Medicaid Administrative Claiming Stratified Random Moment Time Study Services

The Vendor is required to provide regarding the implementation and operation of a stratified time-study infrastructure for Medicaid administrative claiming (MAC) to manage the infrastructure and quarterly cost pool data and provide training, quality assurance, quality improvement, and a platform for reporting and invoicing.
- Time study codes
1. Medicaid related
•    Includes a discussion of Medicaid or a service covered under Medicaid or support accessing a Medicaid service under one of the qualifying activities. 
a. Not Medicaid considered and related
•    Discussion of or access to programs not funded by Medicaid or a service not covered under Medicaid. 
b. Not tied to a specific program
•    Did not discuss or provide access to a specific program or service and cannot attach to Medicaid or non-Medicaid.
2. Enrolled in Medicaid
•    Assisting an individual who is currently enrolled in or applying for Medicaid.
a. At risk of spenddown and institutionalization
•    Assistance may prevent or delay the individual from entering a nursing facility or other Medicaid-funded institution. 
•    It must be documented that the individual meets the spenddown worksheet criteria. 
•    More information about this can be found in subsequent sections.
b. At risk of adverse outcomes that likely increase future Medicaid costs
•    Select door agencies work with children and families to develop skills that will likely reduce costs to the Medicaid system later in the child’s life. 
•    Time spent providing this support that is not otherwise reimbursed is eligible for MAC. 
•    More information about this can be found in subsequent sections.
- At risk of Medicaid spenddown
1. At risk of Medicaid spenddown and institutionalization
•    Used with participants age 19 and older, the participant is not yet eligible for Medicaid but a six-month nursing facility stay would deplete their income and assets to the point where they would be financially eligible for Medicaid. 
•    Must have one or more documented activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment and meet spenddown criteria
2. At risk of adverse outcomes that likely increase future Medicaid costs
•    Used with participants under the age of 19. 
•    Because state operates the TEFRA program, which disregards parental income and assets, participants meet this category if they 1) are not on Medicaid; 2) meet functional criteria; and 3) meet financial criteria for TEFRA.