2014-2015

Train-The-Trainers

Annual workshop

This presentation was provided by:

Oregon Health AuthorityMedicaid Administrative Claiming

Division of Medical Assistance Programs

Linda WilliamsSBHS Medicaid Operations and Policy Analyst

(503) 945-6730

Lasa BaxterDHS Contracted SBHS Medicaid Operations and Policy Analyst

(541) 975-5614

Medicaid in SchoolsMAC Match LeveragingParticipation of Charter Schools in MACCost Pool DevelopmentMAC Audit RequirementsProcedures for Assigning Survey DatesMAC & Oregon Healthy KidsImmunizationsMonitoringReferralsAudit Support DocumentApproved Medicaid OHP ServicesSchool-Based Medicaid/OHP MAC Claiming Coding

Guide

While schools are legally liable to provide IDEA-related health services at no cost to the eligible students Medicaid reimbursement is available for these services because section 1903 (c) of the ACT requires Medicaid to be the primary payer for reimbursement of health-related services provided under IDEA.

CMS 2003 Administrative Claiming Guide

Medicaid Administrative Claiming (MAC)MAC is a Medicaid reimbursement program which

allows school districts to be reimbursed for some of the costs associated with providing administrative activities that directly support the provision of medical services covered under the state Medicaid plan.○ Federal/State partnership○ Kindergarten -21○ Including but not limited to children in special education

Outreach – Assistance with Medicaid eligibility determinationReferral, Coordination and Monitoring of health servicesInteragency Coordination

Reimbursement authorityPursuant to 42 CFR 433.51, only a unit of

government is authorized to participate in Federal Financial Participation (FFP) by providing the non-federal share of public funds for Medicaid reimbursement for covered services.

The ESD certifies by its signature on the MAC

intergovernmental agreement (IGA) that the non-federal matching funds it transfers to DHS are not federal funds, or are federal funds authorized by federal law to be used to match other federal funds and that all sources of funds are allowable.

Charter Schools may participate in the MAC program under an ESD that holds a MAC agreement with OHA.

A charter school will be considered a separate school participating under the MAC contract between the associated ESD and the Oregon Health Authority when a charter school: has its own institutionalized number approved by ODE; is responsible as a separate school from its sponsored school

district to conduct an annual audit and reports findings annually to ODE;

has applied for and has been granted status as a 501 c3 non-profit organization;

possesses its own federal tax id number; and hires and employs its own employees

(As per Barbara Gates, ODE)

Participation of Charter Schools in MAC

Please consider the following internal processes need to be address if a charter school participates under your ESD. A MAC sub-agreement with the charter school must be obtained

in order to participate. If this is an additional sub-agreement, estimate additional MAC

revenue and ensure this will not exceed the cap established in the ESDs MAC agreement with OHA

The charter school will report to the associated ESD their own cost pool, conduct a random survey assigned to them quarterly, and have their own component claim as part of the compiled total MAC claim.

The charter school may desire to have its own MAC site coordinator and trainer to provide trainings, follow-up on the survey process, notify staff of survey days, report supporting documentation, etc. 

Participation of Charter Schools in MAC

Cumulative Report – 2012 Statewide MAC %

Of critical importance is the development of an accurate cost pool. Cost pool is defined as the actual (not estimated) total salary and benefits (including OPE) paid for staff that are eligible to participate in the MAC survey.

Staff supported entirely by federal funds, may NOT be included in the cost pool or survey. Staff partially paid through federal funds may be included in the cost pool as long as only the non-federal fund portion of employee cost is reported. However, the employee must report their entire paid work time in the survey.

Cost Pool Development

STEP ONE:IDENTIFY APPROPRIATE STAFF

Include either certified or classified staff who routinely have contact with students and/or families creating opportunities to provide Medicaid outreach and related activities as outlined in the MAC coding guide or who have direct supervision of employees who do.

Exclude maintenance and food services staff, bus drivers, and volunteers (non-paid staff). These groups have limited contact with students to provide MAC services or are not paid employees.

Staff must participate under the District or ESD they are paid by and on the corresponding survey date assigned to that agency.

Cost Pool Development

STEP TWO:IDENTIFY ACTUAL SALARY AND BENEFITS PAID

After identifying appropriate staff for the cost pool, report the actual salary, benefits and Other Personnel Expenses (OPE) paid for each individual for the survey period, removing all federal funds.○ (For a definition of OPE reference OMB

circular A-87)

Cost Pool Development

STEP THREE: REMOVE FEDERAL FUNDS FROM COST POOL

Only general fund and other fund sources may make up the cost pool calculations. Any federal funds applied to the salary, benefits and OPE package of an individual employee must be removed on a FTE person-by-person basis.

Federal funds the ESD/district expends may include IDEA, ARRA, Title I, federal grants, etc. These funds must be removed from the cost pool to comply with federal regulations. Federal funds expended for services and supplies (S & S) costs, indirect or other non-personnel (non-salary and benefits) costs may not be included in the cost pool.

NOTE: Documentation must be maintained detailing how the federal funds applicable to salary, benefits and OPE have been removed from the cost pool.

Cost Pool Development

The ESD/district will want to set up a process to evaluate the cost pool on a systematic basis, assessing classifications and individuals as to their impact on the claim.

Pruning the cost pool is an acceptable practice in order to present a more effective claim and reduce administrative burdens.

Pruning the Cost Pool

Methods for PruningRemove any staff, who over the course of a

determined period, have never reported a claimable MAC activity.

Blindly survey staff utilizing scenarios for providing MAC activities to determine whether staff may potentially engage in MAC activities over the course of time.

Remove staff employed for .02 FTE or less, as they may have limited contact with students and/or their families to provide MAC activities.

Methods for Pruning the Cost Pool

Maintain all supporting documentation for the MAC claim for a period of seven years.ESD (under MAC Agreement w/OHA)District (MAC Coordinator)Business Office (All supporting financial

documents)

Provide contact information and be available to OHA for review of MAC claims.

DHS will provide ESDs with random survey dates prior to start of the school year.

The ESD will assign the dates to school districts without influence or input from any school district.

The ESD will inform the school district(s) of the week (not the specific date) of their assigned random date prior to the first day of the applicable survey period. This will allow the ESD and school district(s) ample time for scheduling and providing training.

The ESD will inform the school district(s) of the specific random date no greater than 10 business days prior to the assigned

date.

The school district(s) will accomplish the survey on the date assigned.

Procedure for Assigning Survey Dates

Trainers must attend a MAC train-the-trainers workshop annually.

Trainers must schedule and provide training to staff which covers all aspects of the reporting process. Training must occur no less than once annually

○ Prior to the survey day

Staff must sign the training sign in sheet○ Records training date○ Provides access into the MESD web based system

Complete a review of the survey results and obtain necessary supporting documentation from staff.Section V(A) of the 2003 CMS Medicaid Administrative

Claiming Guide states (pg 37): ○ Documentation maintained in support of administrative claims

must be sufficiently detailed to permit CMS to determine whether the activities are necessary for the proper and efficient administration of the state plan. Simply checking a box on a time study form does not facilitate independent validation of the sample results.

It is critically important for additional documentation to be maintained, in order to verify the appropriateness of the claims and to limit the risk of audit findings.

Training should provide staff with:copies of training materials , a referral list, and documentation

formsa description of the survey process

○ three survey periods Fall, Winter, Spring○ random survey day○ selection of survey participants (random or 100%)

an understanding of what is claimable as an administrative activity in the school setting

an understanding of the activity codes and how to report them in the MESD web based reporting system

an understanding of when and how to complete the 10% documentation form

access to technical assistance

Any claimable time reported on a survey may be reviewed by OHA and a request for supporting documentation issued.

○ Request staff complete a MAC Support form for each claimable time frame and activity code recorded. The documentation should: be recorded soon after completing the survey (no less than 5

business days);be brief and concise;use descriptive words (best practice is to use the key words from the

activity guide such as referred, coordinated, monitored, etc.); only provide information pertinent to the claimable activity

performed; anddo not identify the individual student or family by name.

○ Review the MAC Support form to ensure documentation is for allowable MAC activities

○ Submit MAC Support form to your district’s MAC Coordinator

Coding Accuracy Reminders for StaffOver/Under Reporting of Time

○ Do not report claimable time only○ Do not report more time than paid for

Using Correct Login (name on paycheck)Saving the SurveyReporting unpaid lunch

○ time frame should be left blank on surveyReporting Paid Absences

○ code A

Administrative Service Providers

AdministratorsPrincipalsTeachersEducational AssistantsSecretariesCounselorsTSPC School

Psychologists

Claimable Categories

B1 – Medicaid/OHP Outreach and Facilitating Medicaid/OHP Eligibility

C1 – Referral, Coordination, Monitoring and Training of Medicaid OHP Services

D1 – Medicaid/OHP Transportation and Translation

E1 Program Planning, Policy Development, and Interagency Coordination related to Medical Services

Oregon Licensed Health Care ProfessionalsSpeech Language

TherapistOccupational TherapistCertified Occupational

Therapist Assistant (COTA)Physical TherapistLicensed Physical Therapy

Assistant (LPTA)Nurse

○ Delegated Health Care AideClinical PsychologistLicensed Clinical Social

Worker

Claimable Categories

B1 – Medicaid/OHP Outreach and Facilitating Medicaid/OHP Eligibility

C1.4 - Training E1 - Program Planning,

Policy Development, and Interagency Coordination related to Medical Services

Oregon Board Licensed Health ProfessionalsLicensed Health Care Professionals employed by school

districts or ESD’s cannot claim C1 and D1 activities that are considered integral to, or an extension of, direct or consultative medical services. ○ C1.1 – Referral○ C1.2 – Coordination○ C1.3 – Monitoring○ D1.1 – Transportation○ D1.2 – Translation

This applies regardless as to whether or not the district is an enrolled Medicaid provider accessing reimbursement.

TSPC Licensed PsychologistAccording to Oregon Administrative Rules a TSPC

Licensed School Psychologist may provide direct “health” services to students such as, diagnostic evaluations and assessment and behavior counseling for an identified health condition. ○ Referrals and coordination of Medicaid covered services made

by a TSPC Licensed School Psychologist to Medicaid providers for a student in which they provide direct “health” services are considered integral to or an extension of a direct service and are NOT claimable. The service would be reported on the survey as Code F – Direct Service.

If the school psychologist makes a referral to a community Medicaid provider for a student who he/she does not provide direct service to, the referral and coordination would be claimable under C1.

Delegated Health Care Aide – Educational Assistant

An educational /instructional assistant providing delegated nursing tasks under the supervision of a Nurse pursuant to the services identified on an IEP are “Direct Medical Services”. Such activities must be reported as “F” on the survey.

These monitoring activities are considered Direct Medical Services and may not be reported under code C1.3.

It is important staff report the claimable MAC activity performed on the survey date even when the outcome may be unknown.

Claimable example:A school counselor reports C1.1 on their MAC

survey, when on the MAC survey day they refer a child for a mental health evaluation to the local county mental health department. The staff at this time may not know the outcome of the referral, which is acceptable and does not change the reporting the Medicaid-covered referral activity.

Activity vs. Outcome

Claimable vs. Non-Claimable Immunizations

Code C1.3:Physical Monitoring of Direct Services vs.

Follow-up to ensure Direct Services were provided

Points of Clarification

Claimable referrals for Immunizations: (C1.1)Referrals to assist families in accessing immunizations

from enrolled Medicaid providers are claimable as C1.1 as long as they are:○ Not Free of Charge (Billed to Medicaid)○ Provided outside the school setting with an enrolled

Medicaid provider

Claimable scenarios may include:An office secretary, at the request of a parent, referred

a student in need of immunizations to the local County Health Department for covered immunizations.

Immunizations

Non-Claimable referrals for Immunizations: (C2) Activities performed in association with a free immunization clinic offered in

school or other settings Administrative activities performed in association with the immunization

exclusion requirements such as:○ Performing a primary review summary○ Mailing exclusion orders○ Completing a county immunization status report

Non-Claimable scenarios may include: As mandated by state law, a secretary generates a county immunization status

report during exclusion. An office secretary refers a child for immunizations to a free immunization clinic

offered in the community.

Link to exclusion information: http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/

GettingImmunized/Documents/SchLawHandbook.pdf

Immunizations

Use of code C1.3 is used for reporting claimable monitoring or follow-up activities, which includes providing follow-up contact to ensure that a child has received prescribed medical/dental/mental health services covered by Medicaid or that they were arranged/coordinated as planned.

NOTE:Physical monitoring of a child’s health condition

regardless of the severity or type is not a claimable C1.3 monitoring activity.

C1.3 Monitoring & Follow-up Activities

Claimable scenarios may include:A classroom teacher who works closely with a student receiving

Medicaid-covered services on an IEP is involved in a team conference or meets individually with a therapist to evaluate the medical component(s) of an IEP (this excludes the actual IEP meeting).

A classroom teacher who works closely with a student makes follow-up contact with a qualified Medicaid Health Services provider to ensure services previously prescribed or referred for were received.

A referral was made by the school counselor for mental health services to an enrolled provider, the school counselor follows up with the parent following the appointment to coordinate care and changes in medication.

C1.3 Monitoring & Follow-up Activities

Non-Claimable Monitoring or Follow-up Activities:  (F)Monitoring minor acute health conditions, such as scratches,

bruises, headaches, colds, application of Band-Aids or administration of non-prescriptive medications

Monitoring  required by Delegation from a Registered Nurse, such as seizure, catheterization, g-tube feeding & blood sugar monitoring.

Monitoring of a diagnosed health condition (regardless of the severity or type of health condition)○ Activities performed in the initial development of the IEP

and/or formal IEP meetings (i.e., annual, 3-yr) 

Non-Claimable Monitoring & Follow-up Activities

Non-Claimable scenarios may include:An educational/instructional assistant trained by and under the

supervision of a registered nurse monitors a student’s seizures as outlined in the Nursing plan of care pursuant to the IEP.

An office secretary monitors a student in the office or a sick room who has been complaining of a headache and/or nausea.

A classroom teacher monitoring a child for adverse reactions after an insulin injection was self-administered by the child.

A secretary monitoring a child with a bee allergy for adverse reactions to a bee sting.

Non-Claimable Monitoring & Follow-up Activities

Participation in MAC & Oregon Healthy Kids Application Assistor 

Currently, In Oregon all Healthy Kids contracted ESDs are considered “Volunteer Organizations”, meaning they process Healthy Kids applications for free and are not paid the $75 assistor fee for applications that result in eligibility.

This was accomplished to avoid any duplication in payment for outreach activities provided by ESDs who participate in the MAC program. This action was not intended to exclude ESDs from participating as Healthy Kids application assistors.

MAC & Oregon Healthy Kids

Medicaid outreach activities are those performed to inform eligible or potentially eligible individuals about Medicaid and how to access the Medicaid program.

Oregon Health Plan/Healthy Kids ProgramsA State sponsored Medicaid program providing all

of Oregon’s uninsured children under the age of 19 access to no cost or affordable, comprehensive, health insurance coverage.

Healthy Kids covers all of the health care kids need including: Medical, dental and vision care Regular checkups and preventive care Prescription medicines and medical equipment Mental health and chemical dependency services

Coverage lasts for a least one full year.

Three key qualifiers for no-cost or low-cost coverage

1.) Age○ Must be under the age of 19 (19th birthday)

2.) Residency○ Must live in Oregon and be a legal resident

3.) Income○ Must have been without health insurance for two

months (exceptions: parent’s job loss or a child’s serious medical need).

○ For free coverage, household income cannot be more than 300% of federal poverty level ($46,300 for a family of 4).

A family of 4 that makes $46,300 or less annually may qualify for no cost coverage. = $0.00 Monthly Premium

A family of four that earns between $46,330 to $69,380 a year may qualify for a low-cost option. This is determined on a sliding scale. On average, low cost coverage for a family of four = $50.00 Monthly Premium

Healthy Kidshttp://www.oregonhealthykids.gov/General Information

○ On-Line Application

Referrals made for Medicaid covered health services provided by Licensed Health Care Professionals who work for enrolled Medicaid providers and who are billing Medicaid are claimable. These include, but are not limited to:

Some ESD’sSome School DistrictsPublic Health AgenciesHospitalsMental Health AgenciesMedical ClinicsPrivate Practices

As per the Federal 2003 MAC guide: An education agency does not have to be an enrolled or

participating Medicaid provider in order to claim referrals of students to Medicaid-covered medical/health services provided in the community, as long as the provider rendering the services is an enrolled or participating Medicaid provider.Referrals made to medically Qualified direct service providers

employed by a school district or ESD that is not a participating

Medicaid provider are NOT claimable. Medicaid does NOT recognize TSPC licensure; therefore, referrals

made to staff licensed/credentialed through TSPC only (i.e., school counselor, school psychologist, teacher with a Speech endorsement) for the purpose of a health evaluation, diagnostic test and behavior counseling are NOT a claimable MAC activity

Referrals made to staff licensed/credentialed through TSPC (only) for the purpose of a health evaluation, diagnostic testing, and behavior counseling services are not claimable (i.e., school psychologist, school counselor, teacher with a speech endorsement).

• Referrals for state-mandated health services are NOT claimable.• For example, state laws may require that immunizations be provided to all

school children, regardless of the child’s income status or whether the child is Medicaid eligible. In such a case the administrative activities related to assisting the child to obtain such immunizations in the school would not be reimbursable as a Medicaid administrative cost.

• Notifying parents regarding immunizations during exclusions as required by education would not be a claimable activity under MAC.

Referrals to NON-Medicaid health care providers, such as: School Districts and ESD’s which are not enrolled as a Medicaid provider

or not actively participating in Medicaid billing and; Some private health plans

For assistance in finding local Medicaid providers and in applying for Medicaid insurance the following websites are useful:Oregon Health Policy Board – What’s Happening With

Health Care in Oregon ○ http://www.oregon.gov/oha/OHPB/Pages/index.aspx

Oregon County Health Department Directory○ http://public.health.oregon.gov/

ProviderPartnerResources/LocalHealthDepartmentResources/Pages/lhd.aspx

Cover Oregon - Finding Health Insurance For You○ https://www.coveroregon.com//

Find a Local DHS Office Near You○ http://www.oregon.gov/DHS/localoffices/

localoffices.pdf

2014-2015Annual Staff Training

Thank you for participating in this important training. As teachers and professionals who work daily with students, your jobs involve much more than instruction. Your efforts to link students and their families to Medicaid-covered health services that can impact a child’s ability to learn provides structure and support in developing successful learners.

Training Introduction

Your participation in Medicaid Administrative Claiming (MAC) is a way in which you can help your District to receive reimbursement for Medicaid outreach and associated health related activities you provide. This reimbursement helps schools to continue to provide vital health and social services.

Thank you again for your participation in this training and your work with Oregon students and their families!

Training Introduction

MAC is a survey method of identifying and accounting for the time spent by public school staff on medically related activities, that otherwise would be the financial responsibility of the State.

Participation in School-Based MAC allows for the administrative activities associated with the coordination, referral, outreach, and program planning of Medicaid covered health services to be reimbursed for education agencies.

The MAC program strengthens local relationships between service providers and public agencies.

What is Medicaid Administrative Claiming (MAC)

You do not need to know who is Medicaid/OHP eligible

It is the activity you are doing that is being measured, not the outcome of the activity

The time study determines your time spent on eligible and non-eligible activities

When you report claimable MAC activities during your day you must complete a supporting documentation form in support of the activities being reported

Submit the support document to your local building coordinator or designee

Important Facts

The web-based survey is utilized to record activities staff perform during the paid hours of a school day. This is accomplished by reporting the activities in a code category that best fits the activity performed. There are three survey periods per school year. Each survey period DHS/OHA will select random survey dates of which your District/ESD will be assigned one.

○ September – December○ January – March○ April – June

How is MAC time reported?

MAC Claimable Categories B1 – Medicaid Outreach – Healthy Kids/Healthy KidsConnectC1 – OHP Referral, Coordination, Monitoring and Training

C1 = Child SpecificD1 – OHP Transportation/TranslationE1 – Medical Program Planning, Policy Development, and

Interagency Coordination E1 = Everyone Benefits

Non-Claimable Codes A – School Related and Educational Activities B2 – Non Medicaid OHP/Outreach C2 - Referral, Coordination, Monitoring and Training on Non

Medicaid /OHP Services D2 – Non Medicaid/OHP Transportation/Translation E2 – Program Planning, Policy Development and Interagency

Coordination Related to Non-Medical Services F – Direct Medical Services

Non-claimable codes represent non-health related and/or educational activities that DO NOT generate reimbursement

Code AThis code should be used for

any school-related activities that are not health related.○ Including but not limited to

classroom instruction, grading papers, supervision of staff, recess duty, student discipline, and developing curriculum.

Note: Participating in an IEP meeting must also be reported as code A. (This includes the development, coordination and monitoring of a student’s IEP or other education plan.)

Medicaid outreach activities are those performed to inform eligible or potentially eligible individuals about Medicaid and how to access the Medicaid program.

Oregon Health Plan/Healthy Kids ProgramsA State sponsored Medicaid program providing all

of Oregon’s uninsured children under the age of 19 access to no cost or affordable, comprehensive, health insurance coverage.

Healthy Kids covers all of the health care kids need including: Medical, dental and vision care Regular checkups and preventive care Prescription medicines and medical equipment Mental health and chemical dependency services

Coverage lasts for a least one full year.

Three key qualifiers for no-cost or low-cost coverage

1.) Age○ Must be under the age of 19 (19th birthday)

2.) Residency○ Must live in Oregon and be a legal resident

3.) Income○ Must have been without health insurance for two

months (exceptions: parent’s job loss or a child’s serious medical need).

○ For free or low-cost coverage, household income cannot be more than 300% of federal poverty level.

Health Services Well-child exams Immunizations (May not be during exclusion or for education enrollment

requirements) Routine physicals Maternity and newborn care

Medical Services Preventive services such as well-child check ups Laboratory or x-rays Treatment for most major diseases Hospital stay Substance abuse Vision care, routine screenings, and glasses Hearing services, hearing aids, & batteries Home health care Specialists care & referrals Physical, occupational, and speech therapy Medical equipment and supplies

NOTE: If any of these activities are provided as “free care” or free to all students, they must be coded as C2. Activities performed free of charge are not MAC claimable.

Dental Services Preventive services (cleaning, fluoride treatments, sealants for

children) Routine services (fillings, x-rays) Dental check ups Tooth removal Dentures 24-hour emergency care Specialist care and referrals

Mental Health Services Evaluations Therapy Consultations Medication management Programs for daily and community living

The following section is an introduction to the MAC coding categories for claimable activities codes B1, C1, D1, and E1.

Each code category provides a general description of the claimable activities, including examples of those activities and their sub-codes.

B1.1 Informing children and their family’s on how to

effectively access, use, and maintain participation in Medicaid/OHP. ○ Includes describing the range of services, and

distributing OHP literature.Gave a family the details about qualifying for OHP, application

process and whom to contact.Through a Spanish speaking interpreter I identified how to

apply for OHP.Worked with school counselor to answer a family’s questions

about OHP and how to apply. What benefits are covered, eligibility requirements, etc.

Informed the Grandmother of a student who needs extensive surgery on his arm about OHP. The family is uninsured.

B1.2 Assisting the student/family to access, apply for,

and/or complete the Medicaid/OHP application. ○ Includes coordinating transportation and providing

and coordinating translation related to OHP application, and gathering appropriate information.Referred a family for OHP application assistance and

helped get an application for Medicaid/OHP through our Family Support Center.

Phone call with a parent regarding documentation requirements for the OHP application. Explained time frame and importance of providing all documentation.

Assisted a family with resources necessary for them to apply for OHP.

B1.3 Checking a student and/or family's OHP status.

May be done by reviewing the family’s medical card, contacting the local DHS agency, working with in-district staff who have access to Medicaid eligibility.Informed a parent of a child with dental needs how to check

the status of their OHP eligibility.Checked on the OHP eligibility status of a student returning

from foster care to her immediate family. She was covered while in foster care but will need to reapply.

Verified a student who attempted suicide the previous day was not insured and discussed access to OHP. Followed up with school counselor and County Mental Health crisis unit.

B1.4 Contacting pregnant and parenting

teenagers about the availability of Medicaid/OHP for prenatal and well baby care programs.

Spoke with student regarding Medicaid/OHP for prenatal care.

Reviewed availability of services covered under Medicaid/OHP prenatal and well baby programs.

C1.1 - Referral Referring students for medical, mental health, dental health and

substance abuse evaluation and services covered by Medicaid/OHP. Includes gathering information in advance of referrals.

Gathered information on a student identified during a vision screening as needing further evaluation for an eye exam, student has trouble reading instructions at a distance.

Discussion with team regarding the health needs of a student who just returned from an out of state school. Parent reports regression, team discussed referral to County Mental Health agency.

Met with student and mother. Student has substance abuse issues. Referral to County Health Department for UA.

Referral of a student with Mental Health needs to County Mental Health.

Gathered information in advance of a referral for a student with dental health needs from the parents and school nurse.

Immunizations Claimable – C1.1 ReferralAdministrative activities related to referrals to assist families in accessing

immunizations from enrolled Medicaid providers are claimable as C1.1 - Referral.To be claimable the immunization may Not be Free of Charge (An

exception is that the service is billed to Medicaid insurance by the service provider, but may be free of charge to parent/child)

To be claimable, immunizations must be provided outside the school

Free Care Principal – Federal GuidancePrecludes Medicaid from paying for the costs of Medicaid-covered

services and activities which are generally available to all students without charge.

Immunizations Continued Non Claimable – C2

Administrative activities related to assisting children and families to access “FREE” immunizationsActivities performed in association with a free immunization clinic

offered in school or other settingsAdministrative activities performed in association with the

immunization exclusion requirements- Performing a primary review summary- Mailing exclusion orders- Completing a county immunization status report

C1.2Coordinating the delivery of medical health, mental health, dental

health and substance abuse services covered by Medicaid/OHP. ○ Includes Youth Services Team and CARE team meetings

Discussion with School Counselor regarding student who is in need of health and mental health services and how to best assist the family in gaining access to services through OHP.

Contacted local OHP provider to determine resources available for a student needing glasses.

Coordinating the delivery of medical services for a student with depression with administration, student, family and DHS.

C1.3 - The 2003 CMS Medicaid Administrative Claiming guide indicates the following are covered under code C1: Providing follow-up contact to ensure that a child has received the

prescribed medical/dental/mental health services covered by Medicaid.

Monitoring and evaluating the Medicaid service components of the IEP as appropriate.

When necessary and appropriate claimable scenarios may include:A classroom teacher who works closely with a student receiving

Medicaid-covered services on an IEP is involved in a team conference or meets individually with a therapist to evaluate the medical component(s) of an IEP (this excludes the actual IEP meeting).

A classroom teacher who works closely with a student makes follow-up contact with a qualified Medicaid Health Services provider to ensure services previously prescribed or referred for were received.

C1.3The following monitoring activities are NOT claimable:

○ Activities performed in the initial development of the IEP and/or formal IEP meetings (i.e., annual, 3-yr)

○ Monitoring minor acute health conditions, such as scratches, bruises, headaches, colds, application of Band-aids or administration of non-prescriptive medications

○ Monitoring required by Delegation from a Registered Nurse, such as seizure, catheterization, g-tube feeding & blood sugar monitoring.

○ Monitoring of a diagnosed health condition (regardless of the severity or type of health condition)

C1.4Training: Coordinating, conducting or

participating in training events or seminars for outreach staff regarding the benefits of medical/Medicaid related services.○ Participating in a MAC training.

Excludes the amount of time spent learning how to fill out the actual survey.

○ Attending a seminar on how to effectively provide OHP outreach.

○ The portion of a training where the content focuses on recognition of signs and symptoms of specific medical conditions.SuicideAutismDrug and Alcohol Abuse

C1.4○The following State Mandated trainings

are not covered:

First Aid TrainingCPR TrainingEPI TrainingBlood-borne Pathogens Training

D1.1Scheduling and arranging transportation to OHP covered

services.○ Does NOT include the provision of the actual transportation

service or the direct costs of the transportation (bus fare, taxi fare, personal transport, etc, but rather the administrative activities (related paperwork, clerical activities, staff travel time, etc.) involved in providing the transportation.

D1.2Scheduling, arranging or providing translation for OHP

covered services.○ Arranging for or providing translation services (oral and

signing) that assist the individual to access and understand necessary care or treatment covered by Medicaid.

○ Developing translation materials that assist individuals to access and understand necessary care or treatment covered by Medicaid.

E1.1Developing strategies and policies to assess or

increase the capacity of school medical/dental/mental health programs (includes workgroups)

Worked with nurses and local dentists regarding increasing access to dental services for students.

Review with school team current Mental Health support system effectiveness.

Reviewed strategies on how to better identify and provide access to treatment for students with asthma.

E1.2Working with other agencies and/or providers to

improve the coordination and collaboration and delivery of medical, mental health and substance abuse services.

Attended a community meeting in which access to Mental Health services for students was discussed. Brainstormed ways to improve access/delivery of Mental health services to OHP eligible students.

Attended a community health resource meeting. We identified gaps in existing support systems and collaborated w/various agencies about district wide health needs.

Collaborating with other agencies/providers on available OHP options/programs to better serve students in school with Mental Health needs.

El.3Monitoring the medical/mental health/dental

health delivery system in schools.

○ Developing advisory or work groups of health professionals to provide consultation, advice and monitoring of the delivery of health care services to school populations.

○ Evaluating the need and/or effectiveness of medical services provided in the school setting (such as a school based health center).

E1 – Program Planning, Policy Development & Interagency Coordination

Providing Direct Services vs. Administrative ActivitiesThe Centers for Medicare & Medicaid Services

(CMS) rule states: Activities that are considered integral to, or an extension of direct medical services, are NOT CLAIMABLE as an Administrative expense (e.g., patient follow-up, patient assessment, patient counseling, patient

education, patient consultation, billing activities). These activities must be reported under Code F, Direct Medical Services.

EXAMPLES Treatment or monitoring activities related to minor

acute health conditions such as, scratches, bruises, headaches, colds, application of bandages or distribution of non-prescriptive medications.

Physical monitoring of health/medical services on a child’s IEP. (NOTE: Follow-up to ensure the activities on an IEP

(prescribed) are covered under C1.3.) Monitoring a child’s health condition regardless of the

severity or type of condition. School secretary monitoring a child in the health room for

adverse reaction to a bee sting Teacher monitoring a child after an insulin injection Educational assistant monitoring a child following a seizure

Place yourself in the following scenarios and attempt to answer the questions correctly.YOU’RE GOING TO TEST WELL. GOOD

LUCK!!

Test Your Knowledge

Individual surveys reporting claimable MAC activities○ Complete a MAC Support form for each claimable time frame and

activity code recorded. The documentation should: be recorded soon after completing the survey (no less than 5

business days);be brief and concise;use descriptive words (best practice is to use the key words from the

activity guide such as referred, coordinated, monitored, etc.); only provide information pertinent to the claimable activity

performed; anddo not identify the individual student or family by name.

○ Review the MAC Support form to ensure documentation is for allowable MAC activities

○ Submit MAC Support form to your district’s MAC Coordinator

Coding Accuracy Reminders for StaffReporting of Time:

○ Report only PAID work time○ Report time in 15 minute blocks○ Report all activities performed during the paid work

dayUsing Correct Login (name on paycheck)Saving the SurveyReporting unpaid lunch

○ time frame should be left blank on surveyReporting Paid Absences

○ code A

Steps required to complete the MAC survey: Access the MESD website through the following link

http://mac.mesd.k12.or.us From the MESD screen choose Survey Login for the ESD under

which you participate Indicate your first name and last name as it appears on your

paycheck Document the activities performed for your PAID work day from the

list of Activity codes. 7:30 – 8:30 Code A 8:30 – 9:00 Code B1.1 9:00 – 2:30 Code A 2:30 – 3:30 Code E1.2

Save the survey

Note: Paid absences are reported as Code A. Unpaid lunch is left blank

Who do I contact if I need technical assistance?

For assistance in finding local Medicaid providers and in applying for Medicaid insurance the following websites are useful:Oregon Health Policy Board – What’s Happening With

Health Care in Oregon ○ http://www.oregon.gov/oha/OHPB/Pages/index.aspx

Oregon County Health Department Directory○ http://public.health.oregon.gov/

ProviderPartnerResources/LocalHealthDepartmentResources/Pages/lhd.aspx

Cover Oregon - Finding Health Insurance For You○ https://www.coveroregon.com//

Find a Local DHS Office Near You○ http://www.oregon.gov/DHS/localoffices/

localoffices.pdf