Transcript Slide 1

MHMR
Mental Health Mental Retardation
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Housekeeping
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Training duration is approximately 4 hours
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Short breaks will be provided
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Questions will be taken throughout
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Attendance certificates will be sent via e-mail
to all participants that are given credit for
attending and participating in the training
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New News - Changes in 2010
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The various trainings for Time Study, MAC, TAFI and Direct
Service have been combined
Once the Program Contact has been trained it is good for the
full FFY (Oct-Sept)
There is no longer a final survey, polling questions are inserted
through the training to ensure the information is understood
Webinars have proven to be an effective training methodology
and will continue to be used
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There are some requirements that must be monitored in order to
accurately credit training
Participation level, Polling Questions Answered, Log In & Out times
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HHSC will contact anyone that does not appear to have fully
participated to gain understanding
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New Faces
Time Study
Roles
512-491-1715
Ray Wilson - Manager
Beverly Tackett – Lead
Alexandra Young
MAC
512-491-1411
Dan Huggins - Director
Yvonne Moorad – Lead
Serena Lee
TAFI
512-491-1347
Dan Huggins - Director
Yvonne Moorad – Lead
Serena Lee
New Faces
Old Friends
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AGENDA
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Time Study & Coding Process
MAC & Direct Service Financial
Process
TAFI Reporting Process
Questions/ Wrap up
Note: Must be present for entire training to obtain credit
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Purpose of Time Study
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A statistically valid methodology that reflects how
time is allocated among functions
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Determine the amount of time spent on the MHMR
Program in assisting individuals to access medically
necessary Medicaid funded services
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Necessary for determination of interim rates and
final reimbursement for MR service coordination
and MH rehabilitation and case management
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Purpose of Time Study Cont.
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Necessary for participation in Medicaid Administrative
Claiming (MAC)
Assist the State in carrying out the Medicaid State plan
Time Study participants include personnel who are in
direct contact with the service population
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Who Are the Players ?
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MAC Coordinator
 Assistant
MAC Coordinator
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Time Study Participants
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Signing Supervisors
Skilled Professional Medical Personnel (SPMP)
is no longer a recognized distinction for MAC
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What Are Their Roles?
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MAC Coordinator & Asst. MAC Coordinator
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Identifies personnel who spend a portion of their time
performing administrative activities
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Provide Participant and Signing Supervisor time
study training
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Provide ongoing technical assistance to Participants
and Signing Supervisors to ensure coding accuracy
throughout the fiscal year
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Conduct Quality Assurance checks
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What Are Their Roles? (cont.)
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Participant
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Document their activities on Worker Day Logs (WDL)
Determine which activity took the majority of time in each 15
minute increment
Code the time using uniform time study codes
Sign the WDL within 7 days from the last date on the WDL
Signing Supervisor
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Review WDL to ensure that all information and coding is
complete and accurate
Discuss identified errors with the participant
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Supervisors cannot alter the WDL
Sign the WDL within 7 days from the last date on the WDL
and after the participant has signed
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Requirements
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Time Study Periods (Federal Fiscal Quarters)
1st Quarter - October, November, December
2nd Quarter - January, February, March
3rd Quarter - April, May, June
4th Quarter - July, August, September
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Time study begins the 1st day of the mid-month of
the quarter or with approval by HHSC the alternative
mid-month begins the 1st Monday of the mid-month
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The minimum duration is 3 working days
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4th Quarter both the mid-month and alternative time
studies start on the 2nd Monday of July
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Requirements (cont.)
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1500 Valid Worker Day Logs (WDL) or 1 Month
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Personnel included in the time study document their
activities on WDL
One WDL is one person coding 100% of their activities
for one workday, whatever the duration
100% of the paid workday must be time studied
including breaks, meals and paid leave
Do not leave gaps on the time log
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Sample of Time Study Log
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Sample of Time Study Log – Swing Shift
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Who’s Included?
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Persons sharing the same job functions that spend 5%
or more of their normal required job duties annually
performing MR Service Coordination, MH Case
Management and/or Rehabilitation
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Persons sharing the same job functions that spend
10% or more of their normal required job duties
annually performing MAC reimbursable activities
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Contract staff or First line supervisors who do either
of the above
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Who’s Not?
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Clerical staff that support time studied staff but do not
meet the other requirements
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Generally, First-line supervisors or above
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Staff that provide agency wide administrative
functions (e.g., payroll, human resources)
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Staff that only provide ICF-MR, HCS, MR direct
service, MH vocational service, and non-Medicaid
residential direct service
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Participant
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Participant List
Personnel are grouped by similar job
functions
Job functions are assigned to a cost pool to be
used later in coding the claim
Random Sampling is prohibited – Everyone
must time study
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POLLING QUESTION
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Let’s Get Started !
TIME STUDY
CODES
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Physicians’ services
Hospital review
Clinic services for children under 21
Limited maternity care clinics
Lab and X-ray services
Home health care
THSteps/EPSDT screens and services
Medically needed oral surgery and dentistry for adults (not routine
dentistry)
Pharmacy services (prescription drugs)
Rehabilitative mental health and mental retardation services
Family planning
Services provided by licensed clinical psychologist, licensed clinical
social workers, and licensed professional counselors
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Comprehensive Care Program (CCP) services for children under 21
School Health and Related Services (SHARS)
Targeted Case Management for pregnant women and children under 1
Hearing aids and related audiologists’ services
Diagnostic assessment services for person with mental retardations and
mental illness
Optometry and eyeglasses
Emergency medical services
Private duty nursing for children under 21
Intermediate care facilities for the mentally retarded
Physical therapy
Rehabilitation services for chronic medical conditions
Hospice services
Day Activity and Health Services (DAHS)
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Code 1: Facilitating Medicaid Eligibility Determination
Code 2: Facilitating Non-Medicaid Eligibility Determinations
Code 4: Medicaid Outreach
Code 5: Outreach Non-Medicaid
Code 6: Referral, Coordination, and Monitoring of Medicaid Svc.
Code 8: Referral, Coordination, and Monitoring of Non-Medicaid
Services
Code 9: Medicaid Transportation and Translation
Code 10: Medicaid Provider Relations
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Code 11: Program Planning, Development, & Interagency
Coordination
Code 13: Direct Medical Service
Code 14: Non-Medicaid, Other Educational & Social Services
Code 15: General Administration
Code 16: MR Service Coordination & MH Case Management
Code 17: Rehabilitation Services
Code 18: Home & Community Based Services (HCS)
Code 21: Intermediate Care Facility - MR (ICF-MR)
Code L: Lunch
Code O: Off
Codes 3, 7, 12, 19 and 20 are no longer used
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Time Study Codes & Cost Pools
MHMR Centers state wide have three distinct cost pools with
corresponding Time Study codes to facilitate the claiming process
Reimbursable
Non Reimbursable
Codes 1, 4, 6, 9, 10, 11
Medicaid
Codes 2, 5 & 8
Non-Medicaid
Direct Service
Codes 13, 14, 16, 17, 18 & 21
Code 15 is allocated among all codes used
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Facilitating Medicaid Eligibility
Explanation:
Informing and/or assisting
families in becoming eligible
for Medicaid including related
paperwork, travel and clerical
activities
Examples:
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An intake worker assisting a
family in completing the
Medicaid application.
A clerk putting together the
packet of Medicaid
eligibility forms.
A bilingual interpreter
obtaining insurance
information at Medicaid
eligibility intake
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Facilitating Non- Medicaid Eligibility
Explanation:
Informing and/or assisting
families in becoming eligible
for non-Medicaid services
Examples:
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A Social Worker explaining
WIC rules to a group of
women at the local shelter
A Case Coordinator
verifying Medicaid
eligibility for a family
prior to apply for IHFS
A MH Worker assisting a
consumer enroll in literacy
classes
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Medicaid Outreach
Explanation:
Extending Medicaid services or
benefits to a wider section of
population (potential recipients)
about eligibility
Examples:
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A Nurse speaking at a
community function
about early detection of
health problems
A Case Manager talking
to a parenting group
about mental illness and
signs to look for in
adolescents
Explaining Medicaid
services to inmates at a
correctional facility
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Non-Medicaid Outreach
Explanation:
Extending services or benefits of
programs not funded or covered
by Medicaid to a wider section of
population. Include related
paperwork, clerical activities, or
staff travel to
perform these
activities
Examples:
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Scheduling a community
event promoting alcohol
and drug awareness
Traveling to a homeless
shelter to provide
information about area
food banks
Printing brochures to
hand out at the high
school PTA meeting on
gangs
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Referral, Coordination, & Monitoring
of Medicaid Covered Services
Explanation:
Coordinating and monitoring the
completion of prescribed services,
termination of services, & referral to
other Medicaid svc providers to
provide continuity of care
Arranging for any diagnostic
services which may be required as
the result of a condition identified
during an evaluation
Gathering information that may be
required in advance of these referrals
or evaluations
Examples:
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Scheduling a physician or
dental appointment for a
consumer
Linking individuals with
mental illness to crisis
intervention
Writing the DMR report
Initial treatment planning
for an individual prior to
the determination of
eligibility for MR Service
Coordination
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Referral, Coordination, & Monitoring
of Non-Medicaid Covered Services
Explanation:
Screening and making referrals
for, coordinating and/or
monitoring the delivery of
Non-Medicaid services, or
medical services not covered
by Medicaid.
Examples:
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Making referral to Section
8 Housing
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A Non-MR Service
Coordinator transitioning a
individual from state hospital
to the community
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Intakes & funding for In
Home Family Support (IFSP)
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Referral to an indigent care
program
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Medicaid Transportation
& Translation
Explanation:
Assisting a consumer to obtain
and/or accompanying the individual
to services covered by Medicaid
Obtaining translation services for
the purpose of accessing Medicaid
services (Including Braille, ASL,
Examples:
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Accompanying a consumer to
the doctor’s office to translate
from Spanish to English the
medical information between
the doctor and patient
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Transportation from a
consumer’s home to a
Medicaid service & back home
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Waiting for a consumer to
have lab work completed then
transporting them home
alternative languages, or due to illiteracy)
Transportation provided to eligible
individuals in some covered Medicaid
programs is an integral part of those
services and would not be Code 9
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Medicaid Provider Relations
Explanation:
Performing activities to secure
and maintain the pool of eligible
Medicaid providers
Use only for external providers,
not contractors that you
subcontract with for Medicaid
Services
Notice: Code 10 Clarification
available on the HHSC web site:
http://www.hhsc.state.tx.us/medicaid/programs
/rad/AcuteCare/TS/Code10Clarification.pdf
Examples:
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Developing and
maintaining the recruiting
materials for potential
Medicaid providers
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Explaining Medicaid
policy and regulations to
an adaptive equipment
vendor
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Recruiting new Medicaid
providers (HCS physicians,
etc.)
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Program Planning, Development
& Interagency Coordination
Explanation:
Use by staff whose job
description includes program
planning, policy development
or interagency coordination;
including paperwork, data
analysis, staff travel and
clerical activities.
Examples:
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Implementation of the
Planning and Network
Advisory Committee
(PNAC) decisions
regarding Medicaid
Services
Developing Medicaid
policy based on critical
incident data
Inter-agency utilization
review meetings on
Medicaid services
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Direct Medical Services
Explanation:
Use by staff providing client care,
treatment and/or counseling
services to correct or improve a
specific condition
Used when there is no specific
activity code for a direct service
(Medicaid or Non-Medicaid) and
the indirect services required to
perform the activity i.e., travel or
documentation
Examples:
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QA of any direct service
without a specific MAC
code
Calling in a prescription
that is an ancillary function
to the doctor’s appointment
Time spent providing
Rehab Services other than
crisis intervention services
without authorization
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Non-Medicaid, Other
Educational & Social Services
Explanation:
Use for any activities which
are not health related, such
as employment, job training
and social services, as well
as Non-Medicaid health
related.
Examples:
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Transportation to apply for
Section 8 Housing
assistance
Providing client’s family
case-management like
activities
IHFS reports and
administrative activities
Appearing in court on
behalf of consumer trying
to maintain custody of her
children
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General Administration
Explanation:
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Paperwork/clerical not
directly supporting other
activity
Examples:
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Paid time off & breaks
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Data entry/billing
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Staff meetings or board
meetings
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Processing payroll &
personnel documentation
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Attending or presenting
training
Maintaining inventory &
ordering supplies
Chart audits of multiple
services
Activities related to
conducting Death Review
Activities to expand nonMedicaid provider base
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MR Service Coordination
& MH Case Management
Explanation:
Examples:
Used by staff that provide MH Case
Management & MR Service
Coordination to eligible individuals
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Consumer specific consultation
regarding the provision of Case
Management
There are four subdivisions to document costs:
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A Service Coordinator talking
with a State School resident
about to be placed in the
community about Medicaid
services available to them
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A Case Manager meeting with
the consumer to write their Case
Management Plan
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No Show to scheduled
appointment
MR Service Coordination
16-A: MR – Adult and Child
MH Case Management
16-B: MH – Routine – Adult Case
Management
16-C: MH – Routine – Child and
Adolescent Case Management
16-D: MH – Intensive – Child and
Adolescent Case Management
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Rehabilitative Services
Explanation:
Examples:
Used only by staff authorized to provide A therapeutic team member:
Medicaid Rehabilitative Services
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Attending a Rehabilitative
Services staffing on a
There are seven subdivisions to document
specific consumer
costs:
17-A
17-B
17-C
17-D
17-E
17-F
17-G
17- J
17-K
17-L
Day Program for Acute Needs
Crisis Intervention Services
Med Training & Support - Individual
Med Training & Support – Group – Adult
Med Training & Support – Group – Child &
Adolescent
Psychosocial Rehab Services – Individual
Psychosocial Rehab Services – Group
Skills Training & Development – Individual
Skills Training & Development – Adult Group
Skills Training & Development – Child Group
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Providing Group training on
paying bills and talking with
your landlord
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Meeting with an adolescent
and their parents to review
overdose precautions of the
child’s medications
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Working with a consumer to
learn safe cooking practices
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Home & Community
Based Service (HCS)
Explanation:
Used only by staff authorized to
provide HCS Medicaid covered
services
Examples of these services are:
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Adaptive Aids
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Counseling and Therapies
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Dental Treatment
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Respite
Includes: Texas Home Living Svcs.
Examples:
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Assist with housekeeping as
a HCS Companion Care in
someone's home
Providing respite care for a
consumer in their home
Provide training to a
consumer which will allow
them to obtain or sustain
paid work
Assist a consumer with the
process of purchasing a
wheel chair ramp for their
house
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Intermediate Care Facility
(ICF-MR)
Explanation:
Used only by staff authorized to
provide ICF-MR Medicaid covered
services
A few examples of these services
are:
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Dietary
Direct Care Contact
Physical Therapy
Psychology Services
Skills Training
Day Programming
Examples:
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Conducting a QA
review of the ICF-MR
program
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Psychologist
conducting follow-up
sessions with ICF-MR
clients
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Vocational training at a
sheltered workshop
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LUNCH
OFF
Explanation:
Explanation:
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Un-Paid Lunch
Off duty and/or comp time
used
 Un-paid time that may occur
during your normal scheduled
work day
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POLLING QUESTION
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Time Study Contacts
Time Study
512-491-1715
Beverly Tackett (Lead)
Alexandra Young
[email protected]
Time Study Web site:
http://www.hhsc.state.tx.us/medicaid/programs/rad/AcuteCare/TS/SharsTimeStu
dy.html
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Need a chocolate break?
15
minutes
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