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Train-The-Trainers

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Title: Train-The-Trainers


1
  • 2016-2017
  • Train-The-Trainers

2
  • This presentation was provided by
  • Oregon Health Authority
  • Medicaid Administrative Claiming
  • Division of Medical Assistance Programs
  • Linda Williams
  • SBHS Medicaid Operations and Policy Analyst
  • (503) 945-6730
  • Lasa Baxter
  • DHS Contracted SBHS Medicaid Operations and
    Policy Analyst
  • (541) 975-5614

3
  • Medicaid in Schools
  • MAC Match Leveraging
  • Participation of Charter Schools in MAC
  • Cost Pool Development
  • MAC Audit Requirements
  • Procedures for Assigning Survey Dates
  • MAC Oregon Healthy Kids
  • Immunizations
  • Monitoring
  • Referrals
  • Audit Support Document
  • Approved Medicaid OHP Services
  • School-Based Medicaid/OHP MAC Claiming Coding
    Guide

4
  • While schools are legally liable to provide
    IDEA-related health services at no cost to the
    eligible students Medicaid reimbursement is
    available for these services because section 1903
    (c) of the ACT requires Medicaid to be the
    primary payer for reimbursement of health-related
    services provided under IDEA.
  • CMS 2003 Administrative Claiming Guide

5
  • Medicaid Administrative Claiming (MAC)
  • MAC is a Medicaid reimbursement program which
    allows school districts to be reimbursed for some
    of the costs associated with providing
    administrative activities that directly support
    the provision of medical services covered under
    the state Medicaid plan.
  • Federal/State partnership
  • Kindergarten -21
  • Including but not limited to children in special
    education
  • Outreach Assistance with Medicaid eligibility
    determination
  • Referral, Coordination and Monitoring of health
    services
  • Interagency Coordination

6
  • Reimbursement authority
  • Pursuant to 42 CFR 433.50, only a unit of
    government is authorized to participate in
    Federal Financial Participation (FFP) by
    providing the non-federal share of public funds
    for Medicaid reimbursement for covered services.
  • The ESD certifies by its signature on the MAC
    intergovernmental agreement (IGA) that the
    non-federal matching funds it transfers to DHS
    are not federal funds, or are federal funds
    authorized by federal law to be used to match
    other federal funds and that all sources of funds
    are allowable.

7
(No Transcript)
8
Participation of Charter Schools in MAC
  • Charter Schools may participate in the MAC
    program under an ESD that holds a MAC agreement
    with OHA.
  • A charter school will be considered a separate
    school participating under the MAC contract
    between the associated ESD and the Oregon Health
    Authority when a charter school
  • has its own institutionalized number approved by
    ODE
  • is responsible as a separate school from its
    sponsored school district to conduct an annual
    audit and reports findings annually to ODE
  • has applied for and has been granted status as a
    501 c3 non-profit organization
  • possesses its own federal tax id number
  • and hires and employs its own employees
  • (As per Barbara Gates, ODE)

9
Participation of Charter Schools in MAC
  • Please consider the following internal processes
    need to be address if a charter school
    participates under your ESD.
  • A MAC sub-agreement with the charter school must
    be obtained in order to participate.
  • If this is an additional sub-agreement, estimate
    additional MAC revenue and ensure this will not
    exceed the cap established in the ESDs MAC
    agreement with OHA
  • The charter school will report to the associated
    ESD their own cost pool, conduct a random survey
    assigned to them quarterly, and have their own
    component claim as part of the compiled total MAC
    claim.
  • The charter school may desire to have its own MAC
    site coordinator and trainer to provide
    trainings, follow-up on the survey process,
    notify staff of survey days, report supporting
    documentation, etc. 

10
  • Cumulative Report 2012 Statewide MAC

11
  • Of critical importance is the development of an
    accurate cost pool. Cost pool is defined as the
    actual (not estimated) total salary and benefits
    (including OPE) paid for staff that are eligible
    to participate in the MAC survey.
  • Staff supported entirely by federal funds, may
    NOT be included in the cost pool or survey. Staff
    partially paid through federal funds may be
    included in the cost pool as long as only the
    non-federal fund portion of employee cost is
    reported. However, the employee must report
    their entire paid work time in the survey.

12
  • STEP ONE
  • IDENTIFY APPROPRIATE STAFF
  • Include either certified or classified staff who
    routinely have contact with students and/or
    families creating opportunities to provide
    Medicaid outreach and related activities as
    outlined in the MAC coding guide or who have
    direct supervision of employees who do.
  • Exclude maintenance and food services staff, bus
    drivers, and volunteers (non-paid staff). These
    groups have limited contact with students to
    provide MAC services or are not paid employees.
  • Staff must participate under the District or ESD
    they are paid by and on the corresponding survey
    date assigned to that agency.

13
Cost Pool Development
  • STEP TWO
  • IDENTIFY ACTUAL SALARY AND BENEFITS PAID
  • After identifying appropriate staff for the cost
    pool, report the actual salary, benefits and
    Other Personnel Expenses (OPE) paid for each
    individual for the survey period, removing all
    federal funds.

14
Cost Pool Development
  • STEP THREE
  • REMOVE FEDERAL FUNDS FROM COST POOL
  • Only general fund and other fund sources may make
    up the cost pool calculations. Any federal funds
    applied to the salary, benefits and OPE package
    of an individual employee must be removed on a
    FTE person-by-person basis.
  • Federal funds the ESD/district expends may
    include IDEA, ARRA, Title I, federal grants, etc.
    These funds must be removed from the cost pool to
    comply with federal regulations. Federal funds
    expended for services and supplies (S S) costs,
    indirect or other non-personnel (non-salary and
    benefits) costs may not be included in the cost
    pool.
  • NOTE
  • Documentation must be maintained detailing how
    the federal funds applicable to salary, benefits
    and OPE have been removed from the cost pool.

15
Pruning the Cost Pool
  • The ESD/district will want to set up a process to
    evaluate the cost pool on a systematic basis,
    assessing classifications and individuals as to
    their impact on the claim.
  • Pruning the cost pool is an acceptable practice
    in order to present a more effective claim and
    reduce administrative burdens.

16
Methods for Pruning the Cost Pool
  • Methods for Pruning
  • Remove any staff, who over the course of a
    determined period, have never reported a
    claimable MAC activity.
  • Blindly survey staff utilizing scenarios for
    providing MAC activities to determine whether
    staff may potentially engage in MAC activities
    over the course of time.
  • Remove staff employed for .02 FTE or less, as
    they may have limited contact with students
    and/or their families to provide MAC activities.

17
  • Maintain all supporting documentation for the MAC
    claim for a period of seven years.
  • ESD (under MAC Agreement w/OHA)
  • District (MAC Coordinator)
  • Business Office (All supporting financial
    documents)
  • Provide contact information and be available to
    OHA for review of MAC claims.

18
Procedure for Assigning Survey Dates
  • DHS will provide ESDs with random survey dates
    prior to start of the school year.
  • The ESD will assign the dates to school districts
    without influence or input from any school
    district.
  • The ESD will inform the school district(s) of the
    week (not the specific date) of their assigned
    random date prior to the first day of the
    applicable survey period. This will allow the
    ESD and school district(s) ample time for
    scheduling and providing training.
  • The ESD will inform the school district(s) of the
    specific random date no greater than 5 business
    days prior to the assigned date.
  • The school district(s) will accomplish the survey
    on the date assigned.

19
  • Trainers must attend a MAC train-the-trainers
    workshop annually.
  • Trainers must schedule and provide training to
    staff which covers all aspects of the reporting
    process.
  • Training must occur no less than once annually
  • Prior to the survey period
  • Staff must sign the training sign in sheet
  • Records training date
  • Provides access into the MESD web based system

20
  • Complete a review of the survey results and
    obtain necessary supporting documentation from
    staff.
  • Section V(A) of the 2003 CMS Medicaid
    Administrative Claiming Guide states (pg 37)
  • Documentation maintained in support of
    administrative claims must be sufficiently
    detailed to permit CMS to determine whether the
    activities are necessary for the proper and
    efficient administration of the state plan.
    Simply checking a box on a time study form does
    not facilitate independent validation of the
    sample results.
  • It is critically important for additional
    documentation to be maintained, in order to
    verify the appropriateness of the claims and to
    limit the risk of audit findings.

21
  • Training should provide staff with
  • copies of training materials , a referral list,
    and documentation forms
  • a description of the survey process
  • three survey periods Fall, Winter, Spring
  • random survey day
  • selection of survey participants (random or 100)
  • an understanding of what is claimable as an
    administrative activity in the school setting
  • an understanding of the activity codes and how
    to report them in the MESD web based reporting
    system
  • an understanding of when and how to complete the
    10 documentation form
  • access to technical assistance

22
  • Any claimable time reported on a survey may be
    reviewed by OHA and a request for supporting
    documentation issued.
  • Request staff complete a MAC Support form for
    each claimable time frame and activity code
    recorded (no less than 5 business days) after
    completing the survey. The documentation should
  • 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
    Coordinator

23
  • Coding Accuracy Reminders for Staff
  • Over/Under Reporting of Time
  • Do not report claimable time only
  • Do not report more time than paid for
  • 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

24
  • Administrative Service Providers
  • Administrators
  • Principals
  • Teachers
  • Educational Assistants
  • Secretaries
  • Counselors
  • TSPC School Psychologists
  • Claimable Categories
  • B1 Medicaid/OHP Outreach and Facilitating
    Medicaid/OHP Eligibility
  • C1 Referral, Coordination, Monitoring and
    Training of Medicaid OHP Services
  • D1 Medicaid/OHP Transportation and Translation
  • E1 Program Planning, Policy Development, and
    Interagency Coordination related to Medical
    Services

25
  • Oregon Licensed Health Care Professionals
  • Speech Language Therapist
  • Occupational Therapist
  • Certified Occupational Therapist Assistant (COTA)
  • Physical Therapist
  • Licensed Physical Therapy Assistant (LPTA)
  • Nurse
  • Delegated Health Care Aide
  • Clinical Psychologist
  • Licensed Clinical Social Worker
  • Claimable Categories
  • B1 Medicaid/OHP Outreach and Facilitating
    Medicaid/OHP Eligibility
  • C1.4 - Training
  • E1 - Program Planning, Policy Development, and
    Interagency Coordination related to Medical
    Services

26
  • Oregon Board Licensed Health Professionals
  • Licensed Health Care Professionals employed by
    school districts or ESDs cannot claim C1 and D1
    activities that are considered integral to, or an
    extension of, direct or consultative medical
    services.
  • C1.1 Referral
  • C1.2 Coordination
  • C1.3 Monitoring
  • D1.1 Transportation
  • D1.2 Translation
  • This applies regardless as to whether or not the
    district is an enrolled Medicaid provider
    accessing reimbursement.

27
  • TSPC Licensed Psychologist
  • According to Oregon Administrative Rules a TSPC
    Licensed School Psychologist may provide direct
    health services to students such as, diagnostic
    evaluations and assessment and behavior
    counseling for an identified health condition.
  • Referrals and coordination of Medicaid covered
    services made by a TSPC Licensed School
    Psychologist to Medicaid providers for a student
    in which they provide direct health services
    are considered integral to or an extension of a
    direct service and are NOT claimable. The
    service would be reported on the survey as Code F
    Direct Service.

28
  • Delegated Health Care Aide Educational
    Assistant
  • An educational /instructional assistant providing
    delegated nursing tasks under the supervision of
    a Nurse pursuant to the services identified on an
    IEP are Direct Medical Services. Such
    activities must be reported as F on the survey.

29
  • It is important staff report the claimable MAC
    activity performed on the survey date even when
    the outcome may be unknown.
  • Claimable example
  • A school counselor reports C1.1 on their MAC
    survey, when on the MAC survey day they refer a
    child for a mental health evaluation to the local
    county mental health department. The staff at
    this time may not know the outcome of the
    referral, which is acceptable and does not change
    the reporting the Medicaid-covered referral
    activity.

30
  • Claimable vs. Non-Claimable Immunizations
  • Code C1.3
  • Physical Monitoring of Direct Services vs.
    Follow-up to ensure Direct Services were provided

31
  • Claimable referrals for Immunizations (C1.1)
  • Referrals to assist families in accessing
    immunizations from enrolled Medicaid providers
    are claimable as C1.1 as long as they are
  • Provided with an enrolled Medicaid provider
  • Claimable scenarios may include
  • An office secretary, at the request of a parent,
    referred a student in need of immunizations to
    the local County Health Department for covered
    immunizations.

32
  • Non-Claimable referrals for Immunizations (C2)
  • Administrative activities performed in
    association with the immunization exclusion
    requirements such as
  • Performing a primary review summary
  • Mailing exclusion orders
  • Completing a county immunization status report
  • Other Non-Claimable scenarios may include
  • As mandated by state law, a secretary generates a
    county immunization status report during
    exclusion.
  • Link to exclusion information
  • http//public.health.oregon.gov/PreventionWellness
    /VaccinesImmunization/GettingImmunized/Documents/S
    chLawHandbook.pdf

33
  • Use of code C1.3 is used for reporting claimable
    monitoring or follow-up activities, which
    includes providing follow-up contact to ensure
    that a child has received prescribed
    medical/dental/mental health services covered by
    Medicaid or that they were arranged/coordinated
    as planned.
  • NOTE
  • Physical monitoring of a childs health condition
    regardless of the severity or type is not a
    claimable C1.3 monitoring activity.

34
  • 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.
  • A referral was made by the school counselor for
    mental health services to an enrolled provider,
    the school counselor follows up with the parent
    following the appointment to coordinate care and
    changes in medication.

35
  • Non-Claimable Monitoring or Follow-up
    Activities  (F)
  • 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)
  • Activities performed in the initial development
    of the IEP and/or formal IEP meetings (i.e.,
    annual, 3-yr)
  •  

36
  • Non-Claimable scenarios may include
  • An educational/instructional assistant trained by
    and under the supervision of a registered nurse
    monitors a students seizures as outlined in the
    Nursing plan of care pursuant to the IEP.
  • An office secretary monitors a student in the
    office or a sick room who has been complaining of
    a headache and/or nausea.
  • A classroom teacher monitoring a child for
    adverse reactions after an insulin injection was
    self-administered by the child.
  • A secretary monitoring a child with a bee allergy
    for adverse reactions to a bee sting.

37
  • Medicaid outreach activities are those performed
    to inform eligible or potentially eligible
    individuals about Medicaid and how to access the
    Oregon Health Plan.
  • Oregon Health Plan
  • 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.

38
  • The Oregon Health Plan covers all health care
    needs for kids 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.

39
  • 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
  • For free coverage, household income cannot be
    more than 300 of federal poverty level and may
    be up to 74,115 for a family of 4.

40
  • OHP Application/Information
  • http//healthcare.oregon.gov/Pages/index.aspx
  • General Information
  • On-Line Application

41
  • Referrals made for Medicaid covered health
    services provided by Licensed Health Care
    Professionals who work for enrolled Medicaid
    providers and who are billing Medicaid are
    claimable. These include, but are not limited to
  • Some ESDs
  • Some School Districts
  • Public Health Agencies
  • Hospitals
  • Mental Health Agencies
  • Medical Clinics
  • Private Practices

42
  • As per the Federal 2003 MAC guide
  • An education agency does not have to be an
    enrolled or participating Medicaid provider in
    order to claim referrals of students to
    Medicaid-covered medical/health services provided
    in the community, as long as the provider
    rendering the services is an enrolled or
    participating Medicaid provider.
  • Referrals made to medically Qualified direct
    service providers employed by a school district
    or ESD that is not a participating Medicaid
    provider are NOT claimable.
  • Medicaid does NOT recognize TSPC licensure
    therefore, referrals made to staff
    licensed/credentialed through TSPC only (i.e.,
    school counselor, school psychologist, teacher
    with a Speech endorsement) for the purpose of a
    health evaluation, diagnostic test and behavior
    counseling are NOT a claimable MAC activity

43
  • Referrals made to staff licensed/credentialed
    through TSPC (only) for the purpose of a health
    evaluation, diagnostic testing, and behavior
    counseling services are not claimable (i.e.,
    school psychologist, school counselor, teacher
    with a speech endorsement).
  • Referrals for state-mandated health services are
    NOT claimable.
  • Notifying parents regarding immunizations during
    exclusions as required by education would not be
    a claimable activity under MAC.
  • Referrals to NON-Medicaid health care providers,
    such as
  • School Districts and ESDs which are not enrolled
    as a Medicaid provider or not actively
    participating in Medicaid billing and
  • Some private health plans

44
  • 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//www.oregon.gov/oha/OHPB/Pages/index.aspx
  • Oregon County Health Department Directory
  • http//public.health.oregon.gov/ProviderPartnerRes
    ources/LocalHealthDepartmentResources/Pages/lhd.as
    px
  • Oregon Healthcare.gov- Finding Health Insurance
    http//healthcare.oregon.gov/Pages/index.aspx
  • Find a Local DHS Office Near You
  • http//www.oregon.gov/DHS/Offices/Pages/index.aspx

45
  • 2016-17
  • Annual Staff Training

46
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.

47
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!

48
  • 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.

49
  • 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

50
  • 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

51
  • 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

52
  • 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

53
  • 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.)

54
  • Medicaid outreach activities are those performed
    to inform eligible or potentially eligible
    individuals about Medicaid and how to access the
    Oregon Health Plan.
  • Oregon Health Plan
  • 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.

55
  • The Oregon Health Plan covers all health care
    needs for kids 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.

56
  • 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
  • For free coverage, household income cannot be
    more than 300 of federal poverty level and may
    be up to 74,115 for a family of 4.

57
  • OHP Application/Information
  • http//healthcare.oregon.gov/Pages/index.aspx
  • General Information
  • On-Line Application

58
  • 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

59
  • 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

60
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.
61
  • 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,
    etc.
  • Informed the Grandmother of a student who needs
    extensive surgery on his arm about OHP. The
    family is uninsured.

62
  • 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.

63
  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • Immunizations Continued
  • Non Claimable C2
  • Non-claimable Administrative activities performed
    in association with the immunization exclusion
    requirements
  • Performing a primary review summary
  • Mailing exclusion orders
  • Completing a county immunization status report

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  • 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.

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  • 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.

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  • C1.3
  • The 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)

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  • 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

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

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  • 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.

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  • E1.1
  • Developing 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.

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  • 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.

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  • 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).

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  • Providing Direct Services vs. Administrative
    Activities
  • 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.

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  • 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 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
    injection
  • Educational assistant monitoring a child
    following a seizure

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  • Place yourself in the following scenarios and
    attempt to answer the questions correctly.
  • YOURE GOING TO TEST WELL. GOOD LUCK!!

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  • 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 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
    Coordinator

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  • 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

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  • 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.
  • 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
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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
  • ________________________________

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  • 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//www.oregon.gov/oha/OHPB/Pages/index.aspx
  • Oregon County Health Department Directory
  • http//public.health.oregon.gov/ProviderPartnerRes
    ources/LocalHealthDepartmentResources/Pages/lhd.as
    px
  • Oregon Healthcare.gov- Finding Health Insurance
    http//healthcare.oregon.gov/Pages/index.aspx
  • Find a Local DHS Office Near You
  • http//www.oregon.gov/DHS/Offices/Pages/index.aspx
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