MO HealthNet

1. MO HealthNet School District Administrative Claiming August 2013 SDAC Training Presented by the MSBA Medicaid Consortium Reference Material for Presentation: State of Missouri MO HealthNet SDAC Manual March 25, 2011

2. MSBA Medicaid Consortium Contact and Website Information Kim Ratcliffe- (800) 221-MSBA(6722) Ext 362 (Executive) Colleen Mahon- (800) 221-6722 Ext 340 (Business) Collin Swearingen-(573)673-2013 (SDAC, Direct Services) Brenda Wright- (660)651-1534 (SDAC) Lisa Helm- (573)795-0510 (Direct Services) Darcy Frazee- (800)221-6722 (Claims Adjustments and Finance) Ashley Branstetter- (800)221-6722 (Direct Services) E-mail addresses for the above: lastname@msbanet.org http://www.msbanet.org/programs_services/medicaid/sdac

3. AGENDA Purpose of SDAC and Responsibilities of SDAC Coordinator Staff Training Student Roster Selection of Participants to be Included on the Roster How to Effectively Monitor RMS Forms and Understanding the Activity Codes

4. Agenda (c0ntinued) Cost Data/PPR/Quarterly Cert Submission (New Template for Q4-13) SDAC Audit Information Important Information for IT Departments SDAC To-Do List Question and Answer

5. What is School District Administrative Claiming? • SDAC is a federal program under Medicaid that allows a school to become an “administrative arm” of the MO HealthNet Division. • “The purpose of administrative claiming is to: • encourage the development of a framework of activities • that result in each MO HealthNet participant having information and assistance to access needed health care services • from a qualified provider.” • (MHD School District Administrative Claiming Manual, Section 4)

6. What is My District’s Commitment to SDAC? “School districts interested in participating in administrative claiming must begin with policy and executive leadership (i.e. the local Board of Education and top administrative staff) identifying the scope and depth of the health care role which is desirable for the district to play.”(MHD SDAC Manual Section 5.1)

7. Role of District and Community The District and community members must determine the District’s commitment to health and wellness of students. • Continuum of Commitment : • Our district is very active in all areas of student health promotion and provides access to primary and preventative health care, when needed. We regularly interact with community providers for the purpose of coordinating student health care.

8. Continuum of Commitment (continued) • Our district views parents as having the primary role. We interact with community providers on an “as needed” basis for individual students. • Our district considers parents to be the primary health care managers—we contact them on an emergency basis only. (MHD SDAC Manual, Section 5.1)

9. Relevance to Schools SDAC activities are directly related to student learning outcomes.

10. CORE PRINCIPLES OF SDAC • Connect uninsured children with MC+ benefits through MO HealthNet • Link children with appropriate healthcare • Preventive healthcare • Treatment for identified healthcare issues • Coordination, follow-up and monitoring • Plan for efficient delivery of healthcare within the school and community.

11. Key Times to Conduct Referral and Outreach Make referrals for medical, dental or mental health services through the parent/guardian or directly to a provider, with parental/guardian permission, anytime a child has an unmet health need. Conduct outreach, at enrollment if student does not have health insurance.

12. Key Times to Conduct Referral and Outreach Anytime you are in conference with a parent and it is apparent that the child may have physical, mental, or dental health problems which are untreated due to a lack of health insurance—i.e., in need of MO HealthNet services. When working with a pregnant teen who needs healthcare coverage for herself and her unborn child.

13. Key Times to Conduct Referral and Outreach • When the school becomes aware of a change in household status which may result in a change in eligibility for MO HealthNet coverage, such as: • Change in employment status of one or both parents such as a loss of a job or a reduction in hours.

14. Key Times to Conduct Referral and Outreach • Change in household composition • One parent leaves the household • Another sibling is born or returns to the home • http://www.dss.mo.gov/mhk/index.htm

15. Who is Covered by MO HealthNet? 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.

16. Examples of MO HealthNet Covered Services • Primary, preventive, and acute services • Hospital Services - Inpatient and Outpatient • Nursing Services • Dental Services • Immunizations • Physical, Occupational and Speech Therapy • Hearing Services • Home Health • Lab & X-ray • Prescription Drugs • Physician Services • Medical Supplies and Equipment • Behavioral Services (Out-patient counseling & in-patient psychiatric) • Check Up’s, Sports Physicals • Substance Abuse Treatment • Vision Services, glasses

17. Positive Outcomes for Schools Two-Fold Return for Schools: 1) Children come healthy and ready to learn. 2) Schools get reimbursed for eligibility outreach, coordination, and referral activities conducted as an extension of MHD.

18. RESPONSIBILITIES OF LOCAL SDAC COORDINATOR 1. Participate in quarterly training sessions conducted by MSBA. 2. Evaluate the appropriateness of staff placed on quarterly personnel roster. • Persons/positions included must routinely perform SDAC reimbursable activities. • Persons/positions included must not be 100% federally funded. • Persons/positions included must not be paid through function codes 2320-2329.

19. RESPONSIBILITIES OF LOCAL SDAC COORDINATOR (continued) 3. Submit a Personnel Roster on a new 5-tab template each quarter to reflect all relevant personnel. 4. Coordinate and document training of SDAC participants at least annually and coordinate quarterly training as needed for new participants and/or those requiring retraining. 5. Monitor the RMS process to ensure 100% completion of RMS forms in a timely manner. 6. Implement quality control reviews of completed RMS forms.

20. RESPONSIBILITIES OF LOCAL SDAC COORDINATOR (continued) 7. Validate the activities of the sample pool members to justify inclusion of staff in the cost pool. 8. Collect data required for invoicing purposes: • Salary and benefits • PPR • Quarterly Certification of Expenditures • Yearly Student Roster File (Used to determine MEV rate) 9. Maintain audit file for no less than five (5) years after the reporting quarter has been filed with MO HealthNet Division.

21. Staff Education Will Be Provided at Several Key Times: 1. Initially when the program begins in the district; 2. At least yearly thereafter for all staff; 3. Prior to the time a new staff member is to be sampled; and 4. When the results of the time study indicate that one or more people in the sample pool may not be responding correctly. NOTE: At least one hour of training will be provided each year to each staff member included in the sample pool. (The electronic training satisfies this requirement.)

22. The Objectives Of Training Staff • 1. The participant will know the goals and structure of the SDAC Program. • 2. The participant will know the specific meaning of each category of activity in their particular context. • 3. The participant will understand the importance of timely and accurate completion of their RMS form. • 4. The participant will understand the process of RMS form completion and correction, if needed. (MHD SDAC Manual Section 5)

23. Staff Training Quick overview of Training Roster and discussion of benefits…….. Process for Reporting Replacements

24. Student Roster Review handout. Demonstration of how to upload in therapylog.com

25. Personnel Roster Guidelines Positions which are 100% federally funded have not been placed on the roster. Positions which are paid from function codes 2320-2329 have not been placed on the roster. Note:If the position is split funded from some other function code, it may be listed but caution must be exercised to insure that only the “other” function code costs will be reported.

26. Personnel Roster Guidelines Double check to be sure you have identified the correct quarter in cell D4 of the Personneltab. The Personnel tab remains titled Personnel on the 5-tab template. You are using the most current template available at www.msbanet.org.

27. Personnel Roster Guidelines • The district’s MHD code is entered in the first column for each listed participant. • Note: Be sure you are entering your MHD code and not the obsolete MAXIMUS code. If you are unsure of the code, please call MSBA for assistance. • Each employee ID is unique and not recycled from an earlier employee or associated with another individual within the district.

28. Personnel Roster Guidelines Each individual has a unique email address. The same email address is not being used for multiple individuals. Salary and benefit amounts are not shown on the Salary tab when submitting the Personnel Roster prior to the beginning of a quarter. Location of data has not been changed. Note:Columns and rows are set within the template to enable our system to find the data and process it.

29. Personnel Roster Guidelines • Each participant is only listed once. • Each participant has a work schedule entered on the Personnel tab. • The listing of participants begins on line 6 of the PERSONNEL tab. • Note:Do not leave blank lines between participants. • Do not make any changes to this tab after it has been submitted unless you discuss this with MSBA. Changes will only be possible if requested prior to generating RMS samples

30. Examples of Staff to be included in the District Sample Pool Employees who refer, coordinate and monitor the delivery of health care services; Any employee involved in linking the child and family to an ongoing health care delivery system; and Any employee involved in building and sustaining state and local partnerships for the delivery of medical and dental services.

31. Personnel Roster Job ClassificationsMHD Manual 5.4.C • Speech-Language Pathologists or Implementer • Audiologist and Assistants • Occupational Therapist or COTA • Physical Therapist or PT Assistant • Social Workers • Interpreters • Orientation and Mobility Specialists • Bilingual Specialists • Administrators for Special Education • Student Services Personnel

32. Personnel Roster Job ClassificationsMHD Manual 5.4.C • Psychologists • Counselors • Diagnosticians • Physicians • RN’s, LPN’s and School Health Aides • Augmentive Specialists • Dieticians • Respiratory Therapists • Liaisons for Special Education • Other school district staff who routinely engage in MO HealthNet reimbursable administrative activities

33. Am I Limited to the Position List in the MHD Manual? Answer:No Appropriate staff will be chosen by each school district based upon function and duties not on job title. Any staff member, regardless of job description, may be included in the cost pool. However, the district and/or the consortium should be prepared to document and justify the placement of each staff position in the sample pool. SDAC Manual 5.4.C

34. Justification of Other Positions Any staff member, regardless of job description, may be included in the cost pool. However, the district and/or the consortium should be prepared to document and justify the placement of each staff position in the sample pool. Note: Contact MSBA Consortium whenever you receive an audit review request or directive. (Letter goes to the Superintendent from MHD.)

35. Additional Possible Positions Contingent on Job Roles and Responsibilities • Principal • Assistant Principal • Parents as Teachers • Behavioral Specialist • Process Coordinator • Caring Communities Coordinator • Staffing Specialist • Autism Coordinator • Coordinator of Behavioral Services • Attendance/Truant Officer • CRIB Program Staff • Staff/Coordinator of Sensory Impaired • Director of Community Services • Director of Guidance • Director of ESL/ELL or teaching staff • Mental Health Site Coordinator

36. RMS Response Data Positions that have recorded billable activities over this last school year. Personnel Roster Breakout Session

37. Calendar Guidelines • Professional Development and/or Parent-Teacher Conference days have not been listed as days off. • Note:Any time staff is working and paid they are subject to RMS sampling. • Early release days reflect the time the NON-SAMPLING starts. For example, if the early release is at 12:15 p.m., the non-sampling time starts at 12:15 p.m.

38. Calendar Guidelines Date ranges for extended breaks are entered, such as Winter (Christmas) break, Spring break, Summer break, etc.) Take a look at the new calendar entry step in therapylog.com.

39. Simple Steps for RMS Completion • Activity Description -- answer the following questions, as appropriate, and provide limited but sufficient detail to code: • Who were you with? • What were you doing? • What was the intended immediate result? • Activity Code – select proper activity code based on “Activity Description.” • Position Code – Check a position code. If an appropriate code is not listed, select 500 Other and type in position name. • If you have professional licensure, select 500 Other and specify licensure, such as Licensed Clinical Social Worker.

40. SDAC Coordinator: First Level of Validation In Therapylog the under the column heading “Type” will appear the word “Validate” Coordinator must verify by phone or in person that the sampled staff accurately completed the observation form, as well as signed and dated the form correctly. Click “Mark Validated” under Tools for that form. Respond to pop up message. Form will show “Validated” in Therapylog after clicking “OK”.

41. SDAC Coordinator: Second Level of Validation In Therapylog.com under the column heading “Type” will appear the word “Review.” A second method of required validation: Coordinator does a visual check; ensures the coding is correct and form is complete. Click “Mark Reviewed” under Tools for that form. Form will show “Reviewed” in Therapylog.com after clicking “OK”. MSBA calculates a standard error of measure for each activity code and issues a quarterly report.

42. RMS Form Review • Understand the 5 business day rule and troubleshoot or call for assistance before it is too late. • Ensure all forms are completed. • Use the “Paid Leave” and “Reject Survey” buttons appropriately. • When reviewing RMS forms with a code 4 consider licensure status in regard to both activity and position code selection.

43. RMS Form Review (continued) • Training has to be completed before the moment occurs if it has been longer than one (1) year since participant has been trained. • If school is closed and participant is at school, they are indicate what they were doing that moment.

44. Underlying Premise Regarding IEP’s The Medicare Catastrophic Coverage Act of 1988 amended section 1903(c) of the Social Security Act to permit payment for services provided to children under the IDEA. (Administrative and direct services) When schools conduct activities for the purpose of fulfilling education-related mandates (procedural steps ) under the IDEA, the associated costs are not billable activities under SDAC.

45. Underlying Premise Regarding IEP’sSo what does that mean? • Milestone events in the IEP process that are mandate related and not claimable activities (must use a non-billable code) include: • Child find activities • Initial evaluation and reevaluations • Development of the initial IEP • Required annual review and revisions

46. Underlying Premise Regarding IEP’s • Claimable activities under IDEA are related to coordinating, monitoring, and evaluating the MO HealthNet (medical) components of the IEP and related health care plans, as appropriate. • MO HealthNet components include any services that MHD funds under Medicaid-- OT, PT, speech and language, audiology, behavioral health, private duty nursing and personnel care services, as well as other medical services.

47. Section 504 of the Rehabilitation Act of 1973 Section 504 of the Rehabilitation Act of 1973 • Requires schools to provide or pay for certain services to make education accessible to students with disabilities. • These services are described in a 504 plan. • The 1903(c) exception is very specific—it does NOT extend to services described in a Section 504 Plan. • What does this mean? No activities related to Section 504 can be coded with a “B” code.

48. RMS Form Review(continued) Let’s talk through the activity codes…..

49. Cost Data/PPR Guidelines Do not make any changes on the personnel tab when reporting costs. How to handle changes associated with replacements or name changes. Note:We must be able to match the costs being reported to a position/name which was on the original roster used to generate RMS samples for the quarter. No costs have been reported for any person/position that was not subject to RMS sampling for the quarter.

50. Cost Data/PPR Guidelines • Costs have been reported for all contracted positions on the roster. • How to indicate zero costs for a position listed on the PERSONNEL tab. • Do not report any salary or benefit amounts which were paid with federal dollars. (Through Q3-13) • Proportionate costs for private/parochial students • Stay tuned for webinar eblast on how costs will be reported beginning Q4-13. • For positions which are split funded, no costs have been reported which were paid through function codes 2320-2329.