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Medicaid Administrative Claiming “MAC” 2014-2015 Annual Staff Training.

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Presentation on theme: "Medicaid Administrative Claiming “MAC” 2014-2015 Annual Staff Training."— Presentation transcript:

1 Medicaid Administrative Claiming “MAC” 2014-2015 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  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. What is Medicaid Administrative Claiming (MAC)

5  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 Important Facts

6  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 How is MAC time reported?

7 MAC Activity Codes MAC Claimable Categories  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

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 & 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.

11 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.

12 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.

13 Medicaid/OHP Services Health Services  Well-child exams  Immunizations  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  NOTE: If any of these activities are as state mandated health screens, then the cost of the care is the responsibility of the education agency and therefore is not claimable under the MAC program for reimbursement.

14 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

15 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.

16 B1 – Medicaid Outreach  B1.1 Informing children and their family’s 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.

17 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.

18 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.

19 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.

20 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. 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.

21 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, as long as the referral is to an enrolled Medicaid provider. State-Mandated Health Screenings ○ The cost of care for state mandated health screens, such as hearing and vision, are the responsibility of the education agency and therefore are not claimable under the MAC program for reimbursement. Code administrative activities related to the coordination and referral for state mandated health screens as C2.

22 C1 - Referral, Coordination, Monitoring & Training Immunizations Continued  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

23 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. 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.

24 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.

25 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)

26 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

27 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

28 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.

29 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 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.

30 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 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.

31  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

32 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.

33 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

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

35 Providing Appropriate Supporting Documentation  Individual surveys reporting claimable MAC activities ○ Complete a MAC Support form for each claimable time frame and activity code recorded. The documentation should: be recorded soon 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 do not 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

36 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

37 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 Note: Paid absences are reported as Code A. Unpaid lunch is left blank

38 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:  ________________________________

39 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 ○ s/LocalHealthDepartmentResources/Pages/lhd.aspx s/LocalHealthDepartmentResources/Pages/lhd.aspx Cover Oregon - Finding Health Insurance For You ○ Find a Local DHS Office Near You ○ df df

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