Florida Department of Children and Families Community Based Medicaid Admin. Claiming Random Moment Time Study RMTS Tra

1. FloridaDepartment of Children and Families Community Based Medicaid Admin. ClaimingRandom Moment Time Study (RMTS) Training March 2009 (v. 2)

2. Presentation Contents Why Do We Complete the Time Study? What is the Role of Provider Staff? Email-Based System Overview Examples of How the Email-Based System Works Live Demonstration of Email-Based System Paper-Based Process Overview

3. Presentation Contents (Continued) Some Things to Remember! What Should I Do if I Have Any Questions? Which Box Should I Check? Detailed Description/Examples of Activity Codes Questions RMTS Quiz!

4. Why Do We Complete the Time Study? The time study is required to determine the amount of time (and cost) spent on various activities, totaling 100% of time and activities. Based on these results, we determine the amount that can be charged to various funding sources.

5. What is the Role of Provider Staff? Providers play the most critical role in facilitating and carrying out the time study process! Role of Time Study Coordinators Key contact for RMTS Ensure all staff are trained on the RMTS Follow-up with staff that are not responding to their moments in a timely manner Update the participant rosters monthly, including adding/deleting workers and verifying work schedules Distribute and compile paper-based forms, if necessary Notify PCG if staff are out on extended leave Role of Time Study Participants Be knowledgeable of time study codes/definitions Check email account regularly if using email-based system Respond to moments in a timely manner Call the hotline or email us if you need assistance

6. Email Based System Overview Beginning April 1, 2009, the RMTS will be implemented statewide. Those providers with email capability will receive moments via email. You will receive an email notification a few minutes after your moment. You will then logon to a secure website using the user name and password provided in the email. You will respond to a series of questions, each with a list of options, and also provide a description of the activity you are performing. Please Note: This system uses an encrypted connection methodology. All data transferred and collected is secure and confidential. It is expected that you respond to your moment as soon as possible and within 24 hours. You will receive follow-up emails after 24 hours, 48 hours and 72 hours if you have not recorded your moment in the RMTS system. If you are on leave, please respond when you return to the office.

7. Example: How the Email Looks Email text: Hello, This is to notify you that you have been randomly selected to complete a random moment time study (RMTS) for the Florida Department of Children and Families - Community Based Medicaid Administrative Claiming. Upon receipt of this email, if you require additional training or have any questions, please email us at fldcfmac@pcgus.com or call the hotline at 1-866-436-7155. The hotline hours are Monday through Friday, 8:30 am – 5:30 pm; however, you may leave a message at any time. The date and time of your moment is: Mar 5 2009 2:58PM If you are unable to respond at the time of your moment, it is expected that you respond within 24 hours. If you do not respond, you will receive a reminder to complete the time study for your sampled moment 24 hours, 48 hours and 72 hours after the moment. If you are on leave, please respond when you return. Please logon to https://easyrmts.pcgus.com/DTARMTS/LoginCheck.aspx?Client_Id=37674 to access your moment after the selected time. You can click on the website link or type the address into your web browser. Your username is KStanley37675 Your password is 99696824 Please note that the user name and password are case sensitive. Thank you for your response!

8. Example: Start Page

9. Example: Start Page (Continued)

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11. Example: Moment Page

12. Example – Client Related Activity: Activity Page

13. Example: Activity Page (Continued)

14. Example: Activity Page (Continued)

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19. Answering Multiple Moments

20. Paper Based System Overview Providers without email capability will utilize a paper-based system. PCG will provide Time Study Coordinators with the paper-based forms on a weekly basis, one week in advance, via email or mail (if email access is not available). The paper-based observation forms will contain the participant’s name, agency/location, and date and time of the moment. Providers with multiple sites/programs should ensure that each site has a Time Study Coordinator as well as Back-Up Coordinators (or Sample Takers) to assist with the distribution of the random moments. Time Study Coordinators or Sample Takers will deliver the paper observation forms to participants at the time of their moment.  Coordinators or Sample Takers will also ensure that participants have access to the activity code descriptions when responding to the moment. 

21. Paper Based System Overview (Continued) Participants will complete the observation form by answering the questions, describing the activity being performed, and signing/dating the form. The date must be the date that they complete the form. The Time Study Coordinator or Sample Taker will then sign/date the form. If a participant is away from his/her desk at the time of their moment, the Time Study Coordinator or Sample Taker is responsible for notifying the participant that they have been selected for a moment. This notification can occur by leaving a note, voice mail message or sending an email. If participants miss their moment, they must notify the Time Study Coordinator or Sample Taker that they have returned to their desk. The Time Study Coordinator or Sample Taker will then deliver the paper observation form to the participant.

22. Paper Based System Overview (Continued) It is the responsibility of the Time Study Coordinator or Sample Taker to ensure each form is completed and that participants have signed/dated the form. Time Study Coordinators or Sample Takers must review all information prior to leaving the participant. If a participant is on leave for more than five days, the Time Study Coordinator or Sample Taker may indicate this on the observation form, specifying whether the leave is paid or unpaid and signing/dating the form. The Time Study Coordinator or Sample Taker may also indicate on the form if the worker is no longer employed by the agency. Time Study Coordinators will mail the original observations forms to PCG on a weekly basis, no later than the end of the week that follows the sample week. Please refer to the Time Study Coordinator Check List for additional information or contact PCG staff!

23. Some Things to Remember! When you receive your assigned moment, take a minute to analyze your activity. Pick the answer that best reflects what you are doing at that moment. When providing a description of the activity you are performing, make sure the description supports the activity code you selected. Your narrative should be brief, but must clearly describe the activity you are performing. The descriptions you provide will be continually monitored for quality control purposes. When requested, make sure you enter the appropriate Client ID number. The only time this number is not required is if the client has not yet been assigned a number. Remember, this is a federal requirement and you will not be able to submit your moment unless you enter this information. You should not enter SSN or Medicaid ID numbers. All data entered into the system is secure and confidential. Moments are continually checked to identify workers entering “dummy” Client IDs and these workers are followed-up with by DCF and Time Study Coordinators.

24. Some Things to Remember! (Continued) Make sure you complete your moment ASAP. If you are out of the office, make sure it is completed as soon as you return. If you will be out of the office for a long period, please put on your Out of Office Assistant on your email system or notify your Coordinator. Only you can complete your moment. Your user name and password are confidential and cannot be shared with anyone. Once you submit your moment, you cannot change it. All moments are completely random. Each participant has the same chance of being selected for a moment.

25. Some Things to Remember! (Continued) Your Time Study Coordinator will be notified if you are not completing moments or if you are completing all of your moments. If you receive moments via email, your Time Study Coordinator will be cc’d on any follow-up emails you receive, reminding you to respond to your moment. Coordinators may never respond in the system on behalf of participants; participants must answer the survey.

26. What Should I Do if I Have Any Questions? If you are unsure about the activity categories or have any other time study questions, please contact us: Phone: 1-866-436-7155 Email: fldcfmac@pcgus.com

27. Which Box Should I Check? The activities are divided into several categories: Direct Medical and Behavioral Health Services Direct Non-Medical and Non-Behavioral Health Services Referral, Coordination and Monitoring of Medical and Behavioral Health Services Covered by Medicaid Referral, Coordination and Monitoring of Non-Medical and Non-Behavioral Health Services Not Covered by Medicaid Arranging for Client Assistance to Access Medical and Behavioral Health Services Covered by Medicaid Arranging for Client Assistance to Access Non-Medical and Non-Behavioral Health Services Not Covered by Medicaid Outreach for Medicaid Services Outreach for Non-Medicaid Services

28. Which Box Should I Check? (Continued) Facilitating an Application for the Medicaid Program Facilitating an Application for Non-Medicaid Programs Program Planning, Policy Development and Interagency Coordination Related to Medical and Behavioral Health Services Covered by Medicaid Program Planning, Policy Development and Interagency Coordination Related to Non-Medical and Non-Behavioral Health Service Not Covered by Medicaid General Administration Unpaid Time Off Grant Funded and Fundraising Activities Other Activities Not Scheduled to Work

29. 1. Direct Medical and Behavioral Health Services Staff use this code when providing direct medical and/or behavioral health care, treatment and/or counseling services including medical and behavioral health assessments and evaluations to an individual to correct or ameliorate a specific condition. This activity relates to services performed on behalf of an individual client and includes services that are directly billed to various funding sources including Medicaid. Includes all related paperwork, clerical activities, or staff travel required to perform these activities, such as updating charts with information from a specific direct service. Examples Include: Activities which are services or components of services, listed in the State’s Medicaid plan Any activity that may be claimed as Targeted Case Management (TCM) on behalf of a TCM eligible client. Individual and family psychotherapy Psychological testing Personal care assistance services

30. Direct Medical and Behavioral Health Services (continued) Providing billable transportation services Medication management Providing individual, family, or group counseling services to treat health, mental health, or substance abuse conditions Providing therapy services Performing developmental assessments Any staff time spent specifically working one-on-one or in group sessions with clients in Residential I, II, and III settings Documentation of direct medical and behavioral health services Participating in or providing training to improve the provision of direct medical/behavioral health services (this training would literally be related to the provision of these services)

31. 2. Direct Non-Medical and Non-Behavioral Health Services Staff use this code when providing services that are not medical/behavioral health in nature, such as education, employment, job training, or social services provided to clients. Includes all related paperwork, clerical activities or staff travel required to perform these activities. This activity is only to be used for the actual provision of the services, including below examples; time spent referring clients to services, such as vocational education, would be recorded as Activity Code 4 “Referral, Coordination, and Monitoring of Non-Medical and Non-Behavioral Health Services Not Covered by Medicaid”. Examples Include: Providing non-billable transportation (actual provision, not arrangement of travel) One-on-One time with a client that is not related to medical and behavioral health issues (e.g., teaching activities of daily living; assistance with shopping; assistance with financial issues and budgeting, etc.)

32. 2. Direct Non-Medical and Non-Behavioral Health Services (continued) Appearing in court or participating in forensic activities on behalf of a client Teaching vocational education Teaching wellness sessions or exercise programs Providing educational instruction Participating in or providing training to improve the provision of non-medical/behavioral health services

33. 3. Referral, Coordination, and Monitoring of Medical and Behavioral Health Services Covered by Medicaid Staff use this code when making referrals, coordinating, and/or monitoring the delivery of medical and behavioral health services. These activities include, but are not limited to: assessment, service planning, services linkage, ongoing monitoring, ongoing clinical support and advocacy for medical or behavioral health related services. Includes all related paperwork, clerical activities or staff travel required to perform these activities. Examples Include: Making referrals for and/or coordinating necessary medical, mental health, developmental disability, or substance abuse services covered by Medicaid Gathering any information that may be required in advance of referrals, evaluations and treatment for medical/behavioral health care services Preparing documentation for a case to be reviewed by a Utilization Review Team Participating in treatment plan team meetings or “staffings” to coordinate and monitor the medical/behavioral health portion of a client’s care with other staff Gathering information for facilitating prior authorizations

34. 3. Referral, Coordination, and Monitoring of Medical and Behavioral Health Services Covered by Medicaid (continued) Informing and explaining the client’s treatment plan to pertinent individuals, such as family or other staff (i.e., a case manager calls a client’s family to discuss the importance of the client’s bi-weekly group therapy attendance) Updating or documenting case or treatment plans related to the acquisition of services (not specifically related to a direct service that you as a clinician have just provided, which would be recorded as part of Activity Code 1 “Direct Medical and Behavioral Health Services”) Participating in or providing training to improve the effectiveness and efficiencies of the coordination of medical and behavioral health services Note: If you know you are billing TCM for a TCM eligible client, you should select Direct Medical and Behavioral Health Services.

35. 4. Referral, Coordination, and Monitoring of Non-Medical and Non-Behavioral Health Services Not Covered by Medicaid Staff use this code when making referrals for, coordinating, and/or monitoring the delivery of non-medical/behavioral health services such as educational, social, and vocational services. Includes activities related to assisting a client access SSI, TANF, Food Stamps, housing, vocational, and educational services, etc. Non-medical/behavioral health services include, but are not limited to assessment, service planning, services linkage, ongoing monitoring, and ongoing clinical support and advocacy for non-medical and non-behavioral health related services. Includes all related paperwork, clerical activities, or staff travel required to perform these activities. Examples Include: Providing information to individuals seeking assistance related to job-training, employment, housing, education, and social services Making referrals for and/or coordinating necessary job-training, employment, housing, education and social services Gathering any information that may be required in advance of referrals, evaluations, and services for job-training, employment, housing, education, and social services

36. 4. Referral, Coordination, and Monitoring of Non-Medical and Non-Behavioral Health Services Not Covered by Medicaid (continued) Participating in care-planning meetings to coordinate and monitor the non-medical/behavioral health portion of a client’s plan of care with other staff such as job-training, employment, housing, education, and social services Informing and explaining the non-medical/behavioral health components of a client’s care plan, such as family or other staff (i.e, case manager calls a client’s family to discuss the importance of a clients job training plan) Providing follow-up contact to ensure that an individual has received the defined non-medical/behavioral health services Updating case and treatment plans, specifically for these services Participating in or providing training to improve coordination of non-Medicaid services Note: If you know you are billing TCM for a TCM eligible client, you should select Direct Medical and Behavioral Health Services.

37. Arranging for Client Assistance to Access Medical/Behavioral Health Services Covered by Medicaid Arranging for or scheduling specific support provisions, such as transportation or translation assistance, which are necessary for an individual or family to access medical/behavioral health services. Includes related paperwork, clerical activities or staff travel required to perform these activities. Note: Providing Medicaid billable transportation services should be coded to Activity Code 1 “Direct Medical/Behavioral Health Services.” Providing non-Medicaid billable transportation services should be coded to Activity Code 2 “Direct Non-Medical/Behavioral Health Services.” This activity relates to arranging transportation and other client assistance only. Examples Include: Arranging for or providing translation or signing services that assist an individual or family in accessing and understanding necessary care or treatment

38. Arranging for Client Assistance to Access Medical/Behavioral Health Services Covered by Medicaid (Continued) Arranging or providing translation or signing services to assist in the completion of a Medicaid application Arranging for transportation for an individual or family to access medical/behavioral health services Participating in or performing training to assist clients to access medical/behavioral health services Note: If you know you are billing TCM for a TCM eligible client, you should select Direct Medical and Behavioral Health Services.

39. 6. Arranging for Client Assistance to Access Non-Medical/Behavioral Health Services Not Covered by Medicaid Arranging for specific support provisions such as transportation or translation assistance which are necessary for an individual or family to access non-medical/behavioral health, educational and social services such as SSI, TANF, Food Stamps, WIC, child care, housing assistance, legal aid, educational and social services. Includes related paperwork, clerical activities, training or staff travel required to perform these activities. Note: Providing Medicaid billable transportation services should be coded to Activity Code 1 “Direct Medical/Behavioral Health Services.” Providing non-Medicaid billable transportation services should be coded to Activity Code 2 “Direct Non-Medical/Behavioral Health Services.” This activity relates to arranging transportation and other client assistance only. Examples Include: Arranging for or providing translation or signing services that assist an individual or family accessing and understanding educational and social services

40. 6. Arranging for Client Assistance to Access Non-Medical/Behavioral Health Services Not Covered by Medicaid (Continued) Arranging for or providing translation or signing services to assist in the completion of day-care, legal, social service program applications Arranging for transportation for an individual or family to access educational, vocational and other social services. Participating in and performing training to assist clients to access non-Medicaid services Note: If you know you are billing TCM for a TCM eligible client, you should select Direct Medical and Behavioral Health Services.

41. 7. Outreach for Medicaid Services Staff use this code when performing activities that inform individuals about Medicaid, how to access Medicaid and medically related services, the importance of accessing medical, mental health, aging, developmental disability, and alcohol and drug services, and the importance of maintaining a routine place for health care. This includes activities designed bring persons into the Medicaid system. Both written and oral methods may be used. Includes all related paperwork, clerical activities, or staff travel required to perform these activities. Note: This activity does not relate to services performed in an “outreach” setting. Those activities should be recorded as Activity Code 1 “Direct Medical and Behavioral Health Services.” Examples Include: Developing, disseminating or presenting Medicaid outreach materials to inform individuals about Medicaid services and where to obtain services

42. 7. Outreach for Medicaid Services (Continued) Informing individuals and families about the benefits and availability of services provided by Medicaid Informing individuals and their families on how to effectively access, use, and maintain participation in all medical/behavioral health resources under the federal Medicaid program Assisting in early identification of individuals who could benefit from the medical/behavioral health services provided by Medicaid as part of a Medicaid Outreach Campaign Assisting the Medicaid agency to fulfill objectives of the Medicaid program by: Informing eligible individuals of the benefits of prevention Helping individuals and families use medical/behavioral health resources Assuring that medical/behavioral health problems are diagnosed and treated early Participating in or providing training to improve the effectiveness of Medicaid outreach

43. 8. Outreach for Non-Medicaid Services Staff use this code when performing activities that inform individuals about non-Medicaid social (e.g., SSI, Food Stamps, Title IV-E, TANF, WIC, housing, day care, etc.), vocational and educational programs and how to access them. Both written and oral methods may be used. Includes all related paperwork, clerical activities, or staff travel required to perform these activities. Examples Include: Providing information to individuals seeking assistance related to job-training, employment, housing, education and social services Scheduling and promoting activities which educate individuals about the benefits of healthy lifestyles and practices

44. 8. Outreach for Non-Medicaid Services (Continued) Developing, disseminating, or presenting non-Medicaid outreach materials to inform individuals about social , education and legal services and where to obtain services Conducting outreach campaigns directed toward encouraging persons to access social, educational, legal or job employment services Participating in or providing training to improve the effectiveness of non-Medicaid outreach

45. 9. Facilitating an Application for the Medicaid Program Staff use this code when assisting an individual or family to submit applications for Medicaid or referring them to the appropriate agency as well as assisting an individual to maintain Medicaid eligibility. Both written and oral methods may be used. Includes all related paperwork, clerical activities, or staff travel required to perform these activities. Note: This activity does not include the actual determination of Medicaid eligibility, which would not be performed by provider staff. Examples Include: Verifying an individual’s current Medicaid eligibility status for the purpose of the Medicaid Eligibility Process Explaining Medicaid eligibility rules and the Medicaid eligibility process to prospective applicants Assisting individuals or families to complete a Medicaid eligibility application and spend down activities

46. 9. Facilitating an Application for the Medicaid Program (Continued) Assisting individuals or families to collect/gather information and documents for Medicaid program applications Gathering information related to the application and eligibility for an individual, including resource information and Third Party Liability (TPL) information, as a prelude to submitting a formal Medicaid application Providing necessary forms and packaging all forms in preparation for the Medicaid eligibility determination Referring an individual or family to the local assistance office to apply for Medicaid benefits Participating as a Medicaid eligibility outreach outstation Participating in or providing training to learn how to assist an individual to complete a Medicaid application

47. 10. Facilitating an Application for Non-Medicaid Programs Staff use this code when assisting an individual or their family to apply for programs such as SSI, TANF, Food Stamps, WIC, child care, housing assistance, legal aid, and other social or educational programs and referring them to the appropriate agency to make application. This includes all applications other than Medicaid. Both written and oral methods may be used. Includes all related paperwork, clerical activities or staff travel required to perform these activities. Examples Include: Explaining the eligibility process for non-Medicaid programs Assisting individuals or families to collect/gather information and documents for the non-Medicaid program application

48. 10. Facilitating an Application for Non-Medicaid Programs (Continued) Assisting individuals or families in completing the application Developing and verifying initial and continuing eligibility for non-Medicaid programs Providing necessary forms and packaging forms in preparation for the non-Medicaid eligibility determination Participating in or providing training to learn how to assist an individual to complete a non-Medicaid social assistance program application

49. 11. Program Planning, Policy Development and Interagency Coordination Related to Medical and Behavioral Health Services Covered by Medicaid Staff use this code when performing activities associated with the development of strategies to improve the coordination and delivery of medical/behavioral health services to individuals and families, and when performing collaborative activities with other agencies to provide effective medical/behavioral health services. This code includes activities related to establishing and maintaining documentation, internal processes, and policies related to the provision of services. It also includes activities related to establishing and maintaining necessary provider resources. Includes all related paperwork, clerical activities or staff travel required to perform this activity. No time related to a specific client should be recorded here. Examples Include: Developing medical and behavioral health policies and procedures for center and program staff Developing internal plans and strategies that address the clinical capacity of medical/behavioral health services provided to individuals in the agency

50. 11. Program Planning, Policy Development and Interagency Coordination Related to Medical and Behavioral Health Services Covered by Medicaid (Continued) Developing treatment plan documentation guidelines (not client specific but related to overall program requirements) Analyzing and developing strategies to assess or increase the capacity of the medical/behavioral health delivery system in the community, especially for specific populations or geographic areas Educating law enforcement, county attorney, court systems regarding medical/behavioral health Recruiting health care providers including developing written materials in support of recruitment Working with other agencies (i.e., inter-agency coalitions, advisory boards) providing health care services to improve the coordination and delivery of services, to expand access for specific populations, and to improve collaboration around the early identification of medical/behavioral health problems

51. 11. Program Planning, Policy Development and Interagency Coordination Related to Medical and Behavioral Health Services Covered by Medicaid (Continued) Developing advisory or work groups of health professionals to provide consultation and advice regarding the delivery of medical/behavioral health care services to client populations Participating in or providing training to improve program, planning, policy development and interagency coordination related to medical and behavioral health services

52. 12. Program Planning, Policy Development and Interagency Coordination Related to Non-Medical/Behavioral Health Services Not Covered by Medicaid Staff use this code when performing activities associated with the development of strategies to improve the coordination and delivery of Non-Medicaid human services to individuals and families, and when performing collaborative activities with other agencies to provide non-Medicaid services. This code includes activities related to establishing and maintaining necessary provider resources. Includes all related paperwork, clerical activities, or staff travel required to perform these activities. No time related to a specific client should be recorded here. Examples Include: Developing strategies to assess or increase the capacity of social services Monitoring the delivery system for social services in the community Educating law enforcement, county attorney, court systems regarding community human services Recruiting providers including developing written materials in support of recruitment Evaluating the need for social services in relation to specific populations or geographic areas

53. 12. Program Planning, Policy Development and Interagency Coordination Related to Non-Medical/Behavioral Health Services Not Covered by Medicaid (Continued) Analyzing data related to a specific program, population, or geographic area to identify and close non-Medicaid service gaps for needy populations Working with other agencies providing human services to improve the coordination, collaboration, delivery of services, and to expand access to specific populations for needed human services Developing advisory or work groups of human service professionals to provide consultation and advice regarding the delivery of social services to client populations Developing referral sources such as directories of community human services that provide services to targeted population groups Building housing stock for clients (e.g., leasing apartments, identifying housing resources, etc.) Participating in activities that assure compliance with regulations and improve delivery and efficiency of non-Medicaid services Participating in or providing training to improve program, planning, policy development and interagency coordination related to non-medical/behavioral services

54. 13. General Administration Staff use this code when performing activities that cannot be directly assigned to program activities. Includes all related paperwork, clerical activities or staff travel required to perform these activities. No time related to a specific client should be recorded here. Examples Include: Taking lunch, breaks Paid leave; paid administrative leave; vacation, sick and funeral Attending or facilitating unit staff meetings, training, or board meetings Providing general supervision of staff and evaluation of employee performance Preparing or reviewing payroll or other personnel related documents Maintaining inventories and ordering supplies

55. 13. General Administration (Continued) Insurance and/or Risk Management activities related to the agency as a whole and no specific service or program Developing budgets and maintaining records Daily operational tasks, such as setting up voice mailbox Providing general information about site and program (e.g., hours, general information on services provided, intake process, etc.) Performing other administrative or clerical activities related to general building functions or operations Participating in or providing training to learn about agency benefits and/or Human Resource training

56. 14. Unpaid Time Off This code should be used when the staff person being sampled is on an unpaid lunch break or other type of unpaid break or on an extended unpaid leave of absence. This also includes time spent working on another program that is NOT part of this time study, such as an inpatient or residential program. Examples Include: Taking unpaid lunch/breaks Unpaid leave Working for a program that is not part of the time study (such as an inpatient program) at the time of the random moment. (This examples applies to staff that work for multiple programs.)

57. 15. Grant Funded and Fundraising Activities This code should be used for any time that a staff person is working on a task or application specifically for an outside grant (e.g., United Way, not-for-profit, other federal funding source, etc.). It should also be used for any fundraising activities conducted by a provider organization to raise funds.

58. 16. Other Activities This code should be used for activities that are not related to the above and are outside of normal work activities. This includes emergency response or being “activated” to assist with an emergency or natural disaster. This activity should never be used for vacation or other break time!

59. 17. Not Scheduled At Work This code should be used when the staff person being sampled is not scheduled to be at work (i.e., their day has not started, they are part-time, they are carrying pager but not “in action”, etc.).