1. Medicaid Administrative Claiming Train-The-TrainersWorkshop

2. Welcome to Medicaid Administrative Claiming (MAC) The Medicaid Administrative Claiming program is being implemented through a partnership between: The Medicaid Administrative Claiming program is being implemented through a partnership between: –The Department of Human Services (DHS) –Your ESD –Local School Districts –Multnomah Education Service District (MESD)

3. What is Medicaid? Medicaid is a health care program under the Oregon Health Plan (OHP) which provides medical assistance to low-income children and families at little or no cost. OHP health care benefits include: Medicaid is a health care program under the Oregon Health Plan (OHP) which provides medical assistance to low-income children and families at little or no cost. OHP health care benefits include: Medical Medical Dental Dental Mental Health Mental Health Chemical Dependency Services Chemical Dependency Services

4. What is Medicaid Administrative Claiming ? Medicaid Administrative Claiming 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. Medicaid Administrative Claiming 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. Schools provided administrative services that have been found to be necessary for the proper and efficient administration of the State Medicaid plan. Schools provided administrative services that have been found to be necessary for the proper and efficient administration of the State Medicaid plan.

5. Important Facts You do not need to know who is Medicaid/OHP eligible You do not need to know who is Medicaid/OHP eligible You do not need to know all about Medicaid/OHP You do not need to know all about Medicaid/OHP It is the activity you are doing that is being measured, not the outcome of the activity 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 The time study determines your time spent on eligible and non-eligible activities

6. Building Trainer Responsibilities Attend a two hour MAC train-the-trainers workshop. Attend a two hour MAC train-the-trainers workshop. Following direction from District MAC Coordinator, schedule training with staff who have been chosen to take the MAC survey each survey period. Following direction from District MAC Coordinator, schedule training with staff who have been chosen to take the MAC survey each survey period. Provide staff training using training tools/materials provided by your MAC Coordinator. Provide staff training using training tools/materials provided by your MAC Coordinator. Require staff to sign the training sign in sheet. Following the training, return the sign in sheet according to your district process. Require staff to sign the training sign in sheet. Following the training, return the sign in sheet according to your district process. Be available as the first contact on the survey date. Be available as the first contact on the survey date. Follow-up with any questions or concerns you have with your District MAC Coordinator. Follow-up with any questions or concerns you have with your District MAC Coordinator.

7. Resource Materials Medicaid Administrative Claiming Power Point Presentation Medicaid Administrative Claiming Power Point Presentation Directions to access the MAC survey Directions to access the MAC survey School-Based Medicaid/OHP Administrative Claiming Coding Guide School-Based Medicaid/OHP Administrative Claiming Coding Guide Claimable Categories – Activity Codes Claimable Categories – Activity Codes Sample MAC Survey Form Sample MAC Survey Form Questions Relating to the Activity Codes Questions Relating to the Activity Codes Mac Provider Manual Version 2.0 Mac Provider Manual Version 2.0 Section 5: Activity Codes FAQ ’ s

8. MAC Activities Examples of these MAC activities include: Examples of these MAC activities include: discussing access to health care with a student/family discussing access to health care with a student/family assisting in early identification of children who could benefit from health services provided by Medicaid assisting in early identification of children who could benefit from health services provided by Medicaid contacting pregnant and parenting teens about the availability of Medicaid prenatal, and well baby care programs and services contacting pregnant and parenting teens about the availability of Medicaid prenatal, and well baby care programs and services providing referral assistance to families where Medicaid services can be provided providing referral assistance to families where Medicaid services can be provided

9. Where do MAC activities take place? MAC activities may take place anywhere school- age children, their families and school personnel are together. For example: MAC activities may take place anywhere school- age children, their families and school personnel are together. For example: in the classroom in the classroom in the lunchroom in the lunchroom on the playground on the playground on a field trip on a field trip during a meeting (except for IEP) during a meeting (except for IEP) during school conferences during school conferences

10. What school personnel can participate in MAC? ESD and School District staff who have routine contact with students and families: ESD and School District staff who have routine contact with students and families: School District Administrators School District Administrators Principals Principals Classroom Teachers Classroom Teachers Classroom Assistants Classroom Assistants School Secretaries School Secretaries School Nurses School Nurses School Counselors School Counselors

11. Why would a school district choose to participate in MAC? The MAC process permits the costs of allowable administrative activities being performed by school staff, but not otherwise reimbursed, to be reimbursed under Medicaid. The MAC process permits the costs of allowable administrative activities being performed by school staff, but not otherwise reimbursed, to be reimbursed under Medicaid. –Revenue can be used for vital health and social services programs –Strengthens local relationships among planning bodies, service providers, and public entities –Diversifies funding base for needed programs and opportunities

12. Examples of Projects throughout the State funded with MAC dollars  Dental Vans  Family Advocates working out of the school  School Nursing, Mental Health, Substance Abuse services  Other health care or social service programs

13. How is MAC time reported for Medicaid reimbursement? MAC claiming is reported by district staff completing a web-based survey. The survey documents services provided by school personnel on a normal school day. There are three survey periods per school year. Each survey period has five survey days within the period. Survey periods and dates are selected by DHS. MAC claiming is reported by district staff completing a web-based survey. The survey documents services provided by school personnel on a normal school day. There are three survey periods per school year. Each survey period has five survey days within the period. Survey periods and dates are selected by DHS. September – December September – December January – March January – March April – June April – June

14. How is MAC time reported for Medicaid reimbursement? District staff participate in the survey District staff participate in the survey All staff who are chosen through the random survey process must be trained prior to taking the survey All staff who are chosen through the random survey process must be trained prior to taking the survey Staff must sign in at the training Staff must sign in at the training Paid time at school is surveyed in the predominant portion of 15 minute increments Paid time at school is surveyed in the predominant portion of 15 minute increments Staff time falls into any one of ten activity codes Staff time falls into any one of ten activity codes

15. How is MAC time reported for Medicaid reimbursement? It is recommended you complete the survey on the assigned random day, however; to accommodate for times when you may not be able to complete the survey on the assigned day, it is open for 5 days. It is recommended you complete the survey on the assigned random day, however; to accommodate for times when you may not be able to complete the survey on the assigned day, it is open for 5 days. –The survey day, and the next four work days. Example: If the survey day is Tuesday, October 12 you would have until Monday, October 18 (Tuesday, Wednesday, Thursday, Friday, Monday) to fill out the survey for the activities you did on October 12.

16. Ten Activity Codes A. School-Related and Educational Activities, other A. School-Related and Educational Activities, other A B1. Medicaid/OHP Outreach B1. Medicaid/OHP Outreach B2. Non-Medicaid Outreach B2. Non-Medicaid Outreach B2 C1. OHP Referral, Coordination, Training C1. OHP Referral, Coordination, Training C2. Non-OHP Referral, Coordination, Training C2. Non-OHP Referral, Coordination, Training C2 D1. OHP Transportation/Translation D1. OHP Transportation/Translation D2. Non-OHP Transportation/Translation D2. Non-OHP Transportation/Translation D2 E1. Medical program planning, policy development, and interagency coordination E1. Medical program planning, policy development, and interagency coordination E2. Non-medical program planning, policy development, and interagency coordination E2. Non-medical program planning, policy development, and interagency coordination E2 F. Direct Medical Services F. Direct Medical Services F

17. Claimable Categories – Activity Codes When a positive code is used (B1, C1, D1 or E1), staff will select the specific code from the activity description pop up screen. Example of B1 activity descriptions: When a positive code is used (B1, C1, D1 or E1), staff will select the specific code from the activity description pop up screen. Example of B1 activity descriptions: –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) –B1.2 - Assisting the student/family to access, apply for, and/or complete the Medicaid/OHP application. (Includes transportation and translation related to OHP application, and gathering appropriate information) –B1.3 - Checking a student and/or family's OHP status. –B1.4 - Contacting pregnant and parenting teenagers about the availability of Medicaid/OHP for prenatal and well baby care programs.

18. Code A: School Related and Educational Activities This code should be used for: This code should be used for: any school-related activities such as teaching and educational services any school-related activities such as teaching and educational services developing, coordinating and monitoring of a student ’ s education plan or IEP developing, coordinating and monitoring of a student ’ s education plan or IEP discipline or student supervision discipline or student supervision social services and non-health related services social services and non-health related services

19. Code A: Activity Examples I developed a lesson plan. I developed a lesson plan. I graded tests. I graded tests. I supervised the playground, halls, or lunch time. I supervised the playground, halls, or lunch time. I discussed a student’s educational progress with a family at parent-teacher conferences. I discussed a student’s educational progress with a family at parent-teacher conferences. I helped a student to apply for college. I helped a student to apply for college. I assisted in evaluating a textbook. I assisted in evaluating a textbook. I attended an IEP team meeting I attended an IEP team meeting

20. Code B1: Medicaid/OHP Outreach and Facilitating Medicaid/ OHP Eligibility This code should be used for: This code should be used for: informing students/families about OHP informing students/families about OHP helping to get information for filling out or assisting to fill out the OHP application helping to get information for filling out or assisting to fill out the OHP application contacting pregnant and parenting teens about OHP prenatal and well baby care contacting pregnant and parenting teens about OHP prenatal and well baby care checking a student/family OHP eligibility status checking a student/family OHP eligibility status

21. Code B1: Activity Examples I informed a student/family about OHP (B1.1). I informed a student/family about OHP (B1.1). I helped a family fill out the OHP form (B1.2). I helped a family fill out the OHP form (B1.2). I referred a family to the local DHS office for the OHP application (B1.2). I referred a family to the local DHS office for the OHP application (B1.2). I talked to a teen parent about OHP prenatal and/or well baby care programs and services (B1.4). I talked to a teen parent about OHP prenatal and/or well baby care programs and services (B1.4). I provided necessary forms to a student/family in preparation for OHP eligibility determination (B1.3). I provided necessary forms to a student/family in preparation for OHP eligibility determination (B1.3).

22. Code B2: Non-Medicaid/OHP Outreach and Facilitating Non-Medicaid/OHP eligibility This code should be used for: This code should be used for: Child Find outreach activities Child Find outreach activities informing students/families about social, vocational, or educational (including special ed) programs informing students/families about social, vocational, or educational (including special ed) programs describing the services/benefits of these programs describing the services/benefits of these programs helping families fill out the necessary program forms helping families fill out the necessary program forms

23. Code B-2: Activity Examples I informed a student/family about general health information. I informed a student/family about general health information. I assisted a student/family to fill out a Free and Reduced lunch application. I assisted a student/family to fill out a Free and Reduced lunch application. I informed a student/family about social service and educational programs such as WIC, childcare, food stamps, community college, higher education, and job training. I informed a student/family about social service and educational programs such as WIC, childcare, food stamps, community college, higher education, and job training. I participated in Child Find for special education services. I participated in Child Find for special education services.

24. Code C1: Referral, Coordination, Monitoring and Training of Medicaid/OHP Services This code should be used for: This code should be used for: making referrals for medical, mental and dental health services covered by Medicaid making referrals for medical, mental and dental health services covered by Medicaid coordinating the delivery of medical, mental and dental health services covered by Medicaid coordinating the delivery of medical, mental and dental health services covered by Medicaid monitoring the delivery of medical, mental and dental health services covered by Medicaid monitoring the delivery of medical, mental and dental health services covered by Medicaid attending training about MAC and OHP covered services and the benefits of those services attending training about MAC and OHP covered services and the benefits of those services

25. Code C-1: Activity Examples I referred a student to medical, dental or mental health care covered by Medicaid (C1.1). I referred a student to medical, dental or mental health care covered by Medicaid (C1.1). I participated in a meeting/discussion to coordinate or review a student’s need for health related services covered by OHP(C1.2). I participated in a meeting/discussion to coordinate or review a student’s need for health related services covered by OHP(C1.2). I spoke with a student’s doctor or parent about a change in medication (C1.2). I spoke with a student’s doctor or parent about a change in medication (C1.2). I monitored and evaluated the medical service component of the IEP not done during the IEP team meeting (C1.3). I monitored and evaluated the medical service component of the IEP not done during the IEP team meeting (C1.3). I gathered information in order to refer a student/family to health care (C1.1). I gathered information in order to refer a student/family to health care (C1.1). I participated in a MAC training or training about OHP covered service (C1.4). I participated in a MAC training or training about OHP covered service (C1.4).

26. Code C2: Referral, Coordination, Monitoring and Training of Non-Medicaid/OHP Services This code should be used for: This code should be used for: participating in or coordinating state mandated health screening activities participating in or coordinating state mandated health screening activities making referrals for scholastic, vocational, employment and social services making referrals for scholastic, vocational, employment and social services referring to non-Medicaid/OHP services referring to non-Medicaid/OHP services

27. Code C-2: Activity Examples I participated in IDEA training or other education based in-service training. I participated in IDEA training or other education based in-service training. I participated in a meeting/discussion to coordinate or review a student’s need for scholastic, employment, vocational and other non-health services. I participated in a meeting/discussion to coordinate or review a student’s need for scholastic, employment, vocational and other non-health services. I referred a student/family to educational or social services. I referred a student/family to educational or social services. I helped to coordinate and deliver the state mandated vision and hearing screens. I helped to coordinate and deliver the state mandated vision and hearing screens.

28. Code D1: OHP Transportation and Translation This code should be used for: This code should be used for: scheduling, arranging or providing transportation to OHP covered services scheduling, arranging or providing transportation to OHP covered services scheduling, arranging or providing translation services that assist the individual to access and understand necessary care and treatment scheduling, arranging or providing translation services that assist the individual to access and understand necessary care and treatment

29. Code D1: Activity Examples Transportation: Transportation: –I arranged transportation (e.g. bus, taxi, transportation brokerage) to take a student to a physical therapy appointment (D1.1). –I drove a child to the hospital for emergency medical care (D1.1). –I arranged a taxi to take a student to a medical appointment (D1.1) Translation: Translation: –I used the assistance of a translator to inform a family about medical services for their child (D1.2). –I used the assistance of a sign language interpreter to sign with a deaf student about his/her medical/physical, mental health condition and available services (D1.2).

30. Code D2: Non-OHP Transportation and Translation This code should be used for: This code should be used for: scheduling, arranging or providing transportation to social, vocational and/or other educational programs and activities scheduling, arranging or providing transportation to social, vocational and/or other educational programs and activities scheduling, arranging or providing translation services to assist individual to access and understand necessary non- Medicaid/OHP services scheduling, arranging or providing translation services to assist individual to access and understand necessary non- Medicaid/OHP services

31. Code D2: Activity Examples Transportation Transportation –I arranged transportation for a student to go to a vocational assessment. –I arranged transportation for a student to attend a recreational program. Translation Translation –I arranged for a translator to assist me with tutoring a child in math. –I arranged for a translator to assist me to communicate with a students parent about the suspension process.

32. Code E1: Program Planning, Policy Development, Interagency Coordination Related to Medical Services This code should be used for: This code should be used for: develop strategies to assess or increase the capacity of school medical/health programs develop strategies to assess or increase the capacity of school medical/health programs work with other agencies and providers to improve coordination and collaboration of Medicaid/OHP services work with other agencies and providers to improve coordination and collaboration of Medicaid/OHP services monitoring the delivery of medical services system in the schools monitoring the delivery of medical services system in the schools creating and reviewing health policies in the schools creating and reviewing health policies in the schools

33. Code E-1: Activity Examples I helped develop strategies to increase the capacity of the school health programs (E1.1). I helped develop strategies to increase the capacity of the school health programs (E1.1). I monitored the medical/health delivery systems in the school (E1.3). I monitored the medical/health delivery systems in the school (E1.3). I developed an advisory group of health professionals to advise the school on health care services in the school (E1.2). I developed an advisory group of health professionals to advise the school on health care services in the school (E1.2). I participated in an Early Childhood planning meeting to discuss the coordination of health care in our community and school (E1.1). I participated in an Early Childhood planning meeting to discuss the coordination of health care in our community and school (E1.1).

34. Code E2: Program Planning, Policy Development, Interagency Coordination Related to Non-Medical Services This code should be used for: This code should be used for: working collaboratively with other agencies to identify gaps, overlaps or duplication of non- medical/health services, such as vocational, social or educational services working collaboratively with other agencies to identify gaps, overlaps or duplication of non- medical/health services, such as vocational, social or educational services improve coordination, expand access or delivery of non-Medicaid/OHP services improve coordination, expand access or delivery of non-Medicaid/OHP services develop strategies to assess or increase the capacity of non-medical, dental and mental health school programs develop strategies to assess or increase the capacity of non-medical, dental and mental health school programs

35. Code E-2: Activity Examples I developed strategies to increase the capacity of social services in my school. I developed strategies to increase the capacity of social services in my school. I collaborated with a vocational education program to expand services to students. I collaborated with a vocational education program to expand services to students. I coordinated the delivery of social services in my school. I coordinated the delivery of social services in my school. I attended a meeting coordinating the use of the school building by a community group for a non- health activity. I attended a meeting coordinating the use of the school building by a community group for a non- health activity.

36. Code F: Direct Medical Services This code should be used for: This code should be used for: providing health/dental/mental health services contained in the IEP providing health/dental/mental health services contained in the IEP conducting health/dental/mental health assessments/evaluations and diagnostic testing conducting health/dental/mental health assessments/evaluations and diagnostic testing administering first aid or prescribed injection or medication to a student administering first aid or prescribed injection or medication to a student providing speech, occupational, physical therapies or counseling services providing speech, occupational, physical therapies or counseling services

37. Code F: Activity Examples I provided mental health counseling contained in an IEP. I provided mental health counseling contained in an IEP. I administered first aid to a student on the playground. I administered first aid to a student on the playground. I completed a psychological evaluation and wrote the evaluation report. I completed a psychological evaluation and wrote the evaluation report. I provided direct speech therapy. I provided direct speech therapy.

38. Coding Details and Guidelines Code only paid time and actual work hours Code only paid time and actual work hours Paid leave including absences, vacation, and personal leave are Code A Paid leave including absences, vacation, and personal leave are Code A Blank increments on the survey are only used for unpaid time—otherwise the survey will default to Code A: other Blank increments on the survey are only used for unpaid time—otherwise the survey will default to Code A: other Part-time employees only code the portion of the day they are paid Part-time employees only code the portion of the day they are paid

39. Documentation to Support Claimable Activities When completing documentation to support claimable Medicaid Administrative Claiming (MAC) activities, it should be: When completing documentation to support claimable Medicaid Administrative Claiming (MAC) activities, it should be: –Brief; –Concise; –Use descriptive words (For example, use the code descriptions in the MAC provider manual as your guide such as referred, coordinated, monitored, etc.); and –Only provide information pertinent to the claimable activity that was performed.

40. Documentation Examples POOR EXAMPLE POOR EXAMPLE A student with diabetes presented signs of low blood sugar, tested himself and was found to have a low blood sugar level. I referred student to the RN to assess the blood sugar level and provide an injection as needed. The nurse assessed the test results and gave the student the appropriate injection. I monitored the student for 15 minutes to ensure no adverse reactions occurred. GOOD EXAMPLE GOOD EXAMPLE –C1.1 – I referred a student to the RN to receive an insulin injection as needed. –C1.3 – I monitored the student for 15 minutes afterward to ensure no adverse reactions occurred.

41. Are Trainings Claimable? Participation in some trainings is claimable under code C1. The premise for claiming trainings is that they fit within the following description: Participation in some trainings is claimable under code C1. The premise for claiming trainings is that they fit within the following description: This code may also be used when coordinating and participating in training events and seminars for outreach regarding the benefits of the Medicaid/OHP program, how to assist families to access Medicaid/OHP services, and how to more effectively refer students for services. This code may also be used when coordinating and participating in training events and seminars for outreach regarding the benefits of the Medicaid/OHP program, how to assist families to access Medicaid/OHP services, and how to more effectively refer students for services.

42. Examples of Claimable Trainings Participating in a MAC training (Note: This does not include instructions on how to complete a survey form or the web-based survey.) Participating in a MAC training (Note: This does not include instructions on how to complete a survey form or the web-based survey.) Attending a seminar on how to effectively provide OHP outreach to pregnant and parenting teens Attending a seminar on how to effectively provide OHP outreach to pregnant and parenting teens Participating in a training to learn how to assist potential OHP clients in completing an OHP/CHIP application Participating in a training to learn how to assist potential OHP clients in completing an OHP/CHIP application Participation in the portion of a training that focuses on recognition of signs & symptoms of specific medical conditions. Examples of the portion of trainings that may be allowable: Participation in the portion of a training that focuses on recognition of signs & symptoms of specific medical conditions. Examples of the portion of trainings that may be allowable: –Training to recognize signs and symptoms of potential suicide risk –Training to recognize the signs and symptoms of Autism –NOTE: Most trainings to identify signs and symptoms are not claimable in their entirety, such as the portion dealing with the district policies and protocols.

43. Examples of Non-Claimable Trainings Participating in a First Aid Training Participating in a First Aid Training Participating in an EPI Training Participating in an EPI Training Attending a lecture on IDEA Reauthorization: How the changes will affect district and health agencies in disciplining students with disabilities Attending a lecture on IDEA Reauthorization: How the changes will affect district and health agencies in disciplining students with disabilities Participating in a seminar on “Strategies to keep kids in school and lower problem behaviors for students on IEP’s” Participating in a seminar on “Strategies to keep kids in school and lower problem behaviors for students on IEP’s” Bloodbourne Pathogens Training Bloodbourne Pathogens Training NOTE: Trainings whose sole purpose are to assist in the improvement of professional skills or development are not claimable. NOTE: Trainings whose sole purpose are to assist in the improvement of professional skills or development are not claimable.

44. Who do I contact if I need technical assistance? 1) The MAC Trainer in your building: 1) The MAC Trainer in your building: ________________________________ ________________________________ 2) The MAC Coordinator for your district/ESD: 2) The MAC Coordinator for your district/ESD: ________________________________ ________________________________ 3) The MESD Medicaid Facilitator: 3) The MESD Medicaid Facilitator: Wendy Chase – wchase@mesd.k12.or.us Wendy Chase – wchase@mesd.k12.or.uswchase@mesd.k12.or.us 503-257-1775

45. Taking the Survey Web address: Web address: http://www.mesd.k12.or.us/mac/ http://www.mesd.k12.or.us/mac/http://www.mesd.k12.or.us/mac/

46. QUESTIONS