In general, the types of school-based health and outreach activities funded under MAC are :
· Referral of students or their families for Medicaid eligibility determinations
· The distribution of health care information
· Referral, coordination and monitoring of health services
· Interagency coordination.

A key focus of the MAC program is the EPSDT (Early Periodic Screening, Diagnosis and Treatment) Program, which is used to ensure a comprehensive, preventative health care program for Medicaid eligible children ages three to twenty-one.

To participate in the program, Districts participate in a time-study sampling methodology that collects data identifying the percentage of time certain staff spent performing activities that are reimbursable by Medicaid. The results obtained from this effort are used to calculate the cost associated with activities that are reimbursable under the Medicaid Administrative Claiming program. In order to prepare a claim for submission to Medicaid, the results of the time study must be applied to the district's actual cost of performing those activities.

What is RMS?

The random moment sample (RMS) time study methodology measures the work effort of the entire group of approved staff involved in the school district medical and health-related services program by sampling and analyzing the work efforts of a cross-section of the group. RMS methods employ a technique of polling employees at random moments over a given time period and tallying the results of the polling. The method provides a statistically valid means of determining what portion of the selected group of staff's workload is spent performing activities that are reimbursable by Medicaid under the MAC (Medicaid Administrative Claiming) program.

The process is designed to be as quick and unobtrusive to the district selected participants as possible. Each calendar quarter, a portion of the statewide pool of selected employees and contractors will be identified to participate in the RMS time study. For each employee selected, one or more forms will be generated by MAXIMUS indicating the specific date and time that the employee is to be surveyed, or "sampled". Selected employees may be sampled more than once during a given quarter. Forms will be distributed to each District's designated MAC Coordinator, who will then be responsible for distributing each form to the selected employee. At the specified date and time, the employee will be expected to complete the observation form. Forms are then returned to the MAC Coordinator, who is responsible for reviewing each form for correct and complete response and returning forms to MAXIMUS

Whom to Include in the Time Study

Only certain LEA staff and contractors may be included in the Medicaid Administrative Claiming (MAC) random moment sample (RMS) time studies. In order to optimize the effectiveness and accuracy of the time study it is important that all appropriate staff are selected to participate and that inappropriate staff are omitted. Review the following guidelines carefully to select your district's participants:
1. Time study participants may be any direct employees of the school district, contract employees, part time employees, temporary employees and any other category of individuals receiving pay from the school district. This does not include individuals such as parents or other volunteers who receive no compensation for their work or in-kind contributions.
2. Generally, school district employees or contract staff with, but not limited to, the job titles listed below may be included in time studies. Clerical staff, supervisory staff, educational instructors (general education and special education), and administrators who provide direct support exclusively to time study participants usually do not participate in time studies.

· Audiologists / Assistants
· Bilingual Specialists
· Counselors
· Diagnosticians
· Dietitians
· Interpreters
· Occupational Therapists / Assistants
· Orientation and Mobility Specialists
· Physical Therapists / Assistants
· Physicians / Physician Assistants
· Program and Staffing Specialists*
· Psychiatrists
· Psychologists and Interns
· Psychotherapists
· Registered Nurses, Licensed Practical Nurses
· Behavioral Health Providers
· Nurses / School Health Staff
· Respiratory Therapists
· Social Workers
· Speech-Language Pathologists / Assistants
· **Other LEA staff including administrators, augmentative specialists, family resource specialists, and program / staffing specialists can also be included; however additional paperwork is required to be submitted on an annual basis.

**Job titles with asterisks require a MAC Position Classification Form to be completed and submitted to MAXIMUS on an annual basis in order to be included in the personnel roster.

3. Staff that are compensated 100% from federal funds must not be included as time study participants. Staff that are partially paid from federal funds may be included.

**It is the responsibility of the school district to ensure that 100% federally funded employees are not included in the list of time study participants. If MAXIMUS, Inc. discovers any employee(s) who are 100% federally funded the employee's name will be removed. Furthermore the school will be liable for reimbursement inappropriately made for employees who are 100% federally funded**

4. LEAs should only include vacant positions if they are confidant that the position will be filled before the commencement of the quarter. The same holds true for contracted employees obtained through an agency. For example, during the summer quarter, if your district uses a speech therapist from a contractor, but you do not have the individuals name by the time the roster is due, you can put the name of the agency in the first name cell. If the position is vacant, the word "vacant" will go in the first name cell. If you do not believe the position will be filled before the quarter commences, you should not include the individual on the roster, however, your MAC Finance Contact will be able to report the individual(s) costs (if any) on the district wide expenditures after the completion of the quarter.

4. Only staff that ROUTINELY perform any of the following activities as part of their routine work tasks should be selected to participate:

Medicaid Outreach: Use this code when performing specific activities to inform eligible individuals about Medicaid and EPSDT benefits and how to access the program. Information includes a combination of oral and written methods that describe the range of services available through Medicaid and EPSDT, the cost (if any), location, how to obtain services, and the benefits of preventive healthcare. Includes related paperwork, clerical activities or staff travel required to perform these activities.

Facilitating Medicaid Eligibility Determination: Use this code when assisting children and families in establishing Medicaid eligibility, by making referrals to the Division of Family Services for eligibility determination, assisting the applicant in the completion of the Medicaid application forms, collecting information, and assisting in reporting any required changes affecting eligibility. Includes related paperwork, clerical activities or staff travel required to perform these activities.

Transportation-Related Activities in Support of Medicaid Covered Services: School staff when assisting an individual to obtain transportation to services covered by Medicaid should use this code. This does not include the provision of the actual transportation service or the direct cost of the transportation, but rather the administrative activities involved in providing transportation. Includes related paperwork, clerical activities or staff travel required to perform these activities.

Translation Related to Medicaid Services: This code should be used by school staff 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. Please note that a school district does not need to have a separate administrative claiming unit for translation. Includes related paperwork, clerical activities or staff travel required to perform these activities.

Program Planning, Policy Development, And Interagency Coordination Related To Medicaid Services: This code should be used by school staff 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. Only employees whose position descriptions include program planning, policy development, and interagency coordination should use this code. Includes related paperwork, clerical activities or staff travel required to perform these activities.

Medicaid Related Training: This code should be used by school staff when coordinating, conduction, or participating in training events and seminars for outreach staff regarding the benefit of medical/Medicaid related services, how to assist families to access such services, and how to more effectively refer students for those services. Includes related paperwork, clerical activities, or staff travel required to perform these activities.

Referral, Coordination, And Monitoring of Medicaid Services: This code should be used 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. Activities that are part of a direct service are not included in this code. Includes related paperwork, clerical activities, or staff travel necessary to perform these activities.

Position Classification Forms

MAXIMUS requires that only individuals who ROUTINELY perform Medicaid administrative and outreach activities are included in the personnel rosters. However, MAXIMUS realizes that in an educational setting an individual's job title may not always be indicative of all of the functions he / she may routinely perform. As such MAXIMUS has created a Position Classification Form that enables a LEA to identify those Medicaid Administrative and Outreach Activities that are ROUTINELY performed by the individual with the job title in question.
MAXIMUS does not require this form for all job titles as there are some positions by sheer title that are easy to recognize the Medicaid Administrative and Outreach Activities that would be performed on a routine basis. A clinician for example (i.e., Speech Therapist) would routinely monitor a student's progress towards speech therapy goals as well as determine whether or not a student continues to meet medical necessity for speech therapy services in addition to providing the direct medical service (i.e., speech therapy). Other job titles are not as clearly identifiable (please see Section 2 for a detailed list of job titles that require clarification).

Since all personnel included in the Personnel Roster must ROUTINELY perform Medicaid Administrative and Outreach Activities MAXIMUS requires that LEAs submit a Position Classification Form for individuals with job titles requiring clarification on an annual basis. The form can be submitted either via fax at 480-829-0701 or via mail to:
MAXIMUS
Attn: MAC Position Classification Forms
1208 East Broadway # 205
Tempe, AZ, 85282

Please note that the form must be received by the deadline for submitting the personnel roster each quarter. The form needs to be completed for the required job titles. Once received MAXIMUS will review the form and make the final determination as to whether or not accept the individual for inclusion in the personnel roster. Forms that appear to be exact duplicates (e.g., every box is checked for every position) will require verification.
If clarification is needed regarding the form your assigned LEA representative will contact you. If a MAC Coordinator is not available to provide clarification, MAXIMUS may elect to not include the questioned individual(s) on the personnel roster. Please note that this does not necessarily preclude a LEA from submitting the financial data related to these individuals when the report the district wide expenditures.
LEAs will be notified of any changes to the personnel roster made by MAXIMUS. If a LEA submits a personnel roster that contains job titles requiring clarification and the Position Classification Form is not received by the deadline for submitting personnel rosters those individuals will be automatically removed from the roster. MAXIMUS will subsequently send the LEA a final copy of the personnel roster used in the statewide pool.

Medicaid Eligibility Rate (MER) Information

In accordance with CMS regulations, each participating LEA must have their individual Medicaid Eligibility Rate (MER). The MER is a percentage reflecting the number of students in the entire LEA that are AHCCCS eligible (Title XIX) on a specific date. Please note that this percentage reflects the entire student body versus the special education population as a student does not have to have a disability in order to qualify for Medicaid services.
The MER is one of the four variables that directly influence a LEAs reimbursement amount. The MER can influence a LEAs reimbursement by approximately 60%. Given the statistical significance of this variable, it is important that the data submitted to MAXIMUS accurately reflects the entire student population. LEAs submit a district wide student roster for all students reflecting directory information for all students (not including those who have declined inclusion in the dissemination of directory information) including:
· Name of school district
· Student's First Name
· Student's Middle Name
· Student's Last Name
· Student's Date of Birth
· Student's Gender

MAXIMUS will collect district wide / charter wide student rosters (directory information only) for every participating LEA on a bi-annual basis during the second and fourth calendar quarters. Once the MER is calculated during those collection quarters the percentage will be utilized for the quarter in collection as well as the subsequent quarter. For example, data collected in October-December quarter will be used for quarters within date ranges 10/1-3/31 and data collected in April-June quarter will be used for quarters within the data ranges 4/1-9/30.

LEAs that fail to submit a LEA student roster during those collection dates will continue to have an MER of 0% applied to their claim for the respective quarters. Please note that this change is in accordance with federal and state guideline / requirements. Furthermore, LEAs new to the MAC Program will have to wait for the applicable data collection date to calculate their MER.

Since the MER is such a large variable of the Arizona MAC Claim and subsequently the reimbursement to participating LEAs, it is important to ensure accuracy of the information as any findings related to this in an audit will result in a recoupment of funds.

Commencing in the April through June 2004 quarter, MAXIMUS will obtain district wide student rosters (directory information only) from the LEAs MAC Finance Contact. In addition, the student roster must accompany a certification form. The certification form verifies that:

1. The student file submitted contains the names of all students enrolled with the LEA as of the assigned date;
2. It is unduplicated (doesn't contain the same student more than once);
3. and to account for students whose parents (or if applicable themselves) have declined the release of Directory information the name and gender fields are replaced with the word "undisclosed" and the date of birth field is replaced with "99999999"

Furthermore, the financial officer will sign off on the information and provide the contact information for the individual who created the file. Files that are not certified will not be included and as such the LEA will receive a 0% MER for the calculation period and subsequent quarters.