Medicaid Time Study Training for Alaska Public Health Nursing

1. Medicaid Time StudyTraining for Alaska Public Health Nursing How to Use the Web-Based Time Survey for Medicaid Claiming -- June 2011 --

2. About today’s training session • Brief look at who, what, when, where, why • Main focus of training is how to complete survey • Lots of discussion about coding • Time for Q & A DPH Nursing Time Study Training

3. Whowill participate? • All public health nurses (I/II/III) and health practitioners • Basic rule – SOPHN nurses who provide services to the public • List of participants is updated each quarter by Regional Nurse Managers and DPH Director’s Office DPH Nursing Time Study Training

4. What is this survey for? • Medicaid pays for many activities performed by the Section of Public Health Nursing– this time study is necessary to make our claim. • The survey is a random sample that determines the percentage of time spent by Public Health Nurses and Health Practitioners providing services to Medicaid-eligible clients. DPH Nursing Time Study Training

5. When will the survey occur? • All participants will be surveyed 5 times per quarter– 20 survey days per year • Survey dates to be chosen randomly by computer • Time study will be administered simultaneously – all participants do it on same 5 survey days DPH Nursing Time Study Training

6. Where will I do this? • At your computer – the time study is completely web-based • Itinerants can print and take a paper survey on the road, then complete the time study when they return – the survey stays open for 10 days • You will be notified about the survey 5 days before the actual survey day DPH Nursing Time Study Training

7. So, how will this work? • 5 days before survey, you’ll receive an email notifying you of the survey date • On the survey date, you’ll get a second email with instructions and link to survey website • Record what you do that day on the log provided • You’ll open the survey, fill it out and – once it’s complete – click on ‘Save Survey’ • That’s it – you’re finished DPH Nursing Time Study Training

8. How… Completing the log Fill in an appropriate activity description for each 15 minute interval you work that day Select the appropriate code for each activity If working with a client, record the client’s record number next to that activity DPH Nursing Time Study Training

9. How … Completing the survey 1. Select time period 2. Select main code for that time period 3. Select sub-code in pull-down menu, if needed 4. Click on ‘Save Survey’ DPH Nursing Time Study Training

10. Questions? • Information about the SOPHN Nursing time study can be found on these websites: http://www.mesd.k12.or.us/mac/alaska/ or http://in.dhss.ak.local/das/finance/toolbox/ DPH Nursing Time Study Training

11. Overview of the Survey Individual staff complete the survey one day per survey period Survey dates are randomly selected Time is surveyed in 15 minute increments (predominate portion of 15 minute interval) Staff time fall into any one of the ten activity codes DPH Nursing Time Study Training

12. The Medicaid Match The Section of Nursing Medicaid claim is computed using the Time Study, a Medicaid Eligibility Rate (based on a computerized Medicaid Match of the clients we see and the Medicaid Roster), and a federally set claim coverage rate This is why it is SO important to always get an accurate: Social Security #, Medicaid ID, and correct spelling for each client DPH Nursing Time Study Training

13. Medicaid Covered Services Federal Medicaid Program Reviewers have approved our Medicaid Match system, which adjusts the reimbursement generated by the Time Study Therefore, PHNs entering in their Medicaid time study codes do not need to consider whether clients are Medicaid eligible or not What is important is whether the “service” being provided is covered by Medicaid DPH Nursing Time Study Training

14. Reviewing the codes Only 10 main codes to describe your work A1 Outreach Related to Medicaid Services A2 Outreach Related to Non-Medicaid Services B1 Referral, Coordination or Training Related to Medicaid Services B2 Referral, Coordination or Training Related to Non-Medicaid Services C1 Transportation or Translation Related to Medicaid Services C2 Transportation or Translation Related to Non-Medicaid Services D1 System Coordination / Community Assessment of Medicaid Services D2 System Coordination / Community Assessment of Non-Medicaid Services E Direct Health Care Services F Other Work Activities DPH Nursing Time Study Training

15. Code A1 Outreach Related to Medicaid Services Interviews, group meetings, phone contacts or home visits that inform Medicaid-eligible and potentially Medicaid-eligible individuals and their families about the benefits and availability of services provided by the Medicaid program. Informing individuals and their families on how to access, apply for, use and maintain participation in health care resources including Medicaid, Early Periodic Screening, Diagnosis and Treatment (EPSDT), Denali KidCare (DKC), etc.; disseminating materials to inform children and families about Medicaid; helping fill out forms; and related staff travel and paperwork. DPH Nursing Time Study Training

16. Code A1 Sub-Codes in A1 Pop-Up Menu A1.1 Conducted individual or group session to inform Medicaid-eligible or potentially Medicaid-eligible individuals about the benefits and availability of services provided by Medicaid programs. A1.2 Disseminated materials to inform individuals or families about Medicaid; helped with applications / forms. A1.3 Checked a person's Medicaid status. A1.4 Contacted a pregnant woman or parent about the availability of Medicaid / DKC for prenatal and well-baby care programs. A1.5 Conducted a health education outreach program or campaign targeted specifically to Medicaid-covered services such as family planning, prenatal care, immunizations, etc. A1.6 Staff travel or paperwork related to outreach and application assistance for the Medicaid program. DPH Nursing Time Study Training

17. Code A2 Outreach Related to Non-Medicaid Services Activities that assist the patient/client in gaining access to non-Medicaid services, and effectively utilizing social services and community wellness programs. Examples of such non-Medicaid programs are: • Housing • Heating assistance • Food stamps and food banks • The Women’s Infant and Children (WIC) program • Foster care • Temporary Assistance for Needy Families (TANF) • Legal aid, etc… DPH Nursing Time Study Training

18. Code B1 Referral, Coordination or Training Related to Medicaid Services Making referrals for and coordinating the delivery of diagnostic and preventive service and treatment for health, vision, dental, developmental, mental health, substance abuse and other services such as specialty clinics. DPH Nursing Time Study Training

19. Examples of B1 • Staffing to coordinate Medicaid case plan services (participation in multidisciplinary team meetings, conferencing on health, developmental issues, consultations) • Gathering background information and supportive information, such as medical histories, writing case plans, or summaries and preparing and/or presenting materials for case review • Arranging for health services and coordinating services (i.e., psychological counseling, health, substance abuse counseling and consultation, inpatient services) • Conducting or attending training or education related to the delivery of Medicaid services • Related staff travel and paperwork DPH Nursing Time Study Training

20. Code B1 Sub-Codes in B1 Pop-Up Menu B1.1 Referred a person for medical, mental health, dental health and substance abuse evaluations, specialty clinics and other services covered by Medicaid/DKC. (Includes gathering information in advance of referrals) B1.2 Coordinated the delivery of medical health, mental health, dental health and substance abuse services covered by Medicaid/DKC. (Includes participation in multidisciplinary team meetings, conferencing on health, developmental issues, consultations, and preparing or presenting materials for case review) B1.3 Conducted or attended training or education related to the delivery of Medicaid services. B1.4 Participated in Medicaid time study. B1.5 Staff travel or paperwork related to Referral, Coordination and Training of Medicaid Services DPH Nursing Time Study Training

21. Code B2 Referral, Coordination or Training Related to Non-Medicaid Services Making referrals for and coordinating the delivery of non-Medicaid social services and community wellness programs (including housing, food stamps, food banks, WIC, foster care, TANF, preparedness activities, Title X, energy assistance, child care, after school programs, friendly visitor and vocational services) arranging transportation for these services and related staff travel and paperwork. DPH Nursing Time Study Training

22. Code B1 Examples “Answered phone calls regarding individual reproductive health concerns and a pregnancy test” “Working on the vaccine accountability book” Responding to e-mails regarding immunization clinic and community health assessment (if the IZ clinic e-mail is what took the most time) DPH Nursing Time Study Training

23. Code C1 Transportation or Translation Related to Medicaid Services Assisting an individual to obtain transportation to services covered by Medicaid and/or arranging for or providing translation services to facilitate access to Medicaid services. Include related paperwork, clerical activities or staff travel required to perform these activities. DPH Nursing Time Study Training

24. Code C1 Sub-Codes in C1 Pop-Up Menu C1.1 Scheduled or arranged transportation to Medicaid covered services (not as part of the direct services billing for transportation) C1.2 Scheduled, arranged or provided translation for Medicaid covered services (translation for access to or understanding necessary care and treatment) C1.3 Staff travel or paperwork related to Medicaid transportation and translation (not as part of the direct services billing for transportation) DPH Nursing Time Study Training

25. Code C2 Transportation or Translation Related to Non-Medicaid Services Assisting an individual to obtain transportation to services not covered by Medicaid, or arranging for or providing translation services related to social, vocational, or educational programs. Include related paperwork, clerical activities or staff travel required to perform these activities. DPH Nursing Time Study Training

26. Code D1 System Coordination / Community Assessment Related to Medicaid Services Working internally and with other agencies to improve Medicaid health services, identify gaps in services, improve capacity and expand access to community medical and health services and their utilization by Medicaid-eligible target populations; gathering information about the target population to improve early identification of health and developmental problems; and related staff travel and paperwork. DPH Nursing Time Study Training

27. Code D1 Sub-Codes in D1 Pop-Up Menu D1.1 Worked internally or with other agencies and/or providers to improve the coordination and collaboration and delivery of medical, mental health and substance abuse services, including workgroups, coalition building and planning for community health fairs or roundups. D1.2 Staff travel or paperwork related to System Coordination and Community Assessment Related to Medicaid Services DPH Nursing Time Study Training

28. Code D2 System Coordination / Community Assessment Related to Non-Medicaid Services Working internally and with other agencies to improve social services, identify gaps in services, expand and improve capacity to engage in non-Medicaid activities, expand access and linkage to non-Medicaid services, their utilization by target populations; and related staff travel and paperwork. DPH Nursing Time Study Training

29. Code D1 Examples “Talking to nurse manager of an OB dept. about the SHOTS Survey” “Reading about child health indicators” Preparing for leading a MAPP meeting or local immunization coalition meeting Attending a training on how to determine STD rates within your community DPH Nursing Time Study Training

30. Code E Direct Health Care Services Providing direct health care services to a patient, such as well baby checkups, immunizations, disease management, epidemiological investigation, counseling, and medical case management or other activities that are an integral part or extension of a patient visit. Included is all related paperwork, clerical activities, staff time, or travel required to perform these services. DPH Nursing Time Study Training

31. Code E Direct Health Care Services: Sub-Codes in E Pop-Up Menu E1 – Adult Medicaid Services E2 – Adult Non-Medicaid Services E3 – EPSDT / Children’s Medicaid Services E4 – Children’s Non-Medicaid Services E5 – Prenatal and Postpartum Medicaid Services E6 – Prenatal and Postpartum Non-Medicaid Services E7 – Family Planning Medicaid Services E8 – Family Planning Non-Medicaid Services E9 – Breast and Cervical Medicaid Services, after diagnosis DPH Nursing Time Study Training

32. What is and isn’t a Medicaid Service Everything on our fee-for-service is covered by Medicaid If anyone has a question regarding whether a service is or isn’t covered, locate the treatment code and contact the QA/QI Consultant Unless it is a separate federal program it should be covered DPH Nursing Time Study Training

33. Code F Other Work Activities Paid work activities that do not fall under one of the above categories. This includes time off for vacation, sick leave, family leave, holidays, jury duty and breaks. Such activities also may include maintaining inventories, ordering and stocking supplies, developing budgets and related paperwork, clerical activities or staff travel. DPH Nursing Time Study Training

34. Get the “F” Out! • These are activities requiring no application of nursing-specific knowledge • Examples: • Inventorying general office supplies • Breaks during work • Photocopying or other general clerical work • Basically, those activities that do not require your nursing education/knowledge or decision making skills DPH Nursing Time Study Training

35. Questions?Scenarios? DPH Nursing Time Study Training

36. Theoretical coding examples • PHN does a STD contact investigation on a recently confirmed positive. 1.5 hours • (Code E7) • PHN sees mom and 2-year-old son in office. Mom concerned about a possible ear infection and heard the nurse will check the child’s ears. PHN is also worried about infection and refers son to local clinic for diagnosis and treatment. Mom worried about paying. 30 minutes • (Code B1.1) • During same visit, PHN educates client regarding Denali KidCare and helps mother complete application. 15 minutes. • (Code A1.2) DPH Nursing Time Study Training

37. Theoretical coding examples • PHN participates in meeting of local multi-agency coalition working to make sure community is prepared and has needed info in case of flooding. 3 hours • (Code D2) • PHN talks with Community Health Aide about dentist’s upcoming village visit and specific children the PHN wants the dentist to see on this trip. 30 minutes. • (Code D1.1) • PHN calls a mom at home, gives her bus schedule times and address for state office where she can apply for WIC and Food Stamps. 15 minutes. • (Code C2) DPH Nursing Time Study Training

38. Things to remember • IMPORTANT - Always record client’s Medicaid ID number on encounter form; it’s critical on survey days • Think preponderance of work in each time block • Can break up visits [i.e., 45 minutes direct services (Code E) for well-child exam, 15 minutes outreach (Code A1) in same visit for explaining benefits of Denali KidCare] • If the “service” is Medicaid reimbursable, we can claim it, regardless of whether the client has Medicaid or not • Lunch is unpaid time, so do not code it at all DPH Nursing Time Study Training

39. Contact information Coding questions? • Your Regional Nurse Manager • Sean Armstrong QA/QI Nurse Consultant, 465-8243 sean.armstrong@alaska.gov • Annette James SOPHN Deputy Chief 465-8625 annette.james@alaska.gov • Rhonda Richtsmeier SOPHN Chief 465-3151 rhonda.richtsmeier@alaska.gov DPH Nursing Time Study Training

40. Contact information Technical / IT questions? • Regional Nurse Managers may call Wendy Chase, Multnomah Education Service District, 503-257-1775 wchase@mesd.k12.or.us • Maria Abella, Division of Public Health Office of the Director, 465-8426 maria.abella@alaska.gov DPH Nursing Time Study Training