Missouri School District Administrative Claiming

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Missouri School District Administrative Claiming

• Random Moment Sample Training

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Training Objectives

• What is Missouri School District Administrative
  Claiming (SDAC)?
• Why were you chosen to participate?
• What is Medicaid?
• Who is covered by Medicaid?
• What documentation is required?
• How to fill out an RMS Observation Form?
• Review of Activity Codes

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What is Missouri SDAC?

• Department of Social Services (DSS), MO HealthNet
  Division (MHD), and individual school districts
  are able to share in the responsibility for
  promoting access to health care for students in
  the school system, preventing costly or long term
  health care problems for at risk students and
  coordinating students' health care needs with
  other providers.

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What is Missouri SDAC?

• Many of the activities performed by school
  district staff meet the claimable criteria for
  Medicaid administrative claiming. The primary
  purpose of administrative claiming is to
  reimburse school districts for these activities,
  where allowed.

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Why Were You Chosen?

• Your school district chose you to participate
  because as part of your routine job tasks you may
  provide
• Referral, coordination and monitoring the
  delivery of health care services
• Linking the child and family to an ongoing health
  care delivery system and
• Building and sustaining state and local
  partnerships for delivery of medical and dental
  services.

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What is Medicaid?

• Medicaid is a federally funded, health insurance
  program for low income and needy people.
• For children under age 21 and Early Periodic
  Screening, Diagnosis and Treatment (which in
  Missouri is known as Healthy Children and Youth
  Program (HCY), which includes all medical
  services determined medically necessary by
  medical personnel.

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Who is Covered by Medicaid?

• Children in families who are eligible for cash
  assistance under Temporary Assistance to Needy
  Families (TANF), and Supplemental Security
  Income.
• Children for whom adoption assistance or foster
  care payments are made.
• Certain other low-income children may be
  eligible.
• Children with certain disabilities.

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What is Medicaid?
Examples of Medicaid / HCY Covered Services

• Hospital Services - Inpatient and Outpatient
• Case Management
• Dental Services
• Immunizations
• Physical, Occupational and Speech Therapy
• Hearing Services
• Home Health

• Lab X-ray
• Prescription Drugs
• Physician Services
• Medical Supplies and Equipment
• Inpatient Psychiatric Services
• Substance Abuse Treatment
• Vision Services

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What Is School District Medicaid?

• ADMINISTRATIVE CLAIMING (SDAC)
• Outreach to Medicaid HCY eligible children and
  families
• Assistance with the Medicaid Application Process
• Referring Students for Health Services
• Coordination with other Health Care Providers
• Arranging for Special Transportation
• Medicaid / Medical Training
• FOR ALL CHILDREN POTENTIALLY ELIGIBLE FOR MEDICAID

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Who is Covered by Medicaid?

• It is important to note that for Administrative
  Claiming activities it is NOT necessary to know
  which children are Medicaid eligible.

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What Documentation is Required?

• Time is recorded by a process called
• Random Moment Sampling (RMS)
• In order to obtain reimbursement, staff must
  briefly describe the activity at the requested
  moment in time on the comment line of the RMS
  Observation Form

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What is RMS?

• Random Moment Sampling (RMS) is a Federally
  accepted method for documenting the time spent on
  Medicaid administrative activities.
• The RMS System compiles employee data from each
  participating school district to form a statewide
  sample pool.
• From this statewide pool, names are randomly
  selected and paired with random moments in time
  to create Sample Moments.

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What is RMS?

• Each sample moment is printed on a form and
  sent to the each school district (SDAC)
  coordinator for distribution.
• Employees complete the sample form at the sample
  moment and return the form to the district
  coordinator, who then forwards the completed
  forms to the MSBA Consortium.
• The sample forms take no longer than a minute to
  complete!!
• All forms must be returned in order to obtain a
  statistically valid sample.

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Activity Codes

• Always include any paperwork, clerical work or
  travel time associated with a particular activity
  as part of that activity.

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CODE 01(a) Non-Medicaid Outreach

• This code is to be used when informing
  eligible or potentially eligible individuals
  about non-Medicaid social, vocational, general
  health and educational programs and how to access
  them, or when describing the range of benefits
  covered under these non-Medicaid programs and how
  to obtain them.

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CODE 01(a) Examples Non-Medicaid Outreach

• Scheduling and promoting activities which
  educate individuals about the benefits of health
  life-styles and practices
• Conducting general health education programs or
  campaigns addressed to the general population
• Conducting outreach campaigns to encourage
  persons to access social, educational, legal or
  other services not covered by Medicaid.

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CODE 01(b) Medicaid Outreach

• This code is to be used when performing
  specific activities to inform eligible or
  potentially eligible individuals about Medicaid
  benefits and how to access the program.

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CODE 01(b) Examples Medicaid Outreach

• Interpreting materials about Medicaid to persons
  with children within the school district
  boundaries who are illiterate, blind, deaf, or
  who cannot understand the English language
• Utilizing brochures approved by the Division of
  Medical Services, designed to effectively inform
  eligible individuals about the benefits programs
  and services and about how and where to obtain
  services,
• Informing Medicaid eligible pregnant students
  about the availability of HCY services for
  children under the age of 21 (including children
  who are eligible as newborns)

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CODE 02(a)Facilitating an Application for
Non-Medicaid Programs

• This code is to be used when assisting an
  individual or family to make application for
  programs such as TANF, Food Stamps, WIC, day
  care, legal aid, and other social or educational
  programs and referring them to the appropriate
  agency to make application.

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CODE 02(b)Facilitating Medicaid Eligibility
Determination

• This code is to be used when assisting
  children and families in establishing Medicaid
  eligibility by making referrals to the Family
  Support Division for eligibility determination,
  assisting the applicant in completing the
  Medicaid application forms, collecting
  information, and assisting in reporting any
  required changes affecting eligibility.

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CODE 02(b) Examples Facilitating Medicaid
Eligibility Determination

• Assisting the individual or family in completing
  the Medicaid application
• Explaining the Medicaid eligibility process to
  prospective applicants
• Providing assistance to the individual or family
  in collecting required information and documents
  for the Medicaid application
• Referring an individual or family to the local
  assistance office to make an application for
  Medicaid benefits.

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CODE 03School Related and Educational Activities

• This code is to be used for any other
  school-related activities that are not Medicaid
  related, such as social services, educational
  services, teaching services, employment and job
  training.

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CODE 03 Examples School Related and Educational
Activities

• Compiling attendance reports
• Testing, correcting papers,
• Providing general supervision of students (e.g.
  playground, lunchroom)
• Enrolling new students or obtaining registration
  information
• Conferring with students or parents about
  discipline, academic matters or other school
  related issues.
• Providing classroom instruction (including lesson
  planning)

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CODE 04Direct Medical Services

• Use this code when providing direct health
  care, treatment, and/or counseling services
  including mental health assessments and
  evaluations to an individual in order to correct
  or ameliorate a specific condition.

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CODE 04 Examples Direct Medical Services

• Administering first aid, or a prescribed
  injection or medication to a student,
• Providing speech, occupational, physical and
  other therapies
• Performing routine or mandated child health
  screens including but not limited to vision,
  hearing, dental, and HCY screens.
• Conducting medical/health assessments/evaluations
  and diagnostic testing and preparing related
  reports

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CODE 05(a)Transportation for Non-Medicaid
Services

• This code is to be used when assisting an
  individual to obtain transportation to services
  not covered by Medicaid or accompanying the
  individual to services not covered by Medicaid.

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CODE 05(a) Examples Transportation to
Non-Medicaid Services

• Scheduling or arranging transportation to
  social, vocational, and, or educational programs
  and activities.

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CODE 05(b)Transportation-Related Activities in
Support of Medicaid Covered Services

• This code is to be used when assisting an
  individual to obtain transportation to services
  covered by Medicaid. This does not include the
  actual transportation service or the direct cost
  of the transportation, but rather the
  administrative activities involved in arranging
  and providing the transportation.

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CODE 05(b) Examples Transportation-Related
Activities in Support of Medicaid Covered Services

• Scheduling or arranging transportation to
  Medicaid covered services, including those
  received at school.

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CODE 06(a)Non-Medicaid Translation

• School staff are to use this code when
  providing translation services for non-Medicaid
  activities.

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CODE 06(a) ExamplesNon-Medicaid Translation

• Arranging for or providing translation services
  (oral or signing services) that assist the
  individual to access and understand social,
  educational and vocational services
• Developing translation materials that assist
  individuals to access and understand social,
  educational and vocational services.

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CODE 06(b) Translation Related to Medicaid
Services

• School staff should use this code when it is
  not included and paid for as part of a medical
  assistance service and must be provided with by
  separate units or separate employees performing
  solely translation functions for the school and
  it must facilitate access to Medicaid covered
  services.

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CODE 06(b) ExamplesTranslation Related to
Medicaid Services

• Arranging for or providing translation services
  (oral or signing), that assist the individual to
  access and understand necessary care or treatment
  covered by Medicaid and
• Developing translation materials that assist
  individuals to access and understand necessary
  care or treatment covered by Medicaid.

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CODE 07(a) Program Planning, Policy Development
Interagency Coordination Related to
Non-Medical Services

• School staff should use this code when
  performing activities associated with the
  development of strategies to improve the
  coordination and delivery of non-medical services
  to school age children. Non medical may include
  social services, educational services and state
  or state education mandated child health
  screenings provided to the general school
  population.

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CODE 07(a) Examples Program Planning, Policy
Development Interagency Coordination Related to
Non-Medical Services

• Developing strategies to assess or increase the
  capacity of non-medical school programs
• Monitoring the non-medical delivery systems in
  schools
• Working with other agencies providing non-medical
  services to improve the coordination and delivery
  of services and to improve collaboration around
  the early identification of non-medical problems.

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CODE 07(b) Program Planning, Policy Development
Interagency Coordination Related to Medical
Services

• School staff should use this code when
  performing activities associated with the
  development of strategies to improve the
  coordination and delivery of Medicaid covered
  medical/dental/mental health services to school
  age children, and when performing collaborative
  activities with other agencies and/or providers.

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CODE 07(b) Examples Program Planning, Policy
Development Interagency Coordination Related to
Medical Services

• Developing strategies to assess or increase the
  capacity of school medical/dental/mental health
  programs
• Monitoring the medical/dental/mental health
  deliver systems in schools,
• Working with other agencies and/or providers to
  improve collaboration around the early
  identification of medical/dental/mental problems.
• Analyzing Medicaid data related to a specific
  program, population, or geographic area

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CODE 08(a) Non-Medical/Non-Medicaid Related
Training

• School staff should use this code when
  coordinating, conducting or participating in
  training events and seminars for outreach staff
  regarding the benefit of the programs other than
  the Medicaid program.

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CODE 08(a) Examples Non-Medical/Non-Medicaid
Related Training

• Participating in or coordination training that
  improves the delivery of services for programs
  other than Medicaid.

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CODE 08(b) Medical/Medicaid Related Training

• School staff should use this code when
  coordinating, conducting or participating in
  training events and seminars for outreach staff
  regarding the benefit of the medical/Medicaid
  related services, how to assist families to
  access such services, and how to more effectively
  refer students for those services.

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CODE 08(b) ExamplesMedical/Medicaid Related
Training

• Participating in or coordinating training that
  enhances early identification, intervention,
  screening and referral of students with special
  health needs to such services (e.g. Medicaid
  EPSDT services)
• Participating or coordinating training that
  improves the delivery of medical/Medicaid related
  services.

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CODE 09(a) Referral, Coordination Monitoring
of Non-Medicaid Services

• School staff should use this code when making
  referrals for,coordinating and / or monitoring
  the delivery of non-medical, such as educational
  services.

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CODE 09(a) ExamplesReferral, Coordination
Monitoring of Non-Medicaid Services

• Making referrals for and/or coordinating access
  to social and educational services such as child
  care, employment, job training
• Participating in a meeting/discussion to
  coordinate or review a students needs for
  scholastic, vocational, and non-health related
  services not covered by Medicaid
• Monitoring and evaluating the non-medical or
  educational components of the IEP as appropriate.

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CODE 09(b) Referral, Coordination Monitoring
of Medicaid Services

• School staff should use this code when making
  referrals for, coordinating, and/or monitoring
  the delivery of medical (Medicaid covered)
  services. Referral, coordination and monitoring
  activities related to services in an IEP are
  reported in this code.

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CODE 09(b) Examples Referral, Coordination
Monitoring of Medicaid Services

• Making specific medical referrals for and/or
  coordinating medical or physical examinations and
  necessary medical/dental/mental health
  evaluations
• Gathering information that may be required in
  advance of these medical/dental/mental health
  referrals
• Providing follow-up contact to ensure a child has
  received the prescribed medical/dental/mental
  health services,
• Monitoring or evaluating the Medicaid service
  components of the IEP as appropriate
• Providing information to other staff on the
  childs related medical/dental/mental health
  services and plans

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CODE 10 General Administration

• School staff should use this code when
  performing activities that are not directly
  assignable to program activites.

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CODE 10 Examples General Administration

• Reviewing school or district procedures and rules
• Attending or facilitating school or unit staff
  meetings, training, or board meetings
• Taking lunch, breaks, leave or other paid time
  not at work (includes snow days)
• Providing general supervision of staff, including
  supervision of student teachers or classroom
  volunteers and evaluation or employee performance
• Performing other administrative or clerical
  activities related to general building or
  district functions or operations

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Thank you for your participation!

• For more information please contact the MSBA
  Medicaid Consortium
• [phone]
• Jay Bertoch- Ext. 327
• Collin Swearingen- Ext. 321