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Psychotherapy Invoice

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					School-Based Medicaid Programs
     Mississippi Department of Education
          Lea Ann McElroy, Director
          Bureau of Health Services

       Mississippi Division of Medicaid
          Cindy Thames, Director
      Bureau of Maternal & Child Heath
Former Surgeon General Dr.
Antonio Novello


“Health and education go hand in

hand: one cannot exist without the

other. To believe any differently is to

hamper progress. Just as our children

have a right to receive the best

education available, they have a right

to be healthy. As parents, legislators,

and educators, it is up to us to see

that this becomes a reality.”


Healthy Children Ready to Learn: An Essential Collaboration Between Health and
Education, 1992
      Is
   student
  health
  the missing
     link in
    school
improvement?
        The State of School Health in
        Mississippi
   Asthma
       #1 reason for school absenteeism
   Diabetes
       #2 state in the nation for Type II diabetes
   Obesity
       #1 state in the nation for obesity rates
   Medications
       More than 3.5 million schoolchildren take
        medication at school
    MASLOW’S HEIRARCHY AND COORDINATED
              SCHOOL HEALTH



                                   Health Education

          Motivated and            Physical Education
          Learning
                                   Health Services

                                   Nutrition Services
         Sense of Positive
         Self-Esteem               Counseling, Psychological
                                   and Social Services

     Sense of Belonging and        Healthy School Environment
     Importance
                                   Health Promotion for Staff
     Sense of Being Loved
     and                            Family/Community
     Appreciated                    Involvement

Free of Fear and In A Safe place


      Physical Health
       Coordinated School Health Program
               Health Education       Physical
 Family and                          Education
 Community
Involvement


                                               Health Services
  Health
Promotion
 for Staff


                                                 Nutrition
    Healthy School                               Services
     Environment
                            Health Education
Working together for the health of our
children!

       MDE


                            Student
                            Health



      Medicaid
      What is Mississippi Cool Kids
      (EPSDT)?

   A FREE health care program for Mississippi’s
    children ages birth through 21 who are
    eligible for Medicaid

   A way for children to get medical exams,
    checkups, follow-up treatment, and special
    care they need to make sure they enjoy the
    benefits of good health
       What is Mississippi Cool Kids
       (EPSDT)?

   Annual exam for children/youth ages 2 – 21

   Mandatory periodic screening services include:
     Comprehensive physical exam

     Developmental assessment

     Oral health assessment

     Vision and hearing screens

     Adolescent counseling

     Referral if necessary
        We’re Number 1!


   Mississippi is leading the way as the first
    state to offer EPSDT services through
    school nurses!
       That means that with a Registered Nurse (RN) in a
        school-based clinic, a school can become a Medicaid
        Provider for EPSDT services, and file for
        reimbursement from Medicaid for each approved
        screening. Eligible population would determine level of
        sustainability.
      EPSDT Program Objective


   Establish well qualified RN’s to provide
    school based EPSDT services to every
    eligible child
   Finance the RN’s cost to the school in
    whole or in part thru the provision of
    EPSDT services
       What do we want you to do?

   District/school administration will support
    program
   District will establish clinic in a school site with
    qualified RN
   School will include parental permission slips in
    school registration process and develop and
    implement a defined process to compile parental
    permission slips for RN
   School will provide informative meetings for
    school faculty and parents
      What will we do for you?


   Provide assistance with Medicaid provider
    enrollment application
   Provide template permission slips;
    communication materials for parents;
    contracts and other written material
   Provide template PowerPoint
    presentations for faculty, teacher and
    parent presentations
      What will we do for you?


   Provide periodic training
   Provide day-to-day administrative support
   Provide help/assistance for Screen Plus
    software
      What does the EPSDT School Nurse
      really do?

   Consent forms
   Verify Medicaid numbers
   Periodicity schedule/schedules
    appointments
   Screens children (1 hour per screening on
    average)
   Files paperwork/submits claims
   Follow up/referral
Is the program making a difference?
            Parental Follow-up Rates
                   2002-2006

100%
 90%
 80%
 70%
 60%
 50%
 40%
 30%
 20%
 10%
  0%



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The Business of EPSDT
Time is Money!
      Time for screenings + Dollars =
      Sustained Program

# Medicaid        Average        Total
Children Screened Payment/Screen Payment

250             $70.00          $17,500
350             $70.00          $24,500
500             $70.00          $35,000
Teamwork is critical to success!
       Teamwork = WIN-WIN!

   Improved classroom behavior
   Improved academic performance
   Reduced absenteeism
   Onsite access to healthcare for students and
    faculty
   Coordinated effort for improved health education
   Additional funding for coordinated school health
What is School-Based Administrative
Claiming (SBAC)?

     A federally funded program administered by
      the Division of Medicaid in coordination with
      MDE
     A program that allows school districts to be
      reimbursed for some of their costs associated
      with school-based health and outreach
      activities which are not claimable under the
      Medicaid School Health-Related Services
      program or other Medicaid “fee-for-service”
      programs
What is School-Based Administrative
Claiming (SBAC)?

     In general, the types of school-based health
      and outreach activities funded under SBAC
      are:
         Referral of students/families for Medicaid
          eligibility determinations
         Provision of health care information and
          referral
         Coordination and monitoring of health services
         Interagency coordination
      How does it work?

   Roster of participating employees

   Time samples – Random Moment
    Samples (RMS)

   Cost data

   Reimbursement!
      School-Based Administrative
      Claiming and the Office of Healthy
      Schools

   Bringing the process “in-house” and
    eliminating the third-party administrator

             School    MDE      DOM
       School-Based Administrative
       Claiming and the Office of Healthy
       Schools

   Designing a web-based reporting system
    to automate the process

   Processing claims in a timely manner

   Consistency and accountability
        School-Based Administrative
        Claiming Program Guide

   Overview of SBAC
   Implementing SBAC
   Staff Activities Included Under SBAC
   Time Study Participants
   The Time Study Process
   Training for SBAC
   Time Study Results and the Cost
    Allocation Process
   Preparing an Invoice for Medicaid
    Payment
   Monitoring and Quality Assurance
       School-Based Administrative
       Claiming Program Guide

   Appendix B - SBAC Activities List
   Appendix C - MDE Contacts
   Appendix E - SBAC Time Study
    Activities
   Appendix I - 2007-2008 SBAC
    Calendar
   Appendix J – SBAC Training (3 Levels)
   District User’s Guide
        SBAC Training Modules

   Three Levels
       RMS Participant
       SBAC District Coordinator
       MDE SBAC Specialist
   Training is designed incrementally, based on the
    knowledge needed for the level of participation
   Each level has a relationship to the entire
    process
   Each level is dependent on the other
        Level 1 – RMS Participant

   What is Medicaid?
       Who/what is covered?
       What is EPSDT/Mississippi Cool Kids?
       What is theCertified School Match Program?
   What is SBAC?
       What is a RMS?
       Who can be sampled?
   Why must I do this?
       What do I have to do?
       How do I fill out the form?
   True/False test
      Level 2 – SBAC District Coordinator
      and District Business Manager


   Most essential functions
   Mainly computer manipulation
   Quality control
   Assurance that deadlines are met
   Audit compliance piece
       Level 2 – SBAC District Coordinator
       Major Steps (Employee Roster)

   Generate initial roster

   Document participant training by deadline

   Remove untrained participants by deadline

   Submit trained roster by deadline
      Level 2 – SBAC District Coordinator
      Major Steps (RMS forms)


   Track participants’ receipt, completion, and
    return of RMS forms during the quarter

   Verify a percentage of RMS forms

   Submit completed RMS forms by deadline
       Level 2 – SBAC District Coordinator
       Major Steps (Audit file maintenance)

   Quarterly invoice
   ID information on each group member
   Cost summaries for participant grouping
   RMS summary
   Calculations of Medicaid-eligible student
    proportions
   Total costs
   Financial allocation with written explanation
   Certification of State Expenditures form
SBAC Web-Based Reporting System
User Control Panel/Functions
Employee Roster
RMS Participant Training
    Early Success!

“The training this morning was really
helpful. In light of this extremely busy
time for financial people, it was really
awesome to see that so much time and effort was
put into making this process as painless and as
user friendly as possible!”

“I think this new system is going to be
GREAT!!! It is obvious the amount of time and
effort that has gone into making this successful!!
It all seems very organized and easy to use!!”
        What is the School Health-Related
        Services Program?

   Designed to identify children who have a
    learning problem because of a medical
    problem which requires special services
   Services include:
       Speech/language therapy and evaluations
       Occupational therapy and evaluations
       Physical therapy and evaluations
       Psychological evaluations
       Psychotherapy services
      Speech/Language Services

   Services for speech, hearing and language
    disorders means diagnostic screening,
    preventive or corrective services provided
    by or under the direction of a speech
    pathologist for which a patient is referred
    by a physician .
   Services must be provided by a speech
    pathologist licensed in the State of
    Mississippi.
        Speech/Language Services

   The individual must also meet Federal regulation
    licensure requirements:
       Has a certificate of clinical competence from the
        American Speech-Language Hearing Association
        (ASHA)
       Has completed the equivalent educational
        requirements and work experience necessary for
        the certificate; or
       Has completed the academic program and is
        acquiring supervised work experience to qualify
        for the certificate
      What we’re doing to help!


   07-08SY - Pilot program to test a web-
    based system for reporting speech therapy
    claims
   08-09SY – Roll out system to all interested
    schools currently billing for speech therapy
        Contact Information




                              MS Division of Medicaid
 MS Dept. of Education
                              Cindy Thames, Director
Lea Ann McElroy, Director       Bureau of Maternal
Bureau of Health Services         & Child Health
      601-359-3189                601-359-6152
lmcelroy@mde.k12.ms.us      epcet@medicaid.state.ms.us

				
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