Medicaid Administrative Claiming Training January 1, 2017

MAC Training   MAC 101 There are two ways your district gets reimbursed from the Medicaid program: A fee/rate for a direct Medicaid covered service for a Medicaid eligible student. Utah uses a bundled rate for school based health related services. (Nursing has a separate rate for one on one nursing). Each District has a state daily rate based on historical cost.   For administrative time/cost associated with Medicaid outreach, assistance with Medicaid eligibility, training associated with Medical/Medicaid services, program planning related to Medical/Medicaid services in the school setting, and coordination of Medicaid covered services within and with Medicaid providers outside the school system. Administrative cost must be allocated to the program using a federally approved time study process. Utah uses one time study to fulfill both cost settlement and cost allocation requirements.

Time Study Process   We time study three quarters of the year one week each quarter: Oct-Dec, Jan-Mar, Apr-June. An average of those three quarters is used to allocate the summer months (July-Sept). CMS works with coordinators in each district to update the list of time study participants and to coordinate completion of the quarterly time studies and other federal requirements. Persons included in the time study universe include: all OT, PT, Speech Language Therapists, therapist assistants and aides (OT, PT, SLP), Audiologists, Psychologists, Social Workers, Teachers, Para- Educators, Counselors, and Nurses. Other titles are included based on activities they perform. This may include directors and coordinators. Persons that specialize in assisting families with Medicaid applications are also included in the time study. If there is a question if a person should be included in the time study, there is a discussion between CMS and the district coordinator to make that decision. A second cost pool consisting of Directors (if not included in the time study), support personnel and principals and assistant principals involved directly with special education students in part of the claim but not part of the time study. These individual’s salaries are allocated based on the results of the time study.

F1 – IEP Health Related Direct Service Activities   F1 is for HEALTH related (OT/PT/Speech/Nursing/Audiology/Behavioral/Personal Care) direct services only. EDUCATIONAL Special Education service is E. Just because it is documented in an IEP and you are working directly with a student does not make it F1. The activity needs to relate back to a health related goal. Examples: “Teaching math class” is E not F1 “Assisting student with fine motor skills”. This is F1. “Eating lunch with student”. Sounds like Q (if paid for lunch), but if the Para is assisting the student with fine motor skills such as using utensils it should be F1. “Helping student with art”. Is this for the purpose of a health related IEP goal(OT/PT)? “Helping student with reading”. Is this for a speech goal or is this an education goal? Time spent writing and developing the IEP for the health related goal is F1.

  P – Referral, Coordination, Monitoring of Medicaid Services Conversations to coordinate and monitor the Medicaid service includes: Meetings, phone calls, or conversations regarding a specific student’s service, progress, lack of progress, technique, need to change service, feedback to parent or therapist should all be coded P. Therapists, teachers, para-educators, social workers, team members, supervisors, and coordinators involved with coordinating and monitoring the health related services for students should code this time as P. P is coded for IEP meetings when the health related service is discussed. Time in the IEP meeting discussing the academic goals is E. Referrals and communication with the student’s primary care physician or referrals and coordination with mental health providers outside the school should be coded P.

Medicaid Administrative Claiming ACTIVITY CODES   Code A Non-Medicaid Outreach Code B Medicaid Outreach Code C Facilitating Application For Non-Medicaid Programs Code D Facilitating Medicaid Eligibility Determination Code E School Related And Educational Activities Code F Direct Medical Services Code G Transportation For Non-Medicaid Services Code H Transportation-Related Activities In Support Of Medicaid Covered Services

Code I Non-Medicaid Translation Code J Translation Related To Medicaid Services Code K Program Planning, Policy Development, And Interagency Coordination Related To Non-Medical Services Code L Program Planning, Policy Development, And Interagency Coordination Related To Medical Services Code M Non-Medical/Non-Medicaid Related Training Code N Medical/Medicaid Related Training Code O Referral, Coordination, And Monitoring Of Non-Medicaid Services Code P Referral, Coordination, And Monitoring Of Medicaid Services Code Q General Administration The listing of activity codes looks long because it makes use of ‘parallel’ codes. Many activities are listed twice, once when related to Medicaid, and again for when the activity is not related to Medicaid. Think of it as 8 activities with their parallel codes, plus an administrative code for paid leave or other time away from your normal duties.

Time Study Activity Codes Defined

Activity A Non-Medicaid Outreach   Use code A when performing activities that inform potentially eligible individuals about NON-Medicaid programs and how to access them. Informing families of the existence of non-Medicaid programs that may address non-health needs (e.g. SSI and TANF for financial assistance) Conducting outreach programs directed toward encouraging persons to access social, educational, or other services that not medically related; Assisting in early identification of children with special health needs through various Child Search (Child Find) activities; Activity B Medicaid Outreach Use code B when performing activities that inform potentially eligible individuals about Medicaid and how to access it. Informing families of the existence of the Medicaid program, and the benefits it provides. Providing information to students and families on available Medicaid services and how to access them. (For our purposes in this project, Medicaid and CHEC (EPSDT) can be used interchangeably.) Handing out Medicaid brochures. NOTE: Paperwork and travel time related to an activity is coded the same way as the activity. If I speak to a group on the Medicaid program, this is activity B. My travel time getting there is also coded B. If I spend time creating and copying handouts for a presentation on Medicaid, this is also coded B. Paperwork and travel time are coded the same way as the activity they support.

Activity C Facilitating application for non-Medicaid programs   Code C is used when helping an individual to become eligible for NON-Medicaid programs such as TANF, Food Stamps, WIC, day care, and other programs. Assisting an applicant to fill out eligibility applications for NON-Medicaid programs such as TANF and food stamps; Gathering information related to the application and eligibility determination for NON-Medicaid programs for a client;    Activity D Facilitating Medicaid Eligibility Determination Helping a family apply for Medicaid? Code this time D. Assisting an applicant to fill out a Medicaid eligibility application; Providing necessary forms and packaging all forms in preparation for the Medicaid eligibility determination; It doesn’t matter if the family is eligible, or even if they follow through with the application. If you spend time assisting a family relating to a Medicaid application, you code this time D.

Activity E School related and Educational Activities   The code E captures time spent on school-related and educational activities. Providing classroom or individualized instruction (including lesson planning). Testing, correcting papers. Providing general supervision of students (duty). Monitoring student academic achievement. Conferring with students or parents about academic performance. CODE CLARIFICATION Academic “lesson planning” Discussing academics IEP meeting discussing academics IQ testing not part of a special education assessment General supervision of students (duty) Interpreting/translation for the purpose of academics

Activity F1 – IEP Health Related Direct Service activities   Providing health/mental health services contained in an IEP. Medical/health assessment and evaluation as part of the development of an IEP Conducting medical/health assessments/evaluations and diagnostic testing and preparing related reports Providing speech therapy, occupational therapy, physical therapy, personal care services, behavioral health services, nursing services and audiology services Performing developmental assessments Providing counseling services to treat health, mental health, or substance abuse conditions Transportation (if covered as a medical service under Medicaid) CODE CLARIFICATIONS Providing therapy group/individual Documentation/notes of results of therapy Preparing for therapy session Preparing “exercises/plans” to reach Health related service goals (“Lesson Planning” terminology by therapist should be avoided) Assessments, evaluations, testing and preparing reports, for OT/PT/ Speech/ Audiology/Behavior/Personal Care IQ testing is F1 if it is part of an overall assessment to determine the need for health related services including ED, TBI or other health impairments. (Testing for learning and intellectual disabilities is E) Teaching a student how to use braille (preparing braille for class is E) Travel time and paperwork associated with these activities

Activity F2 – Non IEP - Direct Service activities:   Administering first aid, or prescribed injections or medications to a student Providing direct clinical/treatment services Developing a treatment plan (medical plan of care) for a student if provided as a medical service Performing routine or mandated child health screens including buy not limited to vision, hearing, dental, scoliosis, and EPSDT screens Providing immunizations

Activity G Transportation for non-Medicaid Services   Use code G when assisting an individual to obtain transportation to non medical services. Scheduling or arranging transportation to social, vocational, and/or educational programs and activities. Activity H Transportation-Related Activities is support of Medicaid covered services Code it H when assisting an individual to obtain transportation to services covered by Medicaid. Scheduling or arranging transportation to Medicaid covered services. Accompanying the individual to a Medicaid covered service. This includes walking a child to a nurse’s office, a therapist appointment, etc.

Activity I Non-Medicaid translation   Employees who provide translation services for non-Medicaid activities should use I. Arranging for or providing translation services (oral or signing services) that assist the individual to access and understand social, educational, and vocational services. Activity J Translation related to Medicaid Services Employees who provide translation services for Medicaid activities should use J. Arranging for or providing translation services (oral and signing) that assist an individual or family to access and understand necessary care or treatment. Interpreters being used by medical staff.

[K and L are both not child specific [K and L are both not child specific. These are for times when you as a member of the school system are meeting/ communicating with members of an organization that is outside of the school system.] Activity K Program Planning, Policy Development, Interagency Coordination related to Non-Medical Services   Code K is for efforts to improve the coordination and delivery of non-medical services to school age children. Non-medical services may include educational services or vocational services. Working with other agencies who provide non-medical services, to improve the coordination and delivery of these services. Participating in advisory or work groups regarding the delivery of non-medical services. Coordinating with interagency committees to identify, promote and develop non-medical services. Activity L Program Planning, Policy Development, Interagency Coordination related to Medical Services Code L is used when performing activities to improve the coordination and delivery of medical/dental/mental health services to school age children. Developing strategies to increase the capacity of school health programs. Monitoring the medical/dental/mental health delivery systems in schools. Working with other agencies or providers that provide health related services to improve the coordination and delivery of these services. Participating in advisory or work groups of health professionals regarding the delivery of health care services to the school population. An example – A new Substance Abuse clinic opens and has an ‘open house’ and a counselor or social worker attends to learn of the services they offer.

Activity M Outreach Training not related to Medicaid or Medical topics   This code M is for conducting or participating in training events and seminars for outreach staff regarding the benefit of the programs other than the Medicaid program. For example, training may include how to assist families to access the services of education programs. Participating in or coordinating training that improves the delivery of services for programs other than Medicaid. Participating in or coordinating training that enhances IDEA child find programs. Activity N Training related to Medicaid or Medical topics Code it N when conducting or participating in training or seminars for outreach staff regarding the benefits of medical or Medicaid related services. Participating in or coordinating training that enhances early identification, intervention, screening and referral of students with special health needs to such services (e.g., Medicaid EPSDT services). Participating in or coordinating training that improves the delivery of medical related services. Participating in training on administrative requirements related to Medicaid. (Such as training in MAC, or how to bill for services.) An example is attending a presentation by Utah State on Augmentative Communication Devices.

Activity O Referral, Coordination, Monitoring of non-Medicaid Services   Use code O when making referrals for, coordinating, or monitoring the delivery of non-medical services, such as educational services. This includes state mandated across the board vision and hearing screenings. Making referrals for and coordinating access to social and educational services such as child care, employment, job training, and housing. Preparation of an ITP as it relates to coordinating vocational or other non-medical services. Activity P Referral, Coordination, Monitoring of Medicaid Services Code P is used when making referrals to, planning for, or coordinating the delivery of Medicaid covered services. This includes discussions and meetings on the health needs of a child, and the process to determine what services may be needed to address these needs. [Remember as well that you never need concern yourself with whether or not a child is on Medicaid. The time study is about how you spend your time, not the eligibility status of the child. When we refer to a Medicaid covered service it means that the service is included in the Medicaid state plan. It does not mean that the particular child will necessarily have the service paid by Medicaid.] Working with individuals, their families, other staff, and providers to identify, arrange for, or coordinate services covered under Medicaid that may be required as the result of screens, evaluations, or examinations.

Activity P Referral, Coordination, Monitoring of Medicaid Services (Continued) Participating in a meeting or discussion to assess a student’s need for a service covered by Medicaid. This includes informal hallway or lunch time discussions. Referring for medical or physical exams and necessary medical evaluations. Referring a student to a Medicaid covered service, whether or not that service is in the IEP. Include time preparing, writing, and follow up on the referral. Discussion concerning the need for a motor, speech, hearing, or other screening; Monitoring and evaluating the Medicaid service components of the IEP. Arranging for health, speech, behavioral, or other assessments as part of an Eval or Re-eval.   You can see a connection between this code and the code for provision of direct services. If you provide direct health related services to children, activity F, you engage in activity P as well. A service is not provided without the planning, referring, discussing, and monitoring of that service. CODE CLARIFICATIONS Preparation for team meeting Discussing health related service goals, progress, change in service delivery Includes discussions internally (formal or informal), with parents, with health care providers outside the school system IEP meeting discussing health related services Coordinating/discussing the need for physical examinations, or medical/dental/mental health evaluations Following up on needed examinations or health related services Travel time and paperwork associated with these activities

Activity Q General Administration   Use code Q for administrative activities and paid leave time. Some typical examples of general administrative activities: Taking lunch, breaks, leave, or other paid time not at work. Reviewing school or district procedures and rules. Attending school or unit staff meetings. Performing administrative or clerical activities related to district operations. Providing general supervision of staff. Establishing goals and objectives of health-related programs as part of the school’s plan. Reviewing technical literature and research articles, (paper or on the internet), to keep current in your area of specialty. CODE CLARIFICATIONS Leave blanks for hours not at work or not scheduled to work (only code contract hours, or hours scheduled to work.) This is really important! Only use Q for: Paid time off, and breaks (leave blanks for time not scheduled to work) Reviewing of school or district procedures Attending general staff meetings that don’t fit in O or P Reviewing technical literature based on your specialty Evaluations of staff

Completing the Time Study Log During the time study period you may be randomly selected to participate in the narrative time study log. It is important that you code the log as accurately as possible. Also, remember you do not have to write a whole lot. Be brief and concise when documenting your activity, remembering the nature and the purpose of the activity you are performing. Do not use student specific names. Good Examples Small group therapy – OT goal (F1) Reviewed: Fine motor – OT goal (F1) mobility exercise – PT goal (F1) reading with student – Speech Goal (F1) Working on Math (E) Administering First Aid (F2) IEP meeting (P) Monitoring and redirecting behavior (F1) Hallway discussion on students PT progress (P) You do not need to write on each 15 minute line. Write the description of the activity you are performing and line down the length of time you worked on that activity.

Detailed Description of Activity Time Study Log Complete all identifying information on the left. Do not leave fields blank. Provide a detailed description and the code you selected for each 15-minute interval. Code only hours you are scheduled to work. Use the code that describes the activity that took the most time in that 15-minutes. Return form to your coordinator Name:   Signature: Title: Distirct: Date: Detailed Description of Activity Code Hour 1 15 min 30 min 45 min 60 min Hour 2 Hour 3 Hour 4 Hour 5 Hour 6 Hour 7 Hour 8

NARRATIVE LOG INTRUCTIONS   Please complete the narrative log on the 3rd day of the time study week. Please provide brief description of your activity for each 15-minute interval. Descriptions should convey a complete thought and contain a subject and verb (Nature and purpose of the activity and how it relates back to the related activity) PLEASE READ: Examples of good narrative descriptions: Student assessment new services or ongoing services – F1 Student evaluation new services or ongoing services – F1 Provided individual therapy - OT/PT/Speech/Counseling– F1 Provided group therapy – OT/PT/Speech/Counseling F1 Assist with toileting, tube feeding, assist with eating – F1 Met with parent regarding health related service progress - P Called parent regarding health related services- P Call with student’s primary care - P Coordinated meeting with team and parents- P Student observation (therapist) – need for additional/new services –F1

Examples of good narrative descriptions: (Continued) Arrange/Collaborate with team on OT service needs/delivery - P Arrange/Collaborate with therapist on progress/service delivery- P Preparation for team meeting- P Met with supervisor to discuss student goals/progress- P Consult with teacher on student therapy progress/needs- P Consult with parent on grades - E IEP meeting discussing health related goals – P IEP meeting discussing academics - E Filled out Medicaid application for family - D Provided info on Medicaid to family - B Paid Lunch - Q Paid Break - Q OT Assist Student on/off Bus – F1 Paid time off/sick leave – Q Reading with student Speech – F1 If you are not paid for lunch leave it blank. This is also for the web based time study. You will be able to verify your time with a checkbox and will be allowed to move on.

Common Code Patterns SLP/OT/PT/Psychologists/Audiologist – Nurses – F1 – Direct Service – IEP Health Related P – Referral/Coordination/Monitoring Medicaid Services L – Program/Policy Planning E – School Related Educational Q – General Administration   Nurses – F1 – Direct Services – IEP Related F2 – Direct Services – Non-IEP Related P - Referral/Coordination/Monitoring Medicaid Services Maybe B – Medicaid Outreach Maybe D – Facilitating Medicaid Eligibility Determination

Teachers/TA’s/Paraprofessionals - E – School Related Educational P - Referral/Coordination/Monitoring Medicaid Services F1 - Direct Service – IEP Health Related Q – General Administration   Specialists - Involved with Medicaid, Supervision, Program Development - K and/or L – Program Planning, Policy Development, Interagency Coordination O and/or P – Referral, coordination, monitoring of Medicaid or non-Medicaid A and/or B – Outreach – Medicaid or non-Medicaid C and/or D – Assistance with eligibility for Medicaid or non-Medicaid E - School Related Educational F1 or F2 – If you work with students directly

Questions?