Missouri School District
Administrative Claiming
Random Moment Sample Training
Training Objectives
What is Missouri School District
Administrative Claiming (SDAC)?
Why were you chosen to participate?
What is Medicaid?
Who is covered by Medicaid?
What documentation is required?
How to fill out an RMS Observation
Form?
Review of Activity Codes
What is Missouri SDAC?
Department of Social Services (DSS),
MO HealthNet Division (MHD), and
individual school districts are able to
share in the responsibility for promoting
access to health care for students in the
school system, preventing costly or long
term health care problems for at risk
students and coordinating students'
health care needs with other providers.
What is Missouri SDAC?
Many of the activities performed by
school district staff meet the claimable
criteria for Medicaid administrative
claiming. The primary purpose of
administrative claiming is to reimburse
school districts for these activities, where
allowed.
Why Were You Chosen?
Your school district chose you to participate
because as part of your routine job tasks you
may provide:
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Referral, coordination and monitoring the delivery of
health care services
Linking the child and family to an ongoing health care
delivery system; and
Building and sustaining state and local partnerships
for delivery of medical and dental services.
What is Medicaid?
Medicaid is a federally funded, health
insurance program for low income and
needy people.
For children under age 21 and Early &
Periodic Screening, Diagnosis and
Treatment (which in Missouri is known as
Healthy Children and Youth Program
(HCY), which includes all medical services
determined medically necessary by
medical personnel.
Who is Covered by Medicaid?
Children in families who are eligible for
cash assistance under Temporary
Assistance to Needy Families (TANF), and
Supplemental Security Income.
Children for whom adoption assistance or
foster care payments are made.
Certain other low-income children may be
eligible.
Children with certain disabilities.
What is Medicaid?
Examples of Medicaid / HCY Covered Services:
Hospital Services Inpatient and
Outpatient
Case Management
Dental Services
Immunizations
Physical, Occupational
and Speech Therapy
Hearing Services
Home Health
Lab & X-ray
Prescription Drugs
Physician Services
Medical Supplies and
Equipment
Inpatient Psychiatric
Services
Substance Abuse
Treatment
Vision Services
What Is School District Medicaid?
ADMINISTRATIVE CLAIMING (SDAC)
Outreach to Medicaid & HCY eligible children and
families
Assistance with the Medicaid Application Process
Referring Students for Health Services
Coordination with other Health Care Providers
Arranging for Special Transportation
Medicaid / Medical Training
FOR ALL CHILDREN POTENTIALLY ELIGIBLE
FOR MEDICAID
Who is Covered by Medicaid?
It is important to note that for
Administrative Claiming activities it is
NOT necessary to know which
children are Medicaid eligible.
What Documentation is
Required?
Time is recorded by a process called
Random Moment Sampling (RMS)
In order to obtain reimbursement,
staff must briefly describe the activity
at the requested moment in time on
the comment line of the RMS
Observation Form
What is RMS?
Random Moment Sampling (RMS) is a
Federally accepted method for
documenting the time spent on Medicaid
administrative activities.
The RMS System compiles employee data
from each participating school district to
form a statewide sample pool.
From this statewide pool, names are
randomly selected and paired with random
moments in time to create “Sample
Moments.”
What is RMS?
Each “sample moment” is printed on a form
and sent to the each school district (SDAC)
coordinator for distribution.
Employees complete the sample form at the
“sample moment” and return the form to the
district coordinator, who then forwards the
completed forms to the MSBA Consortium.
The sample forms take no longer than a
minute to complete!!
All forms must be returned in order to obtain
a statistically valid sample.
Activity Codes
Always include any
paperwork, clerical
work or travel time
associated with a
particular activity as
part of that activity.
CODE 01(a)
Non-Medicaid Outreach
This code is to be used when informing
eligible or potentially eligible individuals
about non-Medicaid social, vocational,
general health and educational programs
and how to access them, or when
describing the range of benefits covered
under these non-Medicaid programs and
how to obtain them.
CODE 01(a): Examples
Non-Medicaid Outreach
Scheduling and promoting activities which
educate individuals about the benefits of health
life-styles and practices
Conducting general health education
programs or campaigns addressed to the
general population
Conducting outreach campaigns to
encourage persons to access social,
educational, legal or other services not
covered by Medicaid.
CODE 01(b)
Medicaid Outreach
This code is to be used when
performing specific activities to
inform eligible or potentially eligible
individuals about Medicaid benefits
and how to access the program.
CODE 01(b): Examples
Medicaid Outreach
Interpreting materials about Medicaid to persons with
children within the school district boundaries who are
illiterate, blind, deaf, or who cannot understand the
English language
Utilizing brochures approved by the Division of
Medical Services, designed to effectively inform eligible
individuals about the benefits programs and services
and about how and where to obtain services,
Informing Medicaid eligible pregnant students about
the availability of HCY services for children under the
age of 21 (including children who are eligible as
newborns)
CODE 02(a)
Facilitating an Application for
Non-Medicaid Programs
This code is to be used when assisting an
individual or family to make application for
programs such as TANF, Food Stamps,
WIC, day care, legal aid, and other social
or educational programs and referring
them to the appropriate agency to make
application.
CODE 02(b)
Facilitating Medicaid Eligibility
Determination
This code is to be used when assisting children
and families in establishing Medicaid eligibility
by making referrals to the Family Support
Division for eligibility determination, assisting
the applicant in completing the Medicaid
application forms, collecting information, and
assisting in reporting any required changes
affecting eligibility.
CODE 02(b): Examples
Facilitating Medicaid Eligibility
Determination
Assisting the individual or family in completing
the Medicaid application
Explaining the Medicaid eligibility process to
prospective applicants
Providing assistance to the individual or family in
collecting required information and documents for
the Medicaid application
Referring an individual or family to the local
assistance office to make an application for
Medicaid benefits.
CODE 03
School Related and Educational
Activities
This code is to be used for any other schoolrelated activities that are not Medicaid
related, such as social services, educational
services, teaching services, employment and
job training.
CODE 03: Examples
School Related and Educational Activities
Compiling attendance reports
Testing, correcting papers,
Providing general supervision of students (e.g.
playground, lunchroom)
Enrolling new students or obtaining registration
information
Conferring with students or parents about discipline,
academic matters or other school related issues.
Providing classroom instruction (including lesson
planning)
CODE 04
Direct Medical Services
Use this code when providing direct
health care, treatment, and/or
counseling services including mental
health assessments and evaluations to
an individual in order to correct or
ameliorate a specific condition.
CODE 04: Examples
Direct Medical Services
Administering first aid, or a prescribed
injection or medication to a student,
Providing speech, occupational, physical
and other therapies
Performing routine or mandated child health
screens including but not limited to vision,
hearing, dental, and HCY screens.
Conducting medical/health
assessments/evaluations and diagnostic
testing and preparing related reports;
CODE 05(a)
Transportation for Non-Medicaid
Services
This code is to be used when assisting
an individual to obtain transportation to
services not covered by Medicaid or
accompanying the individual to
services not covered by Medicaid.
CODE 05(a): Examples
Transportation to Non-Medicaid Services
Scheduling or arranging transportation
to social, vocational, and, or educational
programs and activities.
CODE 05(b)
Transportation-Related Activities in
Support of Medicaid Covered Services
This code is to be used when assisting an
individual to obtain transportation to services
covered by Medicaid. This does not include
the actual transportation service or the direct
cost of the transportation, but rather the
administrative activities involved in arranging
and providing the transportation.
CODE 05(b): Examples
Transportation-Related Activities in Support
of Medicaid Covered Services
Scheduling or
arranging
transportation to
Medicaid covered
services, including
those received at
school.
CODE 06(a)
Non-Medicaid Translation
School staff are to use this code when
providing translation services for nonMedicaid activities.
CODE 06(a): Examples
Non-Medicaid Translation
Arranging for or providing translation
services (oral or signing services) that assist
the individual to access and understand
social, educational and vocational services
Developing translation materials that assist
individuals to access and understand social,
educational and vocational services.
CODE 06(b)
Translation Related to Medicaid
Services
School staff should use this code when it is
not included and paid for as part of a
medical assistance service and must be
provided with by separate units or separate
employees performing solely translation
functions for the school and it must facilitate
access to Medicaid covered services.
CODE 06(b): Examples
Translation Related to Medicaid Services
Arranging for or providing translation
services (oral or signing), that assist the
individual to access and understand
necessary care or treatment covered by
Medicaid; and
Developing translation materials that assist
individuals to access and understand
necessary care or treatment covered by
Medicaid.
CODE 07(a)
Program Planning, Policy Development &
Interagency Coordination Related to
Non-Medical Services
School staff should use this code when
performing activities associated with the
development of strategies to improve the
coordination and delivery of non-medical services
to school age children. Non medical may include
social services, educational services and state or
state education mandated child health screenings
provided to the general school population.
CODE 07(a): Examples
Program Planning, Policy Development &
Interagency Coordination Related to NonMedical Services
Developing strategies to assess or increase the
capacity of non-medical school programs
Monitoring the non-medical delivery systems in
schools
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.
CODE 07(b)
Program Planning, Policy Development &
Interagency Coordination Related to
Medical Services
School staff should use this code when
performing activities associated with the
development of strategies to improve the
coordination and delivery of Medicaid
covered medical/dental/mental health
services to school age children, and when
performing collaborative activities with other
agencies and/or providers.
CODE 07(b): Examples
Program Planning, Policy Development &
Interagency Coordination Related to
Medical Services
Developing strategies to assess or
increase the capacity of school
medical/dental/mental health programs
Monitoring the medical/dental/mental
health deliver systems in schools,
Working with other agencies and/or
providers to improve collaboration around
the early identification of
medical/dental/mental problems.
Analyzing Medicaid data related to a
specific program, population, or
geographic area
CODE 08(a)
Non-Medical/Non-Medicaid Related
Training
School staff should use this code when
coordinating, conducting or participating in
training events and seminars for outreach
staff regarding the benefit of the programs
other than the Medicaid program.
CODE 08(a): Examples
Non-Medical/Non-Medicaid Related Training
Participating in or coordination training that
improves the delivery of services for
programs other than Medicaid.
CODE 08(b)
Medical/Medicaid Related Training
School staff should use this code when
coordinating, conducting or participating in
training events and seminars for outreach
staff regarding the benefit of the
medical/Medicaid related services, how to
assist families to access such services,
and how to more effectively refer students
for those services.
CODE 08(b): Examples
Medical/Medicaid Related Training
Participating in or coordinating
training that enhances early
identification, intervention,
screening and referral of students
with special health needs to such
services (e.g. Medicaid EPSDT
services)
Participating or coordinating
training that improves the delivery
of medical/Medicaid related
services.
CODE 09(a)
Referral, Coordination & Monitoring of
Non-Medicaid Services
School staff should use this code when
making referrals for,coordinating and / or
monitoring the delivery of non-medical, such
as educational services.
CODE 09(a): Examples
Referral, Coordination & Monitoring of NonMedicaid Services
Making referrals for and/or coordinating access
to social and educational services such as child
care, employment, job training
Participating in a meeting/discussion to
coordinate or review a student’s needs for
scholastic, vocational, and non-health related
services not covered by Medicaid
Monitoring and evaluating the non-medical or
educational components of the IEP as
appropriate.
CODE 09(b)
Referral, Coordination & Monitoring of
Medicaid Services
School staff should use this code when
making referrals for, coordinating, and/or
monitoring the delivery of medical (Medicaid
covered) services. Referral, coordination and
monitoring activities related to services in an
IEP are reported in this code.
CODE 09(b): Examples
Referral, Coordination & Monitoring of
Medicaid Services
Making specific medical referrals for and/or coordinating
medical or physical examinations and necessary
medical/dental/mental health evaluations
Gathering information that may be required in advance of
these medical/dental/mental health referrals
Providing follow-up contact to ensure a child has received
the prescribed medical/dental/mental health services,
Monitoring or evaluating the Medicaid service components
of the IEP as appropriate
Providing information to other staff on the child’s related
medical/dental/mental health services and plans
CODE 10
General Administration
School staff should use this code when
performing activities that are not directly
assignable to program activites.
CODE 10: Examples
General Administration
Reviewing school or district procedures and rules
Attending or facilitating school or unit staff meetings,
training, or board meetings
Taking lunch, breaks, leave or other “paid” time not
at work (includes snow days)
Providing general supervision of staff, including
supervision of student teachers or classroom
volunteers and evaluation or employee performance
Performing other administrative or clerical activities
related to general building or district functions or
operations
Thank you for your
participation!
For more information please
contact the MSBA Medicaid
Consortium:
(573) 445-9920
Jay Bertoch- Ext. 327
Collin Swearingen- Ext. 321