Download MAC Staff Training PowerPoint 2016-2017

Medicaid Administrative Claiming
“MAC”
2016-17
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 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!
What is Medicaid Administrative
Claiming (MAC)
• 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.
Important Facts
• 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
How is MAC time reported?
• 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 Activity Codes
 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
MAC Activity Codes
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
School Related and Educational Activities
• 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 student’s IEP or other
education plan.)
Medicaid Outreach & The Oregon Health
Plan
• 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 Oregon’s uninsured
children under the age of 19 access to no cost or affordable,
comprehensive, health insurance coverage.
What does it cover?
 The Oregon Health Plan covers all health care needs
for kids including:
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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.
Who is eligible?
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.
Oregon Health Plan Application Assistance
• OHP Application/Information
– http://healthcare.oregon.gov/Pages/index.aspx
• General Information
• On-Line Application
Medicaid/OHP Services
 Health Services
 Well-child exams
 Immunizations (May not be during exclusion or for education
enrollment requirements)
 Routine physicals
 Maternity and newborn care
 Medical Services
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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
Medicaid/OHP Services
• Dental Services
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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
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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 – Medicaid Outreach
• B1.1
– Informing children and their family’s on how to
effectively access, use, and maintain participation in
Medicaid/OHP.
• Includes describing the range of services, and distributing OHP literature.
– Gave a family the details about qualifying for OHP, application process and whom to
contact.
– Through a Spanish speaking interpreter I identified how to apply for OHP.
– Worked with school counselor to answer a family’s questions about OHP and how to
apply. What benefits are covered, eligibility requirements, etc.
– Informed the Grandmother of a student who needs extensive surgery on his arm
about OHP. The family is uninsured.
B1 – Medicaid Outreach
 B1.2
 Assisting the student/family to access, apply for,
and/or complete the Medicaid/OHP application.
○ Includes coordinating transportation and providing and coordinating
translation related to OHP application, and gathering appropriate
information.
 Referred a family for OHP application assistance and helped get an application for
Medicaid/OHP through our Family Support Center.
 Phone call with a parent regarding documentation requirements for the OHP
application. Explained time frame and importance of providing all documentation.
 Assisted a family with resources necessary for them to apply for OHP.
B1 – Medicaid Outreach
 B1.3
Checking a student and/or family's OHP status.
 May be done by reviewing the family’s medical card, contacting the local DHS
agency, working with in-district staff who have access to Medicaid eligibility.
 Informed a parent of a child with dental needs how to check the status of their OHP
eligibility.
 Checked on the OHP eligibility status of a student returning from foster care to her
immediate family. She was covered while in foster care but will need to reapply.
 Verified a student who attempted suicide the previous day was not insured and
discussed access to OHP. Followed up with school counselor and County Mental Health
crisis unit.
B1 – Medicaid Outreach
• 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 - Referral, Coordination, Monitoring & Training
 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.
C1 - Referral, Coordination, Monitoring &
Training
• 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.
C1 - Referral, Coordination, Monitoring &
Training
 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
C1 - Referral, Coordination, Monitoring & Training
• C1.2
– Coordinating the delivery of medical health, mental health, dental
health and substance abuse services covered by Medicaid/OHP.
• Includes Youth Services Team and CARE team meetings
– Discussion with School Counselor regarding student who is in need of health and
mental health services and how to best assist the family in gaining access to services
through OHP.
– Contacted local OHP provider to determine resources available for a student needing
glasses.
– Coordinating the delivery of medical services for a student with depression with
administration, student, family and DHS.
C1 - Referral, Coordination, Monitoring & Training
 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 - Referral, Coordination, Monitoring & Training
• 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)
C1 - Referral, Coordination, Monitoring & Training
 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 - Referral, Coordination, Monitoring & Training
 C1.4
○The following State Mandated
trainings are not covered:
– First Aid Training
– CPR Training
– EPI Training
– Blood-borne Pathogens Training
D1 – Transportation/Translation
 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 – Program Planning, Policy Development & Interagency
Coordination
• 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.
E1 – Program Planning, Policy
Development & Interagency Coordination
 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.
E1 – Program Planning, Policy
Development & Interagency Coordination
• 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).
Code F – Direct Services
• 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.
Non Covered Services – CODE F
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
Test Your Knowledge
• Place yourself in the following scenarios and attempt to answer the
questions correctly.
– YOU’RE GOING TO TEST WELL. GOOD LUCK!!
Providing Appropriate Supporting Documentation
• 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 district’s MAC Coordinator
Coding Reminders
• 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
Completing the MAC Survey
 Steps required to complete the MAC survey:
 Access the MESD website through the following link
http://mac.mesd.k12.or.us
 From the MESD screen choose Survey Login for the ESD under
which you participate
 Indicate your first name and last name as it appears on your
paycheck
 Document the activities performed for your PAID work day from the
list of Activity codes.
 7:30 – 8:30 Code A
 8:30 – 9:00 Code B1.1
 9:00 – 2:30 Code A
 2:30 – 3:30 Code E1.2
 Save the survey
Note: Paid absences are
reported as Code A. Unpaid
lunch is left blank
Who do I contact if I need technical
assistance?
 1) The MAC Coordinator for your district:
________________________________
 2) Building Level Trainer:
________________________________
 3) The ESD Medicaid Facilitator:

________________________________
Helpful Resources
• For assistance in finding local Medicaid providers and
in applying for Medicaid insurance the following
websites are useful:
– Oregon Health Policy Board – What’s Happening With
Health Care in Oregon
○ http://www.oregon.gov/oha/OHPB/Pages/index.aspx
– Oregon County Health Department Directory
○ http://public.health.oregon.gov/ProviderPartnerResourc
es/LocalHealthDepartmentResources/Pages/lhd.aspx
– 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