MY
MAA
MANUAL
Everything you ever wanted to know about the
MAA Program
So….let’s get organized:
Dear MAA Participant,
As you know many of the activities performed by school district staff
meet the claimable criteria for Medi-Cal Administrative Activities (MAA).
The primary purpose of administrative claiming is to reimburse school
districts for these activities where allowed. Time reporting is required
in order to accurately assess the percentage of time staff spend on
approved administrative activities.
Your participation in the MAA program will help provide significant
Medi-Cal reimbursements to your school district.
These funds go directly
back into your school’s operating budget to help fund salaries, new
equipment, smaller class sizes, and other important programs that will
positively impact the quality of education that your students receive.
In order to maximize the success of the program, it is essential that you
understand how to accurately complete the time survey. This manual
will guide you through the process to help you understand the MAA
program, how to accurately code your activities, and how to write valid
sample sentences for claimable codes.
As always, if you have any questions regarding MAA, please contact your
MAA Coordinator or the Accelify CA MAA Help Line at 888.523.6110.
Together, we are here to help!
We thank you for your participation.
Alex Brecher
Introduction to MAA
Why MAA
A brief history of MAA
Medi-Cal Administrative Activities
PAGE
6
7
What is MAA, how does the program work, and who can participate?My MAA Tips
Code 1 vs. Code 8
Codes at a Glance
Sampling Guidelines
How to write a valid sampleCode 1 vs. Code 16
Am I performing a Code 1 or Code 16 activity?
How to Code Time During Meetings
Includes IEPs, SSTs, and other meetingsExamples of Medi-Cal Providers Supporting Schools
List of Medi-Cal providers who support schoolsMAA Glossary
Mandated Services
24
26 - 27
28 - 31
32 - 33
34 - 35
36 - 37
38 - 39
40
MAA Codes
Introduction to Department of Health Care Services (DHCS) MAA Codes
MAA Codes 1-16
Code descriptions and examples from the DHCS MAA Manual
10 - 11
12 - 21
TABLE
OF
Introduction
to MAA
Intro to MAA 6 MAA was created!
The government then decided that because health services were being provided in schools, they would use the additional funds to reimburse schools for providing those services. It was decided that for Centers for Medicare & Medicaid Services (CMS) would oversee the reimbursement program federally, and in California, Division of Health Care Services (DHCS) would oversee the program on a state level. It was then legislated that due to California’s size there needed to be regional support in order for schools to participate. This support became an LEC (Local Educational Consortium) system and was based on the existing County Office Regions (of which there are
11) with one county office from each region stepping up to oversee and hold the contract with DHCS.
The LEAs (Local Educational Agencies, which are either county offices or school districts) hold their contract with their LEC.
The evolution of Health Services in Schools Schools have changed greatly over the years.
There were children who needed to be in school but also needed health services. Unfortunately, their needs were more than could be provided for in schools. Because provisions were not made for them, they did not attend school.
Schools started to identify children with health needs, but the only real option for care was in the state mental hospitals.
When the state could not pay for that anymore, special schools were opened to house and educate those children.
Parents did not want their children separated from others, so special classrooms were set up within the schools to accommodate them. However, they were still mostly isolated.
Education now in the 2000s integrates all children as much as possible within regular classrooms regardless of their needs. Children are able to receive most of the health services they need right in their schools and don’t have to turn to the private sector.
In 1995, when the federal government was trying to balance the budget, a savings in health services to children was discovered – a really big savings! The government wondered if children were using fewer health services and, if so, why? The government decided to investigate and found that children were not using fewer health services; rather, schools were providing more of these services relieving the burden on the private sector.
Why MAA?
The Question of Double Dipping
The difference between LEA Billing and MAA claiming:
• LEA billing covers the direct “hands-on” health services provided in schools
• MAA Claiming covers the administrative costs of coordinating Medi-Cal covered health services in schools
Why MAA
A Brief History of MAA
60s
70s
80s
90s
Intro to MAA 7 The MAA Program
MAA allows school districts to conduct time surveys to capture the time staff spend performing activities related to Medi-Cal (health) services and programs for students. A time survey takes place one week each quarter during a school year. Staff identified as MAA participants fill out this time survey which indicates their total paid work hours during the chosen MAA week. All activities are logged in increments of 15 minutes or higher. Certain activities are reimbursale and some are not. However, all time is accounted for on the time survey.
Who is eligible to time survey?
Any and all school staff may participate in MAA if they perform MAA activities as part of their routine jobs. No special license is required. Participants may include office staff, principals, special education teachers, teachers, speech therapists, psychologists, nurses, health aides, OTs, PTs, mental health counselors, aides, translators, etc. Participants are limited only to if their job duties include MAA activities on a regular basis. Some job classifications may require prior approval.
Who cannot participate?
•
100 % Federally funded employees; for example – Title 1•
Cafeteria Staff (unless paid out of general fund)•
Employees who do not perform MAA activities ona routine basis
•
Custodians•
Bus DriversWhat is my role?
Every participant must be trained prior to filling out a time survey for the first time. Yearly re-trainings are required and must be conducted before the third time survey period. Participants must have a working knowledge of the coding system for MAA and be able to provide written samples for reimbursable MAA codes. The codes represent all activities participants routinely perform during a typical work day. There are 15 codes to choose from. All time will fit into these codes because the time survey will reflect your educational duties as well as MAA or Medi-Cal covered health-related services that may be performed during your day. Some examples of the code activities are:
•
Teaching, assessing, therapy, yard duty, enrolling students, etc.•
Providing Medi-Cal outreach or referrals such as referring students to a speech therapist or a school nurse as well as providing health outreach information to parents directed toward connecting both Medi-Cal and non-Medi-Cal persons with appropriate Medi-Cal covered health care services.•
Assisting families with Medi-Cal/Healthy Families or applications or other types of applications.•
Referring, coordinating and maintaining serviceswith Medi-Cal providers within the school enviornment such as nursing services, speech services, psychology services, counseling services, occupational therapy, physical therapy, etc.
Medi-Cal Administrative Activities
Any school staff may participate in MAA if they perform Medi-Cal covered HEALTH CAREactivities.
What is MAA, how does the program work, and who can participate?
The MAA program consists of Medi-Cal covered HEALTH-related activities necessary for the proper and efficient administration of the Medi-Cal program. The federal government, through CMS, will reimburse local schools for a share of the costs of performing allowable Medi-Cal covered HEALTH-related administrative activities. As you read these codes,
remember; Medi-Cal Covered Services are Health Care Covered Services and health is related to any mental health or physical health service or issue. (See list of services on page 42)
Intro to MAA 8 What is my role? continued
•
Coordinating services for students with health concerns such as deafness or hard of hearing, blindness, physical disabilities, mental health concerns, speech impediments, etc.•
Coordinating contracts with community-based organizations or other provider agencies to provide Medi-Cal services and/or MAA.•
Develping interagency coordination to improve the delivery of Medi-Cal services and providers.The Time Survey Process
The time survey is the foundation of the MAA claiming. The time survey should reflect a regular work week of all paid time and activities (whether allowable or unallowable) performed by participants. Each participant is responsible for completing their quarterly time survey. All paid time must be accounted for and whenever a reimbursable activity is reflected on the form a sample must be given to justify the reimbursement. Samples are highly important in the time survey process. Examples of good samples are provided for in this manual as well as job specific examples that you will receive in trainings. The
framework of the sample guidelines must be followed. All samples will receive reviews and if any corrections need to be made you will be notified and expected to
make any and all corrections in a timely manner. Your companion manual, Accelisurvey Guide, will further spell out this process. If every participant successfullly fills out their first three MAA time surveys then the fourth quarter can become an average of those three. Instead of doing 4 survey weeks – you will only need to do 3. All three previous time surveys will need to be correctly filled out and have no corrections to the samples.
MAA Do’s & Don’ts
•
MAA activities should be random and should not be scheduled during the time survey period only!•
Reflect ALL of your regular work week on thesurvey form – every part of your day will fit into one or more of the codes.
•
Review training materials and ask for help if needed.•
Make any and all corrections, if needed, in a timely manner.•
Every time survey is important – because you are important!•
Your time and devotion spent with children matters!•
Making referrals to Medi-Cal services and providing outreach to Medi-Cal covered services must be a part of your normal routine and not performed only during MAA time survey weeks!Medi-Cal Administrative Activities continued
Intro to MAA 9
Notes
Intro to MAA 10
Notes
MAA
Codes
MAA Codes 12
Introduction to DHCS MAA Codes
The following pages are taken directly from the California Department of Health Care Services (DHCS) MAA manual. To download the entire manual, visit http://www.dhcs.ca.gov/provgovpart/Pages/SMAAManual.aspx and follow the link to the current Medi-Cal Administrative Activities program. There are 16 codes represented for MAA. Not all of the codes are reimbursable. The codes that are not allowed for reimbursement are marked with a “U” for unallowable activities. The reason for surveying all of your time, even the unallowable time, is to show your entire week’s activity and average out how much time is spent on reimbursable activities.
To download the entire manual, visit
http://www.dhcs.ca.gov/provgovpart/Pages/SMAAManual.aspx
and follow the link to the current Medi-Cal Administrative Activities manual.
The survey week reflects an average of activities performed during an entire fiscal quarter of a school year. Given that schools are primarily in the business of education, DHCS wants to see both the educational activities in conjunction with the health activities.
Because many children and families look to schools to provide health services, DHCS wants to make sure that these services are reimbursed to school districts.
Providing health services has not always been the norm in education. Schools have increasingly taken on health services and made sure that the health needs of students and their families are met. For many children, school is the primary site for health care delivery.
As schools have increased their roles in the health field, the federal government has recognized that these efforts deserve the same reimbursement that is provided to the private sector.
Along with providing health services, schools have the unique opportunity to be an information catalyst for providing referrals and resources to families for community based health providers and agencies that provide Medi-Cal/health care services. This bridges a valuable connection between school and community, which in turn benefits children. It truly mirrors the concept of a community participating in a working relationship with all entities that come together for a common good: in this case, the health and well-being of children.
As you read these codes, remember:
Medi-Cal Covered Services are Health Care Covered Services and health falls under all mental health and physical health services and issues.
MAA Codes 13 Staff Activities and Codes. Each code is followed by an
indicator (in parentheses) to show if the code is eligible for reimbursement at the FFP rate, to what extent the code is allowable, and if the Medi-Cal Percentage must be applied.
Application of FFP rate of 50 percent. Refers to an administrative activity that is allowable under the Medi-Cal program and claimable at the 50-percent FFP rate.
Unallowable Activities – (U) Refers to an administrative activity that is unallowable under the Medi-Cal program, regardless of whether or not the population served includes Medi-Cal-eligible individuals.
Total Medi-Cal – (TM) Refers to an administrative activity that is 100-percent allowable under the Medi-Cal program.
Proportional Medi-Cal – (PM) Refers to an administrative activity that is allowable under the Medi-Cal program but for which the allocable share of costs must be determined by applying the discounted or proportional Medi-Cal share (the Medi-Cal percentage). The Medi-Cal share is determined by calculating the ratio of Medi-Cal eligible students to total students. Reallocated Activities – (R) Refers to those general administrative activities performed by time study participants that must be reallocated across the other activity codes on a pro rata basis. These reallocated activities are reported under Code 16. Note that certain functions such as payroll, maintaining inventories, developing budgets, and executive direction, are
considered overhead; therefore, they are only allowable through the application of an approved indirect cost rate.
California School-Based Medi-Cal
Administrative Activities Manual
Activity Codes: Descriptions and Examples
When staff perform duties to the proper administration of the California Medi-Cal program, federal funds may be drawn as reimbursement for the appropriate time-studied proportion of salary, benefit, and other costs of providing these administrative activities. To identify the cost of providing these activities, a time study of staff must be conducted. The time study identifies the time and subsequent costs spent on Medi-Cal administrative activities that are allowable and reimbursable under the Medi-Cal program. The following coding scheme must be followed by all time-study participants.
MAA Codes 14 Remember, samples must always include what, who and why.
Codes 1-16
Descriptions and Examples from the DHCS MAA Manual
MAA
Code 1: School -Related, Educational, And Other Activities (U)
This code should be used for school-related activities that are not health-related, such as social services, educational services, and teaching services, employment and job training. Examples are in the Code 1 versus Code 16 matrix, in Appendix H. Performing activities that are specific to education and students particularly instructional, curriculum and student-focused areas (including attendance reports and all other student records) should be coded here. Include in Code 1 all clerical and supervisory activities, and travel related to these activities. These activities include the
development, coordination, and monitoring of a student’s education plan that is not health-related. a. Providing classroom instruction (including lesson planning).
b. Testing, correcting papers. c. Compiling attendance reports.
d. Performing activities that are specific to instructional, curriculum, student-focused areas, including those performed by health providers.
e. Reviewing the education record for students who are new to the school. f. Providing general supervision of students (e.g., playground, lunchroom). g. Monitoring student academic achievement.
h. Providing individualized instruction (e.g., math concepts) to a special education student. i. Conducting external relations related to school educational issues/matters.
j. Compiling report cards. k. Applying discipline activities.
l. Performing clerical activities specific to instructional or curriculum areas.
m. Activities related to the immunization requirements for school attendance. (These activities are considered Free Care and cannot be billed to Medi-Cal.)
n. Compiling, preparing, and reviewing reports on textbooks or attendance. o. Enrolling new students or obtaining registration information.
p. Conferring with students or parents about discipline, academic matters, or other school-related issues. q. Evaluating curriculum and instructional services, policies, and procedures.
r. Participating in or presenting training related to curriculum or instruction (e.g., language arts workshop, computer instruction).
s. Performing clerical activities specific to instructional or curriculum areas.
t. Participating in or coordinating training that improves the delivery of services for programs other than Medi-Cal.
u. Participating in or coordinating training that enhances IDEA child find programs.
v. Developing, coordinating, and monitoring that the IEP is conducted, parental sign-off is obtained, the IEP meetings with the parents are scheduled, and the IEP is completed.
w. Preparing for and providing behavior management principles to student.
MAA Codes 15 Remember, samples must always include what, who and why.
Code 2: Delivering Medical Services (U)
School staff should use this code when providing care, treatment, and/or counseling services to an individual to correct or ameliorate a specific condition when performing activities in their duty statement. Activities that are an integral part of or an extension of a medical service (e.g., student follow-up, student assessment, student counseling, student education, consultation and student billing activities) are considered direct medical services. This code also includes all related, paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email and voicemail. This includes TCM- and LEA-billed Medi-Cal services.
a. Providing health/mental health services contained in an IEP.
b. Providing medical/health assessment and evaluation as part of the development of an IEP. c. Reporting initial health assessment results at IEP.
d. Conducting medical/health assessments/evaluations and diagnostic testing, and preparing related reports. e. Providing health care/personal aide services.
f. Providing speech, occupational, physical, and other therapies.
g. Administering first aid, or a prescribed injection or medication, to a student. h. Providing direct clinical or treatment services.
i. Performing developmental assessments.
j. Providing counseling services to treat health, mental health, or substance abuse conditions.
k. Performing routine or mandated child health screens, including but not limited to vision, hearing, dental, scoliosis, and certain EPSDT/CHDP screens.
l. Providing immunizations.
m. Conducting LEA billed Target Case Management (TCM) Services. n. Activities that are medical services or components of medical services.
Code 3: Non-Medi-Cal Outreach (U)
This code should be used by all school staff when performing activities that inform eligible or potentially eligible individuals about non-Medi-Cal social, vocational, and educational programs (including special education) and how to access them, describing the range of benefits covered and how to obtain them. Both written and oral methods
may be used. Include related paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email and voicemail.
a. Informing families about wellness programs and how to access these programs.
b. Scheduling and promoting activities that educate individuals about the benefits of healthy life styles and healthy practices.
c. Conducting general health education programs or campaigns addressed to the general population.
d. Conducting outreach campaigns directed toward encouraging persons to access social, educational, legal, or other services not covered by Medi-Cal.
e. Assisting in the early identification of children with special medical/dental/mental health needs through various IDEA child find activities.
f. Outreach activities in support of programs that are funded 100 percent by State general revenue.
g. Participating in or coordinating training that improves the delivery of services for programs other than Medi-Cal. h. Participating in or coordinating training that enhances IDEA child find programs.
MAA Codes 16 Remember, samples must always include what, who and why.
Code 4: Initial Medi-Cal Outreach (TM/50-Percent FFP)
This code should be used by school staff when performing initial activities that inform eligible or potentially eligible individuals about Medi-Cal programs and services and how to access them. Initial activities would include bringing potential eligible’s into the Medi- Cal system for the purpose of determining eligibility and initially arranging for the provision of Medi-Cal services. Include related paperwork, clerical activities, or staff travel required to perform these activities (including initiating and responding to email and voicemail). LEAs only conduct outreach for the populations served by their schools (i.e., students and their parents or guardians). The following are examples of activities
that are considered Medi-Cal outreach:
a. Providing initial information about Medi-Cal-covered services and/or CHDP screenings (e.g., dental, vision) in the schools that will help identify medical conditions that can be corrected or improved by services through Medi-Cal. b. Identifying and referring adolescents who may be in need of Medi-Cal family planning services.
c. Informing Medi-Cal-eligible and potential Medi-Cal-eligible children and families about the benefits and availability of services provided by Medi-Cal (including preventive, treatment, and screening), including services provided through the EPSDT program.
d. Informing children and their families on how to effectively access, use, and maintain participation in all health resources under the federal Medi-Cal/Healthy Families program.
e. Assisting in the early identification of children who could benefit from the health services provided by Medi-Cal as part of a Medi-Cal/Healthy Families outreach campaign. Not claimable are child find activities that are required under Special Education regulations (use Code 3 Non-Medi-Cal Outreach).
f. Contacting pregnant and parenting teenagers about the availability of Medi-Cal prenatal and well-baby care programs and services.
g. Conducting a family planning health education outreach program or campaign—if it is targeted specifically to family planning Medi-Cal services that are offered to Medi-Cal-eligible individuals.
h. Providing initial referral assistance to families where Medi-Cal services can be provided. i. Participating in/or coordinating outreach trainings that improve access to Medi-Cal services.
j. Providing information regarding Medi-Cal managed care programs and health plans to individuals and families and how to access that system.
Remember: Medi-Cal covered services and providers are “health care” services and providers. Medi-Cal Covered Services are Health Care Covered Services
Activities that are not considered Medi-Cal outreach under any circumstances are:
a. General preventive health education programs or campaigns addressed to lifestyle changes in the general population (e.g., dental prevention, anti-smoking, alcohol reduction, etc.), and
b. Outreach campaigns directed toward encouraging persons to access social, educational, legal, or other services not covered by Medi-Cal.
Medi- Cal
MAA Codes 17 Remember, samples must always include what, who and why.
Code 5: Facilitating Application For Non-Medi-Cal Programs (U)
This code should be used by school staff when informing an individual or family about programs such as CalWORKS, Food Stamps, WIC, childcare, legal aid, and other social or educational programs, and referring them to the appropriate agency to make application. Include related paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email and voicemail.
a. Explaining the eligibility process for non-Medi-Cal programs.
b. Assisting the individual or family in collecting/gathering information and documents for the non-Medi-Cal program application.
c. Assisting the individual or family in completing the application.
d. Developing and verifying initial and continuing eligibility for the National School Lunch Program.
e. Using client information from Medi-Cal/Healthy Families to facilitate the National School Lunch Program application process.
Code 6: Facilitating Medi-Cal Application (Tm/50-Percent FFP)
School staff should use this code when assisting an individual in becoming eligible for Medi-Cal/Healthy Families. Include related, paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email and voicemail. This activity does not include the actual determination of Medi-Cal eligibility.
a. Verifying an individual’s current Medi-Cal/Healthy Families eligibility status for the purposes of Medi-Cal program. b. Explaining Medi-Cal/Healthy Families eligibility rules and the Medi-Cal/Healthy Families eligibility process to prospective applicants.
c. Assisting individuals or families to complete a Medi-Cal/Healthy Families eligibility application.
d. Gathering information related to the application and eligibility determination for an individual, including resource information and TPL information, as a prelude to submitting a formal Medi-Cal/Healthy Families application. e. Providing necessary forms and packaging all forms in preparation for the Medi- Cal/Healthy Families eligibility determination.
f. Referring an individual or family to the local Medi-Cal/Healthy Families eligibility office to make application for Medi-Cal/Healthy Families.
g. Assisting the individual or family in collecting/gathering required information and documents for the Medi-Cal/ Healthy Families application.
h. Participating as a Medi-Cal/Healthy Families eligibility outreach outstation, but does not include determining eligibility.
i. Using client information gathered from various programs such as CHDP and the Free and Reduced Lunch Program to facilitate the Medi-Cal/Healthy Families application process and expand enrollment into Medi-Cal programs and services.
NOTE: Healthy Family outreach is claimable unless the Medi-Cal eligibility application form box is marked: “I do not want Medi-Cal”. Samples must state Medi-Cal Healthy families—samples with just Healthy families will NOT be accepted.
Remember: This code refers to ONLY assisting with the Medi-Cal Healthy Families applications and not the actual determination of eligibility.
MAA Codes 18 Remember, samples must always include what, who and why.
Code 7: OngoingReferral, Coordination, And Monitoring Of Non-Medi-Cal Services (U)
School staff should use this code when making ongoing referrals for coordinating, and/or monitoring the delivery of non-Medi-Cal services, such as educational services. Include related paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email and voicemail.
a. Making referrals for and coordinating access to social and educational services such as childcare, employment, job training, and housing.
b. Making referrals for, coordinating, and/or monitoring the delivery of State education-agency-mandated immunizations and child health screens (vision, hearing, and scoliosis).
c. Making referrals for, coordinating, and/or monitoring the delivery of scholastic, vocational, and other non-health- related examinations including making referrals to community organizations (i.e. Lions club for glasses). Gathering any information that may be required in advance of these non-Medi-Cal-related referrals.
d. Participating in a meeting/discussion to coordinate or review a student’s need for scholastic, vocational, and non- health-related services not covered by Medi-Cal.
e. Monitoring and evaluating the non-medical components of the individualized plan as appropriate.
NOTE: Case Managers participating in the LEA Medi-Cal Billing Option for IEP case management cannot claim MAA Referral, Coordination, and Monitoring. Staff should claim time under Code 2, Direct Medical Service as TCM billing includes
Referral, Coordination, and Monitoring.
Code 8: Ongoing Referral, Coordination, And Monitoring Of Medi-Cal Services(PM/50-percent FFP)
School staff should use this code when making ongoing referrals for, coordinating, and/or monitoring the delivery of Medi-Cal-covered services. This code is used after an initial referral is made. Referral, coordination, and monitoring activities related to services in an IEP are reported in this code. Activities that are part of a direct service
are not claimable as an administrative service. Furthermore, activities that are an integral part of or an extension of a medical service by the provider to the student (e.g., student follow-up, assessment, counseling, and instruction) or consultation between health providers to enhance the direct medical service, should be reported under Code 2, Direct Medi-Cal Services. Activities that include student health billing are also reported under Code 2. Developing, coordinating, and monitoring that the IEP is conducted, parental sign-off is obtained, the IEP meetings with the parents are scheduled, and the IEP is completed should be reported under Code 1. Include related paperwork, clerical activities, or staff travel necessary to perform these activities, including initiating and responding to email and voicemail.
a. Making referrals for and/or coordinating medical or physical examinations and necessary medical/mental health evaluations.
b. Making referrals for and/or scheduling certain Medi-Cal-covered CHDP screens, inter-periodic screens, and appropriate immunizations, but not to include the state-mandated health services. (See Section 2 – Medicaid in the School Setting – Page 2-1).
c. Referring students for necessary medical health, mental health, or substance abuse services covered by Medi-Cal. d. Arranging for any Medi-Cal-covered medical/dental/mental health diagnostic or treatment services that may be required as the result of a specifically identified medical/dental/mental health condition.
e. Gathering any information that may be required in advance of these referrals.
f. Participating in a meeting/discussion to coordinate or review student(s’) needs for health-related services covered by Medi-Cal.
g. Providing follow-up contact to ensure that a child has received the prescribed medical/dental/mental health services.
Non- Medi-Cal
MAA Codes 19 Remember, samples must always include what, who and why.
h. Coordinating the completion of the prescribed services, termination of services, and the referral of the child to other Medi-Cal service providers as may be required to provide continuity of care.
i. Providing information to other staff on the child’s related medical/dental/mental health services and plans, such as IEPs and/or IFSPs.
j. Coordinating the delivery of interdistrict and community-based medical/mental health services for children with special/severe health care needs.
k. Monitoring and evaluating the Medi-Cal-covered service components of the IEP as appropriate. l. Coordinating medical/dental/mental health service provisions with managed care plans as appropriate. Remember: Working in education today requires a great deal of coordination of services and monitoring of Medic-Cal covered health issues.
Note: Case Managers participating in the LEA Medi-Cal Billing Option for IEP case management cannot claim MAA Referral, Coordination, and Monitoring. Staff should claim time under Code 2, Direct Medical Service as TCM billing includes
Referral, Coordination, and Monitoring.
Code 9: Transportation For Non-Medi-Cal Services (U)
School employees should use this code when assisting an individual to obtain transportation to services not covered by Medi-Cal, or accompanying the individual to services not covered by Medi-Cal. Include related paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email
and voicemail.
a. Scheduling or arranging transportation to social; vocational; educational; and/or any other non-Medi-Cal services, programs, and activities.
b. Actual cost of transportation is not considered MAA.
Code 10: Arranging Transportation In Support Of Medi-Cal Services (PM/50-Percent FFP)
School employees should use this code when assisting an individual or family to obtain transportation to the site where services covered by Medi-Cal are provided. This activity includes:
a. Scheduling or arranging transportation to Medi-Cal covered services. b. A transportation supervisor and staff time coordinating IEP transportation. This activity does not include:
a. The costs of the actual transportation service, but rather the administrative activities involved in scheduling or arranging specialized transportation.
b. Activities that contribute to the actual billing of transportation as a medical service such as with the LEA Medi-Cal Billing Option program.
c. Accompanying the Medi-Cal-eligible individual to Medi-Cal services as an administrative activity. d. Arranging campus security or medical transportation (such as ambulance).
Note: Case Managers participating in the LEA Medi-Cal Billing Option cannot duplicate their time here. Staff should claim time
under Code 2, Direct Medical Service.
MAA Codes 20 Remember, samples must always include what, who and why.
Code 11: Non-Medi-Cal Translation (U)
School employees who provide translation services for non-Medi-Cal activities should use this code. Include related paperwork, clerical activities or staff travel required to perform these activities, including initiating and responding to email and voicemail.
a. Arranging for or providing translation services (oral or signing services) that assist the individual to access and understand social, educational, and vocational services.
b. Arranging for or providing translation services (oral or signing services) that assist the individual to access and understand the State education or Statemandated health screenings (e.g., vision, hearing, and scoliosis) and general health education outreach campaigns intended for the student population.
Code 12: Translation Related To Medi-Cal Services (PM/50-Percent FFP)
Translation may be allowable as an administrative activity if it is not included and paid for as part of a medical assistance service. However, translation must be provided by a third party translator or by separate employees performing
translation functions for the school and it must facilitate access to Medi-Cal-covered services. Please note that a school district does not need to have a separate administrative claiming unit for translation.
School employees who provide Medi-Cal translation services should use this code. Include related paperwork, clerical activities, or staff travel required to perform these activities, including initiating and responding to email and voicemail
a. Arranging for or providing translation services (oral, written, and signing) that assist the individual to access and understand necessary care or treatment covered by Medi-Cal.
b. Arranging for or providing translation to student/parent to understand how to access the application process for Medi-Cal/Healthy Families.
NOTE: Case Managers participating in the LEA Medi-Cal Billing Option cannot duplicate their time here. Staff should claim time under Code 2, Direct Medical Service as TCM billing. TCM Billing Includes Referral, Coordination, and Monitoring.
Remember: Translation = Three (3) people or two (2) people and a written document being translated.
Code 13: Program Planning, Policy Development, And Interagency Coordination Related To Non-Medi-Cal Services (U)
This code should be used by school staff when performing collaborative activities with other agencies associated with the development of strategies to improve the coordination and delivery of non-medical/non-mental health services to students and their families. Non-medical services may include social, educational, and vocational
services. Only employees whose position descriptions include program planning, policy development and interagency coordination should use this code. Staff time-surveying under this code should include related, paperwork, clerical activities, or travel required to perform these activities, including initiating and responding to email and voicemail.
a. Identifying gaps or duplication of other non-medical services (e.g., social, vocational, and educational programs) to students and their families, and developing strategies to improve the delivery and coordination of these services.
b. Developing strategies to assess or increase the capacity of non-medical school programs. c. Monitoring the non-medical delivery systems in schools.
d. Developing procedures for tracking families’ requests for assistance with nonmedical services and the providers of such services.
Non -Medi-Cal
MAA Codes 21 Remember, samples must always include what, who and why.
e. Evaluating the need for non-medical services in relation to specific populations or geographic areas. f. Analyzing non-medical data related to a specific program, population, or geographic area.
g. Working with other agencies providing non-medical services to improve the coordination and delivery of services and to improve collaboration around the early identification of non-medical problems.
h. Defining the scope of each agency’s non-medical service in relation to the other.
i. Developing advisory or work groups of professionals to provide consultation and advice regarding the delivery of non-medical services to the school populations.
j. Developing non-medical referral sources.
k. Coordinating with interagency committees to identify, promote, and develop nonmedical services in the school system.
l. Developing and processing non-medical MOUs, contracts, and agreement.
Code 14: Program Planning, Policy Development, And Interagency Coordination Related To Medi-Cal Services (PM/50-Percent FFP)
This code should be used by school staff when performing collaborative activities within districts, with community agencies, and with other LEAs associated with the development of strategies to improve the coordination and delivery of Medi-Cal-covered medical/dental/mental health services to students and their families. Only employees whose duty statements include program planning, policy development, and interagency coordination should use this code. Staff surveying under this code should include related paperwork, clerical activities or travel required to perform these activities, including initiating and responding to email and voicemail.
a. Identifying gaps or duplication of medical/dental/mental health services to students and their families and developing strategies to improve the delivery and coordination of these services.
b. Developing strategies to assess or increase the capacity of school medical/dental/mental health programs. c. Monitoring the medical/dental/mental health delivery systems in schools.
d. Developing procedures for tracking families’ requests for assistance with Medi- Cal-covered services and providers. (This does not include the actual tracking of requests for Medi-Cal services.)
e. Evaluating the need for Medi-Cal services in relation to specific populations or geographic areas. f. Analyzing Medi-Cal data related to a specific program, population, or geographic area.
g. Working with other agencies and/or providers that perform Medi-Cal services, to expand access to specific populations of Medi-Cal eligibles, and to improve collaboration around the early identification of medical problems.
h. Defining the scope of each agency’s Medi-Cal service in relation to the other.
i. Working with Medi-Cal resources, such as the managed care plans, to make good faith efforts to locate and develop health services referral relationships.
j. Developing advisory or work groups of health professionals to provide consultation and advice regarding the delivery of Medi-Cal care services to the school populations.
k. Developing medical referral sources, such as directories of Medi-Cal providers and managed care plans, which will provide services to targeted population groups such as Medi-Cal and/or CHDP children.
l. Coordinating with interagency committees to identify, promote, and develop Medi-Cal and/or CHDP services in the school system.
m. Negotiating and processing MOUs and special agreements that support interagency coordination to improve the delivery of Medi-Cal services.
n. Participating in or coordinating training that enhances early identification, intervention, screening, and referral of students with special health needs to Medi-Cal services. (This is distinguished from IDEA child find programs.)
Remember: This code is for collaborative team efforts whose outcome reaches larger groups – not individual efforts. MAA
MAA Codes 22 Remember, samples must always include what, who and why.
Code 15: Medi-Cal Claims Administration, Coordination, And Training (TM/50-Percent FFP)
This code should be used by LEA, LEC, and LGA coordinators when performing activities that are directly related to Medi-Cal Administrative Activities claims administration and coordination, and training activities. Include related paperwork, clerical activities, or staff travel necessary to perform these activities, including initiating and responding to email and voicemail. Do not code time for initial or annual training or time spent completing LEA Medi-Cal Billing Option forms or analysis of LEA Medi-Cal Billing Option information.a. Drafting, revising, and submitting MAA operational plans.
a. Drafting, revising, and submitting MAA operational plans.
b. Serving as liaison for regional and local MAA claiming programs and with the State and Federal Governments on Medi-Cal administration (i.e., LEC/LGA Coordinators or their designees).
c. Monitoring the performance of MAA claiming programs.
d. Administering MAA, including overseeing, preparing, compiling, revising, and submitting claims. e. Training program and subcontractor staff on state, federal, and local requirements for MAA claiming. f. Ensuring that MAA claims do not duplicate Medi-Cal claims for the same activities from other providers. g. Attending meetings and conferences that involve MAA for LEA or LEC/LGA ,coordinators.
h. Initial and/or annual claiming for time survey training continues to be disallowed.
Code 16: General Administration/Completing The Maa Time Survey Form/Paid Time Off (R)
This code should be used for General Administration, by time survey participants for completing the MAA time survey form, and paid time off. General Administration duties are more specific to general administrative/clerical activities related to facilities, district functions and operations.
Time recorded under this code will be apportioned appropriately to MAA and non-MAA. Paid time off is when you are being paid, but you’re not at work. This includes paid vacation days, jury duty, sick leave, etc. If you are not paid for your time off, you can’t record that time here. Unpaid time off should be left blank on your time survey.
When not included in the indirect rate, the general operation of LEA such as accounting, budgeting, payroll, purchasing and data processing may be recorded under this code. (Certain functions, such as payroll, maintaining inventories, developing budgets, executive direction, etc., are considered overhead; therefore, they are ONLY allowable
through the approved indirect cost rate.)
Below are typical examples of general administrative activities, but they are not all inclusive:
a. Staff should use this code for completing the MAA time survey form. Staff who time survey should use this code for time spent after initial or annual training in reviewing how to document relevant MAA through the time survey process. Reasonable time spent reviewing how to survey and working with others to complete the survey is acceptable.
b. Reviewing non-instructional school policies, procedures, or rules. c. Attending or facilitating school or unit staff meetings, board meetings. d. Completing personal mileage and expense claims.
MAA Codes 23 Remember, samples must always include what, who and why.
ADDITIONAL NOTE:
According to OMB Circular A-87, Attachment A, Section C, federal funding is available for the cost of administrative activities that directly support efforts to identify and enroll potential eligibles into Medicaid and that directly support the provision of medical services covered under the State Medicaid plan. Therefore, invoices must only include data from the participant’s time surveys that document MAA reimbursable time. DHCS advises the LECs/LGAs/LEAs to review their time surveys and invoices to assess reasonableness of time. Can the Code 15 time be explained and justified adequately to an auditor? If not, the LECs/LGAs/LEAs are advised to revise any invoices that do not meet these criteria. All records in support of allowable MAA activities must be maintained in an audit file for a minimum of three fiscal years after the end of the quarter in which LEC or LGA receives reimbursement from DHCS for the expenditures incurred. Records must be made available to State and the federal California School-Based 5-15 Activity Codes: Descriptions and Examples Medi-Cal Administrative Activities Manual June 2012 reviewers and auditor upon request, in accordance with Title 42 of the Code of Federal Regulations, Section 433.32. DHCS Audits and Investigation Division, the Centers for Medicare and Medicaid Services, and the federal Office of the Inspector General will reference OMB A-87 to verify supportable and allowable costs.
The LEA is responsible to ensure that time survey results are supportable. The LEA is also responsible for any audit disallowances.
Important Things To Remember:
1.Medi-Cal Covered Services are Health Care Covered Services.
2.Health is all Med-Cal covered mental health and physical health services and issues. (See chart on page 42) 3.Samples are crucial to your time survey and justify that what you are doing is health related and covered by Medi-Cal. Please define the Medi-Cal covered service in your samples.
4. Samples must always includewho, what, why, and sometimes where.
5.Always use health wording in your samples, not education wording. If you’re using educational wording then you wouldn’t be in a health-related code.
6.Any school staff can participate in MAA if they perform MAA activities as part of their daily job function. All activities must be a normal part of your job duties, not performed just because it is the time survey week.
7.Activities (referrals, coordination, collaboration, translation) surrounding first aid and general health care issues (playground injuries, flu, sore throat, etc.) are not MAA reimbursable activities.
MAA Codes 24
Notes
My
MAA
My MAA Tips 26
Codes 2 vs. Code 8
Code 2
Direct Medical Services & Extensions
of Direct Medical Services
Code 8
On-Going Referral, Coordination, and
Monitoring of Medi-Cal Services
IEP direct service time (such as counseling, speech, OT/PT, and specialized nursing.
Making referrals for and/or coordinating medical or physical examinations and necessary medical/mental health evaluations.
Monitoring/observation of student by the direct service provider to determine what direct service techniques/strategies to further provide.
Gathering any information that may be required in advance of referrals.
Direct service provider activities that are an integral part of or an extension of a medical service (e.g., student follow-up, student assessment, student counseling, student education, consultation and student billing activities, including arranging and coordination IEP meetings) are considered direct medical services.
Coordinating the completion of the prescribed services, termination of services, and the referral of the child to other Medi-Cal service providers as may be required to provide continuity of care.
Direct service provider research of the health condition, therapy strategies and equipment to use with a student.
Arranging for any Medi-Cal covered medical/dental/mental health diagnostic or treatment services that may be required as the result of a specifically identified medical/dental/mental health condition.
Direct service provider consultation with other health
providers necessary for implementation of a direct service. Providing information to other staff on the child’s related medical/dental/mental health condition.
Examples of Code 2
Examples of Code 8
Met with student/teacher of family to modify student learning environment as required extension of direct service.
Making referrals for and/or coordinating medical or physical examinations and necessary medical/mental health evaluations.
Monitoring/observation of student by the direct service provider to determine what direct service techniques/ strategies to further provide.
Gathering any information that may be required in advance of referrals.
Direct service provider activities that are an integral part of or an extension of a medical service (e.g., student follow-up, student assessment, student counseling, student education, consultation and student billing activities, including arranging and coordination IEP meetings) are considered direct medical services.
Coordinating the completion of the prescribed services, termination of services, and the referral of the child to other Medi-Cal service providers as may be required to provide continuity of care.
My MAA Tips 27
Notes
My MAA Tips 28
Codes at
a Glance
Education
Health
Direct Services
Code 1
• Providing classroom instruction • Testing, correcting papers • Applying discipline activities • Playground supervision
• Performing mandated immunizations • Enrolling students/compiling attendance
Code 2
• Delivering medical/health/mental health treatment or therapy
• Delivering medical/health/mental health assessments • Reporting assessment results at IEP
• Administering first aid, prescribed injections or medication to a student
Initial Outreach and Referrals
Code 3
• Informing families on social, vocational, and educational outreach and referrals
• Providing referral information on WIC, sports teams, tutoring, etc.
• Conducting general health education programs or campaigns addressed to the general population • Assisting in the early identification of children with
special needs through IDEA child find
• Helping families access social, educational or legal services
• Participating in or coordinating trainings that enhances IDEA child find programs
• Participating in or coordinating training that improves the delivery of services for programs other than Medi-Cal
Code 4
• Initial outreach for Medi-Cal services such as: • CHDP program
• Clinics and hospitals • Substance abuse treatment • Family planning
• Initial referral for Medi-Cal covered providers such as: • Psychologists/Mental health counselors
• Speech therapists • Physicians and nurses • OTs and PTs
• Conducting a family health education outreach program targeted towards family planning Medi-Cal services
• Participating in/or coordinating outreach trainings that improve the delivery of Medi-Cal services
Applications
Code 5
• Assisting with applications for programs such as: • CalWORKS
• Food stamps • WIC
• Free/Reduced Lunch Program
Code 6
• Assisting with applications for Medi-Cal/Healthy Families only
• Verifying an individual’s current Medi-Cal/Healthy Families eligibility status for the purposes of the Medi-Cal program
• Gathering information related to the Medi-Cal/ Healthy Families application
Ongoing Coordination and Monitoring
Code 7
• Monitoring student achievement
• IEP discussions or any discussions on academic progress with teachers, special education teachers or administrators
• Following up on referrals made to social and educational services such as childcare, employment, job training and housing
• Participating in a meeting/discussion to coordinate or review a student’s need for scholastic, vocational and non-health related services not covered by Medi-Cal
• Monitoring and evaluating the non-medical components of the IEP as appropriate
• Coordinating and/or monitoring the delivery of mandated immunizations and health screens (vision, hearing, scoliosis)
Code 8*
• Monitoring of Medi-Cal (health and mental health) services
• IEP discussions or any discussions on Medi-Cal (health and mental health) related services and concerns with health/mental health providers • Coordinating mental health service plans with
Medi-Cal providers
• Coordinating managed care plans with Medi-Cal providers
• Arranging or scheduling the Medi-Cal (health or mental health) services
• Following up on referrals made to Medi-Cal providers or to Medi-Cal (health/mental health) services • Gathering information related to student issues for
help in advance of a referral
*Conversations and/or referrals that occur as a direct result of an assessment are considered code 2 if you are the health care provider that provided the assessment.
My MAA Tips 29
Codes at
a Glance
Transportation
Code 9
• Arranging daily transportation to/from school • Arranging transportation for academics, tutoring,
field trips, sports, etc.
Code 10
• Arranging transportation to/from Medi-Cal covered services at school
• Arranging transportation to/from a medical or mental health appointment off campus
Translation
Code 11
• Arranging or providing translation for teacher/academic related matters
Code 12
• Arranging or providing translation for Medi-Cal covered provider/health related matters
Program Planning and Policy Development
Code 13
• Developing strategies to improve delivery of social, educational, vocational services to school populations
• Identifying gaps in social, educational, vocational services
• Developing strategies to assess or increase the capacity of non-medical school programs
Code 14
• Developing strategies to improve delivery of Medi-Cal services to school populations • Participating in, or coordinating, training that
enhances early identification, intervention, screening, and referral of students with special needs to Medi-Cal services
• Interagency collaborations that coordinate and develop new Medi-Cal covered services in schools
Education
Health
MAA Administration (for use of MAA Coordinators only)
Code 15
• MAA Coordination activities
• Overseeing the time survey process, preparing the time survey week, collecting time surveys, gathering signatures for time surveys • Administering MAA program including overseeing, preparing, compiling, revising and submitting MAA claims
Administrative Activities Paid Time Off Time Survey Completion
Code 16
• Administrative activities related
to facilities, district functions, and operations
• General supervision of staff, including evaluations Supervision of facilities for oversight and management
• Reviewing non-instructional school policies and procedures
• Non-instructional staff meetings • Board meetings to gain knowledge
in district policies and procedures
Code 16
• Paid time off
• Sick leave • Maternity leave • Jury duty • Paid vacation days
Code 16
• Completing MAA time survey form
• Reviewing training materials for completion of MAA time survey form
• Asking questions to aid in completion of MAA time survey form
My MAA Tips 30
Sampling Guidelines
How to write a valid sample
Medi-Cal Covered Services are
Health Care Covered
Services
Samples are crucial to your time survey. They provide justification to show that what you are doing is HEALTH–related. The samples basically make the difference between your time survey being accepted and reimbursable or unaccepted and thrown out of the invoicing process. The samples are crucial, and they cannot be educationally based; they must be health based. Wording is essential and must make sense to those who work in health care (DHCS & CMS).
What counts as
Medi-Cal covered
health care services
and issues?
Mental Health
Physical
Health
Use the following guidelines when you are writing your samples to ensure you meet the criteria for valid and claimable samples. Examples of Medi-Cal covered services are listed below. This list is not all inclusive.
Please remember
all health services
must be covered
by Medi-Cal to be
MAA eligible.
Nursing Services Speech Services
Occupational Therapy Services Physical Therapy Services Medical Services
Dental Services Vision Services Hearing Services Pregnancy Services
Well-Baby/Pre-atal Services Psychological Services
Mental Health Counseling Services Mental Health Behaviorist Services Substance Abuse Treatment Services Grief Counseling
My MAA Tips 31 The following chart shows the key words for each code:
Code 1 = Direct Educational Services:
Teaching, routine parts of job that are specific to schools and students only!
Code 2 = Direct Health Services:
Therapy, assessments, routine parts of job specific to schools
Code 4 = New or First Time:
Referring someone to a Medi-Cal covered service they don’t already have
Code 6 = Medi-Cal Application process only:
Completing the application – Medi-Cal/Healthy Families only!
Code 8 = Student Specific/On-going or Known Activities:
Making sure a specific student’s known Medi-Cal covered health needs are being met
Code 10 = Scheduling or Arranging Only:
Transporting is a direct service – this is arranging transportation to a Medi-Cal
covered service only!
Code 12 = Coordinating Translation Services and Actual Translating:
Must have 3 entities present (either people or written form)
Code 14 = Non-student specific/Interagency and Intra-agency Coordination/School or
District Wide Activities:
Adding Medi-Cal covered health care services that can benefit anyone not just one person
Code 15 = To be used for MAA Coordination Only:
Filling out MAA form/Getting Assistance with MAA process/Reviewing MAA materials
Code 16 = Paid Time off/Time Survey Completion:
Must be paid time off (jury duty, sick leave, personal necessity)
Filling out MAA form, getting assistance, reviewing materials
Code 16 =
Administrative Time:
Activities that are not specific to schools – exist in every job market (evaluating staff, facilities, non-educational meetings, non-instructional policies & procedures, board meetings, personal expense claims, negotiations)
Remember
• You must write a complete sentence. Be general (no proper names of students, parents or school staff). Be specific (who, what and why must be answered fully in your sentence)
• Using a code one time only = one sample
• Use a code two or more times = 2 samples
• Use a code more than two-hours in any reimbursable code = 3 samples (recommended)
• Be general – no proper names of students, parents or faculty
• Be specific – need to know why you used a health code
• Medi-Cal providers need to be listed by title
• Medi-Cal covered services must be listed. Please define the Medi-Cal covered service in your samples
• All activities must be a normal part of your job duties, not performed just because it is the time survey week
• Please note that 504 plans are not MAA reimbursable activities
• Referrals, coordination, collaboration and translation surrounding first aid and general health care issues (playground injuries, flu, sore throat, etc.) are not MAA reimbursable activities
My MAA Tips 32
The following codes require samples with
KEY WORDS
because they are
HEALTH
codes
(keywords are bolded in the code titles below)
CODE 4: Initial
referrals, outreach, linking
• Medi-Cal providers must be listed
• Reasons must be medically necessary and Medi-Cal covered
• Example:
I
referred
a student to the speech therapist
for a speech evaluation
.
CODE 6:
Facilitating Medi-Cal
applications
• Medi-Cal/Healthy Families must be listed
• Application must be included
• Example:
I
provided a list of documents to
the parents of a student
that were required to complete their
Medi-Cal/Healhy Families application
.
HOW TO WRITE A VALID SAMPLE
The following information is essential in writing your samples:
Sample:
“
I discussed the ongoing mental health service plan
for a student with the parents, mental health
counselor and school psychologist
to maintain consistency of the mental health services being
delivered at school
during an IEP meeting
”.
WHO
Who did you perform the activity with
and who did the activity pertain to?
4
1
WHAT
What activity was
being performed?
3
WHY
Why was the activity
being performed?
SOMETIMES WHERE
Where did the activity occur?
Pertains mainly to meetings
Sometimes you will need to include “Where” but only in cases when an activity takes you outside of your normal duties for an unusual amount of time.
My MAA Tips 33
