acp training

1. Pennsylvania Administrative Claiming Program (ACP) 2010-2011 school year

3. Overview In meeting students’ educational needs, LEA staff members often find themselves delivering services that help ensure students are healthy and ready and able to learn. The school setting provides an opportunity to enroll children in the Medical Assistance (MA) Program or to assist children and their families who are already enrolled to access the MA services that are available to them.

4. Overview ACP allows LEAs to receive federal Medicaid reimbursement in addition to the School-Based ACCESS Program (direct services revenue). LEAs are eligible to receive MA reimbursement for certain administrative activities that are in support of the state’s Medicaid plan. This does not include direct services to students.

5. Overview LEAs eligible to participate: School districts IUs Charter Schools Approved Private Schools

6. Overview The program is administered by the Department of Education in conjunction with the Department of Public Welfare (DPW). The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for overseeing the program.

7. Overview One-week quarterly time studies held three times per year capture staff time Must represent tasks as they relate to the participants’ job descriptions Must capture 100% of participants’ time

8. Participation Steps Designate an ACP coordinator Select participants (staff who potentially have claimable time) Social workers Counselors Nurses Special education supervisors Early Intervention supervisors Home health visitors Behavioral support staff Special education teachers

9. Participation Steps Train staff Leader trains train-the-trainer online tutorial Sign Agreement to Participate form Select time-study week (three times per year) Upload participants’ salaries/benefits and hours worked Upload student roster

10. Participation Steps Complete time sheets in 15-minute increments using either: Paper time study forms Leader’s PA Administrative Time Study (PATS) web system Review completed time study data for accuracy Sign Certification of Time Study Forms

11. Time Study Schedule

15. Program Codes The following screens define the program codes (A through J) and list examples of typical staff activities that would apply for each code. For all codes, include the time spent on paperwork, travel and clerical time associated with the predominant activity.

16. Code A – Medicaid Outreach

17. Code A – Examples Assisting the Medicaid agency to fulfill outreach objectives of the Medicaid program by informing students and their families on how to effectively use and maintain participation in all health resources under the Medicaid Program. Conducting Medicaid outreach campaigns and Medicaid outreach activities such as developing outreach materials that explain the availability and benefits of the Medicaid Program.

18. Code B – Non-Medicaid Outreach Definition: This code should be used when performing activities that inform eligible or potentially eligible individuals about non-Medicaid, social, vocational and educational programs.

19. Code B – Examples Conducting general health-education programs or campaigns addressed to the general population (e.g., DARE, dental hygiene, anti-smoking, alcohol reduction). Developing and distributing non-Medicaid outreach materials. Scheduling and promoting extracurricular activities, sports, and after-school programs.

20. Code C – Assisting with Medicaid Eligibility Definition: This code should be used by staff when assisting an individual or family in the Medicaid-eligibility process.

21. Code C – Examples

22. Code D – Assisting with Non-Medicaid Eligibility Definition: This code should be used by staff when assisting an individual or family in becoming eligible for non-Medicaid social, vocational and educational programs, including special education.

23. Code D – Examples Assisting an applicant to complete the eligibility applications for non-Medicaid programs such as food stamps, WIC or legal services. Verifying initial and continuing eligibility for non-Medicaid programs.

24. Code E – Referral, Coordination, & Monitoring of Medicaid or Mental Health Services Definition: This code should be used by staff when making referrals, coordinating and/or monitoring the delivery of medical or mental health services. Examples of staff providing these types of services would include members of an instructional support team, multidisciplinary team, teachers, counselors and nurses not involved in the provision of the direct treatment plan.

25. Code E – Examples Making referrals for and/or coordinating medical and mental health evaluations. Arranging for any medical or mental health diagnostic or treatment services which may be required as a result of a specifically identified medical or mental health condition. Following up to ensure that a student received the prescribed medical or mental health IEP services.

26. Code F – Referral, Coordination, and Monitoring of Non-Medicaid Services Definition: This code should be used by staff when making referrals for, coordinating and/or monitoring non-medical/Medicaid services.

27. Code F – Examples Making referrals for, coordinating, and monitoring access to social and educational services such as child care, employment, job training, housing, food, and heating. Monitoring and evaluating the non-medical components of a student’s IEP, as appropriate. Participating in or coordinating training for programs other than Medicaid.

28. Code G – Program Planning, Policy Development & Interagency Coordination Related to Medical Services Definition: This code should be used by staff when performing collaborative activities with other agencies to improve the cost effectiveness of health care service delivery system; improve the availability of services; focus services on specific population groups or geographic areas in need of special attention; or define the scope of each agency’s programs.

29. Code G – Examples Working with other agencies that provide Medicaid services to improve the coordination and delivery of services, to expand their access to specific populations of Medicaid eligibles, and to improve collaboration around the early identification of medical or mental health problems. Monitoring the medical/dental/mental health delivery systems in schools.

30. Code H – Direct Medical, Therapeutic and School Health-Related Services Definition: This code should be used when providing direct care, counseling or treatment to a student to correct a condition. This code also includes collateral activities that are an integral part of, or extension of, a direct health-related service.

31. Code H – Examples Conducting assessments, evaluations and diagnostic testing and preparing related reports. Providing speech therapy, occupational therapy, physical therapy and other therapies. Conducting mandated routine school health screens. Coordinating, preparing or processing paperwork required for SBAP billing.

32. Code I – School-Related, Educational and Social Services Activities Definition: This code should be used for any school-related activity that is not health-related, such as social services, educational services and teaching services. These activities include the developing, coordinating and monitoring of a student’s educational plan.

33. Code I – Examples Providing classroom instruction, testing, correcting papers. Attending an IEP meeting. Holding a parent/teacher conference about a student’s discipline problems. Providing general supervision of students (e.g., playground, lunchroom).

34. Code J – General Administration Definition: This code should be used when staff performs activities for the administration of the local education agency. These include paperwork, clerical activities or staff travel required to perform these activities.

35. Time Sheet Form (page 1)

36. Time Sheet Form (page 2)

37. Reporting of Funds The LEA receives a check from the Commonwealth approximately 6-8 weeks following the time study’s conclusion. No mandate exists on how the funds must be spent. These funds, received for administrative costs incurred for services that are in direct support of the Medicaid Program, are recorded to Code 8820.

38. Contact Information www.pattan.net Roni Russell - PDE rrussell@pattan.net Tom Seben – PDE tseben@state.pa.us Gloria Grego – Leader Services ggrego@leaderservices.com www.leaderservices.com