2 Oregon Health Authority Support This presentation was provided by:Oregon Health AuthorityMedicaid Administrative ClaimingDivision of Medical Assistance ProgramsLinda WilliamsSBHS Medicaid Operations and Policy Analyst(503)Lasa BaxterDHS Contracted SBHS Medicaid Operations and Policy Analyst(541)
3 Agenda Medicaid in Schools MAC Match Leveraging Participation of Charter Schools in MACCost Pool DevelopmentMAC Audit RequirementsProcedures for Assigning Survey DatesMAC & Oregon Healthy KidsImmunizationsMonitoringReferralsAudit Support DocumentApproved Medicaid OHP ServicesSchool-Based Medicaid/OHP MAC Claiming Coding Guide
4 CMS 2003 Administrative Claiming Guide Medicaid In SchoolsWhile schools are legally liable to provide IDEA-related health services at no cost to the eligible students Medicaid reimbursement is available for these services because section 1903 (c) of the ACT requires Medicaid to be the primary payer for reimbursement of health-related services provided under IDEA.CMS 2003 Administrative Claiming Guide
5 Medicaid in Schools Medicaid Administrative Claiming (MAC) MAC is a Medicaid reimbursement program which allows school districts to be reimbursed for some of the costs associated with providing administrative activities that directly support the provision of medical services covered under the state Medicaid plan.Federal/State partnershipKindergarten -21Including but not limited to children in special educationOutreach – Assistance with Medicaid eligibility determinationReferral, Coordination and Monitoring of health servicesInteragency Coordination
6 MAC Match Leveraging Reimbursement authority Pursuant to 42 CFR , only a unit of government is authorized to participate in Federal Financial Participation (FFP) by providing the non-federal share of public funds for Medicaid reimbursement for covered services.The ESD certifies by its signature on the MAC intergovernmental agreement (IGA) that the non-federal matching funds it transfers to DHS are not federal funds, or are federal funds authorized by federal law to be used to match other federal funds and that all sources of funds are allowable.
8 Participation of Charter Schools in MAC Charter Schools may participate in the MAC program under an ESD that holds a MAC agreement with OHA.A charter school will be considered a separate school participating under the MAC contract between the associated ESD and the Oregon Health Authority when a charter school:has its own institutionalized number approved by ODE;is responsible as a separate school from its sponsored school district to conduct an annual audit and reports findings annually to ODE;has applied for and has been granted status as a 501 c3 non-profit organization;possesses its own federal tax id number;and hires and employs its own employees(As per Barbara Gates, ODE)
9 Participation of Charter Schools in MAC Please consider the following internal processes need to be address if a charter school participates under your ESD.A MAC sub-agreement with the charter school must be obtained in order to participate.If this is an additional sub-agreement, estimate additional MAC revenue and ensure this will not exceed the cap established in the ESDs MAC agreement with OHAThe charter school will report to the associated ESD their own cost pool, conduct a random survey assigned to them quarterly, and have their own component claim as part of the compiled total MAC claim.The charter school may desire to have its own MAC site coordinator and trainer to provide trainings, follow-up on the survey process, notify staff of survey days, report supporting documentation, etc.
10 MAC Eligibility Report Cumulative Report – 2012 Statewide MAC %
11 Cost Pool DevelopmentOf critical importance is the development of an accurate cost pool. Cost pool is defined as the actual (not estimated) total salary and benefits (including OPE) paid for staff that are eligible to participate in the MAC survey.Staff supported entirely by federal funds, may NOT be included in the cost pool or survey. Staff partially paid through federal funds may be included in the cost pool as long as only the non-federal fund portion of employee cost is reported. However, the employee must report their entire paid work time in the survey.
12 Cost Pool Development STEP ONE: IDENTIFY APPROPRIATE STAFF Include either certified or classified staff who routinely have contact with students and/or families creating opportunities to provide Medicaid outreach and related activities as outlined in the MAC coding guide or who have direct supervision of employees who do.Exclude maintenance and food services staff, bus drivers, and volunteers (non-paid staff). These groups have limited contact with students to provide MAC services or are not paid employees.Staff must participate under the District or ESD they are paid by and on the corresponding survey date assigned to that agency.
13 Cost Pool Development STEP TWO: IDENTIFY ACTUAL SALARY AND BENEFITS PAIDAfter identifying appropriate staff for the cost pool, report the actual salary, benefits and Other Personnel Expenses (OPE) paid for each individual for the survey period, removing all federal funds.(For a definition of OPE reference OMB circular A-87)
14 Cost Pool Development STEP THREE: REMOVE FEDERAL FUNDS FROM COST POOL Only general fund and other fund sources may make up the cost pool calculations. Any federal funds applied to the salary, benefits and OPE package of an individual employee must be removed on a FTE person-by-person basis.Federal funds the ESD/district expends may include IDEA, ARRA, Title I, federal grants, etc. These funds must be removed from the cost pool to comply with federal regulations. Federal funds expended for services and supplies (S & S) costs, indirect or other non-personnel (non-salary and benefits) costs may not be included in the cost pool.NOTE:Documentation must be maintained detailing how the federal funds applicable to salary, benefits and OPE have been removed from the cost pool.
15 Pruning the Cost PoolThe ESD/district will want to set up a process to evaluate the cost pool on a systematic basis, assessing classifications and individuals as to their impact on the claim.Pruning the cost pool is an acceptable practice in order to present a more effective claim and reduce administrative burdens.
16 Methods for Pruning the Cost Pool Remove any staff, who over the course of a determined period, have never reported a claimable MAC activity.Blindly survey staff utilizing scenarios for providing MAC activities to determine whether staff may potentially engage in MAC activities over the course of time.Remove staff employed for .02 FTE or less, as they may have limited contact with students and/or their families to provide MAC activities.
17 Audit Requirements - District Maintain all supporting documentation for the MAC claim for a period of seven years.ESD (under MAC Agreement w/OHA)District (MAC Coordinator)Business Office (All supporting financial documents)Provide contact information and be available to OHA for review of MAC claims.
18 Procedure for Assigning Survey Dates DHS will provide ESDs with random survey dates prior to start of the school year.The ESD will assign the dates to school districts without influence or input from any school district.The ESD will inform the school district(s) of the week (not the specific date) of their assigned random date prior to the first day of the applicable survey period. This will allow the ESD and school district(s) ample time for scheduling and providing training.The ESD will inform the school district(s) of the specific random date no greater than 10 business days prior to the assigned date.The school district(s) will accomplish the survey on the date assigned.
19 Trainer Responsibilities Trainers must attend a MAC train-the-trainers workshop annually.Trainers must schedule and provide training to staff which covers all aspects of the reporting process.Training must occur no less than once annuallyPrior to the survey dayStaff must sign the training sign in sheetRecords training dateProvides access into the MESD web based system
20 Trainer Responsibilities Complete a review of the survey results and obtain necessary supporting documentation from staff.Section V(A) of the 2003 CMS Medicaid Administrative Claiming Guide states (pg 37):Documentation maintained in support of administrative claims must be sufficiently detailed to permit CMS to determine whether the activities are necessary for the proper and efficient administration of the state plan. Simply checking a box on a time study form does not facilitate independent validation of the sample results.It is critically important for additional documentation to be maintained, in order to verify the appropriateness of the claims and to limit the risk of audit findings.
21 Trainer Responsibilities Training should provide staff with:copies of training materials , a referral list, and documentation formsa description of the survey processthree survey periods Fall, Winter, Springrandom survey dayselection of survey participants (random or 100%)an understanding of what is claimable as an administrative activity in the school settingan understanding of the activity codes and how to report them in the MESD web based reporting systeman understanding of when and how to complete the 10% documentation formaccess to technical assistance
22 Trainer Responsibilities Any claimable time reported on a survey may be reviewed by OHA and a request for supporting documentation issued.Request staff 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; anddo not identify the individual student or family by name.Review the MAC Support form to ensure documentation is for allowable MAC activitiesSubmit MAC Support form to your district’s MAC Coordinator
23 Trainer Responsibilities Coding Accuracy Reminders for StaffOver/Under Reporting of TimeDo not report claimable time onlyDo not report more time than paid forUsing Correct Login (name on paycheck)Saving the SurveyReporting unpaid lunchtime frame should be left blank on surveyReporting Paid Absencescode AReporting time for after school activitiesReporting only claimable time
24 Medicaid in Schools Personnel Reporting MAC Activities Administrative Service ProvidersAdministratorsPrincipalsTeachersEducational AssistantsSecretariesCounselorsTSPC School PsychologistsClaimable CategoriesB1 – Medicaid/OHP Outreach and Facilitating Medicaid/OHP EligibilityC1 – Referral, Coordination, Monitoring and Training of Medicaid OHP ServicesD1 – Medicaid/OHP Transportation and TranslationE1 Program Planning, Policy Development, and Interagency Coordination related to Medical Services
25 Medicaid in Schools Personnel Reporting MAC Activities Claimable CategoriesB1 – Medicaid/OHP Outreach and Facilitating Medicaid/OHP EligibilityC1.4 - TrainingE1 - Program Planning, Policy Development, and Interagency Coordination related to Medical ServicesOregon Licensed Health Care ProfessionalsSpeech Language TherapistOccupational TherapistCertified Occupational Therapist Assistant (COTA)Physical TherapistLicensed Physical Therapy Assistant (LPTA)NurseDelegated Health Care AideClinical PsychologistLicensed Clinical Social Worker
26 Medicaid in Schools Personnel Reporting MAC Activities Oregon Board Licensed Health ProfessionalsLicensed Health Care Professionals employed by school districts or ESD’s cannot claim C1 and D1 activities that are considered integral to, or an extension of, direct or consultative medical services.C1.1 – ReferralC1.2 – CoordinationC1.3 – MonitoringD1.1 – TransportationD1.2 – TranslationThis applies regardless as to whether or not the district is an enrolled Medicaid provider accessing reimbursement.
27 Medicaid in Schools Personnel Reporting MAC Activities TSPC Licensed PsychologistAccording to Oregon Administrative Rules a TSPC Licensed School Psychologist may provide direct “health” services to students such as, diagnostic evaluations and assessment and behavior counseling for an identified health condition.Referrals and coordination of Medicaid covered services made by a TSPC Licensed School Psychologist to Medicaid providers for a student in which they provide direct “health” services are considered integral to or an extension of a direct service and are NOT claimable. The service would be reported on the survey as Code F – Direct Service.If the school psychologist makes a referral to a community Medicaid provider for a student who he/she does not provide direct service to, the referral and coordination would be claimable under C1.
28 Medicaid in Schools Personnel Reporting MAC Activities Delegated Health Care Aide – Educational AssistantAn educational /instructional assistant providing delegated nursing tasks under the supervision of a Nurse pursuant to the services identified on an IEP are “Direct Medical Services”. Such activities must be reported as “F” on the survey.These monitoring activities are considered Direct Medical Services and may not be reported under code C1.3.
29 Activity vs. OutcomeIt is important staff report the claimable MAC activity performed on the survey date even when the outcome may be unknown.Claimable example:A school counselor reports C1.1 on their MAC survey, when on the MAC survey day they refer a child for a mental health evaluation to the local county mental health department. The staff at this time may not know the outcome of the referral, which is acceptable and does not change the reporting the Medicaid-covered referral activity.
30 Points of Clarification Claimable vs. Non-Claimable ImmunizationsCode C1.3:Physical Monitoring of Direct Services vs. Follow-up to ensure Direct Services were provided
31 Immunizations Claimable referrals for Immunizations: (C1.1) Referrals to assist families in accessing immunizations from enrolled Medicaid providers are claimable as C1.1 as long as they are:Provided with an enrolled Medicaid providerClaimable scenarios may include:An office secretary, at the request of a parent, referred a student in need of immunizations to the local County Health Department for covered immunizations.
32 Immunizations Link to exclusion information: Non-Claimable referrals for Immunizations: (C2)Administrative activities performed in association with the immunization exclusion requirements such as:Performing a primary review summaryMailing exclusion ordersCompleting a county immunization status reportOther Non-Claimable scenarios may include:As mandated by state law, a secretary generates a county immunization status report during exclusion.Link to exclusion information:
33 C1.3 Monitoring & Follow-up Activities Use of code C1.3 is used for reporting claimable monitoring or follow-up activities, which includes providing follow-up contact to ensure that a child has received prescribed medical/dental/mental health services covered by Medicaid or that they were arranged/coordinated as planned.NOTE:Physical monitoring of a child’s health condition regardless of the severity or type is not a claimable C1.3 monitoring activity.
34 C1.3 Monitoring & Follow-up Activities 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.A referral was made by the school counselor for mental health services to an enrolled provider, the school counselor follows up with the parent following the appointment to coordinate care and changes in medication.
35 Non-Claimable Monitoring & Follow-up Activities Non-Claimable Monitoring or Follow-up Activities: (F)Monitoring minor acute health conditions, such as scratches, bruises, headaches, colds, application of Band-Aids or administration of non-prescriptive medicationsMonitoring 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)Activities performed in the initial development of the IEP and/or formal IEP meetings (i.e., annual, 3-yr)
36 Non-Claimable Monitoring & Follow-up Activities Non-Claimable scenarios may include:An educational/instructional assistant trained by and under the supervision of a registered nurse monitors a student’s seizures as outlined in the Nursing plan of care pursuant to the IEP.An office secretary monitors a student in the office or a sick room who has been complaining of a headache and/or nausea.A classroom teacher monitoring a child for adverse reactions after an insulin injection was self-administered by the child.A secretary monitoring a child with a bee allergy for adverse reactions to a bee sting.
37 MAC & Oregon Healthy Kids Participation in MAC & Oregon Healthy Kids Application Assistor Currently, In Oregon all Healthy Kids contracted ESDs are considered “Volunteer Organizations”, meaning they process Healthy Kids applications for free and are not paid the $75 assistor fee for applications that result in eligibility.This was accomplished to avoid any duplication in payment for outreach activities provided by ESDs who participate in the MAC program. This action was not intended to exclude ESDs from participating as Healthy Kids application assistors.
38 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 ProgramsA 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.
39 What does it cover?Healthy Kids covers all of the health care kids need including:Medical, dental and vision careRegular checkups and preventive carePrescription medicines and medical equipmentMental health and chemical dependency servicesCoverage lasts for a least one full year.
40 Who is eligible? Three key qualifiers for no-cost or low-cost coverage Must be under the age of 19 (19th birthday)2.) ResidencyMust live in Oregon and be a legal resident3.) IncomeMust have been without health insurance for two months (exceptions: parent’s job loss or a child’s serious medical need).For free coverage, household income cannot be more than 300% of federal poverty level (up to $70,896 for a family of 4).
41 What does it cost?A family of 4 that makes $58,800-$70,896 annually may qualify for no cost coverage. = $0.00 Monthly Premium
42 New Income Guide for Healthy Kids No-Cost Coverage Note: These income levels are approximate. Qualification is based on Federal Poverty Levels (FPL) as set by the federal government annually. For children in Oregon, qualification is set at 300 percent FPL.Family SizeIncome2$0 - $46,692 a year ($0 - $3,891 a month)3$46,692 - $58,800 a year ($3,891 - $4,900 a month)4$58,800 - $70,896 a year ($4,900 - $5,908 a month)5$70,896 - $82,992 a year ($5,908 – $6,916 a month)
43 Healthy Kids Application Assistance General InformationOn-Line Application
44 Referring Students for Medical Services Referrals made for Medicaid covered health services provided by Licensed Health Care Professionals who work for enrolled Medicaid providers and who are billing Medicaid are claimable. These include, but are not limited to:Some ESD’sSome School DistrictsPublic Health AgenciesHospitalsMental Health AgenciesMedical ClinicsPrivate Practices
45 Referring Students for Medical Services As per the Federal 2003 MAC guide:An education agency does not have to be an enrolled or participating Medicaid provider in order to claim referrals of students to Medicaid-covered medical/health services provided in the community, as long as the provider rendering the services is an enrolled or participating Medicaid provider.Referrals made to medically Qualified direct service providers employed by a school district or ESD that is not a participating Medicaid provider are NOT claimable.Medicaid does NOT recognize TSPC licensure; therefore, referrals made to staff licensed/credentialed through TSPC only (i.e., school counselor, school psychologist, teacher with a Speech endorsement) for the purpose of a health evaluation, diagnostic test and behavior counseling are NOT a claimable MAC activity
46 Non Claimable Referrals Referrals made to staff licensed/credentialed through TSPC (only) for the purpose of a health evaluation, diagnostic testing, and behavior counseling services are not claimable (i.e., school psychologist, school counselor, teacher with a speech endorsement).Referrals for state-mandated health services are NOT claimable.Notifying parents regarding immunizations during exclusions as required by education would not be a claimable activity under MAC.Referrals to NON-Medicaid health care providers, such as:School Districts and ESD’s which are not enrolled as a Medicaid provider or not actively participating in Medicaid billing and;Some private health plans
47 Helpful Resources Oregon County Health Department Directory 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 OregonOregon County Health Department DirectoryCover Oregon - Finding Health Insurance For YouFind a Local DHS Office Near You
48 2015-2016 Annual Staff Training Medicaid Administrative Claiming “MAC”Annual Staff Training
49 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.
50 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!
51 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.
52 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 activityThe time study determines your time spent on eligible and non-eligible activitiesWhen you report claimable MAC activities during your day you must complete a supporting documentation form in support of the activities being reportedSubmit the support document to your local building coordinator or designee
53 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 – DecemberJanuary – MarchApril – June
54 MAC Activity Codes MAC Claimable Categories B1 – Medicaid Outreach – Healthy Kids/Healthy KidsConnectC1 – OHP Referral, Coordination, Monitoring and TrainingC1 = Child SpecificD1 – OHP Transportation/TranslationE1 – Medical Program Planning, Policy Development, and Interagency CoordinationE1 = Everyone Benefits
55 MAC Activity Codes Non-Claimable Codes A – School Related and Educational ActivitiesB2 – Non Medicaid OHP/OutreachC2 - Referral, Coordination, Monitoring and Training on Non Medicaid /OHP ServicesD2 – Non Medicaid/OHP Transportation/TranslationE2 – Program Planning, Policy Development and Interagency Coordination Related to Non-Medical ServicesF – Direct Medical ServicesNon-claimable codes represent non-health related and/or educational activities that DO NOT generate reimbursement
56 School Related and Educational Activities Code AThis 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.)
57 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 ProgramsA 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.
58 What does it cover?Healthy Kids covers all of the health care kids need including:Medical, dental and vision careRegular checkups and preventive carePrescription medicines and medical equipmentMental health and chemical dependency servicesCoverage lasts for a least one full year.
59 Who is eligible? Three key qualifiers for no-cost or low-cost coverage Must be under the age of 19 (19th birthday)2.) ResidencyMust live in Oregon and be a legal resident3.) IncomeMust 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.
60 Medicaid/OHP Services Health ServicesWell-child examsImmunizations (May not be during exclusion or for education enrollment requirements)Routine physicalsMaternity and newborn careMedical ServicesPreventive services such as well-child check upsLaboratory or x-raysTreatment for most major diseasesHospital staySubstance abuseVision care, routine screenings, and glassesHearing services, hearing aids, & batteriesHome health careSpecialists care & referralsPhysical, occupational, and speech therapyMedical equipment and supplies
61 Medicaid/OHP Services Dental ServicesPreventive services (cleaning, fluoride treatments, sealants for children)Routine services (fillings, x-rays)Dental check upsTooth removalDentures24-hour emergency careSpecialist care and referralsMental Health ServicesEvaluationsTherapyConsultationsMedication managementPrograms for daily and community living
62 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.
63 B1 – Medicaid OutreachB1.1Informing 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.
64 B1 – Medicaid OutreachB1.2Assisting 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.
65 B1 – Medicaid OutreachB1.3Checking 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.
66 B1 – Medicaid OutreachB1.4Contacting 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.
67 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.
68 C1 - Referral, Coordination, Monitoring & Training ImmunizationsClaimable – C1.1 ReferralAdministrative activities related to referrals to assist families in accessing immunizations from enrolled Medicaid providers are claimable as C1.1 - Referral.
69 Immunizations Continued C1 - Referral, Coordination, Monitoring & TrainingImmunizations ContinuedNon Claimable – C2Non-claimable Administrative activities performed in association with the immunization exclusion requirementsPerforming a primary review summaryMailing exclusion ordersCompleting a county immunization status report
70 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 meetingsDiscussion 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.
71 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.
72 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 medicationsMonitoring 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)
73 C1 - Referral, Coordination, Monitoring & Training 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.SuicideAutismDrug and Alcohol Abuse
74 C1 - Referral, Coordination, Monitoring & Training The following State Mandated trainings are not covered:First Aid TrainingCPR TrainingEPI TrainingBlood-borne Pathogens Training
75 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.D1.2Scheduling, 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.
76 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.
77 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 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.
78 E1 – Program Planning, Policy Development & Interagency Coordination 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).
79 Code F – Direct Services Providing Direct Services vs. Administrative ActivitiesThe 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.
80 Non Covered Services – CODE F EXAMPLESTreatment 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 stingTeacher monitoring a child after an insulin injectionEducational assistant monitoring a child following a seizure
81 Test Your KnowledgePlace yourself in the following scenarios and attempt to answer the questions correctly.YOU’RE GOING TO TEST WELL. GOOD LUCK!!
82 Providing Appropriate Supporting Documentation Individual surveys reporting claimable MAC activitiesComplete 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; anddo not identify the individual student or family by name.Review the MAC Support form to ensure documentation is for allowable MAC activitiesSubmit MAC Support form to your district’s MAC Coordinator
83 Coding Reminders Coding Accuracy Reminders for Staff Reporting of Time:Report only PAID work timeReport time in 15 minute blocksReport all activities performed during the paid work dayUsing Correct Login (name on paycheck)Saving the SurveyReporting unpaid lunchtime frame should be left blank on surveyReporting Paid Absencescode AReporting time for after school activitiesReporting only claimable time
84 Completing the MAC Survey Steps required to complete the MAC survey:Access the MESD website through the following linkFrom the MESD screen choose Survey Login for the ESD under which you participateIndicate your first name and last name as it appears on your paycheckDocument the activities performed for your PAID work day from the list of Activity codes.7:30 – 8:30 Code A8:30 – 9:00 Code B1.19:00 – 2:30 Code A2:30 – 3:30 Code E1.2Save the surveyEmphasize importance of reporting only the paid work day.Note: Paid absences are reported as Code A. Unpaid lunch is left blank
85 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:
86 Helpful Resources Oregon County Health Department Directory 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 OregonOregon County Health Department DirectoryCover Oregon - Finding Health Insurance For YouFind a Local DHS Office Near You