1. 2017-2018 Annual Staff Training
Medicaid Administrative Claiming “MAC”
Annual Staff Training

2. Training Introduction
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.

3. Training Introduction
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!

4. What is Medicaid Administrative Claiming (MAC)
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.
Participation in School-Based MAC allows for the administrative activities associated with the coordination, referral, outreach, and program planning of Medicaid covered health services to be reimbursed for education agencies.
The MAC program strengthens local relationships between service providers and public agencies.

5. Important Facts You do not need to know who is Medicaid/OHP eligible
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
When you report claimable MAC activities during your day you must complete a supporting documentation form in support of the activities being reported
Submit the support document to your local building coordinator or designee

6. How is MAC time reported?
The web-based survey is utilized to record activities staff perform during the paid hours of a school day. This is accomplished by reporting the activities in a code category that best fits the activity performed. There are three survey periods per school year. Each survey period DHS/OHA will select random survey dates of which your District/ESD will be assigned one.
September – December
January – March
April – June

7. MAC Activity Codes MAC Claimable Categories
B1 – Medicaid Outreach – Oregon Health Plan
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

8. MAC Activity Codes Non-Claimable Codes
A – School Related and Educational Activities
B2 – Non Medicaid OHP/Outreach
C2 - Referral, Coordination, Monitoring and Training on Non Medicaid /OHP Services
D2 – Non Medicaid/OHP Transportation/Translation
E2 – Program Planning, Policy Development and Interagency Coordination Related to Non-Medical Services
F – Direct Medical Services
Non-claimable codes represent non-health related and/or educational activities that DO NOT generate reimbursement

9. 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.)

10. Medicaid Outreach & The Oregon Health Plan
Medicaid outreach activities are those performed to inform eligible or potentially eligible individuals about Medicaid and how to access the Oregon Health Plan.
Oregon Health Plan
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.

11. What does it cover?
The Oregon Health Plan covers all health care needs for kids 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.

12. Who is eligible? Three key qualifiers for no-cost or low-cost coverage
Must be under the age of 19 (19th birthday)
2.) Residency
Must live in Oregon and be a legal resident
3.) Income
For free coverage, household income cannot be more than 300% of federal poverty level and may be up to $74,115 for a family of 4.

13. Oregon Health Plan Application Assistance
OHP Application/Information
General Information
On-Line Application

14. 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

15. 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

16. The following section is an introduction to the MAC coding categories for claimable activities codes B1, C1, D1, and E1. Each code category provides a general description of the claimable activities, including examples of those activities and their sub-codes.

17. 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.
Gave a family the details about qualifying for OHP, application process and whom to contact.
Through a Spanish speaking interpreter I identified how to apply for OHP.
Worked with school counselor to answer a family’s 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.

18. 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 for OHP application assistance and helped 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.

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

20. 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 services covered under Medicaid/OHP prenatal and well baby programs.

21. C1 - Referral, Coordination, Monitoring & Training
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.
Gathered information on a student identified during a vision screening as needing further evaluation for an eye exam, student has trouble reading instructions at a distance.
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.
Gathered information in advance of a referral for a student with dental health needs from the parents and school nurse.

22. 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.

23. 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, as long as, the referral is to an enrolled Medicaid provider.
Non-Claimable – C2
Administrative activities performed in association with the immunization exclusion requirements
Performing a primary review summary
Mailing exclusion orders
Completing a county immunization status report
State-Mandated Health Screenings such as hearing and vision, are the responsibility of the education agency and therefore are not claimable under the MAC program for reimbursement.

24. C1 - Referral, Coordination, Monitoring & Training
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.
Contacted local OHP provider to determine resources available for a student needing glasses.
Coordinating the delivery of medical services for a student with depression with administration, student, family and DHS.

25. C1 - Referral, Coordination, Monitoring & Training
C1.3 – Monitoring the delivery of Medicaid-covered health services, including those identified on the IEP. Providing follow-up contact to ensure that a child has received the prescribed medical/dental/mental health services covered by Medicaid. Include related paperwork, clerical activities, or staff travel necessary to perform these activities.
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.
Activities that are part of a direct service are not claimable. Furthermore, activities that are an integral part of or an extension of a direct medical service must be reported under Code F.
Activities related to the development of an IEP must be reported under Code A. Include related paperwork, clerical activities, or staff travel necessary to perform these activities. Providing follow-up contact to ensure that a child has received the prescribed medical/dental/mental health services covered by Medicaid.

26. C1 - Referral, Coordination, Monitoring & Training
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)

27. C1 - Referral, Coordination, Monitoring & Training
Coordinating, conducting or participating in training events or seminars 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

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

29. D1 – Transportation/Translation
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.

30. E1 – Program Planning, Policy Development & Interagency Coordination
Developing strategies and policies to assess or increase the capacity of school medical/dental/mental health programs (includes workgroups)
Worked with nurses and local dentists regarding increasing access to dental services for students.
Review with school team current Mental Health support system effectiveness.
Reviewed strategies on how to better identify and provide access to treatment for students with asthma.

31. E1 – Program Planning, Policy Development & Interagency Coordination
Working with other agencies and/or providers to improve the coordination and collaboration and delivery of medical, mental, dental 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 health resource meeting. We identified gaps in existing support systems and collaborated w/various agencies about district wide health needs.
Collaborating with other agencies/providers on available OHP options/programs to better serve students in school with Mental Health needs.

32. E1 – Program Planning, Policy Development & Interagency Coordination
Monitoring the medical/mental/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).

33. NON-CLAIMABLE DIRECT HEALTH SERVICES ACTIVITIES
The following section is an introduction to the MAC coding categories for NON-claimable direct health services activities code F. This code category provides a general description of the non-claimable activities, including examples of those activities and their sub-codes.

34. 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 (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.

35. Non Covered Services – CODE F
EXAMPLES of Non-Claimable Services:
Direct Therapy or Treatment
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
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

36. Test Your Knowledge
Place yourself in the following scenarios and attempt to answer the questions correctly.
YOU’RE GOING TO TEST WELL. GOOD LUCK!!

37. Providing Appropriate Supporting Documentation
When individuals report claimable MAC activities in their survey, they must:
Complete a MAC Support form for each claimable time frame and activity code recorded. The documentation must:
be recorded timely after completing the survey (no less than 5 business days);
be brief and concise;
use descriptive words (best practice is to use the key words from the activity guide such as referred, coordinated, monitored, etc.);
only provide information pertinent to the claimable activity performed; and
cannot identify the individual student or family by name.
Review the MAC Support form to ensure documentation is for allowable MAC activities
Submit MAC Support form to your district’s MAC Coordinator

38. 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
Reporting time for after school activities
Reporting only claimable time

39. Completing the MAC Survey
Steps required to complete the MAC survey:
Access the MESD website through the following link
From the MESD screen choose Survey Login for the ESD under which you participate.
Indicate your first name and last name as it appears on your paycheck.
Document the activities performed for your PAID work day from the list of Activity codes.
7:30 – 8:30 Code A
8:30 – 9:00 Code B1.1
9:00 – 2:30 Code A
2:30 – 3:30 Code E1.2
Save the survey.
Emphasize importance of reporting only the paid work day.
Note: Paid absences are reported as Code A. Unpaid lunch is left blank.

40. Who do I contact if I need technical assistance?
1) The MAC Coordinator for your district:
________________________________
2) Building Level Trainer:
3) The ESD Medicaid Facilitator:

41. Helpful Resources
For assistance in finding local Medicaid providers and in applying for Medicaid insurance the following websites are useful:
Oregon Health Policy Board – What’s Happening With Health Care in Oregon
Oregon County Health Department Directory
Find a Local DHS Office Near You