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MO HealthNet School District Administrative Claiming

New Coordinator Orientation Training

(SDAC)

August/September 2013Presented by the MSBA Medicaid Consortium

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MSBA Medicaid Consortium MSBA Medicaid Consortium Contact and Website Contact and Website

InformationInformation 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.ht

ml

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AgendaAgenda

What is SDAC? Coordinator Roles and

Responsibilities Complete walk through of

the entire SDAC process

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Terminology and Terminology and AcronymsAcronyms

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

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What is MO HealthNet?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.

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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.

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Examples of MO HealthNet / Examples of MO HealthNet / EPSDT Covered ServicesEPSDT Covered Services

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What is School District What is School District Administrative Claiming Administrative Claiming

(SDAC)?(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

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What is SDAC?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)

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Five Tab TemplateFive Tab TemplateDistricts are to provide all reports on approved Excel Template1-Instructions2-Personnel Roster–due quarterly 6-8 weeks prior to quarter3-Cost Data-due month after the sampled quarter ends4-PPR (Provider Participation Rate)-due month after the sampled quarter ends5-Quarterly Certification of Expenditures Instructions-due after your Cost Data/PPR have been validated

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Personnel Roster: Job Personnel Roster: Job ClassificationsClassifications

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

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Quarterly Personnel RostersQuarterly Personnel Rosters

Name the Excel File: 1. School District name2. Six-Digit DESE code3. Personnel Roster4. Quarter

Example: Missouri R-I, 000-000, Personnel Roster, Q4-13.xls

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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_____”

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RMS General DirectionsRMS General Directions

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

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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.

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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.

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Reporting of Salary and BenefitsReporting 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.

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Reporting of Salary and Reporting of Salary and BenefitsBenefits

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.

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Reporting of Salary and Reporting of Salary and BenefitsBenefits

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.

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Reporting of Salary and Reporting of Salary and BenefitsBenefits

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.

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District Cost Data - Do’s and District Cost Data - Do’s and Don'tsDon'ts

BACK OUT FEDERAL FUNDSBACK OUT FEDERAL FUNDS Report Actual CostsReport Actual Costs Note employees that are Note employees that are

replaced, contracted, and replaced, contracted, and those who are federally those who are federally fundedfunded

Include all board paid benefitsInclude all board paid benefits

INCLUDE FEDERAL FUNDSINCLUDE FEDERAL FUNDS Report annual salaries Report annual salaries

divided by 4.divided by 4. Add additional employeesAdd additional employees Report only Health Insurance Report only Health Insurance

or Retirement benefitsor Retirement benefits

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Provider Participation RateProvider Participation Rate(PPR Form) Spreadsheet(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 for any and all medical services.

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Provider Participation Rate Provider Participation Rate (PPR Form) Spreadsheet(PPR Form) Spreadsheet

The PPR will be calculated by dividing thenumber 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.

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Quarterly Salary and PPR Quarterly Salary and PPR SpreadsheetsSpreadsheets

Name the Excel File: 1. School District name2. Six digit DESE county district

code3. Name of documents in the file4. Quarter (Time period document is

reporting)Example: Missouri R-I, 000-000, Salaries-PPR Q3-13.xls

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Quarterly Certification of Quarterly Certification of State ExpendituresState 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.

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SDAC Quarterly CycleSDAC Quarterly Cycle

1. Personnel Roster Submit list of SDAC participants 4-6 weeks in advance of the next

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

Staff participants(future quarter)

Activity(current quarter)

HOW MUCH Salaries/expenses/

Quarterly Cert(past quarter)

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Student Roster FileStudent 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)

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Student Roster FileStudent Roster File Student Roster File (student enrollment file)

needs to be submitted via therapylog.com (Shown at Regional SDAC Training):

Field Name Example

1. First John2. Last Smith3. SSN* 999999999 (not MOSIS number)4. 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.

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Student Roster FileStudent Roster File

Name the File: 1. School District name2. Six-Digit DESE code3. Student Roster4. 2013 - 2014

Example: Missouri R-I, 000-000, Student Roster, 2013-2014.xls

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SDAC Participation StepsSDAC Participation StepsACTIVITY 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

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SDAC Audit RecordSDAC Audit Record

Master Audit File (Keep Indefinitely):Interagency AgreementMSBA AgreementAny communications received from MHD/OIG (Audits/Reviews)Methodology (All versions)

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SDAC Audit RecordSDAC Audit RecordYearly 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.

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SDAC Audit RecordSDAC Audit Record

Yearly Audit File for Annual Documents (Kept for 5 years):Record of TrainingDate 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.

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SDAC Audit RecordSDAC Audit Record

Required Quarterly Documents (Keep for 5 years):Copy of Personnel File*Copies of all paper RMS formsCopies of all electronic RMS forms*

*INDICATES THAT THE RECORD MAY BE MAINTAINED ELECTRONICALLY AND IS IN THE AUDIT FILE IN THERAPYLOG.COM.

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SDAC Audit RecordSDAC 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.

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SDAC Audit RecordSDAC 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.

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SDAC Audit RecordSDAC Audit Record

Demo of Therapylog.com quarterly audit file feature….

This feature is available from Q3-09 forward.

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Closing RemarksClosing Remarks

Questions?