2014-2015Annual Staff Training

Thank you for participating in this important training. As teachers and professionals who work daily with students, your jobs involve much more than instruction. Your efforts to link students and their families to Medicaid-covered health services that can impact a child’s ability to learn provides structure and support in developing successful learners.

Training Introduction

Your participation in Medicaid Administrative Claiming (MAC) is a way in which you can help your District to receive reimbursement for Medicaid outreach and associated health related activities you provide. This reimbursement helps schools to continue to provide vital health and social services.

Thank you again for your participation in this training and your work with Oregon students and their families!

Training Introduction

MAC is a survey method of identifying and accounting for the time spent by public school staff on medically related activities, that otherwise would be the financial responsibility of the State.

Participation in School-Based MAC allows for the administrative activities associated with the coordination, referral, outreach, and program planning of Medicaid covered health services to be reimbursed for education agencies.

The MAC program strengthens local relationships between service providers and public agencies.

What is Medicaid Administrative Claiming (MAC)

You do not need to know who is Medicaid/OHP eligible

It is the activity you are doing that is being measured, not the outcome of the activity

The time study determines your time spent on eligible and non-eligible activities

When you report claimable MAC activities during your day you must complete a supporting documentation form in support of the activities being reported

Submit the support document to your local building coordinator or designee

Important Facts

The web-based survey is utilized to record activities staff perform during the paid hours of a school day. This is accomplished by reporting the activities in a code category that best fits the activity performed. There are three survey periods per school year. Each survey period DHS/OHA will select random survey dates of which your District/ESD will be assigned one.

○ September – December○ January – March○ April – June

How is MAC time reported?

MAC Claimable Categories B1 – Medicaid Outreach – Healthy Kids/Healthy KidsConnect C1 – OHP Referral, Coordination, Monitoring and Training

C1 = Child Specific D1 – OHP Transportation/Translation E1 – Medical Program Planning, Policy Development, and

Interagency Coordination E1 = Everyone Benefits

Non-Claimable Codes A – School Related and Educational Activities B2 – Non Medicaid OHP/Outreach C2 - Referral, Coordination, Monitoring and Training on Non

Medicaid /OHP Services D2 – Non Medicaid/OHP Transportation/Translation E2 – Program Planning, Policy Development and Interagency

Coordination Related to Non-Medical Services F – Direct Medical Services

Non-claimable codes represent non-health related and/or educational activities that DO NOT generate reimbursement

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.)

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.

Healthy Kids covers all of the health care kids need including: Medical, dental and vision care Regular checkups and preventive care Prescription medicines and medical equipment Mental health and chemical dependency services

Coverage lasts for a least one full year.

Three key qualifiers for no-cost or low-cost coverage

1.) Age○ Must be under the age of 19 (19th birthday)

2.) Residency○ Must live in Oregon and be a legal resident

3.) Income○ Must have been without health insurance for two

months (exceptions: parent’s job loss or a child’s serious medical need).

○ For free or low-cost coverage, household income cannot be more than 300% of federal poverty level.

Health Services Well-child exams Immunizations (May not be during exclusion or for education enrollment

requirements) Routine physicals Maternity and newborn care

Medical Services Preventive services such as well-child check ups Laboratory or x-rays Treatment for most major diseases Hospital stay Substance abuse Vision care, routine screenings, and glasses Hearing services, hearing aids, & batteries Home health care Specialists care & referrals Physical, occupational, and speech therapy Medical equipment and supplies

NOTE: If any of these activities are provided as “free care” or free to all students, they must be coded as C2. Activities performed free of charge are not MAC claimable.

Dental Services Preventive services (cleaning, fluoride treatments, sealants for

children) Routine services (fillings, x-rays) Dental check ups Tooth removal Dentures 24-hour emergency care Specialist care and referrals

Mental Health Services Evaluations Therapy Consultations Medication management Programs for daily and community living

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.

B1.1 Informing children and their family’s on how to

effectively access, use, and maintain participation in Medicaid/OHP. ○ Includes describing the range of services, and

distributing OHP literature.Gave a family the details about qualifying for OHP, application

process and whom to contact.Through a Spanish speaking interpreter I identified how to

apply for OHP.Worked with school counselor to answer a family’s questions

about OHP and how to apply. What benefits are covered, eligibility requirements, etc.

Informed the Grandmother of a student who needs extensive surgery on his arm about OHP. The family is uninsured.

B1.2 Assisting the student/family to access, apply for,

and/or complete the Medicaid/OHP application. ○ Includes coordinating transportation and providing

and coordinating translation related to OHP application, and gathering appropriate information.Referred a family for OHP application assistance and

helped get an application for Medicaid/OHP through our Family Support Center.

Phone call with a parent regarding documentation requirements for the OHP application. Explained time frame and importance of providing all documentation.

Assisted a family with resources necessary for them to apply for OHP.

B1.3 Checking a student and/or family's OHP status.

May be done by reviewing the family’s medical card, contacting the local DHS agency, working with in-district staff who have access to Medicaid eligibility. Informed a parent of a child with dental needs how to check

the status of their OHP eligibility.Checked on the OHP eligibility status of a student returning

from foster care to her immediate family. She was covered while in foster care but will need to reapply.

Verified a student who attempted suicide the previous day was not insured and discussed access to OHP. Followed up with school counselor and County Mental Health crisis unit.

B1.4 Contacting pregnant and parenting

teenagers about the availability of Medicaid/OHP for prenatal and well baby care programs.

Spoke with student regarding Medicaid/OHP for prenatal care.

Reviewed availability of services covered under Medicaid/OHP prenatal and well baby programs.

C1.1 - Referral Referring students for medical, mental health, dental health and

substance abuse evaluation and services covered by Medicaid/OHP. Includes gathering information in advance of referrals.

Gathered information on a student identified during a vision screening as needing further evaluation for an eye exam, student has trouble reading instructions at a distance.

Discussion with team regarding the health needs of a student who just returned from an out of state school. Parent reports regression, team discussed referral to County Mental Health agency.

Met with student and mother. Student has substance abuse issues. Referral to County Health Department for UA.

Referral of a student with Mental Health needs to County Mental Health.

Gathered information in advance of a referral for a student with dental health needs from the parents and school nurse.

Immunizations Claimable – C1.1 Referral Administrative activities related to referrals to assist families in accessing

immunizations from enrolled Medicaid providers are claimable as C1.1 - Referral.To be claimable the immunization may Not be Free of Charge (An

exception is that the service is billed to Medicaid insurance by the service provider, but may be free of charge to parent/child)

To be claimable, immunizations must be provided outside the school

Free Care Principal – Federal Guidance Precludes Medicaid from paying for the costs of Medicaid-covered

services and activities which are generally available to all students without charge.

Immunizations Continued Non Claimable – C2

Administrative activities related to assisting children and families to access “FREE” immunizationsActivities performed in association with a free immunization clinic

offered in school or other settingsAdministrative activities performed in association with the

immunization exclusion requirements- Performing a primary review summary- Mailing exclusion orders- Completing a county immunization status report

C1.2 Coordinating the delivery of medical health, mental health, dental

health and substance abuse services covered by Medicaid/OHP. ○ Includes Youth Services Team and CARE team meetings

Discussion with School Counselor regarding student who is in need of health and mental health services and how to best assist the family in gaining access to services through OHP.

Contacted local OHP provider to determine resources available for a student needing glasses.

Coordinating the delivery of medical services for a student with depression with administration, student, family and DHS.

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.

C1.3The following monitoring activities are NOT claimable:

○ Activities performed in the initial development of the IEP and/or formal IEP meetings (i.e., annual, 3-yr)

○ Monitoring minor acute health conditions, such as scratches, bruises, headaches, colds, application of Band-aids or administration of non-prescriptive medications

○ Monitoring required by Delegation from a Registered Nurse, such as seizure, catheterization, g-tube feeding & blood sugar monitoring.

○ Monitoring of a diagnosed health condition (regardless of the severity or type of health condition)

C1.4Training: 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

C1.4○ The following State Mandated trainings

are not covered:

First Aid TrainingCPR TrainingEPI TrainingBlood-borne Pathogens Training

D1.1 Scheduling and arranging transportation to OHP covered

services.○ Does NOT include the provision of the actual transportation

service or the direct costs of the transportation (bus fare, taxi fare, personal transport, etc, but rather the administrative activities (related paperwork, clerical activities, staff travel time, etc.) involved in providing the transportation.

D1.2 Scheduling, arranging or providing translation for OHP

covered services.○ Arranging for or providing translation services (oral and

signing) that assist the individual to access and understand necessary care or treatment covered by Medicaid.

○ Developing translation materials that assist individuals to access and understand necessary care or treatment covered by Medicaid.

E1.1Developing 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.

E1.2Working 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.

El.3Monitoring the medical/mental health/dental

health delivery system in schools.

○ Developing advisory or work groups of health professionals to provide consultation, advice and monitoring of the delivery of health care services to school populations.

○ Evaluating the need and/or effectiveness of medical services provided in the school setting (such as a school based health center).

E1 – Program Planning, Policy Development & Interagency Coordination

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.

EXAMPLES Treatment or monitoring activities related to minor

acute health conditions such as, scratches, bruises, headaches, colds, application of bandages or distribution of non-prescriptive medications.

Physical monitoring of health/medical services on a child’s IEP. (NOTE: Follow-up to ensure the activities on an IEP

(prescribed) are covered under C1.3.) Monitoring a child’s health condition regardless of the

severity or type of condition. School secretary monitoring a child in the health room for

adverse reaction to a bee sting Teacher monitoring a child after an insulin injection Educational assistant monitoring a child following a seizure

Place yourself in the following scenarios and attempt to answer the questions correctly.YOU’RE GOING TO TEST WELL. GOOD

LUCK!!

Test Your Knowledge

Individual surveys reporting claimable MAC activities○ Complete a MAC Support form for each claimable time frame and

activity code recorded. The documentation should: be recorded soon after completing the survey (no less than 5

business days);be brief and concise;use descriptive words (best practice is to use the key words from the

activity guide such as referred, coordinated, monitored, etc.); only provide information pertinent to the claimable activity

performed; anddo not identify the individual student or family by name.

○ Review the MAC Support form to ensure documentation is for allowable MAC activities

○ Submit MAC Support form to your district’s MAC Coordinator

Coding Accuracy Reminders for StaffReporting of Time:

○ Report only PAID work time○ Report time in 15 minute blocks○ Report all activities performed during the paid work

dayUsing Correct Login (name on paycheck)Saving the SurveyReporting unpaid lunch

○ time frame should be left blank on surveyReporting Paid Absences

○ code A

Steps required to complete the MAC survey: Access the MESD website through the following link

http://mac.mesd.k12.or.us From the MESD screen choose Survey Login for the ESD under

which you participate Indicate your first name and last name as it appears on your

paycheck Document the activities performed for your PAID work day from the

list of Activity codes. 7:30 – 8:30 Code A 8:30 – 9:00 Code B1.1 9:00 – 2:30 Code A 2:30 – 3:30 Code E1.2

Save the survey

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

Who do I contact if I need technical assistance?

For assistance in finding local Medicaid providers and in applying for Medicaid insurance the following websites are useful:Oregon Health Policy Board – What’s Happening With

Health Care in Oregon ○ http://www.oregon.gov/oha/OHPB/Pages/index.aspx

Oregon County Health Department Directory○ http://public.health.oregon.gov/

ProviderPartnerResources/LocalHealthDepartmentResources/Pages/lhd.aspx

Cover Oregon - Finding Health Insurance For You○ https://www.coveroregon.com//

Find a Local DHS Office Near You○ http://www.oregon.gov/DHS/localoffices/

localoffices.pdf