Missouri School District Administrative Claiming

Random Moment Sample Training

Training ObjectivesWhat 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

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.

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.

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.

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.

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.

What is Medicaid?

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

Examples of Medicaid / HCY Covered Services:

ADMINISTRATIVE CLAIMING (SDAC)

Outreach to Medicaid & HCY eligible children and familiesAssistance with the Medicaid Application ProcessReferring Students for Health ServicesCoordination with other Health Care ProvidersArranging for Special TransportationMedicaid / Medical Training

FOR ALL CHILDREN POTENTIALLY ELIGIBLE FOR MEDICAID

What Is School District Medicaid?

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.

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

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.”

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.

Activity Codes

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

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.

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.

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.

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)

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.

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.

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.

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.

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)

CODE 04

Direct 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.

CODE 04: Examples Direct Medical Services

Administering first aid, or a prescribed injection or medication to a student,Providing speech, occupational, physical and other therapiesPerforming 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;

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.

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

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

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.

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.

CODE 06(a)Non-Medicaid Translation

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

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.

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.

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.

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.

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 programsMonitoring the non-medical delivery systems in schoolsWorking 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.

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.

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 programsMonitoring 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

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.

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.

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.

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.

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.

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 student’s 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.

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.

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 evaluationsGathering information that may be required in advance of these medical/dental/mental health referralsProviding 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 appropriateProviding information to other staff on the child’s related medical/dental/mental health services and plans

CODE 10 General Administration

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

CODE 10: Examples General Administration

Reviewing school or district procedures and rulesAttending or facilitating school or unit staff meetings, training, or board meetingsTaking 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 performancePerforming other administrative or clerical activities related to general building or district functions or operations

Thank you for your participation!

For more information please contact the MSBA Medicaid Consortium:

(573) 445-9920Jay Bertoch- Ext. 327

Collin Swearingen- Ext. 321