Medicaid Fee-For-Service Program Personal Care Services

Medicaid Support  Regina Smith, Program Supervisor (o)  Tanisha Vogl, Financial Specialist (o) We’re here to help you!

Fee-For-Service Schools may receive reimbursement for medically-related services provided to their Medicaid eligible special education students.

What is Personal Care? “A range of human assistance services provided to persons with disabilities and chronic conditions. The provision of such services enables them to accomplish tasks that they, if they did not have a disability, would normally do for themselves. Assistance may be in the form of hands on assistance or cueing so that the person performs the task by him/herself.”

Services Assisting with: –Eating/Feeding –Assistance with food, nutrition and diet activities –Toileting (diapers/toilet training) –Maintaining Continence –Bathing/Grooming/Dressing

Services cont. Assisting with: –Personal hygiene –Assistance with self-administered medications –Transferring/Ambulation/Mobility/ Positioning –Redirection and Intervention for Behavior

PC Checklist A completed, signed and dated checklist of the activities for each student must be signed, approved and kept for 7 years

Service Tracker At the end of the month, log on to Service Tracker, enter your services for a student for the month, summarize and click on “Ready to Bill”. Repeat for each student on your list

The False Claims Act Preventing Fraud, Waste, Abuse Detroit Public Schools is committed to ensuring that its coding, billing and reimbursement procedures comply with all federal and state laws. However, we cannot ensure that the services reported were provided as stated, that they were medically necessary or were not false or misleading.

If you have knowledge or information that School-Based Services being reported to Detroit Public Schools Risk Management Office for the purposes of Medicaid billing are false or fraudulent, such as the falsification of records or submitting services for billing that were not performed, please report the situation to your supervisor or to the Attorney General’s Health Care Fraud Division at: The False Claims Act Preventing Fraud, Waste, Abuse cont.

Whistleblower Provision Federal and state law prohibit any retaliation or retribution against any person who reports suspected fraudulent billing to law enforcement officials or who file “whistleblower” lawsuits on behalf of the government.

So, I chart services daily and enter services monthly. Is that all I have to do? Well… not exactly.

Random Moment Time Study (RMTS) Your name has been put in a “pool” with all of the other Personal Care staff in the state.

What is the RMTS? Out of this pool comes the Random Moment Time Study. This is the tool that Michigan uses to determine the amount of time school staff spend on activities that are in support of the Medicaid program

When is the RMTS? Every quarter, names will be drawn and you could be chosen at any point to participate in one or more of these random moment time study surveys. There is no limit to how many times your name can be drawn in a quarter.

How Does It Work? If you are selected to participate, you will receive notification in the mail that you need to complete a RMTS survey on- line. This should take no more than 10 minutes of your time. It is mandatory to complete your moment within 24 hours of the date/time of selected moment.

What Do I Have To Do? In the Random Moment Time Study, a “moment” is one minute of time. Completion of the time study moment will require you to answer four questions regarding the activity you were performing during that one moment of work time.

4 Questions What were you doing? Who were you doing it with? Why were you doing it? Is the service documented in the IEP? (Not exactly worded like this, but you get the idea)

No “Bad” Answers It’s OK to say: –I was on my lunch break –I was on a personal phone call Only Public Consulting Group (PCG) sees your answers… DPS cannot.

What are you doing? Not descriptive: Bus dutyLunchRecess Descriptive: Assisting student with: - Removing their coats and boots - Getting on or off the bus - Tube feeding, eating, meal preparation - Washing up after eating - Taking their medications - Walking/sitting/standing exercises Adjusting the student’s position in their wheelchair Applying cream/ointment to skin Calming student with behavior problems

Why were you doing this? Avoid: Part of my daily activities Required by IEPT Instead, describe why the student needs the service: –They can’t do it themselves because of their impairment –Because the student is physically impaired –The student needs to be kept on track due to their behavioral issues or autism disorder –Because the student is in a wheelchair or is immobile –Avoid the words “supervising” or “supervision”. Instead use “assisting” or “helping”.

No “Bad” Answers It’s OK to say: –I was on my lunch break –I was on a personal phone call –I was not at work (driving home), etc. Only Public Consulting Group (PCG) sees your answers… DPS cannot.

What If I Have Questions? Contact the DPS Medicaid Office.

Questions and Answers