Medicaid Claiming

Overview of the Medicaid Claiming Program

The Medicaid Administrative Claiming (MAC) is a federal program that offers financial reimbursement to agencies for their efforts in promoting and supporting the Medicaid program.  Since we support our families by providing referrals to outside services in addition to education, North Kitsap has applied for and been accepted into this program.  To receive reimbursement, we are required to conduct 5 time studies per quarter which report the amount of time we typically spend on Medicaid related activities.  Some of this reimbursement money is used to support school nursing staff while the rest is split between the schools and covering administrative costs.  The schools allotment may be spent at the discretion of each school.
 
Our district participation is managed by the District Program Coordinator who provides the required information to HCA (Health Care Authority who administers for WA State) and completes the billing process. The district coordinator is also responsible for working with each school to provide information, training materials, time study forms, and review of data submitted by each school.
 
Each school building has a MAC Building Coordinator that assists with the distribution, collection, and verification of the time study forms for participating staff members.  This person and the building principal are responsible for training participating staff in their buildings at least once per year.  They may also attend a training at the district office either before or during each school year.
  
Before the beginning of each quarter (fall, winter, and spring):
    
* We supply a list of eligible staff members to HCA, based on certain funding criteria. 
     * We appoint up to 20% of staff  "designated" - those who will complete time studies every quarter. 
     * From the remaining list of eligible staff, a list of "random" participants is selected by HCA each quarter.
     * HCA then assigns 5 Time Study Days for the quarter  (one for each day of the week).
 
During the quarter, on each of the 5 Time Study Days:
     * Participating staff members track time spent performing various activities on a time study form.
     * These forms are collected by building coordinators and reviewed, then forwarded to the district coordinator.
     * The district coordinator reviews for compliance and then enters the time study data for future billing.
 
After each quarter:
    
* The HCA system calculates the average amount of time a typical staff member spends performing Medicaid-
        related activities. 
     * HCA determines the amount of reimbursement that can be claimed for the quarter.
     * The district submits a bill to HCA for the reimbursement amount.
  
    
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