1. Medicaid Administrative Claiming “MAC” 2012-2013 Annual Staff Training

2.  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

3. 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

4. Feds award Oregon $22.5 million for children's health insurance enrollment  Since October 2010, Oregon has enrolled more than 53,000 kids under age 19 in state health insurance.  That enrollment success, plus outreach and streamlining by the state Healthy Kids program, resulted in the bonus.  This is Oregon's third year of receiving a bonus under the federal law, including $15.1 million last year. http://www.oregonlive.com/health/index.ssf/2011/12/feds_award_oregon_225_million.html Money - Statewide

5. Money – Your District (Fall 2011) DistrictPoolSurveyed% ClaimTotal ClaimDistrict Final NetNet Per Surveyed Astoria122107.88%125,209.8959,391.415,939.14 Banks88140.98%18,060.268,223.04587.36 Beaverton30151900.75%556,828.21252,057.201,326.62 Clatskanie62149.21%75,562.4135,898.612,564.19 Forest Grove499400.97%95,799.8943,461.581,086.54 Hillsboro15641190.63%122,754.5151,177.95430.07 Jewell27152.73%6,661.442,981.39198.76 Knappa44151.09%5,518.902,429.32161.95 NWRESD268190.40%10,954.663,940.40207.39 Rainier85152.99%40,297.6418,891.381,259.43 Sauvie Island1293.16%3,737.801,732.18192.46 Scappoose163143.04%95,338.5544,880.273,205.73 Seaside142121.61%26,917.5212,202.931,016.91 Sherwood385221.51%91,600.2442,005.901,909.36 Sherwood Charter14108.51%7,690.543,616.14361.61 St Helens196200.64%24,428.0610,746.73537.34 Tigard-Tualatin414603.42%291,946.98137,848.462,297.47 Tillamook182161.53%42,894.4919,662.131,228.88 Vernonia41151.96%13,213.426,130.33408.69 Warrenton82159.32%119,404.5056,805.313,787.02

6. District Claimable Time Sample

7.  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.  The MAC process permits the costs of allowable administrative activities being performed in the school setting, to be reimbursed under Medicaid.  The MAC program strengthens local relationships between service providers and public agencies. What is Medicaid Administrative Claiming (MAC)

8.  You do not need to know who is Medicaid/OHP eligible  You do not need to know all about Medicaid/OHP  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 Important Facts

9.  MAC claiming is reported by district staff completing a web-based survey. The survey documents services provided by school personnel on a normal school day. There are three survey periods per school year. Each survey period has five survey days within the period. Survey periods and dates are randomly selected by DHS. ○ September – December ○ January – March ○ April – June How is MAC time reported?

10. MAC Activity Codes  A – School Related and Educational Activities  B1 – Medicaid Outreach – Healthy Kids/Healthy KidsConnect  C1 – OHP Referral, Coordination, Monitoring and Training  C1 = Child Specific  D1 – OHP Transportation/Translation  E1 – Medical Program Planning, Policy Development, and Interagency Coordination  E1 = Everyone Benefits  F – Direct Medical Services

11. School Related and Educational Activities  Code A This 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.)

12. Code B – Medicaid Outreach  B1.1 - Informing children and their families on how to effectively access, use, and maintain participation in Medicaid/OHP. (Includes describing the range of services, and distributing OHP literature)  B1.2 - Assisting the student/family to access, apply for, and/or complete the Medicaid/OHP application. (Includes transportation and translation related to OHP application, and gathering appropriate information)  B1.3 - Checking a student and/or family's OHP status.  B1.4 - Contacting pregnant and parenting teenagers about the availability of Medicaid/OHP for prenatal and well baby care programs.

13. Medicaid Outreach & 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 Programs A 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.

14. What does it cover?  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.

15. Who is eligible? Three key qualifiers for no-cost or low-cost coverage 1.) Age ○ Must be under the age of 19 (19 th 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 ($67,200.00 for a family of four).

16. Medicaid/OHP Services 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

17. Medicaid/OHP Services  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

18. B1 – Medicaid Outreach  B1.1 Informing children and their families on how to effectively access, use, and maintain participation in Medicaid/OHP. ○ Includes describing the range of services, and distributing OHP literature. Through interpreter, gave a family the details about qualifying for OHP, application process and whom to contact. Worked with school counselor to answer a families 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.

19. B1 – Medicaid Outreach  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 and helped contact and 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.

20. B1 – Medicaid Outreach B1.3  Checking a student and/or family's OHP status.  May be done by reviewing the families medical card, contacting the local DHS agency, working with in-district staff who have access to Medicaid eligibility. Contacted parent regarding dental issues. Informed them how to check OHP eligibility. Checked on the OHP status of a student returning from foster care to her immediate family. She was covered while in foster care but will need to reapply. Follow up with school counselor and County Mental Health crisis unit regarding a student who attempted suicide the previous day. Verified the student is not insured and discussed access to OHP.

21. B1 – Medicaid Outreach  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 Medicaid/OHP prenatal and well baby programs during Youth Pregnancy Opportunity Placement Meeting.

22. C1 - Referral, Coordination, Monitoring & Training C1.1 - Referring students for medical, mental health, dental health and substance abuse evaluations and services covered by Medicaid/OHP. (Includes gathering information in advance or referrals) C1.2 - Coordinating 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) C1.3- Monitoring the delivery of medical (Medicaid/OHP) covered services. (Includes monitoring and evaluating the medical services component of the IEP) C1.4- Training: Coordinating, conducting or participating in training events or seminars for outreach staff regarding the benefits of medical/Medicaid related services.

23. C1 - Referral, Coordination, Monitoring & Training 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. 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.

24. C1 - Referral, Coordination, Monitoring & Training  Immunizations Claimable – C1.1 Referral Administrative activities related to referrals to assist families in accessing immunizations from enrolled Medicaid providers are claimable as C1.1 - Referral. Not Free of Charge (Billed to Medicaid) Provided outside the school setting  Free Care Principal Precludes Medicaid from paying for the costs of Medicaid-covered services and activities which are generally available to all students without charge.

25. C1 - Referral, Coordination, Monitoring & Training Immunizations Continued  Non Claimable – C2  Administrative activities related to assisting children and families to access “FREE” immunizations 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 -Performing a primary review summary -Mailing exclusion orders -Completing a county immunization status report

26. C1 - Referral, Coordination, Monitoring & Training  C1.2 Coordinating 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. Followed up on OHP resources available for a student needing glasses. Coordinating the delivery of medical services for a student with depression (possibly suicidal) with administration, student, family and DHS.

27. C1 - Referral, Coordination, Monitoring & Training 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.

28. C1 - Referral, Coordination, Monitoring & Training  C1.3 The 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)

29. C1 - Referral, Coordination, Monitoring & Training  C1.4 Training: 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. Suicide Autism Drug and Alcohol Abuse

30. C1 - Referral, Coordination, Monitoring & Training  C1.4 ○ The following State Mandated trainings are not covered: First Aid Training CPR Training EPI Training Blood-borne Pathogens Training

31. C1 - Referral, Coordination, Monitoring & Training  Activities required to coordinate or make referrals for Medicaid covered services may be claimable for each person involved, not just the final person to coordinate or refer.  Example:  Principal/Counselor asks you to put together information on a student for possible referral to service – C1.1  Meeting with Principal/Counselor/Other Teachers – C1.1  Actual Meeting with Family/Student – C1.1  Just because you may not meet with the family, does not mean you are not involved in gathering information or history in advance of the referral that will reflect accurately the needs of the student  Students on an IEP – periodic meetings to review effectiveness of medical component(s) – Claimable as C1.3  Activities that occur in a “Formal” IEP meeting are reported A. Periodic meetings to review the effectiveness of the medical services, which are NOT IEP meetings, may be claimable. Proper supporting documentation must indicate the meeting was not an IEP meeting.

32. C1 - Referral, Coordination, Monitoring & Training C1.1 can often lead to B1.1 If you meet with a student or family for a referral to Medicaid Covered Services ask at the end of the meeting “Would you like information on State Programs that can help pay for your child to receive these services”  You don’t have to ask if they have insurance. The referral is to be reported as C1.1 regardless If the answer is yes, providing information on Oregon Healthy Kids is appropriate and the activity may be reported as B1.1.

33. D1 – Transportation/Translation  D1.1 Scheduling 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.  D1.2 Scheduling, 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.

34. E1 – Program Planning, Policy Development & Interagency Coordination  E1.1 - Developing strategies and policies to assess or increase the capacity of school medical/dental/mental health programs. (Includes workgroups)  E1.2 - Working with other agencies and/or providers to improve the coordination and collaboration and delivery of medical, mental health and substance abuse services.  E1.3 - Monitoring the medical/mental health/dental health delivery system in schools.

35. E1 – Program Planning, Policy Development & Interagency Coordination  E1.1 Developing strategies and policies to assess or increase the capacity of school medical/dental/mental health programs (includes workgroups) Worked with nurses and volunteers regarding increased access to dental services for students. Review with school team current Mental Health support system effectiveness.

36. E1 – Program Planning, Policy Development & Interagency Coordination E1.2  Working 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 resource meeting at DHS office. We identified gaps in existing support systems and collaborated w/various agencies about district wide needs. Meeting: Collaborating with other agencies/providers on available OHP options/programs to better serve students in school with Mental Health needs.

37.  El.3 Monitoring 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

38. Code F – Direct Services  Providing Direct Services vs. Administrative Activities The 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.

39. Non Covered Services – CODE F 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

40. Providing Appropriate Supporting Documentation  Take notes on any activity related to the medical needs of students on the day of the survey (Form Provided) Don’t worry about what code it is – Just the time and activity  After survey day use MAC Activities sheet to determine appropriate code  When in doubt – Ask!  Complete online survey  Provide a copy of the Supporting Documentation to your district coordinator or NWRESD Keep FERPA in mind – general description of activity Saves asking 3 months later what you did!

41. Providing Appropriate Supporting Documentation Time FrameActivity CodeDescription of Activity 7:30-8:00 Phone calls and email correspondence re: setting up appt. for applying for OHP for two separate families 8:15-8:30 Gather info to share with parent for a different 6 th grade student (suicidal) who is currently seeing outside counselor under OHP to facilitate care coordination. 2:00-3:30 Prevention Matters County meeting. Discussing mental health and substance abuse services and trends in Washington County.

42. Coding Reminders  Coding Accuracy Reminders for Staff Reporting of Time: ○ Report only PAID work time ○ Report time in 15 minute blocks ○ Report all activities performed during the paid work day Using Correct Login (name on paycheck) Saving the Survey Reporting unpaid lunch ○ time frame should be left blank on survey Reporting Paid Absences ○ code A

43. Online Survey – LAST STEP!

44. Employee Resources Links to additional resources  http://www.oregonhealthykids.gov/ - Healthy Kids of Oregon is a program that expands on the success of the OHP Program. No family makes too much money for Healthy Kids. http://www.oregonhealthykids.gov/  http://www.oregonhelps.org/ - OregonHelps is a free and easy program prescreener. This site will estimate your potential eligibility for 33 programs and assistance. http://www.oregonhelps.org/  http://www.oregon.gov/DHS/how_do_i.shtml – The main page for the Oregon Department of Human Services with links to finding Medicaid Services, Alcohol and Drug treatment centers, county health departments and other Medicaid covered/related services. http://www.oregon.gov/DHS/how_do_i.shtml  http://www.oregon.gov/DHS/healthplan/managed-care/plans.shtml - OHP Medical and Dental Plans by County. This page provides information to help OHP and Healthy Kids applicants choose an OHP medical and dental plan. http://www.oregon.gov/DHS/healthplan/managed-care/plans.shtml  http://egov.oregon.gov/DHS/mentalhealth/cmh-programs.shtml – Community Mental Health Programs by County http://egov.oregon.gov/DHS/mentalhealth/cmh-programs.shtml