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Annual Staff Training


2014-2015 Annual Staff Training – PowerPoint PPT presentation

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Title: Annual Staff Training

  • 2014-2015
  • Annual Staff Training

Training Introduction
  • 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 childs 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!

  • 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.

  • You do not need to know who is 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
  • 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

  • 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

  • MAC Claimable Categories
  • B1 Medicaid Outreach Healthy Kids/Healthy
  • C1 OHP Referral, Coordination, Monitoring and
  • 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
  • F Direct Medical Services
  • Non-claimable codes represent non-health related
    and/or educational activities that DO NOT
    generate reimbursement

  • Code A
  • This 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
    students 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 Programs
  • A State sponsored Medicaid program providing all
    of Oregons 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
  • 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 parents job loss or a
    childs serious medical need).
  • For free or low-cost coverage, household income
    cannot be more than 300 of federal poverty

  • Health Services
  • Well-child exams
  • Immunizations
  • 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 as state
    mandated health screens, then the cost of the
    care is the responsibility of the education
    agency and therefore is not claimable under the
    MAC program for reimbursement.

  • 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 familys 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 familys
    questions about OHP and how to apply. What
    benefits are covered, eligibility requirements,
  • 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
  • Includes coordinating transportation and
    providing and coordinating translation related to
    OHP application, and gathering appropriate
  • 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
  • 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 familys 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
  • 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
  • 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, as long as the referral is to an
    enrolled Medicaid provider.
  • State-Mandated Health Screenings
  • The cost of care for state mandated health
    screens, such as hearing and vision, are the
    responsibility of the education agency and
    therefore are not claimable under the MAC program
    for reimbursement. Code administrative activities
    related to the coordination and referral for
    state mandated health screens as C2.

  • Immunizations Continued
  • Non Claimable C2
  • Administrative activities performed in
    association with the immunization exclusion
  • 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
  • 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
  • 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
  • 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.

  • C1.3
  • The following monitoring activities are NOT
  • 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 of a diagnosed health condition
    (regardless of the severity or type of health

  • C1.4
  • Training 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.
  • Suicide
  • Autism
  • Drug and Alcohol Abuse

  • C1.4
  • The following State Mandated trainings are not
  • First Aid Training
  • CPR Training
  • EPI Training
  • Blood-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.

  • E1.1
  • Developing strategies and policies to assess or
    increase the capacity of school
    medical/dental/mental health programs (includes
  • Worked with nurses and local dentists regarding
    increasing access to dental services for
  • 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

  • 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 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.3
  • Monitoring 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).

  • Providing Direct Services vs. Administrative
  • The 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.

  • Treatment or monitoring activities related to
    minor acute health conditions such as, scratches,
    bruises, headaches, colds, application of
    bandages or distribution of non-prescriptive
  • Physical monitoring of health/medical services on
    a childs IEP.
  • (NOTE Follow-up to ensure the activities on an
    IEP (prescribed) are covered under C1.3.)
  • Monitoring a childs 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
  • Educational assistant monitoring a child
    following a seizure

  • Place yourself in the following scenarios and
    attempt to answer the questions correctly.

  • Individual surveys reporting claimable MAC
  • 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 and
  • do 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 districts MAC

  • Coding Accuracy Reminders for Staff
  • Reporting of Time
  • Report only PAID work time
  • Report time in 15 minute blocks
  • Report all activities performed during the paid
    work day
  • Using Correct Login (name on paycheck)
  • Saving the Survey
  • Reporting unpaid lunch
  • time frame should be left blank on survey
  • Reporting Paid Absences
  • code A

  • Steps required to complete the MAC survey
  • Access the MESD website through the following
    link http//
  • 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.
  • 730 830 Code A
  • 830 900 Code B1.1
  • 900 230 Code A
  • 230 330 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?
  • 1) The MAC Coordinator for your district
  • ________________________________
  • 2) Building Level Trainer
  • ________________________________
  • 3) The ESD Medicaid Facilitator
  • ________________________________

  • For assistance in finding local Medicaid
    providers and in applying for Medicaid insurance
    the following websites are useful
  • Oregon Health Policy Board Whats Happening
    With Health Care in Oregon
  • http//
  • Oregon County Health Department Directory
  • http//
  • Cover Oregon - Finding Health Insurance For You
  • https//
  • Find a Local DHS Office Near You
  • http//