Presentation on theme: "Department of Finance 1 Medicaid Reimbursement: Administrative Time Study Program C. Andrew Long, School District of Pittsburgh 5/10/11."— Presentation transcript:
Department of Finance 1 Medicaid Reimbursement: Administrative Time Study Program C. Andrew Long, School District of Pittsburgh 5/10/11
2 Program Overview Process and Procedures Coding Structure Questions and Answers Agenda
3 Overview The school environment offers advantages and opportunities to reach children and families to inform, encourage, and assist them to access needed health care services, including enrolling in the Medicaid program. PPS has the responsibility to identify, evaluate, and accommodate the physical and mental health needs of all children who may be at-risk for poor school outcomes. Schools have become an important link for children and families to vital health care services.
4 Overview cont. Federal law allows for reimbursement for allowable administrative activities required for provision of these services. Available federal funding has important economic implications for local education agencies. Quarterly time studies of staff activities are conducted three times a school year to identify the costs of allowable administrative activities.
5 Time study Process During a five (5) day period determined by PPS and Leader Services, each participant tracks their individual time by identifying the task performed (in 15-minute increments) using the Code Sheet and filling out the appropriate bubble on the time study bubble sheet. A coordinator designated by the Principal at each location distributes the time-study bubble form to participants. Completed forms are submitted by the site coordinator to the Medicaid reimbursement section of Finance (room 301 admin building). Administrative claims are submitted by the District through the Commonwealth of Pennsylvania’s designated agent, LEADER Services.
6 Coding Structure 10 Codes: A – J: At least one code should represent each 15-minute increment of your day. A – Outreach Medicaid B – Outreach Non-Medicaid C – Assisting with Medicaid eligibility D – Assisting with Non-Medicaid eligibility E – Referral, Coordination, and Monitoring of Medical/Mental Health Services F – Referral, Coordination, and Monitoring of Non-Medical Services G – Interagency coordination H – Direct Medical, Therapeutic, and School Health Related Services I – School-related, educational, and social services activities J – General Administration
7 Coding Details Start with the easy codes: I – School-related, educational, and social services activities: Should be most of your day Examples: teaching, field trips, talking to parents about student’s grades, speaking about discipline problems, coordinating a student’s IEP Performing activities that are specific to instructional, curriculum, student-focused areas. J– General Administration: Examples: Lunch and other breaks, staff meetings, clerical activities related to the operation of the school
8 Coding Details, cont. Outreach Activities: Primarily counselors, developmental advisors, nurses, etc. A – Outreach Medicaid: Specific to informing individuals about Medicaid and how to access it. Examples: telling parents about Medicaid, the services offered through the program, the EPSDT program, assisting in early identification of children with special medical/mental health needs through various child find activities. B – Outreach Non-Medicaid: Any other form of outreach activities not included above Examples: wellness activities and general health programs (i.e. dental hygiene, DARE), assisting with other programs not covered under Medicaid (educational, social, legal).
9 Coding Details, cont. Eligibility assistance: Primarily counselors, developmental advisors, nurses, etc. C – Assisting with Medicaid eligibility: Includes paperwork, clerical activities, and travel required to assist students and parents with Medicaid eligibility only Examples: Explaining Medicaid process, verifying eligibility status, assisting with application. D – Assisting with Non-Medicaid eligibility: Any other form of eligibility activities not included above Examples: assisting with the following programs: SSI, CHIP, food stamps, WIC, day care, legal aid, and other social and educational programs
10 Coding Details, cont. Referral, coordination, and monitoring activities: E – Referral, coordination, and monitoring of medical/mental health services: Some teachers, counselors, and advisors Examples: Reviewing health records, referring and coordinating examinations and evaluations, participating in a meeting/discussion to coordinate or review a student’s needs for health-related services(with parent or other staff). F – Referral, coordination, and monitoring of non- medical services: Examples: referring and coordinating access to child care, employment, job training, housing, food, heating, etc.
11 Coding Details, cont. Other activities: G – Interagency coordination: Specific to health care service delivery system Examples: Working with other agencies providing Medicaid services in the early identification of medical/mental health problems (i.e. Familylinks) H – Direct Medical, Therapeutic, and School-Health Related Services: Primarily nurses but may include teachers Examples: administering first aid, assisting in any aspect of providing a related service under the IEP (speaking with an OT, PT, speech therapist). Related paperwork and clerical activities should be included in this code as well.
12 Important Changes/Notes Participants: Should include teachers, counselors, advisors,etc. Should not include administrators and clerical/secretarial staff (reimbursed under an overhead calculation). No parent volunteers. IEPs: All aspects of IEP development and coordination, including the health related portion should be coded an I.
13 Compliance Process Accuracy is not only expected but required. Process: Each time study form is examined for coding irregularities and compared to the individual’s job description Letters are mailed to the appropriate principal to notify of irregularity Training is mandatory for any school that has more than 10 irregular forms Backup documentation needs to be produced for any accurate irregular forms (i.e. a teacher attends a day-long meeting with FamilyLinks to discuss a specific child’s health problems and actions to be taken)
14 Key Notes to Remember Please make sure that only one code is used for every 15 minutes Sign and date the form in ink Include your PPS employee ID number (please do not confuse with your PPID). Utilize the make-up week if necessary – i.e. you called in sick one day during the time study week
15 Time Study Resources Training video: 3&BMDRN=2000&BCOB=0&c=56731 Presentations and additional information: 3&BMDRN=2000&BCOB=0&c=54156 Questions can be directed to C. Andrew Long at or