MEDICAID ADMINISTRATIVE

CLAIMING

Staff Training

Medicaid Administrative Claiming Is:

• A method of identifying and accounting for the time spent by public school and related staff on medically related activities.

• Reimbursement is then claimed for the time spent doing those activities; Many are already being done by school staff.

• Staff do not need to know who is Medicaid/OHP eligible, nor do they need to become Medicaid experts.

Why a School District Would Participate

• Staff are already doing the activities• Reimbursement for these activities is available• It takes staff approximately 10-15 minutes to

complete survey and document activity• Revenue can be used for vital health and social

service programs in the school• Diversifies funding base for needed programs and

opportunities

MAC Claiming Formula

• 1. Cost pool

• X

• 2. Medicaid eligible percentage

• X

• 3. Percent of allowable time (survey)

• =

• Your school’s total claim

Training Requirements

• All staff who are to be surveyed must be knowledgeable prior to taking the survey

• All staff in cost pool must be trained face to face at a minimum of once per year prior to taking the survey

• Staff must sign in at training• Trainers ensure adequate time for training and are

the first line for technical assistance for staff

MAC Survey How It Works

• Individual staff does the survey one day per survey period

• There are three survey periods during school year

• Surveys dates are randomly selected by DHS

• Paid time at school is surveyed in 15-minute increments.

• Staff time falls into any one of the ten activity codes.

• Predominant portion of a 15-minute increment is what’s recorded.

MESD Online Medicaid Administrative Survey

MESD Online Medicaid Administrative Survey

Ten Activity Codes

• A. School-related and educational activities, other.

• B1. Medicaid/OHP outreach.• B2. Non-Medicaid outreach.• C1. OHP referral, coordination, training.• C2. Non-OHP referral , coordination,

training.

Ten Activity Codes

• D1. OHP transportation/translation.• D2. Non-OHP transportation/translation.• E1. Medical program planning, policy

development, and interagency coordination.

• E2. Non-medical program planning, policy development, and interagency coordination.

• F. Direct medical services.

Coded A: School Related and Educational Activities

• This code should be used for:Any school-related activities such as

teaching and educational servicesDeveloping, coordinating and monitoring

of a student’s education plan or IEPDiscipline or student supervisionFor social services and non-health related

services

Code A: Activity Examples

• I developed a lesson plan• I graded tests• I supervised the playground, halls, or lunch time• I discussed a student’s educational progress with a

family at parent-teacher conferences• I helped a student to apply for college• I assisted in evaluating a textbook

Code B1: Medicaid/OHP Outreach and Facilitating Medicaid/ OHP

Eligibility

• This code should be used for:informing students/families about OHPhelping to get information for filling out or

assisting to fill out the OHP applicationcontacting pregnant and parenting teens

about OHP prenatal and well baby carechecking a student/family OHP eligibility

status

Code B1: Activity Examples• I informed a student/family about OHP• I helped a family fill out the OHP form• I referred a family to the local DHS office for the

OHP application• I talked to a teen parent about OHP prenatal

and/or well baby care programs and services• I provided necessary forms to a student/family in

preparation for OHP eligibility determination

Code B2: Non-Medicaid/OHP Outreach and Facilitating Non-

Medicaid/OHP Eligibility

• This code should be used for:Child find outreach activities Informing students/families about social,

vocational, or educational (including special ed) programs

Describing the services/benefits of these programsHelping families fill out the necessary program

forms

Code B-2: Activity Examples• I informed a student/family about general health

information• I assisted a student/family to fill out a free and

reduced lunch application• I informed a student/family about social service

and educational programs such as WIC, childcare, food stamps, community college, higher education, and job training

• Participated in child find activities

Code C1: Referral, Coordination, Monitoring and Training of

Medicaid/OHP Services • This code should be used for:Making referrals for medical, mental and dental

health servicesCoordinating the delivery of medical, mental and

dental health servicesMonitoring the delivery of medical, mental and

dental health servicesAttending training about MAC and OHP covered

services and the benefits of those services

Code C-1: Activity Examples• I referred a student to medical, dental or mental

health care• I participated in a meeting/discussion to

coordinate or review a student’s need for health related services covered by OHP

• I spoke with a student’s doctor or parent about a change in medication

• I monitored and evaluated the medical service component of the IEP

• I gathered information in order to refer a student/family to health care

• I attended a MAC training or training about OHP covered service

Code C2: Referral, Coordination, Monitoring and Training of Non-

Medicaid/OHP Services

• This code should be used for:Participating in or coordinating state

mandated health screening activitiesMaking referrals for scholastic, vocational,

employment and social services Referring to non-Medicaid/OHP services

Code C-2: Activity Examples

• I participated in IDEA training or other education based in-service training

• I participated in a meeting/discussion to coordinate or review a student’s need for scholastic, employment, vocational and other non-health services

• I referred a student/family to educational or social services

• I helped to coordinate and deliver the state mandated vision and hearing screens

Code D1: Medicaid/OHP Translation and Transportation

• This code should be used for:Scheduling, arranging or providing

transportation to Medicaid/OHP covered services

Scheduling, arranging or providing translation services to assist individual to access and understand necessary care and treatment

Code D2: Non-Medicaid/OHP Transportation and Translation

• This code should be used for:Scheduling, arranging or providing

transportation to social, vocational and/or other educational programs and activities

Scheduling, arranging or providing translation services to assist individual to access and understand necessary non-Medicaid/OHP services

Code E1: Program Planning, Policy Development, Interagency Coordination

Related to Medical Services

• This code should be used for:develop strategies to assess or increase the

capacity of school medical/health programswork with other agencies and providers to

improve coordination and collaboration of Medicaid/OHP services

monitoring the delivery of medical services system in the schools

creating and reviewing health policies in the schools

Code E-1: Activity Examples

• I helped develop strategies to increase the capacity of the school health programs

• I monitored the medical/health delivery systems in the school

• I developed an advisory group of health professionals to advise the school on health care services in the school

• I attended an early childhood planning meeting to discuss the coordination of health care in our community and school

Code E2: Program Planning, Policy Development, Interagency Coordination

Related to Non-medical Services

• This code should be used for:working collaboratively with other agencies to

identify gaps, overlaps or duplication of non-medical/health services, such as vocational, social or educational services

improve coordination, expand access or delivery of non-Medicaid/OHP services

develop strategies to assess or increase the capacity of non-medical, dental and mental health school programs

Code E-2: Activity Examples• I developed strategies to increase the capacity of

social services in my school• I collaborated with a vocational education

program to expand services to students• I coordinated the delivery of social services in

my school• I attended a meeting coordinating the use of the

school building by a community group for a non-health activity

Code F: Direct Medical Services

• This code should be used for:Providing health/dental/mental health services

contained in the IEPConducting health/dental/mental health

assessments/evaluations and diagnostic testingAdministering first aid or prescribed injection or

medication to a studentProviding speech, occupational, physical therapies

or counselling services

Using Code C1 Versus Code F

• Administering first aid, or administering an insulin injection – who does it, and then who “monitors” it is the question to ask

• Providing direct mental health treatment following DSM IV protocols – code F

• Coordinating with a community-based mental health provider for monitoring follow-up of the provider’s services – code C1

Survey Documentation Protocols

• When a positive code is used (B1, C1, D1 or E1), staff will need to document activity.

• Documentation is in form of numeric system that associates an activity narrative with a number.

• It is not necessary for staff to provide a written narrative account of activity.

• If more than one time increment is the same activity narrative, list the number once.

Coding Details and Guidelines

• Code only paid time and actual work hours• Paid leave including absences, vacation, etc. Are

code A (supervisor may need to complete survey)• Blank increments on survey are only used for

unpaid time—otherwise will default to code A: other

• Part-time employees survey only paid time worked on the day of survey

Good Information Remember• Staff do not need to

know who is Medicaid/OHP eligible

• It is the activity of staff that is being measured, not the outcome of the activity

• Staff do not need to know all about Medicaid/OHP

• Time study determines staff time spent on eligible and non-eligible activities

Local MAC Coordinator and Contacts

Questions