2. School-Based Medicaid Programs
Mississippi Department of Education
Lea Ann McElroy, Director
Bureau of Health Services
Mississippi Division of Medicaid
Cindy Thames, Director
Bureau of Maternal & Child Heath

3. Former Surgeon General Dr. Antonio Novello
“Health and education go hand in hand: one cannot exist without the other. To believe any differently is to hamper progress. Just as our children have a right to receive the best education available, they have a right to be healthy. As parents, legislators, and educators, it is up to us to see that this becomes a reality.”
Healthy Children Ready to Learn: An Essential Collaboration Between Health and Education, 1992
Former Surgeon General, Dr. Antonia Novello, noted how health and education are interrelated saying, “Health and education go hand in hand: one cannot exist without the other.” She went on to say that children have a right to be healthy and that families, schools, and policy-makers must ensure this becomes a reality.

4. Is
student
health
the missing
link in
school
improvement?

5. The State of School Health in Mississippi
Asthma
#1 reason for school absenteeism
Diabetes
#2 state in the nation for Type II diabetes
Obesity
#1 state in the nation for obesity rates
Medications
More than 3.5 million schoolchildren take medication at school

6. MASLOW’S HEIRARCHY AND COORDINATED SCHOOL HEALTH
Health Education
Motivated and Learning
Physical Education
Health Services
Nutrition Services
Sense of Positive
Self-Esteem
Counseling, Psychological and Social Services
Sense of Belonging and
Importance
Sense of Being Loved and
Appreciated
Healthy School Environment
Health Promotion for Staff
Family/Community Involvement
Free of Fear and In A Safe place
Physical Health

7. Coordinated School Health Program
Health Education
Physical Education
Family and Community Involvement
Health Services
Health
Promotion
for Staff
Nutrition
Services
Healthy School Environment
Health Education

8. Working together for the health of our children!
MDE
Student Health
Medicaid

9. What is Mississippi Cool Kids (EPSDT)?
A FREE health care program for Mississippi’s children ages birth through 21 who are eligible for Medicaid
A way for children to get medical exams, checkups, follow-up treatment, and special care they need to make sure they enjoy the benefits of good health

10. What is Mississippi Cool Kids (EPSDT)?
Annual exam for children/youth ages 2 – 21
Mandatory periodic screening services include:
Comprehensive physical exam
Developmental assessment
Oral health assessment
Vision and hearing screens
Adolescent counseling
Referral if necessary

11. We’re Number 1!
Mississippi is leading the way as the first state to offer EPSDT services through school nurses!
That means that with a Registered Nurse (RN) in a school-based clinic, a school can become a Medicaid Provider for EPSDT services, and file for reimbursement from Medicaid for each approved screening. Eligible population would determine level of sustainability.

12. EPSDT Program Objective
Establish well qualified RN’s to provide school based EPSDT services to every eligible child
Finance the RN’s cost to the school in whole or in part thru the provision of EPSDT services
Lee Ann’s page

13. What do we want you to do?
District/school administration will support program
District will establish clinic in a school site with qualified RN
School will include parental permission slips in school registration process and develop and implement a defined process to compile parental permission slips for RN
School will provide informative meetings for school faculty and parents
Lea Ann’s page

14. What will we do for you?
Provide assistance with Medicaid provider enrollment application
Provide template permission slips; communication materials for parents; contracts and other written material
Provide template PowerPoint presentations for faculty, teacher and parent presentations
Lea Ann’s page

15. What will we do for you? Provide periodic training
Provide day-to-day administrative support
Provide help/assistance for Screen Plus software

16. What does the EPSDT School Nurse really do?
Consent forms
Verify Medicaid numbers
Periodicity schedule/schedules appointments
Screens children (1 hour per screening on average)
Files paperwork/submits claims
Follow up/referral

17. Is the program making a difference?

18. The Business of EPSDT

19. Time is Money!

20. Time for screenings + Dollars = Sustained Program
# Medicaid Children Screened
Average Payment/Screen
Total
Payment
250
$70.00
$17,500
350
$24,500
500
$35,000

21. Teamwork is critical to success!

22. Teamwork = WIN-WIN! Improved classroom behavior
Improved academic performance
Reduced absenteeism
Onsite access to healthcare for students and faculty
Coordinated effort for improved health education
Additional funding for coordinated school health

23. What is School-Based Administrative Claiming (SBAC)?
A federally funded program administered by the Division of Medicaid in coordination with MDE
A program that allows school districts to be reimbursed for some of their costs associated with school-based health and outreach activities which are not claimable under the Medicaid School Health-Related Services program or other Medicaid “fee-for-service” programs

24. What is School-Based Administrative Claiming (SBAC)?
In general, the types of school-based health and outreach activities funded under SBAC are:
Referral of students/families for Medicaid eligibility determinations
Provision of health care information and referral
Coordination and monitoring of health services
Interagency coordination

25. How does it work? Roster of participating employees
Time samples – Random Moment Samples (RMS)
Cost data
Reimbursement!

26. School-Based Administrative Claiming and the Office of Healthy Schools
Bringing the process “in-house” and eliminating the third-party administrator
School
MDE
DOM
So what does the Office of Healthy Schools mean for School-Based Administrative Claiming?
We are bringing the SBAC process in-house and eliminating the third-party administrator. As a result, the process is streamlined with schools communicating directly with MDE, and only with DOM at audit time. MDE communicates directly with DOM to process and pay the claims.
“In house” means two (2) dedicated staff (100% of their time) for this program, ready to serve you and provide technical assistance at anytime.

27. School-Based Administrative Claiming and the Office of Healthy Schools
Designing a web-based reporting system
to automate the process
Processing claims in a timely manner
Consistency and accountability
So what does the Office of Healthy Schools mean for School-Based Administrative Claiming?
A web-based reporting system has been created exclusively for this project, which will allow for electronic submission of rosters, RMS, cost data, and invoices. Training for staff can be done electronically as well.
The process is structured around deadlines, to allow for timely processing and payment of claims.
Materials – whether electronic or paper – are identical and consistent. Our staff is completely accountable for this program and the process involved.

28. School-Based Administrative Claiming Program Guide
Overview of SBAC
Implementing SBAC
Staff Activities Included Under SBAC
Time Study Participants
The Time Study Process
Training for SBAC
Time Study Results and the Cost Allocation Process
Preparing an Invoice for Medicaid Payment
Monitoring and Quality Assurance
You can see from the Table of Contents the different Chapters in the Guide. We will not really cover these today – everyone here is already a participant in the program and should know these basics. The guide is yours and we encourage you to review it later at your convenience.

29. School-Based Administrative Claiming Program Guide
Appendix B - SBAC Activities List
Appendix C - MDE Contacts
Appendix E - SBAC Time Study Activities
Appendix I SBAC Calendar
Appendix J – SBAC Training (3 Levels)
District User’s Guide
You can also see from the Table of Contents the different Appendices in the Guide. Some you can look at later, but I do want to point out these…

30. SBAC Training Modules Three Levels
RMS Participant
SBAC District Coordinator
MDE SBAC Specialist
Training is designed incrementally, based on the knowledge needed for the level of participation
Each level has a relationship to the entire process
Each level is dependent on the other

31. Level 1 – RMS Participant
What is Medicaid?
Who/what is covered?
What is EPSDT/Mississippi Cool Kids?
What is theCertified School Match Program?
What is SBAC?
What is a RMS?
Who can be sampled?
Why must I do this?
What do I have to do?
How do I fill out the form?
True/False test

32. Level 2 – SBAC District Coordinator and District Business Manager
Most essential functions
Mainly computer manipulation
Quality control
Assurance that deadlines are met
Audit compliance piece

33. Level 2 – SBAC District Coordinator Major Steps (Employee Roster)
Generate initial roster
Document participant training by deadline
Remove untrained participants by deadline
Submit trained roster by deadline

34. Level 2 – SBAC District Coordinator Major Steps (RMS forms)
Track participants’ receipt, completion, and return of RMS forms during the quarter
Verify a percentage of RMS forms
Submit completed RMS forms by deadline

35. Level 2 – SBAC District Coordinator Major Steps (Audit file maintenance)
Quarterly invoice
ID information on each group member
Cost summaries for participant grouping
RMS summary
Calculations of Medicaid-eligible student proportions
Total costs
Financial allocation with written explanation
Certification of State Expenditures form

36. SBAC Web-Based Reporting System

37. User Control Panel/Functions

38. Employee Roster

39. RMS Participant Training

40. Early Success! “The training this morning was really
helpful. In light of this extremely busy
time for financial people, it was really
awesome to see that so much time and effort was put into making this process as painless and as user friendly as possible!”
“I think this new system is going to be
GREAT!!! It is obvious the amount of time and effort that has gone into making this successful!! It all seems very organized and easy to use!!”

41. What is the School Health-Related Services Program?
Designed to identify children who have a learning problem because of a medical problem which requires special services
Services include:
Speech/language therapy and evaluations
Occupational therapy and evaluations
Physical therapy and evaluations
Psychological evaluations
Psychotherapy services

42. Speech/Language Services
Services for speech, hearing and language disorders means diagnostic screening, preventive or corrective services provided by or under the direction of a speech pathologist for which a patient is referred by a physician .
Services must be provided by a speech pathologist licensed in the State of Mississippi.

43. Speech/Language Services
The individual must also meet Federal regulation licensure requirements:
Has a certificate of clinical competence from the American Speech-Language Hearing Association (ASHA)
Has completed the equivalent educational requirements and work experience necessary for the certificate; or
Has completed the academic program and is acquiring supervised work experience to qualify for the certificate

44. What we’re doing to help!
07-08SY - Pilot program to test a web-based system for reporting speech therapy claims
08-09SY – Roll out system to all interested schools currently billing for speech therapy

45. Contact Information
MS Division of Medicaid
Cindy Thames, Director
Bureau of Maternal
& Child Health
MS Dept. of Education
Lea Ann McElroy, Director
Bureau of Health Services