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School-Based Medicaid Programs

School-Based Medicaid Programs. Mississippi Department of Education Lea Ann McElroy, Director Bureau of Health Services. Former Surgeon General Dr. Antonio Novello

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School-Based Medicaid Programs

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  1. School-Based Medicaid Programs Mississippi Department of Education Lea Ann McElroy, Director Bureau of Health Services

  2. Former Surgeon General Dr. Antonio Novello “Health and education go hand in hand: one cannot exist without the other. To believe any differently is to hamper progress. Just as our children have a right to receive the best education available, they have a right to be healthy. As parents, legislators, and educators, it is up to us to see that this becomes a reality.” Healthy Children Ready to Learn: An Essential Collaboration Between Health and Education, 1992

  3. Is student health the missing link in school improvement?

  4. The State of School Health in Mississippi • Asthma • #1 reason for school absenteeism • Diabetes • #2 state in the nation for Type II diabetes • Obesity • #1 state in the nation for obesity rates • Medications • More than 3.5 million schoolchildren take medication at school

  5. MASLOW’S HEIRARCHY AND COORDINATED SCHOOL HEALTH Health Education Motivated and Learning Physical Education Health Services Nutrition Services Sense of Positive Self-Esteem Counseling, Psychological and Social Services Sense of Belonging and Importance Sense of Being Loved and Appreciated Healthy School Environment Health Promotion for Staff Family/Community Involvement Free of Fear and In A Safe place Physical Health

  6. Coordinated School Health Program Physical Education Health Education Family and Community Involvement Health Services Health Promotion for Staff Nutrition Services Healthy School Environment Health Education

  7. Working together for the health of our children! MDE Student Health Medicaid

  8. What is Mississippi Cool Kids (EPSDT)? • A FREE health care program for Mississippi’s children ages birth through 21 who are eligible for Medicaid • A way for children to get medical exams, checkups, follow-up treatment, and special care they need to make sure they enjoy the benefits of good health

  9. What is Mississippi Cool Kids (EPSDT)? • Annual exam for children/youth ages 2 – 21 • Mandatory periodic screening services include: • Comprehensive physical exam • Developmental assessment • Oral health assessment • Vision and hearing screens • Adolescent counseling • Referral if necessary

  10. We’re Number 1! • Mississippi is leading the way as the first state to offer EPSDT services through school nurses! • That means that with a Registered Nurse (RN) in a school-based clinic, a school can become a Medicaid Provider for EPSDT services, and file for reimbursement from Medicaid for each approved screening. Eligible population would determine level of sustainability.

  11. EPSDT Program Objective • Establish well qualified RN’s to provide school based EPSDT services to every eligible child • Finance the RN’s cost to the school in whole or in part thru the provision of EPSDT services

  12. What do we want you to do? • District/school administration will support program • District will establish clinic in a school site with qualified RN • School will include parental permission slips in school registration process and develop and implement a defined process to compile parental permission slips for RN • School will provide informative meetings for school faculty and parents

  13. What will we do for you? • Provide assistance with Medicaid provider enrollment application • Provide template permission slips; communication materials for parents; contracts and other written material • Provide template PowerPoint presentations for faculty, teacher and parent presentations

  14. What will we do for you? • Provide periodic training • Provide day-to-day administrative support • Provide help/assistance for Screen Plus software

  15. What does the EPSDT School Nurse really do? • Consent forms • Verify Medicaid numbers • Periodicity schedule/schedules appointments • Screens children (1 hour per screening on average) • Files paperwork/submits claims • Follow up/referral

  16. Is the program making a difference?

  17. The Business of EPSDT

  18. Time is Money!

  19. Time for screenings + Dollars = Sustained Program

  20. Teamwork is critical to success!

  21. Teamwork = WIN-WIN! • Improved classroom behavior • Improved academic performance • Reduced absenteeism ** • Onsite access to healthcare for students and faculty • Coordinated effort for improved health education • Additional funding for coordinated school health

  22. **Reduced absenteeism means… (2007-2008 figures) • Statewide Enrollment: 493,302 • ADA Statewide: 470,879 • Statewide Attendance: 95% • $4,574 per student based on fully funded MAEP • Statewide schools leaving $102,562,802 on table (not taking into consideration local contribution)

  23. **Reduced absenteeism means… • School District: 3,000 Students • Each 1% attendance improvement = $137,220

  24. What is School-Based Administrative Claiming (SBAC)? • A federally funded program administered by the Division of Medicaid in coordination with MDE • A program that allows school districts to be reimbursed for some of their costs associated with school-based health and outreach activities which are not claimable under the Medicaid School Health-Related Services program or other Medicaid “fee-for-service” programs

  25. What is School-Based Administrative Claiming (SBAC)? • In general, the types of school-based health and outreach activities funded under SBAC are: • Referral of students/families for Medicaid eligibility determinations • Provision of health care information and referral • Coordination and monitoring of health services • Interagency coordination

  26. How does it work? • Roster of participating employees • Time samples – Random Moment Samples (RMS) • Cost data • Reimbursement!

  27. School-Based Administrative Claiming and the Office of Healthy Schools • Bringing the process “in-house” and eliminating the third-party administrator School MDE DOM

  28. School-Based Administrative Claiming and the Office of Healthy Schools • Designing a web-based reporting system to automate the process • Processing claims in a timely manner • Consistency and accountability

  29. School-Based Administrative Claiming Program Guide • Overview of SBAC • Implementing SBAC • Staff Activities Included Under SBAC • Time Study Participants • The Time Study Process • Training for SBAC • Time Study Results and the Cost Allocation Process • Preparing an Invoice for Medicaid Payment • Monitoring and Quality Assurance

  30. SBAC Training Modules • Three Levels • RMS Participant • SBAC District Coordinator • MDE SBAC Specialist • Training is designed incrementally, based on the knowledge needed for the level of participation • Each level has a relationship to the entire process • Each level is dependent on the other

  31. Level 1 – RMS Participant • What is Medicaid? • Who/what is covered? • What is EPSDT/Mississippi Cool Kids? • What is SBAC? • What is a RMS? • Who can be sampled? • Why must I do this? • What do I have to do? • How do I fill out the form? • True/False test

  32. Level 2 – SBAC District Coordinator and District Business Manager • Most essential functions • Mainly computer manipulation • Quality control • Assurance that deadlines are met • Audit compliance piece

  33. Level 2 – SBAC District CoordinatorMajor Steps (Employee Roster) • Generate initial roster • Document participant training by deadline • Remove untrained participants by deadline • Submit trained roster by deadline

  34. Level 2 – SBAC District CoordinatorMajor Steps (RMS forms) • Track participants’ receipt, completion, and return of RMS forms during the quarter • Verify a percentage of RMS forms • Submit completed RMS forms by deadline

  35. Level 2 – District Business Manager Major Steps • Submit cost data by deadline • Roster participant salaries • Other cost data • Create invoice • Certify invoice for payment

  36. SBAC Web-Based Reporting System

  37. User Control Panel/Functions

  38. Employee Roster

  39. RMS Participant Training

  40. Early Success! “The training this morning was really helpful. In light of this extremely busy time for financial people, it was really awesome to see that so much time and effort was put into making this process as painless and as user friendly as possible!” “I think this new system is going to be GREAT!!! It is obvious the amount of time and effort that has gone into making this successful!! It all seems very organized and easy to use!!”

  41. Early Success! “Thanks for your help! We only have four people left to do their training and our roster has only been up for two days. This is much easier than trying to train people in person.” “I have migrated my SBAC employees. It was so easy. Thanks for the great job y’all do in making things easier.”

  42. What is the School Health-Related Services Program? • Designed to identify children who have a learning problem because of a medical problem which requires special services • Services include: • Speech/language therapy and evaluations • Occupational therapy and evaluations • Physical therapy and evaluations • Psychological evaluations • Psychotherapy services

  43. Speech/Language Services • Services for speech, hearing and language disorders means diagnostic screening, preventive or corrective services provided by or under the direction of a speech pathologist for which a patient is referred by a physician . • Services must be provided by a speech pathologist licensed in the State of Mississippi.

  44. Speech/Language Services • The individual must also meet Federal regulation licensure requirements: • Has a certificate of clinical competence from the American Speech-Language Hearing Association (ASHA) • Has completed the equivalent educational requirements and work experience necessary for the certificate; or • Has completed the academic program and is acquiring supervised work experience to qualify for the certificate

  45. What we’re doing to help! • 07-08SY - Pilot program to test a web-based system for reporting speech therapy claims • 08-09SY – Roll out system to all interested schools currently billing for speech therapy

  46. Proposed Policy for Expenditure of Medicaid Funds • School districts shall spend no less than ninety percent (90%) of the revenue from school-based Medicaid programs on health-related services, including but not limited to, personnel, supplies, equipment, and/or curriculum, available to all students as part of an eight-component coordinated school health program. These funds should supplement, not replace, other funds available for the same purpose. • The purpose of this policy is to ensure that maximum funds be expended to meet the health needs of all students, ensure adequate health and physical education, instill healthy nutritional choices, and contribute to the academic achievement of students.

  47. Sources & Uses of Funds

  48. Contact Information MS Dept. of Education Lea Ann McElroy, Director Bureau of Health Services 601-359-3189 lmcelroy@mde.k12.ms.us

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