MO HealthNet School District Administrative Claiming New Coordinator Orientation Training (SDAC)

1. MO HealthNet School District Administrative Claiming New Coordinator Orientation Training (SDAC) August/September 2013 Presented by the MSBA Medicaid Consortium

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/school-district-administrative-claiming.html

3. Agenda What is SDAC? Coordinator Roles and Responsibilities Complete walk through of the entire SDAC process

4. Terminology and Acronyms Medicaid (Federal term) = MO HealthNet (MO term) MO HealthNet Division = MHD Department of Social Services = DSS Centers for Medicare and Medicaid Services = CMS School District Administrative Claiming = SDAC Random Moment Sample = RMS

5. What is MO HealthNet? MO HealthNet is a federally funded, health insurance program for low income and needy people. For children under age 21, the federal program is called Early & Periodic Screening, Diagnosis and Treatment or EPSDT Program. In Missouri, EPSDT is referred to as the Healthy Children and Youth program or HCY.

6. 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.

7. Examples of MO HealthNet / EPSDT Covered Services

8. What is School District Administrative Claiming (SDAC)? Outreach to MO HealthNet & HCY Assistance with the MO HealthNet Application Process Referring Students for Health Services Coordination with other Health Care Providers Arranging for Special Transportation MO HealthNet / Medical Training FOR ALL CHILDREN POTENTIALLY ELIGIBLE FOR MO HealthNet

9. What is SDAC? SDAC 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.” (MO HealthNet School District Administrative Claiming Manual, Section 4)

10. Five Tab Template Districts are to provide all reports on approved Excel Template 1-Instructions 2-Personnel Roster–due quarterly 6-8 weeks prior to quarter 3-Cost Data-due month after the sampled quarter ends 4-PPR (Provider Participation Rate)-due month after the sampled quarter ends 5-Quarterly Certification of Expenditures Instructions-due after your Cost Data/PPR have been validated

11. Personnel Roster: Job Classifications Speech-Language Pathologists/Assistants Audiologists/Assistants Occupational Therapists/Assistants Physical Therapists/Assistants Social Workers Psychologists Counselors Diagnosticians Physicians Registered Nurses/Licensed Practical Nurses/School Health Aides Interpreters Orientation and Mobility Specialists Bilingual Specialists Administrators for Special Education Student Services Personnel Augmentative Specialists Dietitians Respiratory Therapists Liaisons for Special Education Other school district staff who routinely engage in MO HealthNet reimbursable administrative activities

12. Quarterly Personnel Rosters Name the Excel File: School District name Six-Digit DESE code Personnel Roster Quarter Example: Missouri R-I, 000-000, Personnel Roster, Q4-13.xls

13. RMS General Directions “Description”—remarks should answer all the following questions: Who were you with? What were you doing? What was the immediate intended result? Activity Code: Select proper activity code based upon “Activity Description” Position Section: Check one. If not in list, type in position name next to “Other_____”

14. RMS General Directions It is important to note that for Administrative Claiming activities it is NOT necessary to know which children are MO HealthNet eligible.

15. RMS General Directions Review of RMS Observation Form 10% of all forms from your district are to be reviewed Coordinator on their own must verify the sampled staff accurately completed the observation form. Coordinator can mark a form reviewed by clicking “Mark Reviewed” in therapylog and then confirming by clicking okay that they have completed this step.

16. RMS General Directions Validation of RMS Observation Form 10% of all forms from your district are to be validated Coordinator must verify by phone or in person that the sampled staff accurately completed the observation form. Coordinator validates a form by clicking “Mark Validated” in therapylog and then confirming by clicking okay that they have completed this step.

17. Reporting of Salary and Benefits Staff whose costs are captured in the school district’s federally approved unrestricted indirect cost allocation plan will not be included in the sampling process. Salary and associated expenses paid to employees from federal sources cannot be included in computing the cost base for SDAC billings.

18. Reporting of Salary and Benefits Staff whose salaries are comprised of both federal funds and general funds may be included in time studies although their associated cost must be adjusted accordingly. All federal funds must be removed from the reporting process.

19. Reporting of Salary and Benefits Full-time employees, part-time employees, and contracted employees who participate in SDAC activities will be included in the cost pool. Contracted employees who “only” provide direct services should not be included.

20. Reporting of Salary and Benefits Report ACTUAL costs including salary AND benefits in Cost Data Provide report on the Five Tab Template with the personnel roster that was submitted prior to the quarter starting.

21. District Cost Data - Do’s and Don'ts BACK OUT FEDERAL FUNDS Report Actual Costs Note employees that are replaced, contracted, and those who are federally funded Include all board paid benefits INCLUDE FEDERAL FUNDS Report annual salaries divided by 4. Add additional employees Report only Health Insurance or Retirement benefits

22. Provider Participation Rate(PPR Form) Spreadsheet PPR is due quarterly at same time as Cost Data (within 30 days after the end of the reported quarter)--Do not send prior to the end of the quarter being reported List all MO HealthNet and non-MO HealthNet providers the district referred students to forany and all medical services.

23. Provider Participation Rate (PPR Form) Spreadsheet The PPR will be calculated by dividing the number of MO HealthNet providers by the number of any and all providers referred to for each district. This percentage will then be applied to the MO HealthNet claimable activity related to referral, monitoring and coordination.

24. Quarterly Salary and PPR Spreadsheets Name the Excel File: School District name Six digit DESE county district code Name of documents in the file Quarter (Time period document is reporting) Example: Missouri R-I, 000-000, Salaries-PPR Q3-13.xls

25. Quarterly Certification of State Expenditures The school district will include a quarterly certification stating that sufficient state funds are available to comply with MO HealthNet federal matching requirements. A copy of this form can be downloaded from therapylog once your cost data and ppr have been validated by MSBA.

26. SDAC Quarterly Cycle Staff participants(future quarter) 1. Personnel RosterSubmit list of SDAC participants 4-6 weeks in advance of the next quarter HOW MUCH Salaries/expenses/Quarterly Cert(past quarter) Activity(current quarter) 2. Random Moment Sampling (“RMS”) Observation Forms are assigned to randomly selected staff in the pool of employees, requesting a description of activity during their “random moment.” RMS forms are completed and submitted electronically through Therapylog.com 3. Cost Data/Provider Participation Rate After close of the sampling quarter, submit that quarter’s cost data within 30 days, to request partial federal reimbursements for the participating staff salaries

27. Student Roster File Student Roster Files (school enrollment K-12 all student file) must be updated by the school district annually and submitted to the MSBA Medicaid Consortium in early September Standard Excel format (ONLY)

28. Student Roster File Student Roster File (student enrollment file) needs to be submitted via therapylog.com (Shown at Regional SDAC Training): FieldNameExample First John Last Smith SSN* 999999999 (not MOSIS number) DOB 10/01/1999 (Month/Day/Year) *Some schools no longer have or may have limited SSN’s. If you do not have a SSN for a child, please leave the cell blank. Not having a SSN is acceptable, but it may effect the percentage of match for MO HealthNet eligibility if the name and DOB do not match the child’s birth certificate.

29. Student Roster File Name the File: School District name Six-Digit DESE code Student Roster 2013 - 2014 Example: Missouri R-I, 000-000, Student Roster, 2013-2014.xls

30. SDAC Participation Steps ACTIVITY FREQUENCY 1. Contact MO HealthNet to Request/Submit Interagency Agreement Start-up 2. Enroll on www.msbanet.org to request agreement Start-up 3. Coordinator attends Regional SDAC Training Yearly 4. Upload completed Personnel Roster into Therapylog.com Quarterly 5. Conduct SDAC training for participants on Personnel Roster At Least Yearly 6.Upload completed Salary/Benefits/PPR into Therapylog.com Quarterly 7. Upload or fax completed Certification of Expenditures Quarterly 8. Upload completed Student Roster into Therapylog.com Yearly 9.Maintain Audit Files (Keep for 5 years) Quarterly

31. SDAC Audit Record Master Audit File (Keep Indefinitely): Interagency Agreement MSBA Agreement Any communications received from MHD/OIG (Audits/Reviews) Methodology (All versions)

32. SDAC Audit Record Yearly Audit File for Annual Documents (Keep for 5 years): Copy of the Student Roster used to generate MEV rate.* MO HealthNet MEV letter.* Verification of DESE calculated indirect cost rate. (Obtain copy from district bookkeeper/ CFO.) *INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.

33. SDAC Audit Record Yearly Audit File for Annual Documents (Kept for 5 years): Record of Training Date of group SDAC training with names of attendees and instructors and signatures of participants; or, Certificate of Verification of online training. Copies of all training materials given to staff.* *INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.

34. SDAC Audit Record Required Quarterly Documents (Keep for 5 years): Copy of Personnel File* Copies of all paper RMS forms Copies of all electronic RMS forms* *INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.

35. SDAC Audit Record Copy of cost file detailing salaries, benefits, and PPR.* Support Documentation to your cost file. Certified expenditures are separately identified and supported in the district accounting system. Documentation of any federal revenues removed from costs for specific individuals on the personnel roster. Quarterly Certification of Expenditures* *INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.

36. SDAC Audit Record Completed quarterly invoice.* Receipt of payment from MHD (may be downloaded from vendor payment web site.) Any notification of required actions resulting from an audit review. (File in every application quarter resulting from action.) *INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.

37. SDAC Audit Record Demo of Therapylog.com quarterly audit file feature…. This feature is available from Q3-09 forward.

38. Closing Remarks Questions?