Medicaid Administrative Claiming by mifei

VIEWS: 39 PAGES: 11

									             Medicaid Administrative Claiming


                     Time Study Codes
                 Responses Received During
                   Participant Interviews
               Conducted in 99-00 School Year




                              July 24, 2000




*This document contains responses from the 1997-1998 , 1998 –1999, and 1999-2000
school years. Those responses received in 1999-2000 are bolded. All years are being
     provided to give the most complete listing of interview responses received.
              Code 1: Facilitating Medicaid Eligibility Determinations (All Staff)

Acceptable:                                        Unacceptable:
+ Discuss Medicaid with family                     - Confer with doctor regarding Medicaid
                                                   student
+ Call Medicaid office for family                  - Refer to TANF, WIC, other non-medical
                                                   services
+ Refer to Medicaid office                         - Refer for medical services
+ Help parents fill out Medicaid forms             - Refer to PRS/court – child abuse
+ Transport family to Medicaid office to make      - Talk to parents about new evaluation and
an application                                     getting parent input
+ Translating for family to assist them in         - Counsel students about health issues
applying for Medicaid
+ Make appointments at Medicaid office for         - Referral to self-paced alternative school
family
+ Verify if family is already on Medicaid          - Parent conference regarding academics
+ Refer to eligibility for CHIP-Phase I            - Conference regarding attendance
+ Verify student’s eligibility for SHARS




           Code 2: Facilitating Non-Medicaid Eligibility Determinations (All Staff)

Acceptable:                                        Unacceptable:
+ Talk with family about TANF, WIC, other          - Try to find Medicaid providers for family
non-medical services
+ Free/reduced lunch assistance                    - Gather information needed for special
                                                   education referrals
+ Facilitate access to day care, legal aid, etc.   - Refer to Medicaid; assist in application for
                                                   Medicaid
+ Help families apply for TANF, food               - Refer for medical services
stamps, WIC, employment, day care
+ Help families get after-school care              - Writing grant proposal
+ Verify attendance requirements for TANF          - Coordinate charitable events
+ Review list of needy families                    - Referral to CIS
                                                   - Assessments
                                                   - Modification of “504” for new student
                                                   - Inform about SSI appeal
                                                   - Counselors staff meeting
                                                   - In-take for alternative education
                                                   - Filling out applications for college
                                                   admissions
                             Code 3: Medicaid Outreach (SPMP)

Acceptable:                                       Unacceptable:
+ Identify students with health needs (child      - Make dental/vision follow-up
find) – not child specific
+ Plan campaign to immunize student due to        - Schedule medical appointments
outbreak of …
+ Plan strategy to provide pre-natal care         - Discuss medication with doctor
+ Notice of asthma clinic with brochures to       - Student observation
parents
                                                  - Review referrals for psychological services
                                                  - Professional development
                                                  - Working on child abuse case (giving medical
                                                  opinion)
                                                  - Rescreen students who didn‟t pass initial
                                                  screen
                                                  - Consult with teacher to develop behavioral
                                                  strategies to deal with student
                                                  - Admit people into the clinic
                                                  - Check for head lice
                                                  - Conference with parents about child‟s
                                                  progress or test results and options
                                                  - Discuss upcoming ARD with counselor
                                                  - In front office, checking on kids who were
                                                  sick
                                                  - Making list of students who need
                                                  mandatory screens
                                                  - Meetings with counselors/staff at new
                                                  schools to discuss role and way to handle
                                                  referrals to her
                                                  - Conducting in-service
                                                  - Discussion regarding CPS referral
                                                  requirements with staff
                                                  - Individual counseling
                                                  - Scored test materials



Note: Use of this code is restricted to staff designated as SPMP (Skilled Professional Medical
Personnel). Staff should use this code only when their additional skill and knowledge are
required to perform the function.
                           Code 4: Medicaid Outreach (All Staff)

Acceptable:                                      Unacceptable:
+ Check on additional Medicaid services          - Discuss behavior
available
+ Inform about available Medicaid services and   - Transport student to clinic/doctor
the various Medicaid agencies
+ Coordinate health fair (Medicaid services      - Collaborate with CCMS regarding child care
portion only)                                    and pre-k
+ Arrange for Medicaid presentations and         - Discuss medication/medical issues with
speakers (immunizations, Texas Health Steps)     family/staff
+ Distributed Medicaid brochures to schools      - Refer to social services
                                                 - Schedule medical appointments
                                                 - Discuss family status with staff
                                                 - ARD notices/immunization notices
                                                 - Home visit related to ARD (forms); calling
                                                 parents to remind of ARD meeting
                                                 - Gathering health information on a student
                                                 - Monitor student achievement
                                                 - „504” referral
                                                 - Parent/teacher conference
                                                 - Schedule “Red Ribbon” speakers
                                                 - Folder review of IEPs
                                                 - Refer for medical services
                                                 - Take student to CLARIS Center
                                                 - Distribute medical/hygiene supplies to
                                                 students
                                                 - Prepare for probation – judge needs
                                                 - Implement “Drug Free” program
                                                 - Group counseling
                                                 - Any work with attendance/grades/discipline
                                                 - Develop materials/information for use in
                                                 testing
                                                 - Copy/send medical records to another agency
                                                 - Counsel parents regarding medication policies
                                                 and following medication directions
                                                 - Order office supplies
                                                 - Kindergarten “Round-Up”
                                                 - PEP program – information about the
                                                 program
                                                 - Checking immunizations
                                                 - Student supervision
                                                 - Parent conference regarding conflict with
                                                 teacher
                                                 - ARD meeting/SST meeting
                                                 - Filling out Medicaid forms for family
                         Code 5: Outreach Non-Medicaid (All Staff)

Acceptable:                                       Unacceptable:
+ Inquire regarding additional Non-Medicaid       - Classroom teaching
services available
+ Distribute information on general health        - Guidance lessons
issues (drugs, hygiene, nutrition, etc).
+ Healthy lifestyles campaigns                    - Refer to medical services
+ Coordinate finger printing program (child       - Provide information regarding GED, ESL
safety)
+ Coordinate DARE, other healthy lifestyle        - Working with police – citations for smoking
programs
+ Provide information to students/staff on        - Refer to WIC, food banks, etc.
WIC, day care, etc.
+ Health fairs (non-Medicaid portion)             - Restroom checks
+ Program about dating violence                   - Listen to voice mail/ return phone calls
+ Character building programs


       Code 6: Referral, Coordination & Monitoring of Medicaid Services (All Staff)

Acceptable:                                       Unacceptable:
+ Gather information for ARD (medical             - In-service for special education teachers
portion)
+ Participate in ARD (medical portion)            - Participate in ARD (non-medical portion)
+ Refer to doctor/clinic/agencies for medical     - Scoring tests/writing reports
servcies
+ Follow-up to ensure medical care was            - Assessments/testing
obtained
+ Coordinate health needs of a student            - Referral to CIS for behavior/tutoring
+ Explain diagnosis to parent                     - Check immunization records
+ Paperwork related to ARD (medical               - Paperwork related to ARD (non-medical
portion)                                          portion)
+ Talk with teachers/staff about student‟s        - Translate/transport for ARD
health needs
+ Determine transition needs for child referred   - Help parent fill out paperwork for Medicaid
from ECI
+ Gather medical information for special          - Discuss/explain CIS program in general
education referrals
+ Parent conference regarding medical             - Programs such as ESL, Schools to Work,
issues                                            Open House, Kindergarten “Round-Up”,
                                                  Operation School Bell, “Red Ribbon”
                                                  - Student schedules
                                                  - Work with mother on SSI benefits
                                                  - Call parents to get children immunized
                                                  - Arrange for speakers for programs or classes
                                                  - Discuss TAAS with principal
                                                  - Sort middle school catalogs and information
                                                  - Supervision/Duty
                                                  - Get ready for day/prepare materials
                                                    - Generic use for travel
                                                    - Read and respond to mail
                                                    - Conduct/coordinate mandated screenings
                                                    - Administer medications
                                                    - Send immunization notices to parents
                                                    - Referral to CPS
                                                    - Copied procedural safeguards and sent to
                                                    central files
                                                    - Any TAAS activities
                                                    - Direct care/therapy
                                                    - Counseling
                                                    - Coordinate college visit for student
                                                    - Evaluate transcripts of transfer students
                                                    - Attendance issues


        Code 7: Referral, Coordination & Monitoring of Medicaid Services (SPMP)

Acceptable:                                         Unacceptable:
+ ARD (medical portion when SPMP skill &            - Schedule health screens
knowledge is required)
+ Discuss medical condition with parents            - LVN refers student to doctor
+ Talk to doctor about diagnosis, treatment,        - Check immunizations/update
medication, etc.                                    immunizations
+ Refer to medical services (SPMP skill             - Testing/assessments
required)
+ Coordinate with TDH on positive TB test           - Refer for mandated health screens
+ Conference with parents/other staff regarding     - Writing assessment reports
student‟s medical status (SPMP required)
+ Work with orthopedic doctors/specialists –        - Coordinate ARDs (non-medical or SPMP
referrals/appointment/coordination of care          skill not required)
+ Refer for special education testing (related to   - Getting supplies, materials, room ready for
speech therapy)                                     treatment
+ Follow-up on medical services for a child         - Reviewing IEP/folder prior to treatment
+ Monitor health services/status                    - Progess notes
+ Confer with TDH regarding suspected TB            - Schedule treatment/ARDs
                                                    - Verify if Medicaid covers equipment
                                                    purchase
                                                    - Interpret immunization records
                                                    - Direct services
                                                    - Make referrals for vision/hearing screens
                                                    - Campus improvement committee meeting



Note: Use of this code is restricted to staff designated as SPMP (Skilled Professional Medical
Personnel). Staff should use this code only when their additional skill and knowledge are
required to perform the function.
    Code 8: Referral, Coordination & Monitoring of Non-Medicaid Services (All Staff)

Acceptable:                                       Unacceptable:
+ Refer student to JOBS program                   - Gifted and Talented screenings
+ Refer to CCMS for child care                    - Interest and Aptitude tests
+ Coordinate mandated health screens              - TAAS
(vision, hearing,scoliosis)
+ Refer to social services (housing, clothing,    - Classroom guidance
food, other basic services)
+ Discuss student family situations with staff    - Refer for medical services, supplies, or
                                                  equipment
+ Refer to CIS                                    - Supervision/Duty
+ Refer to mandated health screens                - Interpreting
+ Discuss employment with student                 - Charting/documentation
+ Collect social case history                     - Meet with teachers about student absences
+ Refer to TCB – transition plan                  - Checking voice mail
+ Observation in vocational classroom             - Parent conference regarding magnet
                                                  schools
+ ITP meeting – employment training after
graduation



                Code 9: Medicaid Transportation and Translation (All Staff)

Acceptable:                                       Unacceptable:
+ Take student to doctor/medical services         - Drive to parent‟s home to discuss truancy
+ Arrange transportation for medical services     - Generic use for all travel
+ Translate the medical portion of the ARD        - ARD paperwork for Non-Medicaid student
+ Translate for student/family during the         - Reprimand students
delivery of medical services
+ Arranged for a translator for an ARD            - Issue books
                                                  - Travel to ARD meeting



                       Code 10: Medical Provider Relations (All Staff)

Acceptable:                                       Unacceptable:
+ Recruit speech therapists and other             - Take child home (any reason)
medical personnel
+ Prepare a referral list of Medicaid providers   - Discuss medical problem with parent/staff
+ Meet with TDH regarding provider list           - Arrange clinic appointment
                                                  - Train special education counselor on
                                                  procedures
                                                  - Coordinate/set-up vision/hearing screens
                                                  - Set-up clinic for medications
                                                  - Private practitioner consult on student
   Code 11: Program Planning, Development and Interagency Coordination (All Staff)

Acceptable:                                    Unacceptable:
+ Coordinate with agencies to determine gaps   - Help families in colonias
in Medicaid services
+ Medicaid planning with health/community      - Plan with SBDM team
agencies (Medicaid)
+ Develop crisis plan for district             - CIS coordination
                                               - CPS referral
                                               - Lesson/therapy plans
                                               - Office staffing
                                               - Inventory of test protocols
                                               - Work with teachers to implement IEP
                                               - Work with families to hook up with DHS,
                                               MHMR, etc.
                                               - Prepare materials for next day
                                               - Staffing to discuss needs of student for
                                               additional modifications or other placements
                                               - Work on referrals from other agencies
                                               - Teacher surveys
                                               - Collecting for fund raiser
                                               - Recruit/register students for PSAT
                                               - Presentation and coordination of Safe/Drug
                                               Free Schools
                                               - Research student‟s problem
                                               - Staff meeting
                                               - Intake for an ED child
                                               - Medical part of ARD meeting
                                               - Conference with other OT‟s and PT‟s
                                               - Progress notes
                                               - Get more information on supplies for required
                                               catheterization
                                               - Call family to remind that they have a
                                               medical appointment
                                               - Fill out Medicaid forms for students
                                               - Conference/training
                                               - Board meeting
                                               - Scheduling students
                                               - Pre-registration of students
                                               - TAAS coordination
                                               - Writing IEP‟s/behavior modification plans
                                               - Call DHS about services available for child
                                               - Drug testing
                                               - General office duties
                                               - Reviewing student records
                                               - Preparing for next day
                                               - Speech therapy staff meeting
                                               - Conference period
                                               - Meeting about Career Day
                                                  - Work with kids having trouble adjusting to
                                                  school
                                                  - Planning for PSAT
                                                  - Review student transcripts
                                                  - Counseling with student
                                                  - Parenting class



    Code 12: Program Planning, Development, and Interagency Coordination (SPMP)

Acceptable:                                       Unacceptable:
+ Coordinate with agencies to determine gaps      - Life Management/ECI referrals
in Medicaid services
+ Medicaid planning with health agencies          - Referrals to health agencies for medical
                                                  services
+ Plan/develop strategies for Autism Support      - Interaction with Head Start
Team
+ Interagency task force on health care –         - Reading research materials
strategies to develop linkages to primary care
                                                  - Lesson/therapy plans
                                                  - Assessments for other agencies
                                                  - Progress reports
                                                  - Medical Alert Cards for students – update
                                                  - Coordinate care for student
                                                  - Budget
                                                  - Verify with MHMR type of equipment child
                                                  has at home
                                                  - Fill out SHARS tickets
                                                  - Evaluate and provide therapy services
                                                  - Report writing/planning and consultation
                                                  - Train assistants to implement therapy plans
                                                  - Order/evaluate health supplies
                                                  - Plan for autism report
                                                  - Faxing notes to office
                                                  - Looking up exercise program


Note: Use of this code is restricted to staff designated as SPMP (Skilled Professional Medical
Personnel). Staff should use this code only when their additional skill and knowledge are
required to perform this function.
                         Code 13: Direct Medical Services (All Staff)

Acceptable:                                       Unacceptable:
+ Direct therapy/medical services                 - Transportation to health clinic
+ Counseling – group and individual               - Call parent regarding attendance/behavior
+ First aid                                       - Check on eligibility
+ Medications administration                      - Paid leave (sick, annual, etc.)
+ Assessments/testing/scoring/report writing      - Recording immunizations
+ Crisis intervention/grief counseling            - Translation
+ Performing mandated screens                     - Parent conferences
+ Computer/manual logging of                      - Content mastery activities
medications/clinic visits
                                                  - ARD meeting
                                                  - Standardized testing (PALM, TAAS, DSP)



         Code 14: Non-Medicaid, Other Educations and Social Services (All Staff)

Acceptable:                                       Unacceptable:
+ Check/update immunization records               - Generic use for all travel
+ Transport student home due to discipline        - Office duties
problems
+ Instruction/tutoring/grading                    - CIS referral
+ Classroom guidance                              - Counseling – group and individual
+ Parent/teacher conference                       - Score tests/write assessments
+ Enroll new students                             - Generic use for all paperwork
+ Monitor students (cafeteria, before/after       - Read research materials
school)
+ Attendance/truancy/discipline activities        - Timestudy write-up
+ ARD (non-medical portion)                       - Getting equipment/materials ready for
                                                  treatment of students
+ Monitor student achievement                     - Prepare classroom for treatments
+ Academic counseling                             - Direct services/therapy
+ Training related to curriculum or instruction   - Therapy/progress notes
+ Peer mediation, PAL program                     - Meet with nurse to discuss medical issues
+ TAAS coordination/training/testing
+ Classroom interpreting
+ Arrange for tutors
+ Review progress reports (academic)
+ School ceremonies (attend/supervise)
+ GED/ESL sign-up, coordination
+ Lesson plans
+ Student scheduling
+ Vocational assessments
+ Review curriculum
+ PEIMS – drop-out report
                        Code 15: General Administration (All Staff)

Acceptable:                                   Unacceptable:
+ Timestudy                                   - Lesson/therapy plans
+ Order supplies                              - Assessment notices
+ In-service/professional development         - Discuss special education referral with
                                              teacher
+ Budget activities                           - Cafeteria duty/student supervision
+ Paid leave (sick, annual)                   - Classroom observations
+ Preparation for next day                    - Check attendance/truancy issues
+ Read research materials                     - Check immunization status
+ Supervise staff/volunteers                  - Parent conference
+ Campus Decision Making Committee            - Newsletter for Pre-K teachers
meeting (central office representative)
+ General office duties (mail, phone calls,   - Report writing (related to assessments or
copying, etc.)                                ARD/IEP)
+ Staff meetings/faculty meetings             - Generic use for all travel
                                              - Generic use for all paperwork
                                              - Discipline activities
                                              - Chart screening results/immunizations
                                              - Progress notes
                                              - Tardy duty
                                              - Mock TAAS test coordination/field test
                                              - Field trip
                                              - Update medication log/clinic log
                                              - Tutoring
                                              - Research/update transcripts
                                              - Letters to parents regarding academics
                                              - Scheduling
                                              - Enrolling students
                                              - Make copies of file for student’s doctor
                                              - Student assemblies
                                              - work on Special Education referrals
                                              - Report cards
                                              - Phone parents on medical permissions
                                              - Updating/filing health records
                                              - Meeting regarding curriculum, materials
                                              - Work on “Special Olympics” and health
                                              fairs
                                              - Conferences with staff regarding
                                              academics or medical issues

								
To top