Random Moment Time Study (RMTS) Training New York State Department of Health (DOH) School Supportive Health Services Program (SSHSP) Fall 2015

| NYS SSHSP Fall Training Agenda RMTS Overview RMTS Participant Role RMTS Coordinator Role RMTS Impact on Cost Settlement County Time Tracking Process PCG Claiming System Demo – How to Add Shifts Important Things to Remember! PCG Contact Information

RMTS Coordinators, do you know who prepares the cost report in your district? Financial Reporting Staff, do you know who the RMTS Coordinator(s) is in your district? Yes? Great! No? You have homework!

RMTS Overview The random moment time study (RMTS) is used to determine the amount of time (and cost) spent on various activities. The RMTS is required as part of the annual cost settlement process. This is one of the most crucial reimbursement determinants used by the NYS Department of Health (DOH). | NYS SSHSP Fall Training 20154

RMTS Overview Who participates in the RMTS? | NYS SSHSP Fall Training Included in RMTS Process School district staff providing direct medical services Excluded from RMTS Process × School district or county contracted providers of SSHSP services (cost included in cost report process) × County staff providing direct medical services (staff included in separate 100% time tracking process)

| NYS SSHSP Fall Training RMTS Overview The RMTS includes the distribution of 2,827 moments to participants within each cost pool on a quarterly basis. Moments are randomly assigned to participants at the start of the quarter. Moments are not generated for the summer quarter (no moments sent July-September). The RMTS is an ongoing, quarterly process. The RMTS is NOT a management tool used to evaluate staff activities or performance. The results of the time study are ONLY to be used in the cost settlement process. What is the role of a RMTS participant? Participants are responsible for responding to each and every moment they receive within two schools days with a detailed and accurate submission.

| NYS SSHSP Fall Training RMTS Overview 1.All moment notifications are sent to participants via from 2.Shortly after the moment has occurred, participants will receive an automated with a link to the secure PCG Claiming System (RMTS) website. 3.Participants are asked to respond to a series of questions describing the activity performed at the time of the moment. 4.A reminder is sent to participants 24 hours after the moment if the moment response has not been submitted. Moment notifications are sent shortly AFTER the moment occurs; NO advance notification is provided!

| NYS SSHSP Fall Training RMTS Participant Role Participants selected for a moment must log onto the Claiming System website and answer the following questions: 1.Were you working at the time of the moment? 2.Who was with you? 3.What were you doing? Please be as specific as possible. 4.Why were you performing this activity? 5.Is this activity regarding a Special Education student? 6.Is the service you provided part of the child’s IEP? If the participant is providing direct medical services to several students or a group of students, it is acceptable to respond “Yes” to question 6 if at least one student has that related service in their IEP.

| NYS SSHSP Fall Training RMTS Participant Role Participants should provide detailed information when a narrative response is required. If there is not enough information provided in the response, PCG will follow up and request that the moment be resubmitted by the participant. Participants should provide only one activity as part of a moment response. Remember the moment represents a specific minute in time! Participants need to be trained on the RMTS process in order to understand and meet expectations.

| NYS SSHSP Fall Training RMTS Participant Role DO’s of moment submission! Provide a descriptive narrative response. Be sure whether the student is classified as Special Education or not prior to submitting a response if working with a student(s). Respond to the last question carefully. If that participant performs a direct service or an activity that supports the provision of medical service identified in the student’s IEP, it is appropriate to select “Yes.” DO NOT’s of moment submission! × Submit responses similar to: “I was working,” “Acting as a nurse,” “Entering Notes” as these ARE NOT specific enough! × Submit a response with multiple activities. Provide information on the single, predominant activity performed at the assigned minute in time. × Use acronyms. PCG will follow up to ask participants to define acronyms.

| NYS SSHSP Fall Training RMTS Coordinator Role Quarterly Staff Pool List (SPL) and Calendar Certification Review, update, and certify the SPL to ensure the appropriate staff are participating in the RMTS process. If an eligible staff member does not participate in the RMTS, their cost will not be captured in the cost settlement process for that quarter. Update and certify the calendar for the upcoming quarter to include holidays when moments should not be assigned to participants. Holidays only include non-work days in the district, for example, winter break and spring break. Do not include conference, professional development, or training days as these are considered work days. Train RMTS Participants The participant training presentation is posted to the dashboard of the PCG Claiming System for Coordinators to access and distribute to participants at any time. The expectation is that participants are trained by Coordinators on an annual basis, at a minimum, and new participants are trained when they are added to the system.

What happens when you exclude an eligible service provider from your SPL? Either… 1.The provider’s name will not appear in the “Annual Payroll” section of the cost report if they did not participate for the entirety of the school year OR 2.Costs will only be allowable under the “Annual Payroll” section of the cost report for the quarters the staff member participated even if the district paid them for the entire year. Example: If the direct medical services RMTS percentage is 50% and a school district paid a physical therapist $60,000, the direct medical service cost is $30,000 (60,000 x 0.50). If this staff member was excluded from the time study for the school year, the district is unable to include this cost in the Medicaid cost report.

| NYS SSHSP Fall Training RMTS Coordinator Role District Response Rate Compliance RMTS Coordinators are expected to monitor the district response rate throughout the school year. The expectation is that all districts exceed a 90% response rate each quarter. PCG Provides Tools to Help You! 1.Reminder s – Coordinators are copied on 24 hour reminder s sent to non-responsive participants. 2.Coordinator Compliance Report – Available to Coordinators at any time with live response data, specific to your district. 3.Weekly Compliance Report – PCG s a Weekly Compliance Report to all RMTS Coordinators. This includes final response data for the previous week and quarterly response rate to date for ALL districts. 4.Hotline and – Contact PCG at any time! We can assist with training efforts in your district if necessary.

What is a “Vacant” Job Position and why does PCG ask so many questions about my district vacancies? It is possible your district requires a Job Position to be vacated or a vacant job position to be added when: 1.The district anticipates filling the Job Position within the quarter. 2.The district understands the impact on the response rate if the vacancy is not filled within the quarter. Throughout the certification process, PCG follows up with districts carrying over several vacated Job Positions to ensure accurate use and understanding of this action. We are looking out for your district!

The RMTS identifies the statewide proportion of allowable and reimbursable direct service time, and the results are used as a statistic in the cost reimbursement process. | NYS SSHSP Fall Training RMTS Impact on Cost Settlement

Why does the RMTS response rate truly matter for cost settlement? Statewide quarterly response rates. What happens when we do not meet 85% statewide for one quarter? Example assumes meeting exactly 85% in two of the three RMTS quarters. Based on Direct Service Therapy Pool results from school year adjusted to meet total moment sampling changes from 3000 per quarter to 2827 per quarter. Dollar impact is reflective only of the DMS applied to total annual salary reported (No FFP applied). RMTS Response Rate Does Not Meet 85% Moments Generated for Quarter2827 Moments Submitted for Quarter2300 Moments Required to Meet 85%103 Moments Added to Unallowable Activity Code103 Impact on Direct Medical Service Activity % of Direct Medical Service Pre 85% Adjustment41% % of Direct Medical Service Post 85% Adjustment40% % Difference-1% Average District Compensation of Staff$1,153, Impact of 1% Decrease on Average District$11, Impact of 1% Decrease Statewide$6,552,426.79

County employees (employed directly by the County) providing SSHSP services are required to participate in a 100% time tracking process in order for their costs to be reported under “Annual Payroll.” What is 100% time tracking? Similar to a RMTS process, 100% time tracking is used to quantify the amount of time, and therefore the specific staff costs, spent in support of various programs. Staff track their time in 15-minute intervals for all time spent at work. Only county employees providing direct medical services will transition to 100% time tracking. School district employees will continue to participate in the RMTS process. | NYS SSHSP Fall Training County Time Tracking Process

Starting with certifications for the January-March 2016 quarter, Coordinators have the ability to add shifts to accommodate a variety of RMTS participant work schedules. Before editing this information in the PCG claiming system, it is CRITICAL to review the step-by-step instructions provided by PCG when the quarter is opened (estimated date is 12/1/2015). Why add shifts? Currently, each district has one shift which all participants in your district fall into. For example, M-F 8:00AM – 3:00PM. By adding shifts, participants are only eligible to receive moments during the hours specified in the shift they are assigned to. | NYS SSHSP Fall Training PCG Claiming System Demo – How to Add Shifts

What if all providers work the same schedule that is already in the PCG Claiming System? That is OK and you do not have to update! The “Shifts” option is most useful for: 1.Districts with part-time and full-time staff. 2.Districts with a variety of work schedules. PCG cannot stress the following enough with the “Shifts” configuration. 1.Do NOT wait until the certification due date to configure this setting. 2.Read the instructions provided CAREFULLY before editing “Shifts.” Why? If the shift configuration is set up incorrectly, there is potential for moments to be generated during non-work hours (3AM, for example).

Select “Configuration” and “Shifts” from the Menu Bar. To edit an existing “Shift” click on the appropriate “Shift.” If you add shift types, there will be multiple shifts listed. | NYS SSHSP Fall Training PCG Claiming System Demo – How to Add Shifts

Coordinators can edit the shift name, position (where it appear on the list of multiple shifts when editing the SPL), and the work schedule. | NYS SSHSP Fall Training PCG Claiming System Demo – How to Add Shifts Coordinators can assign any “Shift” name, and the “Duration” can include any increments of time.

Important! “Shifts” include a begin time and DURATION! When adjusting a “Shift” or creating a new shift make sure you do not include an End Time in place of duration! Example: If a provider works 8:00AM-2:30PM, the “Shift” would be set like the snapshot above, with a Begin Time of 8:00AM and a Duration of 6h 30m.

To create a new “Shift,” select “Add a New Shift” on the top left of the screen. Complete all required fields, outlined in red. | NYS SSHSP Fall Training PCG Claiming System Demo – How to Add Shifts

To change a Job Position’s “Shift,” go to the district SPL, click on the Job Position to be edited, and change the “Shift Type.” | NYS SSHSP Fall Training PCG Claiming System Demo – How to Add Shifts

A moment represents a minute in time. Participants have two (2) school days from the time of the moment to submit the moment. After two school days, the moment expires and can no longer be accessed or submitted by the participant. Train your participants! Coordinators are responsible for managing the RMTS process for their district(s). It is a critical element within the cost reporting process. Districts have the option to manage “Shift” configurations next quarter. PLEASE review all guidance prior to making edits, attend a PCG led Web-Ex refresher, and call/ PCG with any questions. | NYS SSHSP Fall Training Important Things to Remember! For example, a moment for Monday at 8:30AM must be submitted by 8:30AM Wednesday.

| NYS SSHSP Fall Training PCG Contact Information Questions? Comments? If you have any RMTS questions, contact PCG at: (866) Option #1 for RMTS or