Medi-Cal Administrative Activities Messages

07/08 Training Dates

Chris Davis — Thu, 05 Jul 2007 15:09:16 GMT

VENDORS

What is MAA all about?

KCSOS Webteam — Tue, 30 May 2006 23:02:38 GMT

Medi-Cal Administrative Activities (MAA)

MAA reimburses County Offices of Education, school districts, and community colleges for the Medi-Cal Administrative Activities that they may be already doing. For example, time spent referring students to health care services during School Attendance Review Board (SARB) meetings, Student Study Team (SST), Crisis Intervention Meetings, and IEP’s may be billable through MAA.

What kind of reimbursement are we speaking of?

UNRESTRICTED!

Example of program staff that might perform MAA activities:

• Special Education Staff
• Nurses, Health clerks, Health aids
• School Psychologist, Counselors
• Speech Language Pathologists
• Healthy Start Staff Members
• Child Development Programs
• State Preschool Programs

What Exactly Are MAA Activities?

How Can My District Get Started?

How Does the LEC assist the District?

What Are the District’s Responsibilities?

Who Funds This Program?

Margaret Roux — Fri, 12 May 2006 17:57:53 GMT

The LEC (Kern County Superintendent of Schools) contracts with the state, California Department of Health Services (CDHS) who is the oversight agency for the State of California. CDHS contracts with the Center for Medicaid Services (CMS) who is the oversight agency at the federal level.

What Are the District's Responsibilities?

Margaret Roux — Fri, 12 May 2006 17:55:17 GMT

Enlist the support from your administration and business office. Talk with your region's LEC Coordinator. Set up a meeting with your LEC coordinator, your superintendent, school administrators, CBO, and/or a representative from the school business office to discuss the financial benefits of MAA and explain the process. MAA dollars are unrestricted! Therefore, determine how these funds might assist your district prior to implementing the MAA program. This is a key factor in your program's successful implementation. The MAA process can involve time for the business office and their support is essential.

Designate a MAA coordinator for your district to serve as liaison among the LEC, business office, district administrators and the time survey participants. Make sure that the MAA Coordinator gets the support needed to implement the program successfully!

Decide whether you need additional outside help. Vendors can help implement the MAA program and may assist you with the time survey process and/or claims development. Choose carefully. Contact several vendors to assess their services and prices. Also, contact other school districts and ask them for recommendations. The LEC can assist you in this process.

Identify the staff conducting MAA claimable activities and the funding streams through which they are paid. Employees cannot be 100% federally funded and participate in the MAA program. When choosing the participants, keep in mind what their workday entails and the meetings they attend. For example, time spent referring students to health care services during School Attendance Review Board (SARB) meetings, Student Study Team (SST), Crisis Intervention Meetings, and IEPs may be billable through MAA.

How Does the LEC assist the District?

Margaret Roux — Fri, 12 May 2006 17:52:25 GMT

• Provide guidance and program information to the MAA coordinator.
• Oversee the LEA time survey process.
• Submit detailed quarterly invoices to DHS on behalf of the LEA.
• Review the Operational Plan for quality assurance and compliance.
• Offer customer support, both program and fiscal.
• Monitor compliance of LEA with all Federal, State and CDHS program requirements.
• Represent the LEA at the statewide LEC Committee and in workgroup meetings.
• Receives and distributes reimbursements.

How Can My District Get Started?

Margaret Roux — Fri, 12 May 2006 17:32:40 GMT

To participate in MAA, each district/LEA contracts with their LEC, the designated county office of education in their region. Please contact Kern County Superintendent of Schools, Margaret Roux at 661-636-4769 or maroux@kern.org for more information.

What is MAA all about?

Margaret Roux — Fri, 12 May 2006 17:29:49 GMT

What is MAA all about?

 MAA reimburses County Offices of Education, school districts, and community colleges for the Medi-Cal Administrative Activities that they may be already doing. For example, time spent referring students to health care services during School Attendance Review Board (SARB) meetings, Student Study Team (SST), Crisis Intervention Meetings, and IEP’s may be billable through MAA.

What kind of reimbursement are we speaking of?
UNRESTRICTED!

• Example of program staff that might perform MAA activities:
• Special Education Staff
• Nurses, Health clerks, Health aids
• School Psychologist, Counselors
• Speech Language Pathologists
• Healthy Start Staff Members
• Child Development Programs
• State Preschool Programs
• Principals, Administrators
• Teachers, Teachers Aides and Clerical Staff
• Superintendent (if not an elected official)

1

Margaret Roux — Fri, 12 May 2006 17:29:31 GMT

What is MAA all about?

What kind of reimbursement are we speaking of?
UNRESTRICTED!

What Exactly Are MAA Activities?

Margaret Roux — Fri, 12 May 2006 17:23:42 GMT

Administrative Activities that facilitate enrollment into Medi-Cal and assisting students and families to access Medi-Cal services such as:

• Outreach-Providing Medi-Cal information to students and their families. Initial referral of
students to medical services.

• Facilitating Applications-Referring or assisting families with the Medi-Cal application.

• Monitoring, Coordination, or Referral to Medi-Cal Covered Services-Such as; speech,
   OT, PT, counseling, and any follow-up on these issues.

• Arranging Transportation to medical services within the community or IEP services at the
   school site.

• Translation-Arranging or providing translation for medical services, e.g. speech, counseling.

• Program Planning, Policy Development & Interagency Coordination-Developing strategies
to improve the delivery or coordination of medical services.

Latest page

Margaret Roux — Tue, 02 May 2006 21:32:14 GMT

Outreach Materials

Download materials now

Outreach Materials

KCSOS Webteam — Fri, 28 Apr 2006 21:47:23 GMT

Outreach Materials

MAA Forms

KCSOS Webteam — Fri, 28 Apr 2006 21:45:46 GMT

Calendar

KCSOS Webteam — Fri, 28 Apr 2006 21:44:20 GMT

LEC Meeting Minutes

KCSOS Webteam — Fri, 28 Apr 2006 21:42:26 GMT

Contact MAA

KCSOS Webteam — Fri, 28 Apr 2006 21:41:47 GMT

Kern County Superintendent of Schools
Local Educational Consortium-Region 8

Margaret Roux
1300 17th Street
Bakersfield, CA 93301
Phone 661-636-4769
Fax 661-636-4121
maroux@kern.org

Ken Gragg
Phone 661-636-4356
kegragg@kern.org

Links

KCSOS Webteam — Fri, 28 Apr 2006 21:41:21 GMT

MAA Links

MAA Tools

KCSOS Webteam — Tue, 25 Apr 2006 17:50:25 GMT

Links

07/08 MAA Manual

MAA LEA Appeals Process

Outreach Materials

Coding Sheet--IEP & Other Meetings

07/08 Code Descriptions and Samples

07/08 MAA Time Survey Form

About

KCSOS Webteam — Tue, 25 Apr 2006 17:03:55 GMT

Who are you? What's this site about? How can people send you feedback?

California School Based Medi-Cal Administrative Activities (MAA)

KCSOS Webteam — Mon, 24 Apr 2006 17:03:51 GMT

NEWS RELEASE

Committee on Energy and Commerce
Rep. John D. Dingell, Chairman

For Immediate Release: April 9, 2008

Contact: Jodi Seth or Brin Frazier, 202-225-5735

Subcommittee Moves to Block Medicaid Cuts

Approved Legislation would place a one-year moratorium on seven Administration-imposed Medicaid regulations

Washington, D.C. – The Committee on Energy and Commerce’s Subcommittee on Health today completed a markup on legislation to place a temporary, one-year moratorium on seven Administration-imposed Medicaid regulations that would make significant cuts to the program over the next five years. Committee Chairman John D. Dingell (D-MI) offered an amendment in the nature of a substitute to H.R. 5613, the “Protecting the Medicaid Safety Net Act of 2008,” which was forwarded to the full Committee by voice vote.

“This legislation will help protect the health of millions of Medicaid beneficiaries, and I am proud to move it forward” said Dingell. “Though the Administration issued new Medicaid regulations without conducting a thorough and proper assessment of their effects, it’s clear that these rules would harm the most vulnerable among us. I am heartened by the strong bipartisan support this bill received today, and I look forward to bringing it to the full committee for consideration as soon as possible.”

During the past year, the U.S. Department of Health and Human Services (HHS) has issued a number of regulations that would reverse longstanding Medicaid policies and eliminate federal payments for a variety of critical Medicaid functions. The rules in question would affect: payments provided to public safety net institutions; coverage of rehabilitation services for people with disabilities; outreach and enrollment in schools as well as specialized medical transportation to school for children covered by Medicaid; graduate medical education payments; coverage of hospital clinic services; case management services that allow people with disabilities to remain in the community; state provider tax laws; and appeals filed through HHS.

"I commend the subcommittee for supporting legislation that protects Medicaid beneficiaries from an onslaught of harmful regulations issued by the Bush administration," said Rep. Frank Pallone (D-NJ), Chairman of the Subcommittee on Health. "By passing this legislation, we are delaying regulations that undermine the longstanding partnership between the federal and state government that should not be implemented without considerable research on how they will impact millions of vulnerable Americans."

Dingell’s amendment makes four key changes to H.R. 5613:

It narrows the scope of the activities prohibited by replacing the language in H.R. 5613, as introduced, with the language used in the Medicare, Medicaid, and SCHIP Extension Act passed this past December. This language was acceptable to the Republican Members.

It establishes an independent, comprehensive review of the regulations prior to the expiration of the moratorium next year.

It provides additional funding to fight fraud and abuse in Medicaid. It would provide $25 million to HHS each year, beginning in FY2009, for anti-fraud activities related to Medicaid.

It includes two offsets to ensure that the bill is fully paid for:
- Extending of an electronic asset verification demonstration for Medicaid applicants and beneficiaries; and
- Borrowing money from the Physician Assistance and Quality Improvement (PAQI) Fund in 2013 that will be replenished in 2014.

During the markup, Ranking Member Joe Barton (R-TX), signaled his support for Dingell’s amendment, saying, “The bill, in its current form, H.R. 5613, we expected, and may yet get, a veto message from the Administration. The key phrase being ‘in its current form.’ Having said that, thanks to Chairman Pallone and Chairman Dingell for their good faith efforts to work with Congressman Murphy, myself and Ranking Member Deal. There is going to be a Manager’s Amendment sometime in this markup that changes 5613. I have asked the Administration and am reasonably confident that they will accede to my request that if the Manager’s Amendment is ultimately presented to them that they will not veto the legislation.”

The National Governors Association, the National Association of State Medicaid Directors, and the American Public Human Services Association have all written bipartisan letters to HHS in opposition to the regulations. Additionally, numerous groups representing beneficiaries, particularly people with disabilities, have also publicly opposed these regulations.

-30-

Prepared by the Committee on Energy and Commerce
2125 Rayburn House Office Building, Washington, DC 20515

February 29, 2008

From the Daily Report:

What Is the Implementation Date for the
Revised Medicaid Reimbursement Regulations?

Q. On slide E-8 of the Governor's Budget materials, you describe the unfavorable treatment of future Medicaid Administrative Activities (MAA) money. This money usually is received well after claims are filed. If the regulations become operative in September 2008, does that mean that claims filed in 2007-08 (and 2008-09 Q1) would be unfunded? Or will this timeline only affect claims filed after the September 2008 timeline?

A. According to a member of the Administrative Claiming Team, Division of Reimbursement and State Financing, of the Centers for Medicaid and Medicare Services (CMS), this is the latest on the implementation of the federal Medicaid Reimbursement Regulations:

The publication of the final school-based rule (CMS-2287-F) on December 28, 2007, does not affect the ability of States to submit claims for costs incurred prior to the effective date of the rule; the rule will be applied prospectively. However, as you [may] know, there's a six-month moratorium on CMS' ability to enforce the rule, due to legislation recently signed into law. This moratorium is scheduled to end June 30, 2008.

Final regulations are typically effective 60 days after publication; however, due to the moratorium, that 60-day period starts once the moratorium ends. As a result, the implementation date for the rule will technically be September 1, 2008. CMS never intended States and schools to be in compliance with the final rule prior to the start of the 2008-2009 school year, so the moratorium really has no effect on that timeline.

With respect to claims for prior periods, all such claims must meet the timeliness requirements specified at 45 Code of Federal Regulations (CFR) 95.7. In addition, Section 1132(a) of the Social Security Act requires that a claim for federal financial participation (FFP) must be filed within a two-year period that begins on the first day of the calendar quarter immediately following the quarter in which the expenditure was made. The implementing regulations for timely filing are at 45 CFR Subpart A and provide specific guidelines for determining when an expenditure is said to have been made, so as to initiate the two-year filing period.

Finally, although I indicated that CMS was considering developing some sort of additional guidance to address questions surrounding implementation of CMS-2287-F, there are no official plans to do so at the current time and no format specified for any guidance that may ultimately be issued.

Hopefully that will change. Additional guidance would be more than welcome. There continue to be legislative efforts at the federal level to extend the moratorium or repeal the regulations altogether. Stay tuned.

-Nancy LaCasse

January 8, 2007

From the Daily Report:

Final Regulations Regarding Reimbursement for Medicaid Expenditures Released. Just before the end of 2007, the Centers for Medicare and Medicaid Services (CMS) finalized regulations that would eliminate reimbursement for Medicaid expenditures for school-based administrative activities and special education transportation services, thus marking the first step in the federal rulemaking process. The final regulations, printed in the December 28, 2007, edition of the Federal Register, were approved on December 14.

Under normal circumstances, these new regulations would go into effect 60 days after publication in the Federal Register, which would be February 26, 2008. However, a provision in the recently enacted Medicare, Medicaid, and SCHIP Extension Act included a six-month moratorium on any new Medicaid-related regulations. According to CMS, this provision was included in the bill, so there would be no impact on school budgets for the 2007-08 school year.

CMS has released a fact sheet outlining the new rules. It can be found on the CMS website:
http://www.cms.hhs.gov/apps/media/fact_sheets.asp.

Please submit your 07/08 invoices as soon as possible. We will let you know if we receive additional information.

November 5, 2007

We are just around the corner from the 2nd quarter time survey period which begins on November 20th for most districts. Please work with your vendor to get the first quarter for 07/08 wrapped up.

Tomorrow is the last day to comment on the CMS proposed regulation to eliminate MAA and reimbursement for specialized transportation. If you would like to submit a comment online, I have pasted the link at the bottom of this email. We will send out an email once there is any new information available.

Below is an excerpt similar to an email sent out on March 23, 2007. After looking at some of the 06/07 time surveys, a review of this email may be warranted:

We often see time in code 4 with samples such as: "Copied and handed out Medi-Cal flyers, created Medi-Cal bulletin board, stuffed envelopes with Medi-Cal information, spoke with students about Medi-Cal, and/or wrote Medi-Cal article for newsletter" from non health related positions. We are hearing more and more from DHCS that survey participants must be "...necessary for the proper and efficient administration of the Medi-Cal program".

We urge you to carefully consider who time surveys in order to prevent unnecessary frustration on the part of your district and your participants. Remember, the activities that are captured in the time survey must be a part of normal duties, not duties simply scheduled and performed because it is time survey week. Time surveys, or entire districts, that fall under this scenario will be reviewed.

September 7, 2007

This morning CMS published CMS-2287-P. This proposed rule would eliminate reimbursement for administrative activities (MAA) and much of the transportation claimed through the LEA Billing Option program. The publishing of the proposed rule is the beginning of the final step necessary for implementation.

It is our understanding that CMS intends for implementation to begin in the 2008-09 school year. We are trying to clarify precisely what impact this would have on the payment of invoices. In other words, will they pay for invoices for the 2007-08 school year regardless of when filed, or will they only pay invoices filed by a certain date? We will pass on any information that we receive.

Our recommendation is that you submit invoices as soon as possible. Early filing of invoices cannot hurt! Finalize your time survey results and get them to us for review. Once you get word of approval for the time survey's get the fiscal information pulled and to your vendor ASAP.

Please let us know if you have any questions.

June 13, 2007

We will be updating this site with all new forms for Region 8 and CaliforniaDepartment of Health Services by July 1st.

Have a great summer.

March 23, 2007

During our MAA Coordinators meetings last month the majority of our discussion was on the use of Code 16. As we discussed, the interpretation of Code 16 has evolved dramatically over the last several years as the California Department of Health Services (CDHS) clarified its expectations, and as we were able to discuss with other LEC's and LGA's results from their regions. Additionally, from audits performed in other states, the Centers for Medicare and Medicaid Services (CMS) appears to have taken an extremely restrictive stance when dealing with MAA administration.

During our early review of 2006-07 invoices we find that Code 16 has averaged a little less than 18%. While we are unable to tell you how CDHS and/or CMS would respond to these percentages should they perform audits or reviews, we are generally pleased with what we see so far. As discussed in last months meetings, we continue to believe that the use of Code 16 will be curtailed dramatically via regulation very soon, and that in the meantime CDHS will monitor for overuse. We will let you know if and when there are changes.

Another area that we feel still warrants attention is:

Time survey participants that have little time spent performing MAA activities and/or time being claimed for MAA activities that are not a part of normal job duties. For example, we often see time for "Copied and handed out Medi-Cal flyers" from positions not typically involved with the MAA program. We are hearing more and more from CDHS that survey participants must be "...necessary for the proper and efficient administration of the Medi-Cal program".

According to CDHS, little MAA time generally suggests that the staff member is not necessary for the MAA program and typically warrants removal from the invoice. We understand that many districts have been encouraged to train a large number of staff members even though MAA activities may be a very small portion of their duties. We urge you to carefully consider who time surveys in order to prevent unnecessary frustration on the part of your employees. Remember, the activities that are captured in the time survey must be a part of normal duties, not duties simply scheduled and performed because it is time survey week. We acknowledge that there is a fine line here, we simply encourage you to take a realistic, reasonable, and informed approach.

March 15, 2007

We have been asked by several districts whether or not MAA regulations allow a vendor, using "time trackers" which have been completed by the time survey participant, to prepare the time survey form for the participant. This is clearly against the regulations. The MAA regulations that address this issue can be found in sections 6-4 and 6-5 of the MAA manual:

"Each time survey participant attends time survey training to learn which MAA activities are within his or her scope of work and how to properly document his or her paid time. Each individual is responsible for completing the form as instructed" and, "Only the survey participant can clarify the sample activities or make corrections to the amount of time per code." Further, Section 6-2 states, "The MAA time survey is the basis of the claim for federal funds, and its completion must be done with strict controls on how it is conducted and how time is recorded."

In order to get the most current position from CDHS on this issue we spoke to them this morning and they are emphatic that each individual MUST complete and correct their own form. The exception to this is the header information: name, school site, hours worked, etc.

In addition, please be very careful about utilizing services that create brochures or marketing materials for your district. This is likely duplication of effort and is against the regulations to claim for these activities. The federal regulations from Centers for Medicaid and Medicare Services (CMS) state that "....school developed outreach materials should have prior approval of the Medicaid agency." (2003 CMS Guide, page 24) As most materials can be obtained through the CDHS website or your local health department.

January 9, 2007

We are starting the third quarter time survey period today and hopefully we all will have the opportunity to begin on the right foot in the new year. We are aware of all the frustration surrounding the MAA program in recent months, and, feel that much of the frustration could have been avoided if we would have been able to review the survey results in a timely manner. We appreciate your cooperation in getting your time surveys back your vendors in the requested time frame. We expect to review the time survey results from the first quarter of 06/07 by February 16th, six months after the time survey period. We are looking to shorten this time frame in the future.

As many of you know, we have sent out requests to review and respond to the 05/06 time survey results, and we are facing a tight deadline imposed by California Department of Health Services (CDHS). We have been granted a one-time blanket extension from the original December 31, 2006, deadline. All invoices for the first quarter of 05/06 are due to us, ready to file, by January 19th. After that date we can not assure you that we will be able to file your invoices or if CDHS will accept them.

December 4, 2006

Recently the LEC has sent out information to districts regarding the use of code 16. As a result it appears that further clarification is needed. Should you have any questions regarding correspondence from the LEC, please contact us directly.

Office work does not automatically qualify as a code 16 activity and you do not have to be in the classroom or with students to have time in code 1. Since you are employed by an educational entity, no matter what your job title might be, a vast majority of your time should appear in code 1. This also applies to staff that work in a health center environment either on or off the school campus.

Code 16 is not a "catch all" code, that distinction goes to code 1 under the premise that "Activities that do not relate to Medi-Cal, are not administrative in nature, or do not meet the definition of any other code category." Code 16 activities are reserved for positions that are responsible for making district-wide or school-wide decisions. There are very few positions that would have a considerable amount of time in this code. If you are receiving guidance that code 1 is only for time with students, this is incorrect.

The reason behind the clarification is this; reimbursements under the MAA program are for expenses that are necessary for the proper and efficient administration of the Medicaid program. It was never intended for MAA to reimburse districts for the time staff spend doing their general job duties. As the LEC it is our responsibility to communicate program guidance. We understand how CDHS and CMS interpret code 16 and code 1, and we are passing this information along to you.

Medi-Cal Administrative Activities Messages

07/08 Training Dates

What is MAA all about?

What kind of reimbursement are we speaking of?

UNRESTRICTED!

Example of program staff that might perform MAA activities:

Who Funds This Program?

What Are the District's Responsibilities?

How Does the LEC assist the District?

How Can My District Get Started?

What is MAA all about?

1

What Exactly Are MAA Activities?

Latest page

Outreach Materials

MAA Forms

Calendar

LEC Meeting Minutes

Contact MAA

Links

MAA Tools

Links

About

California School Based Medi-Cal Administrative Activities (MAA)

NEWS RELEASE

Committee on Energy and Commerce Rep. John D. Dingell, Chairman

Subcommittee Moves to Block Medicaid Cuts

Approved Legislation would place a one-year moratorium on seven Administration-imposed Medicaid regulations

Committee on Energy and Commerce
Rep. John D. Dingell, Chairman