2012-2013Annual 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

Feds award Oregon $22.5 million for children's health insurance enrollment Since October 2010, Oregon has enrolled more than 53,000 kids

under age 19 in state health insurance. That enrollment success, plus outreach and streamlining by

the state Healthy Kids program, resulted in the bonus. This is Oregon's third year of receiving a bonus under the federal

law, including $15.1 million last year.

http://www.oregonlive.com/health/index.ssf/2011/12/feds_award_oregon_225_million.html

Money - Statewide

Money – Your District (Fall 2011)

District Pool Surveyed % Claim Total Claim District Final Net Net Per Surveyed

Astoria 122 10 7.88% 125,209.89 59,391.41 5,939.14

Banks 88 14 0.98% 18,060.26 8,223.04 587.36

Beaverton 3015 190 0.75% 556,828.21 252,057.20 1,326.62

Clatskanie 62 14 9.21% 75,562.41 35,898.61 2,564.19

Forest Grove 499 40 0.97% 95,799.89 43,461.58 1,086.54

Hillsboro 1564 119 0.63% 122,754.51 51,177.95 430.07

Jewell 27 15 2.73% 6,661.44 2,981.39 198.76

Knappa 44 15 1.09% 5,518.90 2,429.32 161.95

NWRESD 268 19 0.40% 10,954.66 3,940.40 207.39

Rainier 85 15 2.99% 40,297.64 18,891.38 1,259.43

Sauvie Island 12 9 3.16% 3,737.80 1,732.18 192.46

Scappoose 163 14 3.04% 95,338.55 44,880.27 3,205.73

Seaside 142 12 1.61% 26,917.52 12,202.93 1,016.91

Sherwood 385 22 1.51% 91,600.24 42,005.90 1,909.36

Sherwood Charter 14 10 8.51% 7,690.54 3,616.14 361.61

St Helens 196 20 0.64% 24,428.06 10,746.73 537.34

Tigard-Tualatin 414 60 3.42% 291,946.98 137,848.46 2,297.47

Tillamook 182 16 1.53% 42,894.49 19,662.13 1,228.88

Vernonia 41 15 1.96% 13,213.42 6,130.33 408.69

Warrenton 82 15 9.32% 119,404.50 56,805.31 3,787.02

District Claimable Time Sample

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.

The MAC process permits the costs of allowable administrative activities being performed in the school setting, to be reimbursed under Medicaid.

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

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

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

Important Facts

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 randomly selected by DHS.

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

How is MAC time reported?

MAC Activity CodesA – School Related and Educational ActivitiesB1 – Medicaid Outreach – Healthy Kids/Healthy

KidsConnectC1 – OHP Referral, Coordination, Monitoring and

Training C1 = Child Specific

D1 – OHP Transportation/TranslationE1 – Medical Program Planning, Policy Development,

and Interagency Coordination E1 = Everyone Benefits

F – Direct Medical Services

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.)

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.

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 ($67,200.00 for a family of four).

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

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

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.Through interpreter, gave a family the details about qualifying

for OHP, application process and whom to contact.Worked with school counselor to answer a families 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 and helped contact and 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 families medical card, contacting the local DHS agency, working with in-district staff who have access to Medicaid eligibility. Contacted parent regarding dental issues. Informed them

how to check OHP eligibility. Checked on the OHP status of a student returning from

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

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

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 Medicaid/OHP prenatal and well baby programs during Youth Pregnancy Opportunity Placement Meeting.

C1.1 - Referring students for medical, mental health, dental health and substance abuse evaluations and services covered by Medicaid/OHP. (Includes gathering information in advance or referrals)

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)

C1.3 - Monitoring the delivery of medical (Medicaid/OHP) covered services. (Includes monitoring and evaluating the medical services component of the IEP)

C1.4 - Training: Coordinating, conducting or participating in training events or seminars for outreach staff regarding the benefits of medical/Medicaid related services.

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.

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.

Immunizations Claimable – C1.1 ReferralAdministrative activities related to referrals to assist families in

accessing immunizations from enrolled Medicaid providers are claimable as C1.1 - Referral.Not Free of Charge (Billed to Medicaid)Provided outside the school setting

Free Care PrincipalPrecludes 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.

Followed up on OHP resources available for a student needing glasses.

Coordinating the delivery of medical services for a student with depression (possibly suicidal) 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

Activities required to coordinate or make referrals for Medicaid covered services may be claimable for each person involved, not just the final person to coordinate or refer.

Example: Principal/Counselor asks you to put together information on a student

for possible referral to service – C1.1 Meeting with Principal/Counselor/Other Teachers – C1.1 Actual Meeting with Family/Student – C1.1

Just because you may not meet with the family, does not mean you are not involved in gathering information or history in advance of the referral that will reflect accurately the needs of the student

Students on an IEP – periodic meetings to review effectiveness of medical component(s) – Claimable as C1.3

Activities that occur in a “Formal” IEP meeting are reported A. Periodic meetings to review the effectiveness of the medical services, which are NOT IEP meetings, may be claimable. Proper supporting documentation must indicate the meeting was not an IEP meeting.

C1.1 can often lead to B1.1If you meet with a student or family for a referral to Medicaid Covered Services ask at the end of the meeting “Would you like information on State Programs that can help pay for your child to receive these services”

You don’t have to ask if they have insurance.The referral is to be reported as C1.1 regardless

If the answer is yes, providing information on Oregon Healthy Kids is appropriate and the activity may be reported as B1.1.

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.

E1.1 - Developing strategies and policies to assess or increase the capacity of school medical/dental/mental health programs. (Includes workgroups)

E1.2 - Working with other agencies and/or providers to improve the coordination and collaboration and delivery of medical, mental health and substance abuse services.

E1.3 - Monitoring the medical/mental health/dental health delivery system in schools.

E1.1Developing strategies and policies to assess or

increase the capacity of school medical/dental/mental health programs (includes workgroups)

Worked with nurses and volunteers regarding increased access to dental services for students.

Review with school team current Mental Health support system effectiveness.

E1.2 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 resource meeting at DHS office. We identified gaps in existing support systems and collaborated w/various agencies about district wide needs.

Meeting: 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

Take notes on any activity related to the medical needs of students on the day of the survey (Form Provided) Don’t worry about what code it is – Just the time and activity

After survey day use MAC Activities sheet to determine appropriate code

When in doubt – Ask! Complete online survey Provide a copy of the Supporting Documentation to your

district coordinator or NWRESD Keep FERPA in mind – general description of activity Saves asking 3 months later what you did!

Time Frame Activity Code Description of Activity

 7:30-8:00 

  

Phone calls and email correspondence re: setting up appt. for applying for OHP for two separate families

8:15-8:30   Gather info to share with parent for a different 6th grade student (suicidal) who is currently seeing outside counselor under OHP to facilitate care coordination. 

 2:00-3:30 

  

Prevention Matters County meeting. Discussing mental health and substance abuse services and trends in Washington County.

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

Links to additional resourceshttp://www.oregonhealthykids.gov/ - Healthy Kids of Oregon is a program that expands on the success of the OHP Program. No family makes too much money for Healthy Kids.http://www.oregonhelps.org/  - OregonHelps is a free and easy program prescreener. This site will estimate your potential eligibility for 33 programs and assistance.http://www.oregon.gov/DHS/how_do_i.shtml – The main page for the Oregon Department of Human Services with links to finding Medicaid Services, Alcohol and Drug treatment centers, county health departments and other Medicaid covered/related services.http://www.oregon.gov/DHS/healthplan/managed-care/plans.shtml - OHP Medical and Dental Plans by County. This page provides information to help OHP and Healthy Kids applicants choose an OHP medical and dental plan.http://egov.oregon.gov/DHS/mentalhealth/cmh-programs.shtml – Community Mental Health Programs by County