1. MEDICAID ADMINISTRATIVE CLAIMING Staff Training

2. Medicaid Administrative Claiming Is: A method of identifying and accounting for the time spent by public school and related staff on medically related activities. Reimbursement is then claimed for the time spent doing those activities; Many are already being done by school staff. Staff do not need to know who is Medicaid/OHP eligible, nor do they need to become Medicaid experts.

3. Why a School District Would Participate Staff are already doing the activities Reimbursement for these activities is available It takes staff approximately 10-15 minutes to complete survey and document activity Revenue can be used for vital health and social service programs in the school Diversifies funding base for needed programs and opportunities

4. MAC Claiming Formula 1. Cost pool X 2. Medicaid eligible percentage X 3. Percent of allowable time (survey) = Your school’s total claim

5. Training Requirements All staff who are to be surveyed must be knowledgeable prior to taking the survey All staff in cost pool must be trained face to face at a minimum of once per year prior to taking the survey Staff must sign in at training Trainers ensure adequate time for training and are the first line for technical assistance for staff

6. MAC Survey How It Works Individual staff does the survey one day per survey period There are three survey periods during school year Surveys dates are randomly selected by DHS Paid time at school is surveyed in 15-minute increments. Staff time falls into any one of the ten activity codes. Predominant portion of a 15-minute increment is what’s recorded.

7. MESD Online Medicaid Administrative Survey

9. Ten Activity Codes A. School-related and educational activities, other.A B1. Medicaid/OHP outreach. B2. Non-Medicaid outreach.B2 C1. OHP referral, coordination, training. C2. Non-OHP referral, coordination, training.C2

10. Ten Activity Codes D1. OHP transportation/translation. D2. Non-OHP transportation/translation.D2 E1. Medical program planning, policy development, and interagency coordination. E2. Non-medical program planning, policy development, and interagency coordination.E2 F. Direct medical services.F

11. Coded A: School Related and Educational Activities This code should be used for: Any school-related activities such as teaching and educational services Developing, coordinating and monitoring of a student’s education plan or IEP Discipline or student supervision For social services and non-health related services

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

13. Code B1: Medicaid/OHP Outreach and Facilitating Medicaid/ OHP Eligibility This code should be used for: informing students/families about OHP 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 checking a student/family OHP eligibility status

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

15. Code B2: Non-Medicaid/OHP Outreach and Facilitating Non- Medicaid/OHP Eligibility This code should be used for: Child find outreach activities Informing students/families about social, vocational, or educational (including special ed) programs Describing the services/benefits of these programs Helping families fill out the necessary program forms

16. Code B-2: Activity Examples I informed a student/family about general health information 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 Participated in child find activities

17. Code C1: Referral, Coordination, Monitoring and Training of Medicaid/OHP Services This code should be used for: Making referrals for medical, mental and dental health services Coordinating the delivery of medical, mental and dental health services Monitoring the delivery of medical, mental and dental health services Attending training about MAC and OHP covered services and the benefits of those services

18. Code C-1: Activity Examples I referred a student to medical, dental or mental health care I participated in a meeting/discussion to coordinate or review a student’s need for health related services covered by OHP I spoke with a student’s doctor or parent about a change in medication I monitored and evaluated the medical service component of the IEP I gathered information in order to refer a student/family to health care I attended a MAC training or training about OHP covered service

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

20. Code C-2: Activity Examples 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 referred a student/family to educational or social services I helped to coordinate and deliver the state mandated vision and hearing screens

21. Code D1: Medicaid/OHP Translation and Transportation This code should be used for: Scheduling, arranging or providing transportation to Medicaid/OHP covered services Scheduling, arranging or providing translation services to assist individual to access and understand necessary care and treatment

22. Code D2: Non-Medicaid/OHP Transportation and Translation 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 translation services to assist individual to access and understand necessary non- Medicaid/OHP services

23. Code E1: Program Planning, Policy Development, Interagency Coordination Related to Medical Services This code should be used for: 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 monitoring the delivery of medical services system in the schools creating and reviewing health policies in the schools

24. Code E-1: Activity Examples I helped develop strategies to increase the capacity of the school health programs I monitored the medical/health delivery systems in the school I developed an advisory group of health professionals to advise the school on health care services in the school I attended an early childhood planning meeting to discuss the coordination of health care in our community and school

25. Code E2: Program Planning, Policy Development, Interagency Coordination Related to Non-medical Services 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 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

26. Code E-2: Activity Examples 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 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

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

28. Using Code C1 Versus Code F Administering first aid, or administering an insulin injection – who does it, and then who “monitors” it is the question to ask Providing direct mental health treatment following DSM IV protocols – code F Coordinating with a community-based mental health provider for monitoring follow-up of the provider’s services – code C1

29. Survey Documentation Protocols When a positive code is used (B1, C1, D1 or E1), staff will need to document activity. Documentation is in form of numeric system that associates an activity narrative with a number. It is not necessary for staff to provide a written narrative account of activity. If more than one time increment is the same activity narrative, list the number once.

31. Coding Details and Guidelines Code only paid time and actual work hours Paid leave including absences, vacation, etc. Are code A (supervisor may need to complete survey) Blank increments on survey are only used for unpaid time—otherwise will default to code A: other Part-time employees survey only paid time worked on the day of survey

32. Good Information Remember Staff do not need to know who is Medicaid/OHP eligible It is the activity of staff that is being measured, not the outcome of the activity Staff do not need to know all about Medicaid/OHP Time study determines staff time spent on eligible and non-eligible activities

33. Local MAC Coordinator and Contacts

34. Questions