Medicaid Administrative Claiming
“MAC”
2015-2016
Annual Staff Training
Training Introduction
 Thank
you for participating in this
important training. As teachers and
professionals who work daily with
students, your jobs involve much more
than instruction. Your efforts to link
students and their families to Medicaidcovered health services that can impact a
child’s ability to learn provides structure
and support in developing successful
learners.
Training Introduction
Your participation in Medicaid Administrative
Claiming (MAC) is a way in which you can
help your District to receive reimbursement
for Medicaid outreach and associated health
related activities you provide. This
reimbursement helps schools to continue to
provide vital health and social services.
Thank you again for your participation in this
training and your work with Oregon students
and their families!
What is Medicaid Administrative
Claiming (MAC)
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MAC is a survey method of identifying and
accounting for the time spent by public school
staff on medically related activities, that otherwise
would be the financial responsibility of the State.
Participation in School-Based MAC allows for the
administrative activities associated with the
coordination, referral, outreach, and program
planning of Medicaid covered health services to
be reimbursed for education agencies.
The MAC program strengthens local relationships
between service providers and public agencies.
Important Facts
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You do not need to know who is
Medicaid/OHP eligible
It is the activity you are doing that is being
measured, not the outcome of the activity
The time study determines your time spent on
eligible and non-eligible activities
When you report claimable MAC activities
during your day you must complete a
supporting documentation form in support of
the activities being reported
Submit the support document to your local
building coordinator or designee
How is MAC time reported?
 The
web-based survey is utilized to record
activities staff perform during the paid hours
of a school day. This is accomplished by
reporting the activities in a code category
that best fits the activity performed. There
are three survey periods per school year.
Each survey period DHS/OHA will select
random survey dates of which your
District/ESD will be assigned one.
 September
– December
 January – March
 April – June
MAC Activity Codes

MAC Claimable Categories
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
B1 – Medicaid Outreach – Healthy Kids/Healthy
KidsConnect
C1 – OHP Referral, Coordination, Monitoring and Training
 C1


= Child Specific
D1 – OHP Transportation/Translation
E1 – Medical Program Planning, Policy Development,
and Interagency Coordination
 E1
= Everyone Benefits
MAC Activity Codes
Non-Claimable Codes
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A – School Related and Educational Activities
B2 – Non Medicaid OHP/Outreach
C2 - Referral, Coordination, Monitoring and Training on
Non Medicaid /OHP Services
D2 – Non Medicaid/OHP Transportation/Translation
E2 – Program Planning, Policy Development and
Interagency Coordination Related to Non-Medical
Services
F – Direct Medical Services
 Non-claimable codes represent non-health related
and/or educational activities that DO NOT generate
reimbursement
School Related and Educational Activities
 Code A
 This code should be used for any
school-related activities that are
not health related.
 Including but not limited to
classroom instruction, grading
papers, supervision of staff,
recess duty, student discipline,
and developing curriculum.
 Note: Participating in an IEP
meeting must also be reported
as code A. (This includes the
development, coordination and
monitoring of a student’s IEP or
other education plan.)
Medicaid Outreach & Oregon Healthy
Kids
 Medicaid
outreach activities are those
performed to inform eligible or potentially eligible
individuals about Medicaid and how to access
the Medicaid program.
 Oregon Health Plan/Healthy Kids Programs

A State sponsored Medicaid program providing all of
Oregon’s uninsured children under the age of 19 access
to no cost or affordable, comprehensive, health
insurance coverage.
What does it cover?

Healthy Kids covers all of the health care kids
need including:
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Medical, dental and vision care
Regular checkups and preventive care
Prescription medicines and medical equipment
Mental health and chemical dependency services
Coverage lasts for a least one full year.
Who is eligible?
Three key qualifiers for no-cost or low-cost coverage
1.) Age
 Must
be under the age of 19 (19th birthday)
2.) Residency
 Must
live in Oregon and be a legal resident
3.) Income
 Must
have been without health insurance for two months
(exceptions: parent’s job loss or a child’s serious medical
need).
 For free or low-cost coverage, household income cannot
be more than 300% of federal poverty level.
Medicaid/OHP Services

Health Services
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Well-child exams
Immunizations
Routine physicals
Maternity and newborn care
Medical Services
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Preventive services such as well-child check ups
Laboratory or x-rays
Treatment for most major diseases
Hospital stay
Substance abuse
Vision care, routine screenings, and glasses
Hearing services, hearing aids, & batteries
Home health care
Specialists care & referrals
Physical, occupational, and speech therapy
Medical equipment and supplies

NOTE: If any of these activities are as state mandated health screens, then
the cost of the care is the responsibility of the education agency and
therefore is not claimable under the MAC program for reimbursement.
Medicaid/OHP Services
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Dental Services
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Preventive services (cleaning, fluoride treatments,
sealants for children)
Routine services (fillings, x-rays)
Dental check ups
Tooth removal
Dentures
24-hour emergency care
Specialist care and referrals
Mental Health Services
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Evaluations
Therapy
Consultations
Medication management
Programs for daily and community living
CODING CATEGORIES
 The
following section is an introduction to the
MAC coding categories for claimable activities
codes B1, C1, D1, and E1.
Each code category provides a general
description of the claimable activities,
including examples of those activities and
their sub-codes.
B1 – Medicaid Outreach
 B1.1
 Informing
children and their family’s on how to
effectively access, use, and maintain participation
in Medicaid/OHP.
 Includes
describing the range of services, and distributing
OHP literature.
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Gave a family the details about qualifying for OHP, application
process and whom to contact.
Through a Spanish speaking interpreter I identified how to apply
for OHP.
Worked with school counselor to answer a family’s questions
about OHP and how to apply. What benefits are covered,
eligibility requirements, etc.
Informed the Grandmother of a student who needs extensive
surgery on his arm about OHP. The family is uninsured.
B1 – Medicaid Outreach

B1.2

Assisting the student/family to access, apply for,
and/or complete the Medicaid/OHP
application.
○
Includes coordinating transportation and providing and
coordinating translation related to OHP application,
and gathering appropriate information.
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Referred a family for OHP application assistance and
helped get an application for Medicaid/OHP through our
Family Support Center.
Phone call with a parent regarding documentation
requirements for the OHP application. Explained time
frame and importance of providing all documentation.
Assisted a family with resources necessary for them to apply
for OHP.
B1 – Medicaid Outreach

B1.3
 Checking
a student and/or family's OHP status.
 May
be done by reviewing the family’s medical card,
contacting the local DHS agency, working with in-district
staff who have access to Medicaid eligibility.
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Informed a parent of a child with dental needs how to check
the status of their OHP eligibility.
Checked on the OHP eligibility status of a student returning
from foster care to her immediate family. She was covered
while in foster care but will need to reapply.
Verified a student who attempted suicide the previous day
was not insured and discussed access to OHP. Followed up
with school counselor and County Mental Health crisis unit.
B1 – Medicaid Outreach
 B1.4
 Contacting
pregnant and parenting
teenagers about the availability of
Medicaid/OHP for prenatal and well
baby care programs.
 Spoke
with student regarding
Medicaid/OHP for prenatal care.
 Reviewed availability of services covered
under Medicaid/OHP prenatal and well
baby programs.
C1 - Referral, Coordination, Monitoring & Training

C1.1 - Referral

Referring students for medical, mental health, dental health
and substance abuse evaluation and services covered by
Medicaid/OHP.

Includes gathering information in advance of referrals.

Gathered information on a student identified during a vision screening as
needing further evaluation for an eye exam, student has trouble reading
instructions at a distance.

Discussion with team regarding the health needs of a student who just
returned from an out of state school. Parent reports regression, team
discussed referral to County Mental Health agency.
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Met with student and mother. Student has substance abuse issues.
Referral to County Health Department for UA.
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Referral of a student with Mental Health needs to County Mental Health.
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Gathered information in advance of a referral for a student with dental
health needs from the parents and school nurse.
C1 - Referral, Coordination, Monitoring &
Training
Immunizations
 Claimable
– C1.1 Referral
 Administrative activities related to referrals to assist families in
accessing immunizations from enrolled Medicaid providers are
claimable as C1.1 – Referral, as long as the referral is to an enrolled
Medicaid provider.
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State-Mandated Health Screenings

The cost of care for state mandated health screens, such as hearing
and vision, are the responsibility of the education agency and
therefore are not claimable under the MAC program for
reimbursement. Code administrative activities related to the
coordination and referral for state mandated health screens as C2.
C1 - Referral, Coordination, Monitoring &
Training
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Immunizations Continued
 Non Claimable – C2

Administrative activities performed in association with the
immunization exclusion requirements
-
Performing a primary review summary
Mailing exclusion orders
Completing a county immunization status report
C1 - Referral, Coordination, Monitoring & Training
 C1.2
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Coordinating the delivery of medical health, mental health,
dental health and substance abuse services covered by
Medicaid/OHP.
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Includes Youth Services Team and CARE team meetings

Discussion with School Counselor regarding student who is in
need of health and mental health services and how to best
assist the family in gaining access to services through OHP.
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Contacted local OHP provider to determine resources available
for a student needing glasses.
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Coordinating the delivery of medical services for a student with
depression with administration, student, family and DHS.
C1 - Referral, Coordination, Monitoring & Training

C1.3 - The 2003 CMS Medicaid Administrative Claiming
guide indicates the following are covered under code C1:
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Providing follow-up contact to ensure that a child has received the
prescribed medical/dental/mental health services covered by
Medicaid.
Monitoring and evaluating the Medicaid service components of
the IEP as appropriate.

When necessary and appropriate claimable scenarios may include:
 A classroom teacher who works closely with a student receiving
Medicaid-covered services on an IEP is involved in a team conference
or meets individually with a therapist to evaluate the medical
component(s) of an IEP (this excludes the actual IEP meeting).
 A classroom teacher who works closely with a student makes follow-up
contact with a qualified Medicaid Health Services provider to ensure
services previously prescribed or referred for were received.
C1 - Referral, Coordination, Monitoring & Training
 C1.3
 The
following monitoring activities are NOT
claimable:
 Activities
performed in the initial development of the IEP
and/or formal IEP meetings (i.e., annual, 3-yr)
 Monitoring
minor acute health conditions, such as scratches,
bruises, headaches, colds, application of Band-aids or
administration of non-prescriptive medications
 Monitoring
required by Delegation from a Registered Nurse,
such as seizure, catheterization, g-tube feeding & blood
sugar monitoring.
 Monitoring
of a diagnosed health condition (regardless of the
severity or type of health condition)
C1 - Referral, Coordination, Monitoring & Training

C1.4

Training: Coordinating, conducting or
participating in training events or seminars for
outreach staff regarding the benefits of
medical/Medicaid related services.
○
Participating in a MAC training.
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○
○
Excludes the amount of time spent learning how to fill
out the actual survey.
Attending a seminar on how to effectively provide
OHP outreach.
The portion of a training where the content
focuses on recognition of signs and symptoms of
specific medical conditions.
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Suicide
Autism
Drug and Alcohol Abuse
C1 - Referral, Coordination, Monitoring & Training

C1.4
The
following State Mandated
trainings are not covered:
 First
Aid Training
 CPR Training
 EPI Training
 Blood-borne Pathogens Training
D1 – Transportation/Translation

D1.1
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Scheduling and arranging transportation to OHP
covered services.
○
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Does NOT include the provision of the actual
transportation service or the direct costs of the
transportation (bus fare, taxi fare, personal transport,
etc, but rather the administrative activities (related
paperwork, clerical activities, staff travel time, etc.)
involved in providing the transportation.
D1.2

Scheduling, arranging or providing translation for
OHP covered services.
○
○
Arranging for or providing translation services (oral
and signing) that assist the individual to access and
understand necessary care or treatment covered by
Medicaid.
Developing translation materials that assist individuals
to access and understand necessary care or
treatment covered by Medicaid.
E1 – Program Planning, Policy Development & Interagency
Coordination
 E1.1
 Developing
strategies and policies to assess or
increase the capacity of school
medical/dental/mental health programs
(includes workgroups)
 Worked with nurses and local dentists
regarding increasing access to dental
services for students.
 Review
with school team current Mental
Health support system effectiveness.
 Reviewed
strategies on how to better
identify and provide access to treatment
for students with asthma.
E1 – Program Planning, Policy
Development & Interagency Coordination

E1.2
 Working
with other agencies and/or providers to
improve the coordination and collaboration and
delivery of medical, mental health and
substance abuse services.

Attended a community meeting in which access to Mental
Health services for students was discussed. Brainstormed
ways to improve access/delivery of Mental health services
to OHP eligible students.
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Attended a community health resource meeting. We
identified gaps in existing support systems and collaborated
w/various agencies about district wide health needs.

Collaborating with other agencies/providers on available
OHP options/programs to better serve students in school
with Mental Health needs.
E1 – Program Planning, Policy
Development & Interagency
Coordination
 El.3
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Monitoring the medical/mental
health/dental health delivery system in
schools.
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Developing advisory or work groups of health
professionals to provide consultation, advice
and monitoring of the delivery of health care
services to school populations.
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Evaluating the need and/or effectiveness of
medical services provided in the school setting
(such as a school based health center).
Code F – Direct Services
 Providing
Direct Services vs.
Administrative Activities

The Centers for Medicare & Medicaid Services
(CMS) rule states: Activities that are considered
integral to, or an extension of direct medical
services, are NOT CLAIMABLE as an Administrative
expense (e.g., patient follow-up, patient
assessment, patient counseling, patient
education, patient consultation, billing activities).
These activities must be reported under Code F,
Direct Medical Services.
Non Covered Services – CODE F
EXAMPLES
 Treatment or monitoring activities related to minor acute
health conditions such as, scratches, bruises, headaches,
colds, application of bandages or distribution of nonprescriptive medications.
 Physical monitoring of health/medical services on a child’s
IEP.
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(NOTE: Follow-up to ensure the activities on an IEP
(prescribed) are covered under C1.3.)
Monitoring a child’s health condition regardless of the
severity or type of condition.
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School secretary monitoring a child in the health room for
adverse reaction to a bee sting
Teacher monitoring a child after an insulin injection
Educational assistant monitoring a child following a seizure
Test Your Knowledge
 Place
yourself in the following scenarios
and attempt to answer the questions
correctly.

YOU’RE GOING TO TEST WELL. GOOD LUCK!!
Providing Appropriate Supporting Documentation
 Individual

surveys reporting claimable MAC activities
Complete a MAC Support form for each claimable time
frame and activity code recorded. The documentation
should:
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be recorded soon after completing the survey (no less than 5
business days);
be brief and concise;
use descriptive words (best practice is to use the key words
from the activity guide such as referred, coordinated,
monitored, etc.);
only provide information pertinent to the claimable activity
performed; and
do not identify the individual student or family by name.
Review the MAC Support form to ensure documentation is for
allowable MAC activities
 Submit MAC Support form to your district’s MAC Coordinator

Coding Reminders
 Coding

Accuracy Reminders for Staff
Reporting of Time:
 Report
only PAID work time
 Report time in 15 minute blocks
 Report all activities performed during the paid work day
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Using Correct Login (name on paycheck)
Saving the Survey
Reporting unpaid lunch
 time
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frame should be left blank on survey
Reporting Paid Absences
 code
A
Completing the MAC Survey
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Steps required to complete the MAC survey:
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Access the MESD website through the following link
http://mac.mesd.k12.or.us
From the MESD screen choose Survey Login for the ESD under
which you participate
Indicate your first name and last name as it appears on your
paycheck
Document the activities performed for your PAID work day
from the list of Activity codes.
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7:30 – 8:30 Code A
8:30 – 9:00 Code B1.1
9:00 – 2:30 Code A
2:30 – 3:30 Code E1.2
Save the survey
Note: Paid absences are reported as
Code A. Unpaid lunch is left blank
Who do I contact if I need technical
assistance?

1) The MAC Coordinator for your
district:
 ________________________________

2) Building Level Trainer:
 ________________________________

3) The ESD Medicaid Facilitator:

________________________________
Helpful Resources

For assistance in finding local Medicaid providers and in
applying for Medicaid insurance the following websites are
useful:
 Oregon Health Policy Board – What’s Happening With
Health Care in Oregon
 http://www.oregon.gov/oha/OHPB/Pages/index.aspx

Oregon County Health Department Directory
 http://public.health.oregon.gov/ProviderPartnerResourc
es/LocalHealthDepartmentResources/Pages/lhd.aspx

Cover Oregon - Finding Health Insurance For You
 https://www.coveroregon.com//

Find a Local DHS Office Near You

http://www.oregon.gov/DHS/localoffices/localoffices.pdf