MO HealthNet School District Administrative

Claiming

Participant Training

Presented by MSBA Medicaid Consortium

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Terminology and Acronyms

School District Administrative Claiming = SDAC

Random Moment Sample = RMS

MO HealthNet Division = MHD

Medicaid (Federal term) = MO HealthNet

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Training and Support Materials

www.MSBAnet.org/Medicaid/SDAC

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

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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)

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.

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.

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.

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.

What is MO HealthNet?

Hospital Services - Inpatient and Outpatient

Dental Services

Immunizations

Physical, Occupational and Speech Therapy

Hearing Services

Home Health

Lab & X-rayPrescription DrugsPhysician ServicesMedical Supplies and EquipmentBehavioral ServicesCheck Up’sSubstance Abuse Treatment Vision Services

Examples of MO HealthNet / HCY Covered Services:

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.

ADMINISTRATIVE CLAIMING (SDAC)

Outreach to MO HealthNet & HCYAssistance with the MO HealthNet Application ProcessReferring Students for Health ServicesCoordination with other Health Care ProvidersArranging for Special TransportationMO HealthNet / Medical Training

FOR ALL CHILDREN POTENTIALLY ELIGIBLE FOR MO HealthNet

WHAT IS SCHOOL BASED MO HealthNet?

Activity Codes

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

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).

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).”

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.

BEFORE YOU GET STARTED ASK YOURSELF THREE QUESTIONS!!!

What were you doing?

Who were you with?

Why were you doing this activity?

CODE 1 A

NON-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.

CODE 1 A - Examples Non-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.

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.

CODE 1 B Examples MO 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.

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.

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 Divisionassisting the applicant to complete the form,or to collect the required information for the application process.

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.

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.

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.

CODE 4

Direct 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.

CODE 4 Examples Direct 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.

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.

CODE 5 A Examples Transportation 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…

CODE 5 B Transportation-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.

CODE 5 B Examples Transportation-Related Activities in Support of MO HealthNet Covered Services

Scheduling or arranging special transportation to MO HealthNet covered services, including those received at school.

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.

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.

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.

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.

CODE 7 A Program 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.

CODE 7 A Examples Program 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.

CODE 7 B Program 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.

CODE 7 B Examples Program 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.

CODE 8 A Non-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.

CODE 8 A Examples Non-MO HealthNet Training

Participating in, conducting or coordinating training that improves the delivery of educational, vocational or social programs in the school setting.

CODE 8 B MO 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.

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.

CODE 9 A Referral, 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.

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.

CODE 9 B Referral, 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…

CODE 9 B Examples Referral, 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,

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CODE 9 B Examples Referral, 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.

CODE 10 General Administration

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

CODE 10 Examples General Administration

Reviewing district policy & procedures,

Attending staff meetings,

Breaks,

Vacation,

Sick Days,

Personal time etc…

Thank you for your participation!

For more information please contact: MSBA Medicaid Consortium

1-800-221-MSBA (6722)Or visit our website at

www.MSBAnet.org/Medicaid/SDAC