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This section provides
definitions of various topics that are used in the two school-based
Medicaid Programs: Direct Service Claiming (DSC) and Medicaid
Administrative Claiming (MAC).
Arizona Health Care Cost Containment System (AHCCCS): The Medicaid
Agency for the state of Arizona.
Center for Medicare / Medicaid Services (CMS): Federal governing
entity that oversees that Medicaid/Medicare programs in the United
States of America.
Certification of Match: Documentation that certifies that a
school district has expended dollars reported on the claim and that
those dollars have not been used to match other Federal revenue sources.
Central Coding Methodology: The Process of having a
qualified coder at a central location choose appropriate Medicaid
Administrative Claiming activity codes based on the response of the
participant indicating what he or she was doing during the sample
moment. This methodology eliminates the need for the RMS participant
to choose an activity code on the actual RMS form.
CMS 1500: Federally approved form to claim for direct services.
Control List: Master list of all sampled employees within a
quarter, used in the MAC program.
Cost Data: The actual dollar amount for expenses (salaries
and benefits) paid on a quarterly basis to employees listed on the
Employee Data File (a.k.a. Personnel Roster), used in the MAC program.
Diagnosis Code: A code utilized to identify a student's condition(s)
within the Direct Service Claiming Program.
Direct Service Claiming (DSC) Program: A means for school districts
to receive federal reimbursement for direct (face to face) Medicaid
approved medical services rendered to qualified students ages three
to twenty-one years of age.
Early Periodic Screening Diagnosis and Treatment (EPSDT): Medicaid
program that allows for the provision of AHCCCS eligible medical services
to qualified recipients ages three to twenty-one years of age.
Employee Data File (Personnel Roster): School district's list
of selected employees / personnel who routinely render Medicaid outreach
and administration, used in the MAC program.
Federal Funding: A classification (originating source) of funding
used to reimburse school district personnel.
MAXIMUS, Inc.: Arizona's program administrator for the Medicaid
Administrative Claiming (MAC) and Direct Service Claiming (DSC) Programs
Medicaid Administrative Claiming (MAC) Coordinator: Employee(s)
of a school district that coordinates the district's involvement in
the Medicaid Administrative Claiming Program
Medicaid Administrative Claiming (MAC) Program: A means for
school districts to receive federal reimbursement for Medicaid administrative
activities that support students receiving health services, such as
referrals made for health services, and the coordination of health
services.
Medicaid Eligibility Rate (MER): The percentage of Medicaid
eligible students from the school district's total student population.
Medicaid: Federally funded, health insurance program for select
populations.
Object Codes: Classification used to record the "type" of costs
that you are reporting for particular functions, used in the MAC program.
Observation Form: The form utilized to capture the information
obtained during the random moment sample (RMS) process of the MAC
program.
Position Classification Form: Form used in the MAC program
that provides information about the routinely performed Medicaid Administrative
and Outreach Activities performed by individuals with certain job
titles.
Position Codes: Classification of employee types, used in the
MAC program
Procedure Code: The code utilized to claim for direct services
billed.
Random Moment Sample (RMS): Federally accepted method for documenting
the time school district personnel spend on Medicaid administrative
activities.
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