RANDOM MOMENT SAMPLE (RMS) TRAINING

Why Were You Selected ?You are probably wondering why you have been asked to complete a Random Moment Sample (RMS) form. The School Board of Broward County participates in a program called the Medicaid Certified School Match program.The Administrative Outreach Claiming portion of this program reimburses the school district for helping students and their families access health and therapy services.This program has been a significant revenue source for the District and allows for enhancements to Student Support and Exceptional Student Education services in Broward schools.To learn more about this program please visit our website at:http://www.broward.k12.fl.us/studentsupport/Operations/medicaid.htm

The district uses a software product to randomly select staff and randomly assign moments to be sampled. The software generates the printed Random Moment Sample forms that you receive.How Was Your Name Selected ?

Your name was randomly selected based on your Florida Department of Education Job Title and its description. Your name can be randomly selected more than once a quarter and more than once a year.

If you have received a letter directing you to watch this presentation, you will soon receive a survey form that you are required to complete. Data gathered from the Random Moment Sample form is used for potential reimbursement from activities that our district staff perform. The school system is required to remit all participant forms at the end of each quarter. Be sure to indicate exactly what you were doing at your moment in time, regardless of the activity. These forms are permanently retained and read by state and federal auditors. Please word your response in a professional manner.

4HOW TO STATE AN ACTIVITYLets go over the instructions and review a few examples.When you document your activity, you do not need to use the entire space. Describe your activities for just the one minute you were assigned. Please do not document multiple tasks. Your statement should reflect who you were with, what you were doing, and why you were performing the activity. Remember the terms who, what, and why !Please use the spaces below to describe the activity in which you were involved at the exact moment of your random sample time. It will be necessary for you to be as specific as possible when writing your response. Document exactly what issues, ideas, or services were being conveyed at that time as it relates to the academics, behavioral, administrative or medical concern. Review the example sentences on the back of this form to help you illustrate how to accurately record a detailed account of your sample moment.The instructions for this section read as follows:

5TWO SECTIONS TO THE RMS FORM Section 1 the Activity portion,

and Section 2the Signature and Date portion.

There are two major sections of this form that you will need to complete. These consist of . . .You are being asked to complete the survey form by writing a short response describing your activities during one specific moment in time (example: June 3, 2014 @ 8:32 a.m.). You will receive the actual form, along with detailed instructions, approximately three days prior to your assigned date of documentation. It is mandatory that you complete your form and return it to the ESE & Support Services Medicaid/504 Department immediately after completion. IMPORTANT REMINDERS

6EXAMPLESThe sentence . . . I was in an IEP Meeting. is too vague. A more specific response is . . . I was in a meeting explaining an ESE students annual goals to the students parent.Notice that in the example the name of the committee, such as IEP, was replaced with specific details. It is not enough to say you were writing or discussing goals. It is important that we know who you were with and what was being discussed (or being done) and for what purpose, so that the form may be coded properly. We need to know if the topic was focused on academic, behavioral, administrative, or medical concerns.

Here is another example . . .

I was talking to a teacher about a students progress in therapy. While we were talking, another students mother called and we discussed his classroom behavior. I suggested he receive a hearing evaluation. I then went to lunch. This statement reflects too many activities. Think about what you actually did during your moment in time. If you were multi-tasking, what task would you continue doing if you could only work on one? A better response is . . .I was talking to a teacher about a students progress in therapy.While it is important to refrain from giving too much information, it is also important to refrain from giving too little information. For instance . . .

I was driving in my car. . . . is too vague. Do tell us where you were going to and from.I was driving back to work from a training session on how to use behavior modification techniques in the classroom with students diagnosed as hyperactive.

SECTON 1 - ACTIVITY PORTION WHO ? WHAT ? WHY ?The response written in the Activity portion of the form should answer the following 3 questions:(Who - students parents and teachers) ( What - discussing the students difficulty with gross motor skills) (Why - to determine if an evaluation for OT/PT is needed)Who were you with?What were you doing?Why were you doing this?

8Keep In Mind . . .If at your selected moment you were not scheduled to work or you were at lunch, please indicate that in the area below and proceed to complete the rest of the form. No further description is required if at lunch or not scheduled to work.If you make an error while completing the form, please cross out the error and initial, and date the change you are making and continue to complete the form.

9JOB TITLEWhen indicating your Job Title, it is important to write your Job Title exactly as it appears at the top of the form.

This Job Title reflects the Florida Department of Education Job Title that corresponds with your Job Description and may not be the same as the School Board of Broward County Job Title that you are familiar with.For example, Behavioral Specialists and Support Facilitators can expect to see Teacher, Varying Exceptionalities as their Job Title on their form.* If the Job Title on the form is not descriptive of your position, please contact our office as soon as possible at 754-321-3400.

10SECTION 2: SIGN AND DATE WITH CORRECT JOB TITLEOnce you have answered section 1 and review the important reminders, please be sure to complete the bottom of the form by Signing your Name, Indicating your Job Title, and Dating the Form.Now you are ready to complete the Signature and Date portion of the form.

11FINISHING UP

Please remember that completing and dating the form prior to your assigned date will invalidate the form.

Please be sure to provide us with your work telephone number (including Area Code).

12MAILING AND CONTACT INFORMATIONAs soon as you have completed the Random Moment Sample form, please return it to our office using the pre-addressed label provided with the form.

Thank you for your time and cooperation with this program.Our address is :ESE & Support Services Medicaid/504 Dept.Arthur Ashe 2nd Floor, Attn: Nanci English.If you do not receive your Random Moment Sample form via pony within two days of your assigned date, please contact our office at: 754-321-3400.

For Additional Information or Questions Contact : ESE & Support Services - Medicaid/504 Department

Phone : 754-321-3400Fax: 754-321-8483 Deneen Gorassini - Medicaid Coordinator Lisa-Ann Clarke - Medicaid Accountant Nanci English - Customer Service Analyst

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