3/8/2012 1PASBO

Increasing Revenue:SBAP Funding Procedures

Looking for Revenues?

3/8/2012 2PASBO

SBAP & ACP $

You’re in the right place!

3/8/2012 3PASBO

SBAP & ACP $

Carlisle Recently Jump Started their SBAP Billing Program

May 2010

Added 1 FTE – Dedicated Access Billing CoordinatorUpdated Leader Services Software Setup

Billing Form/File Management

June 2011

Revenues increased > $100,000Year 1

3/8/2012 4PASBO

14 Buildings4,800 Students

General Fund Budget: $64m

3/8/2012 5PASBO

Carlisle Area School District

Special Ed – 15.5% populationof that: 32.2 % MA Eligible30% Free & Reduced Lunch

Spec Ed Budget $7m + Pupil Health $5m

3/8/2012 6PASBO

How did we do it?

Billed by Service Category:• IEP’s and Transportation• Speech, OT, PT, and Psych Svc• And various smaller categories

Year 2-3: need to add:• PCA Services• Social Work Services

YEAR 3 GOAL: $300,000

School-Based ACCESS Program (SBAP)

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SBAP-Direct Services overview

SBAP affords schools the opportunity to receive federal Medicaid funds for providing certain health-related services to special education students who are enrolled in the MA Program.The program began in 1992 and is jointly operated by the PA Department of Education (PDE) and Department of Public Welfare (DPW).

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Eligible schools

School Districts Intermediate Units MAWAs Charter Schools Approved Private Schools

Currently, over 600 schools participate.

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Covered services

Assistive Devices Audiology IEP Development Nursing (RN) Nursing (LPN) Occupational Therapy Orientation and

Mobility Personal Care

Assistant Physical Therapy

Physician Psychiatry Psychology Social Work Speech/Language Teacher of Hearing

Impaired Special Transportation

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PCA

$44,794,541 Speech, Language

$28,274,559 OT

$15,252,994 Transportation

$12,362,406 IEP Development

$15,132,210 Physical Therapy

$8,596,718 Psychology

$7,539,680 RN Nursing

$5,191,279

Teacher of HI

$2,925,027 Social Work

$1,870,712 LPN Nursing

$1,533,872 O&M

$676,106 Physician

$774,464 Asst. Devices

$151,314 Psychiatry

$56,713 Audiology

$100,985

Reimbursements by specialtyFor the 2010-2011 school year:

Total = $145,233,580

Considerations for participationDo you have:

• Sufficient staff and resources?

• Accessibility of records?

• Ability to maintain internal compliance programs?

• Commitment to keep current on program regulations?

• Commitment to training and conducting self-audits?

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Reimbursement factors

Special education population MA population Health-related services provided by school

staff and/or contracted services Number of MA-qualified service providers Number of parents providing consent Level of management

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Student must:

• Be entitled to services under IDEA.

• Be three years of age and under 21.

• Be enrolled in MA.

• Have an IEP that defines the MA-covered service.

Eligible students

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Student must:

• Have written Parental Consent.

• Have Medical Authorization.

• Receive the MA-covered service by a school employee or contractor who meets MA Provider qualifications.

Eligible students

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Documentation

Must be maintained for six years. Must fully disclose the nature and extent of

the service rendered. Must be legible. Must be readily available for an audit.

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Reimbursements

Reimbursements are made to PDE’s Comptroller’s Office and deposited into an LEA-restricted account.

Leader provides monthly Financial Reports. LEAs must ensure the availability of funds

prior to making a withdrawal request. Funds must be used for special education

programs and services.

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Administrative Claiming Program (ACP)

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In meeting students’ educational needs, LEA staff members often find themselves delivering services that help ensure students are healthy and ready and able to learn.

The school setting provides an opportunity to enroll potentially eligible children in the MA Program or to assist children and their families who are already enrolled to access the MA services that are available to them.

ACP overview

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ACP allows LEAs to receive federal Medicaid funds in addition to the School-Based ACCESS Program (direct services revenue).Federal matching funds are available for certain administrative activities that are in support of the state’s Medicaid program.

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ACP overview

• School districts

• IUs

• Charter schools

• Approved Private Schools

Participating LEAs must also participate in the Direct Services Program.

Currently, over 150 schools participate.

Eligible schools

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One-week quarterly time studies held three times per year capture staff time.The time study must:

• represent tasks as they relate to the participants’ job descriptions.

• capture 100 percent of participants’ time.

ACP time studies

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Examples of administrative claimable activities:

• Informing individuals about the MA Program.

• Assisting individuals with the MA-application process.

• Monitoring, referring, or coordinating MA-covered services.

ACP claimable activities

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Reimbursements by quarter

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For the 2010-2011 fiscal year:

• July-Sept. 2010

$3,979,820

• Oct.-Dec. 2010

$3,753,608

• Jan.-March 2011$4,016,334

• April-June 2011

$4,104,988

Total = $15,854,750

Reimbursements

LEAs receive a check from DPW. Reimbursement is calculated at the Federal

Financial Participation rate of 50 percent. DPW retains 50 percent of the

reimbursement. Funds should be spent within health-care

services.

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