ TAFI Audit File Checklist: ___ Copy of automated summary of time study forms report generated from

original time log. ___ Copies of all worksheets or spreadsheets used in developing the claim.

(Include the detail expenditure journal, the detail revenue journal and depreciation schedules.)

___ Detailed list of all unallowable costs.

___ Copy of TAFI reconciliation to the local agency general ledger.

___ Copy of all pro forma logs prepared for the quarter with documentation.

___ Documentation to support the units of service data.

___ Documentation to support the direct charge.

___ A written statement describing how the Medicaid percentage was determined.

___ Completed Quarterly Summary Invoice Checklist.

___ Completed TAFI report.

___ Provide information on where the files are physically located and secured.

X. Effective Dates (Renew Annually)

___ Current dates on the Implementation Plans should be July 1, CURRENT YEAR through June 30, FOLLOWING YEAR. (Must indicate month, day and year.)

XI. Authorizing Signatures

___ Submitted on local agency letterhead.

___ Include the date, name, title, and signature of the:

___ Local agency CEO/ED who has oversight of MAC.

___ Local Agency MAC Coordinator.

___ Any other designated personnel with direct responsibility for MAC (e.g., financial officer, etc.) with title.

XII. MAC and TAFI Contacts List

___ All requested information is completed and current.


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Current Manual Worker-Day Logs Current Manual Worker-Day Logs

For the All Staff manual worker-day time log, please double-click on the icon below. For the All Staff manual worker-day time log, please double-click on the icon below.

"all staff timelog.doc"

For the SPMP manual worker-day time log, please double-click on the icon below. For the SPMP manual worker-day time log, please double-click on the icon below.

"spmp timelog.doc"

Back to Back to Table of Contents


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Medicaid Administrative Claiming Skilled Professional Medical Personnel (SPMP) Survey

NAME:________________________________________________________________ EMPLOYER:____________________________________________________________ DEPARTMENT:_________________________________________________________ JOB TITLE:_____________________________________________________________ ACADEMIC DEGREE:____________________________________________________ COLLEGE OR UNIVERSITY:_______________________________________________ Please check and complete all that apply: Physician ( License Number ______________) Registered Nurse (License Number ______________) Doctoral-level Psychologist (License Number_______________) Licensed Psychological Associate (License Number_________________) Department Certified Psychologist (Certification Number ______________) Licensed Master of Social Work – Advanced Practitioner

(License Number_______________)

Licensed Clinical Social Worker (License Number_______________) Licensed Master of Social Work (License Number_______________) Dentist (License Number______________) Dietician (License Number______________) Attach the following: photocopy of license and current validation of renewal, or letter from licensing/certifying body verifying

current status; current job description indicating required SPMP license or certification and use of SPMP education and

training. September 2004



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Quarterly Summary Invoice (QSI) Checklist

For Use by All Participating Local Agencies When Preparing to Submit a QSI

for Medicaid Administrative Claiming Instructions: To assist personnel in the state agencies in reviewing and processing the Medicaid Administrative Claim in an expeditious manner, please use this checklist to verify that all required elements of the summary invoice and detail invoices are accurate and complete. 1. The invoice must be submitted on local agency letterhead or on a computer-generated form

which contains all the information on the local agency's letterhead. 2. The invoice must be signed and dated by the CEO/ED or CFO and the TAFI Preparer with

their job titles indicated. The original invoice must be submitted to the department. Each invoice must identify the name of the local agency and the period for which the claim is being submitted.

3. All invoices must be submitted using the QSI format. 4. The Medicaid percentage must be established for each invoice. 5. The SPMP Cost Pool and non-SPMP Cost Pool have separate and unique costs and time study

results. 6. Documentation that personnel meet the education and training requirements for SPMP is in the

SPMP Review File. This includes the SPMP Survey, valid job description, and license. 7. "Other Costs" directly attributed to the SPMP Cost Pool or non-SPMP Cost Pool have been

placed in the appropriate "Other Costs" column, not in the "Other Costs" line of Cost Pool #4. 8. An itemization of "Other Costs" that are included in the SPMP Cost Pool, non-SPMP Cost

Pool, or Cost Pool #4 has been placed in the TAFI Audit File.


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October 2002

Quarterly Summary Invoice Medicaid Administration

Period of Service ____/____/____ to ____/____/____ Agreement Number: ______________________ Invoice Number: ________________

COST CATEGORIES

[A] Total Federal Enhanced Share Costs [B] Total Federal Non-Enhanced Share Costs [C] Total Federal Direct Charge Share Costs [D] Total Federal Share

SPMP COST POOL

FORMULAS SPMP

Add Line AC $_________ Totals from each Separate invoice. Add Line AD $________ Totals from each Separate invoice for the SPMP Cost Pool. Add Line AE $_________ Totals from each Separate invoice for the SPMP Cost Pool. A + B + C $_________

NON-SPMP COST POOL

FORMULAS NON-SPMP XXXXXX XXXXXX Add Line AD $__________ totals from each separate invoice for the non-SPMP Cost Pool. Add Line AE $__________ totals from each separate invoice for the non-SPMP Cost Pool. B + C $__________

[E] Total to be reimbursed by Federal Government (FFP) (Add Line D, SPMP Cost Pool + non-SPMP Cost Pool) $___________________ I certify that the information provided on this invoice is true and that the funds/contributions necessary to match Federal expenditures for administrative activities have been provided pursuant to the requirements of 42 CFR 433.32. ________________________________ ______________________________________ Signature (CEO/ED or CFO) Date Signature (Preparer) Date ________________________________ ______________________________________ Title Title



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OCTOBER 2002

Agency Review File Checklist

To be used by Local Agency MAC Coordinators The following time study materials are in the Agency Review File for the FFY Quarter ending _____________ (FFY, # of Qtr.)

_____ 1.

Signed original time study logs that have also been signed by the personnel's supervisor per mandated time lines.

_____ 2. Signed copy of the approved Annual Implementation Plan in effect for this quarter.

_____ 3. Copies of all training materials given to personnel, dated for the quarter they were used.

_____ 4. A list of personnel who participated in this study organized by name, personnel identification number, physical office address, SPMP status, and pro forma personnel, if any. Also indicate personnel who are classified as Service Coordinators.

5. A list of all of the acronyms with the complete job titles or classifications. _____ 6. Annual Self-Evaluation Report of required MAC performance review.

(4th Quarter Agency Review File Only) _____ 7. Annual Report. (2nd Quarter Agency Review File of the following year only) _____ 8. MAC/TAFI Memo Binder-all department policy clarifications, letters, or

memos pertaining to MAC and/or TAFI _____ 9. Local Agency MAC Coordinator’s Quarterly Status Report to CEO/ED signed

by the CEO/ED. _____ 10. Job descriptions for those who use MAC Code(s) 11 and/or 12. – Valid job

description must indicate Medicaid program planning and Medicaid policy decision-making authority for a unit of one or more personnel. (Valid = current for quarter being reviewed, personnel and supervisor signatures, and signature dates.)


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OCTOBER 2002

Skilled Professional Medical Personnel (SPMP) Review File Checklist The following materials are on file for all personnel who have been identified as SPMP. (NOTE: This information can be kept in the SPMP Review File or in the personnel's personnel folder.) _____ 1. A copy of the valid job description indicating the requirement of the specific

SPMP licensure of certification and use of SPMP education and training. (Valid = current for quarter being reviewed, personnel and supervisor signatures, and signature dates.)

_____ 2. A copy of the SPMP Survey. _____ 3. A copy of the appropriate license or certificate as indicated on the SPMP Survey. _____ 4. A table or organizational chart showing the relationship of SPMP to their direct

supporting clerical personnel, if the costs of these clerical personnel are being claimed at 75%.

OCTOBER 2000

Time and Financial Information (TAFI) Audit File Checklist

To be used by Local Agency MAC Coordinators and TAFI Preparers The following time study materials are in the TAFI Audit File for the FFY Quarter ending ____________________(FFY, # of Qtr.)

____ 1. Copy of automated summary of time study forms report generated from original

time log, if applicable. ____ 2. Copies of all worksheets or spreadsheets used in developing the claim. (Include

the detail expenditure journal, detail revenue journal, and depreciation schedules.)____ 3. Detail list of all unallowable costs. ____ 4. Copy of TAFI reconciliation to the local agency general ledger. ____ 5. Copy of all pro forma logs prepared for the quarter with documentation. ____ 6. Documentation to support the units of service data. ____ 7. Documentation to support the direct charge. ____ 8. A written statement describing how the Medicaid percentage was determined. ____ 9. Completed Quarterly Summary Invoice Checklist. ____ 10. Completed TAFI report.




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Agency Medicaid Administrative Claiming Annual Report

DADS MEDICAID ADMINISTRATIVE CLAIMING

P.O. BOX 149030 AUSTIN, TEXAS 78714-9030

FEDERAL FISCAL YEAR: ________________________

1. Agency Name:

Mailing Address:

Phone: ( ) Fax: ( )

Name of CEO/ED:

Name of Local Agency MAC Coordinator:

2. Total MAC revenues received during the FFY $

This will be monies actually disbursed by the Texas Office of the Comptroller from

October 1 through September 30 of the FFY being reported. Note: this would not

include claims submitted but not disbursed by the close of the FFY.

Please list by quarter and year, the quarterly amounts included in the above total:

Quarter: 1st FFY $ . Quarter: 3rd FFY $ .

Quarter: 2nd FFY $ . Quarter: 4th FFY $ .

3. Top five priorities that MAC revenues were used for in this FFY.

Total amount of MAC revenue expended for each priority.

A.

B.

C.

D.

E.


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Total Amount Expended for Priorities $

F.

Deferrals/Resubmits

$

G.

Carry Forward

$

H.

Total

$

(Add #3A-G and reconcile with #2 Total MAC Revenue received.)

4.

Top five anticipated priorities for use of MAC revenues in the next FFY.

A.

B.

C.

D.

E.

5. Who completes the Medicaid Administrative Claiming Annual Report?

Name/Title:

Phone: ( ) Fax: ( )

I certify that the financial information reported is a true and correct accounting of the revenues and expenditures of the local agency's participation in Medicaid Administrative Claiming. ______________________________________________________________________________

Signature of Chief Executive Officer (CEO) or Executive Director (ED) Date ______________________________________________________________________________

Signature of MAC Annual Report Preparer Date ______________________________________________________________________________

Signature of MAC Coordinator Date


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EXAMPLE ANNUAL REPORT

Agency Medicaid Administrative Claiming Annual Report

DADS MEDICAID ADMINISTRATIVE CLAIMING

P.O. BOX 149030 AUSTIN, TEXAS 78714-9030

FEDERAL FISCAL YEAR 2004

1. Agency Name: Texas Community MHMR Center

Mailing Address: P.O. Box 5000, Anywhere, TX 12345-6789

Phone: ( 555 ) 910-1000 Fax: ( 555 ) 910-1001

Name of CEO/ED: John Doe

Name of Local Agency MAC Coordinator: Jane Doe

2. Total MAC revenues received during the FFY $583,410.78

This will be monies actually disbursed by the Texas Office of the Comptroller

from October 1 through September 30 of the FFY being reported. Note: this

would not include claims submitted but not disbursed by the close of the FFY.

Please list by quarter and year, the quarterly amounts included in the above total:

Quarter 1st FFY 2004 $ 125,183.30 Quarter: 3rd FFY 2004 $ 135,852.70

Quarter: 2nd FFY 2004 $ 145,852.70 Quarter: 4th FFY 2004 $ 176,522.08

3. Top five priorities that MAC revenues were used for in this FFY.

Total amount of MAC revenue expended for each priority.

A.

Increase medically related transportation $ 45,375.19

B.

Increase the number of Medicaid service providers $ 150,850.20

C.

Increase Medicaid outreach campaigns $ 87,715.15

D.

Increase Service Coordination with regional agencies $ 105,450.14

E.

Develop electronic data entry for center service logs $ 145,709.10


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Total Amount Expended for Priorities $ 535,099.78

F. Deferrals/Resubmits $ (2,533.00)

G. Carry Forward $ 50,844.00

H. Total $ 583,410.78

(Add #3A-G and reconcile with #2 Total MAC Revenue received.)

4.

Top five anticipated priorities for use of MAC revenues in the next FFY.

A.

Increase medically related transportation

B.

Increase the number of Medicaid service providers

C.

Increase Service Coordination with regional agencies

D.

Increase Medicaid outreach campaigns

E.

Develop electronic data entry for center service logs

5. Who completes the Medicaid Administrative Claiming Annual Report?

Name/Title: Clark Gable, Chief Accountant

Phone: ( 555 ) 910-1002 Fax: ( 555 ) 910-1003

I certify that the financial information reported is a true and correct accounting of the revenues and expenditures of the local agency's participation in Medicaid Administrative Claiming.

John Doe _______________________3/12/05___ Signature of Chief Executive Officer (CEO) or Executive Director (ED) Date

Clark Gable____________________________3/9/05___ Signature of MAC Annual Report Preparer Date

Jane Doe ___________________________3/12/05 Signature of MAC Coordinator Date



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Chapter 8 Helpful Optional Tools for Medicaid

Administrative Claiming

Technical Assistance

REQUEST FOR TECHNICAL ASSISTANCE FROM THE MAC UNIT

Identify the question(s)/ issue(s) you would like addressed. Provide a brief explanation or description of the events that led to this question/issue. For technical assistance contact: E-mail: [email protected] FAX: (512) 438-2180 Mailing address: DADS, Medicaid Administrative Claiming, PO Box 149030, Austin, TX 78714-9030

REQUEST FOR TECHNICAL ASSISTANCE FROM THE TAFI UNIT

Identify the question(s)/issue(s) you would like addressed. Provide a brief explanation or description of the events that led to this question/issue. For technical assistance contact: E-mail: [email protected] Mailing address: HHSC – Rate Analysis, Mail Code H-400, 1100 West 49th Street, Austin, TX 78756 TAFI Help Desk : 512-438-4720 or 1-888-452-4357



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Training Addendum for Supervisors

Please read the information below. Sign the original and return to your MAC Coordinator to document training on this important issue. Supervisors play an important role in the MAC project. It is the supervisors’ responsibility to review and sign the time study log(s). The supervisors are mandated to review and sign the logs within seven days of the end date on the time study daily log. Given that the supervisor is required to review the accuracy of the time study participant’s completed log, the supervisor’s signature date cannot precede the participant’s signature date. Failure to obtain the required signature(s) within the seven must be documented and attached to the log(s). If it is known that a supervisor will be out of the office and unable to sign within seven days, another supervisor must be trained and designated to perform this function. In these situations, the time study daily logs will be signed by the designee for the absent supervisor. Example: Jabba D. Hutt is the regular supervisor. Jabba D. Hutt takes two weeks off to join forces with the Emperor. George Lucas is designated as Jabba’s replacement. Time study participants would print “Hutt, Jabba D.” as the supervisor. George Lucas would sign on the supervisor line, “George Lucas for Jabba D. Hutt.” Under the MAC guidelines, supervisors are primarily responsible for ensuring the accuracy of MAC coding on time study daily logs. They are also responsible for the identification of MAC coding inconsistencies among personnel in similar positions under their supervision. When inconsistencies and/or questions concerning MAC coding occur, it is the supervisor’s responsibility to discuss and explain appropriate code selection. The accuracy of the MAC claim is directly dependent upon the accuracy of the coding and reviewers from CMS and the department will focus their attention on this area. The reviewers hold the supervisors who review and sign the time study daily logs accountable for the accuracy of the coding, as the supervisors have direct knowledge of the personnel’s job description and can determine if the personnel is accurately coding based on that job description. Supervisors are expected to review, sign, and forward the time study logs to the Local Agency MAC Coordinator within 7 days of the end of the end date on the time log. Supervisor’s Signature

Date



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Internal Quality Validation Medicaid Administrative Claiming (MAC)

Automated Time Study Logs NAME: _____________________________________LOCATION:___________________ SUPERVISOR’S NAME:_____________________________DATE:__________________

Description Date Date Date Date Date Date Personnel Name (Print) (last, first, middle initial)

Personnel Job Title (Print)

Supervisor Name (Print) (Last, First, MI.)

Personnel Signature (MUST BE IN INK) Personnel Signature Date (MUST BE IN INK) (No later than seven days after the last date on each log.)

Supervisor Signature (MUST BE IN INK)

Supervisor Signature Date (MUST BE IN INK) (No later than seven days after the last date on each log.)

Personnel SSN

Quarter FFY Year

Personnel Position Number (Starting at left.)

Personnel Status (Exempt or Non-Exempt)

SPMP (Yes or No)

Log Date: Start and End (Month, Day, Year)

Correct Error Procedure

Scheduled Hours (Hours Scheduled to Work)

Times Written in “AM” or “PM” (Front and Back)

One Bubble Per Row

No Blanks Except after End of Work Day

Code O at the End of the Day



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MAC Who’s In and Who’s Out Policy Flowchart MAC Who’s In and Who’s Out Policy Flowchart Start Start

The Local Agency MAC Coordinator must answer the following questions prior to determining which personnel must participate in the MAC time study. (Note: Personnel, for MAC purposes, includes both staff and contracted staff.): 1. Is the staff person performing job duties that are similar to other staff personnel? If yes, then the whole group must be reviewed to determine if need to time study. 2. Is one staff person only performing these job duties? If yes, then only one position needs to be reviewed to see if it needs to be time studied.

Yes Yes No No Yes Yes No No Yes Yes

No No Yes Yes No No Yes Yes No No Yes Yes No No

Do they provide 10% or more of their time on an annual basis in MAC reimbursable codes?

Are they clerical personnel who support time study personnel but do not qualify under the 5% or the 10% rule above?

Position(s) do not time study.




Are they personnel that exclusively provide HCS, TxHmL, ICF-MR, MH and/or MR Vocational, and non-Medicaid residential?

Are they personnel that provide agency-wide administrative functions only (CEO, CFO, payrolls, etc.)?

Are they 1st-line supervisors and above who do not qualify under the 5%?

Position(s) time study.

Position(s) time study.

Do they provide direct or indirect Service Coordination and/or MH Case Management and/orRehabilitative Services 5% or more of the time on an annual basis?

If the above guidelines do not help determine which position(s) should or should not be included in the MAC time study please contact [email protected] for guidance.


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SPMP Flowchart

Begin

Yes Yes

No

Job description requires the use of medical expertise?

Qualifies as an SPMP

Has traditional medical degree? (physician, physician’s assistant, RN, dentist, dental hygienist, dietician)

Yes Yes Is a Licensed Psychological Associate, or department Certified Associate Psychologist, Ph.D. Psychologist, LMSW, LCSW or LMSW-AP required?

Job description requires the use of medical expertise?

Qualifies as an SPMP

No

Yes

Does not qualify as an SPMP

No

Has medical or health related training with their professional education (lasting at least 2 years)?

Yes If the above guidelines do not help determine which position(s) should or should not be included in the MAC time study please contact [email protected] for guidance. Qualifies as an SPMP

Has a job description that includes a requirement of medical knowledge or skills (including mental health or substance abuse). Excludes LPCs and LMFTs.

Does not qualify as an SPMP

No



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Desk Review Form Medicaid Administrative Claiming

Component 000 Provider A Center

For: 2 Qtr. FFY 05 Date due to DADS 05/16/5

QSI Rec'd 05/16/05 Size of claim: $ 32,669.41

1st Review By: Charlotte Krueger Date: 07/05/05

2nd Review By: Mike Moore Date: 07/06/05

Ref: 2 Qtr. FFY 05 Size of claim: $ 32,669.41 Medicaid % 36.00

1 Qtr. FFY 05 Size of claim: $ 34,460.93 Medicaid % 38.44

4 Qtr. FFY 04 Size of claim: $ 11,880.06 Medicaid % 41.72

y 1. Was claim submitted on time?

y 2. Is invoice signed by the CEO or CFO? Is it on letterhead? y

y 3. Do totals on QSI agree with TAFI generated totals?

y 4. Is there a direct charge? If yes, is the direct charge detail included? y

y 5. Is the Direct Charge Detail on the QSI, Line AE within $1 of the back-up documentation?

y 6. Do the QSI and TAFI match?

Unrecognized Revenues: y 7. Is there a positive entry in Medicaid Administrative Reimbursement?

Recognized Revenues, Cost Pool 4: y 8. Is there a positive entry in Cost Pool 4, Federal Grant and Match? (s/b YES)

Cost Pool 4: y a) Is there a zero or blank in Cost Pool 4 insurance? (s/b YES)

y b) Is the amount in Fees under $10,000? (s/b YES)

y c) Is there a zero or blank in Donations to Contractors? (s/b YES)

y d) Is there a positive entry in Other Revenues? (s/b YES)

n 9. Are there additional items?

Note: This is an example of a completed Desk Review Form. DADS will notify the center by e-mail when the following occurs and there is no explanation included with the QSI:

1. The actual amount of the claim is + of – 25% from the previous two quarters; 2. The Medicaid percentage is + or - 5% from the previous two quarters; 3. Fees are over $10,000; 4. There is a zero or a negative amount in the Medicaid Administrative Reimbursement; 5. There is a zero or a negative amount in the Federal Grant and Match; 6. Cost Pool 4 Insurance is not blank or zero; 7. Donation to contractors is not blank or zero; 8. Other Revenues does not have a positive entry.


Revised: October 2005 114

Documents-At-A-Glance Activity and/or Document Brief Description Due date Signatures Required Send To

Agency Review File All the required

documentation per time study. Includes all of the activities and documents on this chart.

Quarterly Varies per item N/A

Agency Review File Checklist

Listing of required documentation per time study. Assists in generating the Agency Review File.

Prior to submission of the Quarterly Summary Invoice to HHSC – Quarterly

none N/A

Annual Report Summary of MAC revenues and expenditure of those funds.

March 15 ED/CEO, Annual Report Preparer, & Local Agency MAC Coordinator.

DADS

Annual Self-Evaluation Written review of the effectiveness of the strategies delineated in the Implementation Plan.

4th Quarter ED/CEO & Local Agency MAC Coordinator

N/A

Implementation Plan Local policies and procedures for the monitoring and oversight of the MAC project.

June 15 or within 30 days of any significant changes

ED/CEO, CFO, Local Agency MAC Coordinator, Local Agency Assistant MAC Coordinator, TAFI Preparer, Assistant TAFI Preparer

DADS

Implementation Plan Checklist

Listing of required elements of the Implementation Plan.

Prior to any submission of the Implementation Plan to the department

None N/A


115

Activity and/or Document Brief Description Due date Signatures Required Send To

MAC/TAFI Memo Binder Contains all memos, letters, and policy clarifications pertaining to MAC and/or TAFI.

On-going none N/A

MAC & TAFI Contacts List Identifies names and means of contacting individuals who are key to the MAC project.

Part of the Implementation plan – June 15 or within 30 days of any significant changes

none DADS

Local Training & Testing Required training of all time study personnel.

Quarterly - Prior to each time study

none N/A

Quarterly Summary Invoice (QSI)

Invoice used to submit MAC claim for reimbursement by DADS

45 days after each Quarter: February 15 May15 August 15 November 15 OR upon revision of the claim

ED/CEO or CFO, TAFI Preparer

DADS & HHSC

Quarterly Summary Invoice Checklist

Listing of required elements of the QSI. Assists in generating the QSI.

Prior to submission of the QSI to HHSC – Quarterly

none N/A

Quarterly Status Report Written report to ED/CEO regarding the quarterly time study and claim.

Quarterly ED/CEO N/A

SPMP Review File All required documentation of personnel’s qualification to use SPMP codes.

Part of Agency Review File – Quarterly

none N/A


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117

Activity and/or Document Brief Description Due date Signatures Required Send To

SPMP Survey Required per SPMP

personnel to verify SPMP status. Part of the SPMP Review File.

Once per SPMP personnel

none N/A

State Training & Testing Required training of all Local MAC Coordinators and Local Assistant MAC Coordinators.

Fall – All Spring – Assigned responsibilities since fall training or required per MAC Review Report

none N/A

TAFI Audit File All required documentation that supports the compilation of the MAC Claim.

Part of Agency Review File – Quarterly

none N/A

TAFI Audit File Checklist Listing of required elements of the TAFI Audit File. Assists in generating the TAFI Audit File.

Prior to the submission of the Quarterly Summary Invoice to HHSC – Quarterly.

none N/A

Who’s In/Out Review MAC policy that determines who must and who cannot participate in the time study.

Annually none N/A


Acronyms Used in the MHMR Service System ACT Assertive Community Treatment AIMS Abnormal Involuntary Movement Scale ARD Admission, Review, Dismissal BHO Behavioral Health Organization CAP Cost Allocation Plan CA-PFEP Child and Adolescent Patient and Family Education Program CARE Client Assignment and Registration System CA-TRAG Child and Adolescent Texas Recommended Authorization Guidelines CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CHIP Children’s Health Insurance Plan CMS Centers for Medicare and Medicaid Services COPSD Co-Occurring Psychiatric and Substance Use Disorders CPR Cardiopulmonary Resuscitation CRCG Community Resource Coordination Group DADS Department of Aging and Disability Services DARE Drug Awareness Recognition Enforcement DFPS Department of Family and Protective Services DMR Determination of Mental Retardation ECI Early Childhood Intervention ED Executive Director FEMA Federal Emergency Management Assistance (Title IV-A) FFP Federal Financial Participation FFY Federal Fiscal Year FLSA Fair Labor Standards Act HCS Home and Community-based Services HHSC Health and Human Services Commission HIV Human Immunodeficiency Virus HUD Department of Housing and Urban Development ICAP Inventory for Client and Agency Planning ICF-MR Intermediate Care Facility for the Mentally Retarded IHFS In-Home and Family Support Program IMD Institution for Mental Diseases ITP Individual Transition Plan LAR Legally Authorized Representative LCSW Licensed Clinical Social Worker LMFT Licensed Marriage and Family Therapist LMSW Licensed Master Social Worker LOC Level of Care LON Level of Need LPC Licensed Professional Counselor LPHA Licensed Practitioner of the Healing Arts LVN Licensed Vocational Nurse


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MAC Medicaid Administrative Claiming MD Doctor of Medicine MH Mental Health MHA Mental Health Authority MIS Management Information System MR Mental Retardation MRA Mental Retardation Authority MR/RC Mental Retardation/Related Condition Assessment NF Nursing Facility OBRA Omnibus Budget Reconciliation Act OMB Office of Management and Budget PATH Partnerships and Transitions Homeless PDP Person Directed Plan PFEP Patient and Family Education Program PMRA Persons with Mental Retardation Acts PNAC Planning and Network Advisory Committee POC Plan of Correction QA Quality Assurance QMB Qualified Medicare Beneficiary QMHP Qualified Mental Health Professional QSI Quarterly Summary Invoice R&DM Resiliency and Disease Management RASH Rights, Abuse, neglect & exploitation, Safety and Health RN Registered Nurse SHARS School Health and Related Services SIYR See If You’re Reading SLMB Specific Low-Income Medicare Beneficiary SPMP Skilled Professional Medical Personnel SSDI Social Security Disability Insurance SSI Supplemental Security Income SSN Social Security Number TAFI Time and Financial Information TANF Temporary Assistance to Needy Families TCADA Texas Commission on Alcohol and Drug Abuse TCOOMMI Texas Correctional Office on Offenders with Medical or Mental Impairments TEA Texas Education Agency THSteps Texas Health Steps (Texas EPSDT Program) TIMA Texas Implementation of Medication Algorithm TMHP Texas Medicaid and Healthcare Partnership TPL Third Party Liability TRAG Texas Recommended Authorization Guidelines TxDot Texas Department of Transportation TxHmL Texas Home Living UM Utilization Management UOC Unallowable Operating Costs UR Utilization Review


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WDL Worker-Day Log WIC Women, Infants, and Children


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