MO HealthNet School District Administrative Claiming

1. MO HealthNet School District Administrative Claiming Participant Training Presented by MSBA Medicaid Consortium

2. Terminology and Acronyms • School District Administrative Claiming = SDAC • Random Moment Sample = RMS • MO HealthNet Division = MHD • Medicaid (Federal term) = MO HealthNet

3. Training and Support Materials www.MSBAnet.org/Medicaid/SDAC

4. Training Objectives • What is Missouri School District Administrative Claiming (SDAC)? • Why were you chosen to participate? • What is MO HealthNet? • Who is covered by MO HealthNet? • What documentation is required? • How do you fill out a RMS form? • Review of Activity Codes

5. WHAT IS SCHOOL BASED MO HealthNet? • 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)

6. What is Missouri SDAC? A means for Missouri school districts to receive federal reimbursement for MO HealthNet administrative activities such as: • outreach to the MO HealthNet & HCY program • referrals made for health services, and • coordination of health services for students.

7. Why Were You Chosen? Your school district chose you to participate because: • as part of your routine job tasks • you provide one or more of the reimbursable SDAC activities • to children who are MO HealthNet eligible or potentially MO HealthNet eligible.

8. 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.

9. 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.

10. Hospital Services - Inpatient and Outpatient Dental Services Immunizations Physical, Occupational and Speech Therapy Hearing Services Home Health Lab & X-ray Prescription Drugs Physician Services Medical Supplies and Equipment Behavioral Services Check Up’s Substance Abuse Treatment Vision Services What is MO HealthNet? Examples of MO HealthNet / HCY Covered Services:

11. Who is Covered by MO HealthNet? • It is important to note that for Administrative Claiming activities it is NOT necessary to know which children are MO HealthNet eligible.

12. WHAT IS SCHOOL BASED MO HealthNet? 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

13. Activity Codes • You should always include any paperwork, clerical work or travel time associated with a particular activity as part of that activity.

14. What Documentation is Required? • In order to obtain reimbursement, staff must document the amount of time spent on all activities. • Time is documented using a process called Random Moment Sampling (RMS).

15. What is a Random Moment Sample or RMS? • It is a Federally accepted method . • The RMS system compiles employee data from each participating school district in the MSBA Medicaid Consortium to form a sample pool. • From this pool, names are randomly selected and paired with random moments in time to create “random moment samples (RMS).”

16. Simple Three-Step Process • Step 1: The school district’s SDAC Coordinator distributes RMS forms to selected personnel. • Step 2: Selected personnel complete their RMS form at their “sample moment.” • Step 3: The completed RMS form is returned to the district SDAC coordinator. All three steps are critical to generating a valid sample.

17. BEFORE YOU GET STARTED ASK YOURSELFTHREE QUESTIONS!!! • What were you doing? • Who were you with? • Why were you doing this activity?

18. CODE 1 ANON-MO HealthNet OUTREACH This code should be used when informing individuals about non-MO HealthNet programs and how to access them, or when describing the range of benefits covered under these non-MO HealthNet programs and how to obtain them.

19. CODE 1 A - ExamplesNon-MO HealthNet Outreach Scheduling and promoting extra curricular activities, sports programs, after school programs etc… Conducting general health education programs, Conducting outreach campaigns to encourage access to social, educational, legal or other services not covered by MO HealthNet.

20. CODE 1 B MO HealthNet / EPSDT OUTREACH Performing activities that inform eligible or potentially eligible individuals about MO HealthNet & HCY benefits and how to access services.

21. CODE 1 B ExamplesMO HealthNet / EPSDT Outreach Informing children and families about the benefits and availability of services provided by MO HealthNet & HCY. Providing referral assistance to families where these services can be obtained. Informing MO HealthNet eligible pregnant students of the availability of HCY services.

22. CODE 2 AFacilitating an Application for Non-MO HealthNet Programs This code should be used when assisting an individual or family to prepare an application for programs such as TANF, Food Stamps, WIC, day care, legal aid, and other social or educational programs and when referring them to the appropriate agency to complete an application.

23. CODE 2 BFacilitating MO HealthNet Eligibility Determination This code should be used when assisting children and families to establish MO HealthNet eligibility by: • making referrals to the Children’s Division • assisting the applicant to complete the form,or • to collect the required information for the application process.

24. CODE 2 B Examples Facilitating MO HealthNet Eligibility Determination Assisting an individual or family to complete an application for MO HealthNet / HCY benefits. Updating forms you receive that relate to MO HealthNet eligibility when a child’s circumstances change. Providing assistance by collecting required information.

25. CODE 3School Related & Educational Services This code should be used for any other school-related activities that are not health related, such as social services, educational services, teaching services, employment and job training.

26. CODE 3 Examples School Related & Educational Services Providing classroom instruction Fulfilling school attendance requirements Testing, grading papers, Providing general supervision of students, Improving the coordination of non-medical activities.

27. CODE 4Direct Medical Services Use this code when providing direct health care, treatment, and/or counseling services including mental health assessments and evaluations to an individual or group in order to correct a medical or mental health problem.

28. CODE 4 ExamplesDirect Medical Services • Administering first aid, a prescribed injection or medication to a student. • Providing speech, occupational, physical and other therapies contained in the IEP. • Performing routine or mandated child health screens including, but not limited to: vision, hearing, dental, scoliosis, and HCY screens.

29. CODE 5 ATransportation for Non-MO HealthNet Services Use this code when performing activities associated with assisting an individual to obtain transportation to services not covered by MO HealthNet or when accompanying the individual to such services.

30. CODE 5 A ExamplesTransportation to Non-MO HealthNet Services Scheduling or arranging transportation to social, vocational, and, or educational programs and activities. Arranging transportation for field trips,after school programs, sports programs, etc…

31. CODE 5 BTransportation-Related Activities in Support of MO HealthNet Covered Services School staff should use this code when assisting an individual to obtain transportation to services covered by MO HealthNet. The code does not cover the actual transportation, but rather the administrative activities involved in arranging and providing the transportation.

32. CODE 5 B ExamplesTransportation-Related Activities in Support of MO HealthNet Covered Services • Scheduling or arranging special transportation to MO HealthNet covered services, including those received at school.

33. CODE 6 ANon-MO HealthNet Translation School staff should use this code when performing translation services related to social, vocational, or educational programs and activities.

34. CODE 6 A ExamplesNon-MO HealthNet Translation • Face-to-face translation from one language to another in a classroom or other setting not related to Mo HealthNet services. • Sign-language for the deaf or the hearing impaired when the content is not related to Mo HealthNet services.

35. CODE 6 BTranslation Related to MO HealthNet Services School staff should use this code when assisting an individual to obtain translation services in order to receive medical, dental or mental health services covered by MO HealthNet.

36. CODE 6 B ExamplesTranslation Related to MO HealthNet Services • Arranging for translation services, including sign language, in order for a student or family to receive MO HealthNet covered services. • Explaining medical or other technical terminology to a family in order for them to properly understand MO HealthNet covered services.

37. CODE 7 AProgram Planning, Policy Development & Interagency Coordination Related to Non-MO HealthNet Services School staff should use this code when performing activities associated with the development of strategies to improve the coordination and delivery of educational, vocational and social services to students and families.

38. CODE 7 A ExamplesProgram Planning, Policy Development & Interagency Coordination Related to Non-MO HealthNet Services • Developing strategies to increase the capacity of after school programs, sports programs etc… • Monitoring the delivery of educational or social services in schools. • Working with outside agencies to improve the delivery of educational and social activities.

39. CODE 7 BProgram Planning, Policy Development & Interagency Coordination Related to MO HealthNet Services School staff should use this code when performing activities associated with the development of strategies to improve the coordination and delivery of Mo HealthNet covered medical/dental/mental health services to school age children, and when performing collaborative activities with other agencies and/or providers.

40. CODE 7 B ExamplesProgram Planning, Policy Development & Interagency Coordination Related to MO HealthNet Services • Developing strategies to increase the capacity of school medical and mental health programs. • Monitoring the delivery of medical & mental health services in schools. • Working with outside agencies to improve the delivery of medical & mental health services in schools.

41. CODE 8 ANon-MO HealthNet Training School staff should use this code when coordinating, conducting or participating in training events and seminars that are educational, vocational or social in nature.

42. CODE 8 A ExamplesNon-MO HealthNet Training • Participating in, conducting or coordinating training that improves the delivery of educational, vocational or social programs in the school setting.

43. CODE 8 BMO HealthNet Specific Training School staff should use this code when coordinating, conducting or participating in training events and seminars for staff regarding the benefits of the MO HealthNet / HCY program, how to assist families to access such services, and how to effectively refer students for services.

44. CODE 8 B ExamplesMO HealthNet Specific Training • Participating or coordinating training which enhances early identification, intervention, screening and referral of students with special health needs to HCY services. • Participating or coordinating training which improves the delivery of MO HealthNet services.

45. CODE 9 AReferral, Coordination & Monitoring of Non-MO HealthNet Services School staff should use this code when making referrals for,coordinating and / or monitoring the delivery of educational, vocational or social services to students.

46. CODE 9 A ExamplesReferral, Coordination & Monitoring of Non-MO HealthNet Services • Making referrals for educational, social or disciplinary issues. • Participating in meetings or conferences regarding a student’s educational performance. • Monitoring and evaluating the non-medical or educational components of a student’s IEP.

47. CODE 9 BReferral, Coordination & Monitoring of MO HealthNet Services School staff should use this code when making referrals for, coordinating, and / or monitoring the delivery of medical, dental, and mental health services to school age children, including but not limited to evaluations, screenings, examinations etc…

48. CODE 9 B ExamplesReferral, Coordination & Monitoring of MO HealthNet Services • Scheduling or coordinating referrals for medical or mental health evaluations or examinations, • Gathering information in advance of such referrals or evaluations, • Participating in meetings, discussions, or conferences with parents or other staff regarding a student’s health services,

49. CODE 9 B ExamplesReferral, Coordination & Monitoring of MO HealthNet Services (continued) • Providing follow-up contact to ensure a child has received the prescribed health services. • Monitoring or evaluating the medical and mental health components of the IEP, once developed.

50. CODE 10General Administration School staff should use this code when they are performing general administrative activities of the school or local school district.