MHMR

1
Time Study Training

• MHMR
• Mental Health Mental Retardation

2
Housekeeping

• Training duration is approximately 4 hours
• Short breaks will be provided
• Questions will be taken throughout
• Attendance certificates will be sent via e-mail
  to all participants that are given credit for
  attending and participating in the training

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New News - Changes in 2010

• The various trainings for Time Study, MAC, TAFI
  and Direct Service have been combined
• Once the Program Contact has been trained it is
  good for the full FFY (Oct-Sept)
• There is no longer a final survey, polling
  questions are inserted through the training to
  ensure the information is understood
• Webinars have proven to be an effective training
  methodology and will continue to be used
• There are some requirements that must be
  monitored in order to accurately credit training
• Participation level, Polling Questions
  Answered, Log In Out times
• HHSC will contact anyone that does not appear to
  have fully participated to gain understanding

4
New Faces Roles

• Time Study 512-491-1715
• Ray Wilson - Manager
• Beverly Tackett Lead
• Alexandra Young
• MAC 512-491-1411
• Dan Huggins - Director
• Yvonne Moorad Lead
• Serena Lee
• TAFI 512-491-1347
• Dan Huggins - Director
• Yvonne Moorad Lead
• Serena Lee
• New Faces Old Friends

5
AGENDA

• Time Study Coding Process
• MAC Direct Service Financial Process
• TAFI Reporting Process
• Questions/ Wrap up
• Note Must be present for entire training to
  obtain credit

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Purpose of Time Study

• A statistically valid methodology that reflects
  how time is allocated among functions
• Determine the amount of time spent on the MHMR
  Program in assisting individuals to access
  medically necessary Medicaid funded services
• Necessary for determination of interim rates and
  final reimbursement for MR service coordination
  and MH rehabilitation and case management

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Purpose of Time Study Cont.

• Necessary for participation in Medicaid
  Administrative Claiming (MAC)
• Assist the State in carrying out the Medicaid
  State plan
• Time Study participants include personnel who are
  in direct contact with the service population

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Who Are the Players ?

• MAC Coordinator
• Assistant MAC Coordinator
• Time Study Participants
• Signing Supervisors
• Skilled Professional Medical Personnel (SPMP)
  is no longer a recognized distinction for MAC

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What Are Their Roles?

• MAC Coordinator Asst. MAC Coordinator
• Identifies personnel who spend a portion of their
  time performing administrative activities
• Provide Participant and Signing Supervisor time
  study training
• Provide ongoing technical assistance to
  Participants and Signing Supervisors to ensure
  coding accuracy throughout the fiscal year
• Conduct Quality Assurance checks

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What Are Their Roles? (cont.)

• Participant
• Document their activities on Worker Day Logs
  (WDL)
• Determine which activity took the majority of
  time in each 15 minute increment
• Code the time using uniform time study codes
• Sign the WDL within 7 days from the last date on
  the WDL
• Signing Supervisor
• Review WDL to ensure that all information and
  coding is complete and accurate
• Discuss identified errors with the participant
• Supervisors cannot alter the WDL
• Sign the WDL within 7 days from the last date on
  the WDL and after the participant has signed

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Requirements

• Time Study Periods (Federal Fiscal Quarters)
• 1st Quarter - October, November, December
• 2nd Quarter - January, February, March
• 3rd Quarter - April, May, June
• 4th Quarter - July, August, September
• Time study begins the 1st day of the mid-month of
  the quarter or with approval by HHSC the
  alternative mid-month begins the 1st Monday of
  the mid-month
• The minimum duration is 3 working days
• 4th Quarter both the mid-month and alternative
  time studies start on the 2nd Monday of July

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Requirements (cont.)

• 1500 Valid Worker Day Logs (WDL) or 1 Month
• Personnel included in the time study document
  their activities on WDL
• One WDL is one person coding 100 of their
  activities for one workday, whatever the duration
• 100 of the paid workday must be time studied
  including breaks, meals and paid leave
• Do not leave gaps on the time log

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Sample of Time Study Log
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Sample of Time Study Log Swing Shift
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Whos Included?

• Persons sharing the same job functions that spend
  5 or more of their normal required job duties
  annually performing MR Service Coordination, MH
  Case Management and/or Rehabilitation
• Persons sharing the same job functions that spend
  10 or more of their normal required job duties
  annually performing MAC reimbursable activities
• Contract staff or First line supervisors who do
  either of the above

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Whos Not?

• Clerical staff that support time studied staff
  but do not meet the other requirements
• Generally, First-line supervisors or above
• Staff that provide agency wide administrative
  functions (e.g., payroll, human resources)
• Staff that only provide ICF-MR, HCS, MR direct
  service, MH vocational service, and non-Medicaid
  residential direct service

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Participant Participant List

• Personnel are grouped by similar job functions
• Job functions are assigned to a cost pool to be
  used later in coding the claim
• Random Sampling is prohibited Everyone must
  time study

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• POLLING QUESTION

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Lets Get Started !

• TIME STUDY
• CODES

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Medicaid Covered Services

• Physicians services
• Hospital review
• Clinic services for children under 21
• Limited maternity care clinics
• Lab and X-ray services
• Home health care
• THSteps/EPSDT screens and services
• Medically needed oral surgery and dentistry for
  adults (not routine dentistry)
• Pharmacy services (prescription drugs)
• Rehabilitative mental health and mental
  retardation services
• Family planning
• Services provided by licensed clinical
  psychologist, licensed clinical social workers,
  and licensed professional counselors

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Medicaid Covered Services cont.

• Comprehensive Care Program (CCP) services for
  children under 21
• School Health and Related Services (SHARS)
• Targeted Case Management for pregnant women and
  children under 1
• Hearing aids and related audiologists services
• Diagnostic assessment services for person with
  mental retardations and mental illness
• Optometry and eyeglasses
• Emergency medical services
• Private duty nursing for children under 21
• Intermediate care facilities for the mentally
  retarded
• Physical therapy
• Rehabilitation services for chronic medical
  conditions
• Hospice services
• Day Activity and Health Services (DAHS)

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MHMR Time Study Codes

• Code 1 Facilitating Medicaid Eligibility
  Determination
• Code 2 Facilitating Non-Medicaid Eligibility
  Determinations
• Code 4 Medicaid Outreach
• Code 5 Outreach Non-Medicaid
• Code 6 Referral, Coordination, and Monitoring of
  Medicaid Svc.
• Code 8 Referral, Coordination, and Monitoring of
  Non-Medicaid
• Services
• Code 9 Medicaid Transportation and Translation
• Code 10 Medicaid Provider Relations

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MHMR Time Study Codes

• Code 11 Program Planning, Development,
  Interagency
• Coordination
• Code 13 Direct Medical Service
• Code 14 Non-Medicaid, Other Educational Social
  Services
• Code 15 General Administration
• Code 16 MR Service Coordination MH Case
  Management
• Code 17 Rehabilitation Services
• Code 18 Home Community Based Services (HCS)
• Code 21 Intermediate Care Facility - MR (ICF-MR)
• Code L Lunch
• Code O Off
• Codes 3, 7, 12, 19 and 20 are no longer used

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Time Study Codes Cost Pools

• MHMR Centers state wide have three distinct cost
  pools with
• corresponding Time Study codes to facilitate the
  claiming process

Reimbursable
Non Reimbursable
Direct Service
Codes 1, 4, 6, 9, 10, 11 Medicaid
Codes 2, 5 8 Non-Medicaid
Codes 13, 14, 16, 17, 18 21
Code 15 is allocated among all codes used
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Facilitating Medicaid Eligibility
Code 1

• Explanation
• Informing and/or assisting
• families in becoming eligible
• for Medicaid including related
• paperwork, travel and clerical
• activities

• Examples
• An intake worker assisting a family in
  completing the Medicaid application.
• A clerk putting together the packet of Medicaid
  eligibility forms.
• A bilingual interpreter obtaining insurance
  information at Medicaid eligibility intake

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Facilitating Non- Medicaid Eligibility
Code 2

• Examples
• A Social Worker explaining WIC rules to a group
  of women at the local shelter
• A Case Coordinator verifying Medicaid eligibility
  for a family prior to apply for IHFS
• A MH Worker assisting a consumer enroll in
  literacy classes

• Explanation
• Informing and/or assisting
• families in becoming eligible
• for non-Medicaid services

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Medicaid Outreach
Code 4

• Explanation
• Extending Medicaid services or
• benefits to a wider section of
• population (potential recipients)
• about eligibility

• Examples
• A Nurse speaking at a community function about
  early detection of health problems
• A Case Manager talking to a parenting group about
  mental illness and signs to look for in
  adolescents
• Explaining Medicaid services to inmates at a
  correctional facility

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Non-Medicaid Outreach
Code 5

• Examples
• Scheduling a community event promoting alcohol
  and drug awareness
• Traveling to a homeless shelter to provide
  information about area food banks
• Printing brochures to hand out at the high school
  PTA meeting on gangs

• Explanation
• Extending services or benefits of
• programs not funded or covered
• by Medicaid to a wider section of
• population. Include related
• paperwork, clerical activities, or
• staff travel to
• perform these
• activities

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Referral, Coordination, Monitoring of Medicaid
Covered Services
Code 6

• Examples
• Scheduling a physician or dental appointment for
  a consumer
• Linking individuals with mental illness to crisis
  intervention
• Writing the DMR report
• Initial treatment planning for an individual
  prior to the determination of eligibility for MR
  Service Coordination

• Explanation
• Coordinating and monitoring the
• completion of prescribed services,
• termination of services, referral to
• other Medicaid svc providers to
• provide continuity of care
• Arranging for any diagnostic
• services which may be required as
• the result of a condition identified
• during an evaluation
• Gathering information that may be
• required in advance of these referrals
• or evaluations

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Referral, Coordination, Monitoring of
Non-Medicaid Covered Services
Code 8

• Examples
• Making referral to Section 8 Housing
• A Non-MR Service Coordinator transitioning a
  individual from state hospital to the community
• Intakes funding for In Home Family Support
  (IFSP)
• Referral to an indigent care program

• Explanation
• Screening and making referrals for, coordinating
  and/or monitoring the delivery of Non-Medicaid
  services, or medical services not covered by
  Medicaid.

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Medicaid Transportation Translation
Code 9

• Examples
• Accompanying a consumer to the doctors office
  to translate from Spanish to English the medical
  information between the doctor and patient
• Transportation from a consumers home to a
  Medicaid service back home
• Waiting for a consumer to have lab work
  completed then transporting them home

• Explanation
• Assisting a consumer to obtain and/or
  accompanying the individual to services covered
  by Medicaid
• Obtaining translation services for the purpose of
  accessing Medicaid services (Including Braille,
  ASL, alternative languages, or due to illiteracy)
• Transportation provided to eligible individuals
  in some covered Medicaid programs is an integral
  part of those services and would not be Code 9

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Medicaid Provider Relations
Code 10

• Explanation
• Performing activities to secure and maintain the
  pool of eligible Medicaid providers
• Use only for external providers, not contractors
  that you subcontract with for Medicaid Services
• Notice Code 10 Clarification available on the
  HHSC web site
• http//www.hhsc.state.tx.us/medicaid/programs/rad/
  AcuteCare/TS/Code10Clarification.pdf

• Examples
• Developing and maintaining the recruiting
  materials for potential Medicaid providers
• Explaining Medicaid policy and regulations to an
  adaptive equipment vendor
• Recruiting new Medicaid providers (HCS
  physicians, etc.)

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Program Planning, Development Interagency
Coordination
Code 11

• Explanation
• Use by staff whose job description includes
  program planning, policy development or
  interagency coordination including paperwork,
  data analysis, staff travel and clerical
  activities.

• Examples
• Implementation of the Planning and Network
  Advisory Committee (PNAC) decisions regarding
  Medicaid Services
• Developing Medicaid policy based on critical
  incident data
• Inter-agency utilization review meetings on
  Medicaid services

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Direct Medical Services
Code 13

• Examples
• QA of any direct service without a specific MAC
  code
• Calling in a prescription that is an ancillary
  function to the doctors appointment
• Time spent providing Rehab Services other than
  crisis intervention services without
  authorization

• Explanation
• Use by staff providing client care, treatment
  and/or counseling services to correct or improve
  a specific condition
• Used when there is no specific activity code for
  a direct service (Medicaid or Non-Medicaid) and
  the indirect services required to perform the
  activity i.e., travel or documentation

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Non-Medicaid, Other Educational Social Services
Code 14

• Explanation
• Use for any activities which are not health
  related, such as employment, job training and
  social services, as well as Non-Medicaid health
  related.

• Examples
• Transportation to apply for Section 8 Housing
  assistance
• Providing clients family case-management like
  activities
• IHFS reports and administrative activities
• Appearing in court on behalf of consumer trying
  to maintain custody of her children

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General Administration
Code 15

• Explanation
• Paperwork/clerical not
• directly supporting other
• activity
• Paid time off breaks
• Data entry/billing
• Staff meetings or board
• meetings
• Processing payroll
• personnel documentation

• Examples
• Attending or presenting training
• Maintaining inventory ordering supplies
• Chart audits of multiple services
• Activities related to conducting Death Review
• Activities to expand non-Medicaid provider base

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MR Service Coordination MH Case Management
Code 16

• Explanation
• Used by staff that provide MH Case Management
  MR Service Coordination to eligible individuals
• There are four subdivisions to document costs
• MR Service Coordination
• 16-A MR Adult and Child
• MH Case Management
• 16-B MH Routine Adult Case
• Management
• 16-C MH Routine Child and
• Adolescent Case Management
• 16-D MH Intensive Child and
• Adolescent Case Management

• Examples
• Consumer specific consultation regarding the
  provision of Case Management
• A Service Coordinator talking with a State School
  resident about to be placed in the community
  about Medicaid services available to them
• A Case Manager meeting with the consumer to write
  their Case Management Plan
• No Show to scheduled appointment

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Rehabilitative Services
Code 17

• Explanation
• Used only by staff authorized to provide Medicaid
  Rehabilitative Services
• There are seven subdivisions to document costs
• 17-A Day Program for Acute Needs
• 17-B Crisis Intervention Services
• 17-C Med Training Support - Individual
• 17-D Med Training Support Group Adult
• 17-E Med Training Support Group Child
  Adolescent
• 17-F Psychosocial Rehab Services Individual
• 17-G Psychosocial Rehab Services Group
• 17- J Skills Training Development Individual
• 17-K Skills Training Development Adult Group
• 17-L Skills Training Development Child Group

• Examples
• A therapeutic team member
• Attending a Rehabilitative Services staffing on a
  specific consumer
• Providing Group training on paying bills and
  talking with your landlord
• Meeting with an adolescent and their parents to
  review overdose precautions of the childs
  medications
• Working with a consumer to learn safe cooking
  practices

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Home Community Based Service (HCS)
Code 18

• Explanation
• Used only by staff authorized to
• provide HCS Medicaid covered
• services
• Examples of these services are
• Adaptive Aids
• Counseling and Therapies
• Dental Treatment
• Respite
• Includes Texas Home Living Svcs.

• Examples
• Assist with housekeeping as a HCS Companion Care
  in someone's home
• Providing respite care for a consumer in their
  home
• Provide training to a consumer which will allow
  them to obtain or sustain paid work
• Assist a consumer with the process of purchasing
  a wheel chair ramp for their house

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Intermediate Care Facility (ICF-MR)
Code 21

• Explanation
• Used only by staff authorized to
• provide ICF-MR Medicaid covered
• services
• A few examples of these services
• are
• Dietary
• Direct Care Contact
• Physical Therapy
• Psychology Services
• Skills Training
• Day Programming

• Examples
• Conducting a QA review of the ICF-MR program
• Psychologist conducting follow-up sessions with
  ICF-MR clients
• Vocational training at a sheltered workshop

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Code L
Code O
LUNCH
OFF

• Explanation
• Un-Paid Lunch

• Explanation
• Off duty and/or comp time used
• Un-paid time that may occur during your normal
  scheduled work day

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• POLLING QUESTION

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Time Study Contacts

• Time Study 512-491-1715
• Beverly Tackett (Lead)
• Alexandra Young
• TimeStudy_at_hhsc.state.tx.us
• Time Study Web site
• http//www.hhsc.state.tx.us/medicaid/programs/rad/
  AcuteCare/TS/SharsTimeStudy.html

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