medicaid in education - georgia department of education · medicaid in education (background) ciss...

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Ben Appling Georgia Department of Community Health

August 28, 2014

Medicaid in Education

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Mission The Georgia Department of Community Health

We will provide Georgians with access to affordable, quality health care through

effective planning, purchasing and oversight.

We are dedicated to A Healthy Georgia.

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Title or Chapter Slide (use as needed; feel free to delete)

Medicaid in Education (Background) CISS and ACE Requirements

Financial Process Documentation

How to Enroll in the Program

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Title or Chapter Slide (use as needed; feel free to delete)

CISS and ACE Requirements

Financial Process Documentation

How to Enroll in the Program

Medicaid in Education (Background)

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Medicaid in Education (Background)

– Joint federal/state medical assistance program established by Title XIX of the Social Security Act. All Medicaid programs in Georgia are administered by the Georgia Department of Community Health (DCH).

– Funding for the Medicaid program comes from federal and state sources, with the largest share provided by the federal government.

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Medicaid in Education (Background)

Two School-Based Medicaid programs:

– Children’s Intervention School Services (CISS) • Direct Medical Service Costs

– Administrative Claiming for Education (ACE)

• Administrative Costs

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Medicaid in Education (Background)

Two Medicaid programs:

– Managed Separately

– Operated Separately

– Reporting Separately

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Medicaid in Education (Background)

Bottom Line: Provides reimbursement for medical services delivered to Medicaid-eligible students, as well as the administrative activities that support the delivery of these services

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Title or Chapter Slide (use as needed; feel free to delete)

Financial Process Documentation

How to Enroll in the Program

Medicaid in Education (Background) CISS and ACE Requirements

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CISS and ACE Requirements

• For CISS: – School system must be registered with DCH as a

Medicaid-provider – Student must be Medicaid-eligible – Services must be Medically necessary and authorized

by PCP – Services must be documented in the Individualized

Education Program (IEP)

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CISS and ACE Requirements

• For CISS: – Limited to these service categories:

• Audiology • Counseling • Nursing • Nutrition • Occupational Therapy • Physical Therapy • Speech Therapy

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CISS and ACE Requirements

• For CISS: – Must be provided by Certified personnel

• Licensed Speech Language Pathologist; • Licensed Audiologists; • Licensed Physical Therapists; • Licensed Registered Professional Nurses, etc.

– LEAs must bill Medicaid throughout the year – Must report costs and IEP data on annual basis – Must participate in an annual Cost Settlement process

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CISS and ACE Requirements

• For ACE: – Must also participate in CISS – Must submit CISS billing on a quarterly basis – Must report costs on a quarterly basis

• Payroll • Other Costs • Direct Support Staff Costs

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CISS and ACE Requirements

• For ACE: – Eligible positions include:

• Administrators; • Speech Therapy Assistants; • School Counselors, etc.

– Eligible activities include: • Medicaid outreach and related training; • Facilitating Medicaid eligibility application; • Medical service program planning; etc.

– Two hours weekly

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Title or Chapter Slide (use as needed; feel free to delete)

CISS and ACE Requirements

Documentation

How to Enroll in the Program

Medicaid in Education (Background)

Financial Process

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Financial Process

• For CISS and ACE: – Provide staff list quarterly

• Basis for conducting a Random Moment Time Study • Basis for determining reimbursement amounts

– Employees must participate in RMTS • Sample of employees report their activities at certain pre-

selected moments • Each quarter except July-September

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Financial Process

• For CISS: – Bill throughout year and receive interim payments – Submit cost report at end of year – Participate in Cost Settlement process annually

• Calculates final eligible reimbursement amount • “Settle” the difference between the amount paid and the

amount eligible

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Financial Process

• For ACE: – Bill within the same quarter – Submit costs quarterly – Quarterly reimbursements

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Financial Process

• For CISS and ACE: – Each LEA will receive a validation review at least once

every 3 years • Payroll costs – salary and benefits and contracted staff costs • Other costs • IEP data • Licensure/Certification

– Many occur onsite

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Title or Chapter Slide (use as needed; feel free to delete)

CISS and ACE Requirements

Financial Process

How to Enroll in the Program

Medicaid in Education (Background)

Documentation

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Documentation

• For CISS and ACE: – Payroll records for all CISS/ACE employees – IEP records for all Medicaid students – Itemized records of purchase (Invoices) for equipment

and supplies – Licensure/Certification for the review time period – 5 years retention

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Title or Chapter Slide (use as needed; feel free to delete)

CISS and ACE Requirements

Financial Process Documentation

Medicaid in Education (Background)

How to Enroll in the Program

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How to Enroll

Three Things to Enroll:

Obtain a Medicaid provider ID www.mmis.georgia.gov

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How to Enroll

Three Things to Enroll:

Obtain a National Provider Identifier (NPI) number: https://nppes.cms.hhs.gov/NPPES/Welcome.do

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How to Enroll

Three Things to Enroll:

Contact DCH’s Partner, Public Consulting Group (PCG)

gaace@pcgus.com 1-888-805-0498

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How to Enroll

• Will be eligible at the beginning of the next quarter • Regular trainings • Step-by-Step process guides • Georgia-based staff to assist you with compliance

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How to Enroll in the Program

• For CISS and ACE: – Log on to www.xxxxxxx.gov and sign up for a Medicaid

Provider ID – Log on to www.xxxxxxx.com to get an NIP number – Call the DCH Medicaid service provider (PCG) at 1-888-

805-0498 or gaace@pcgus.com and notify them that your LEA wants to enroll in the program

Questions ?

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How to Enroll in the Program

• For CISS and ACE: – Log on to www.xxxxxxx.gov and sign up for a Medicaid

Provider ID – Log on to www.xxxxxxx.com to get an NIP number – Call the DCH Medicaid service provider (PCG) at 1-888-

805-0498 or gaace@pcgus.com and notify them that your LEA wants to enroll in the program

Ben Appling Department of Community Health

404-463-4012 bappling@dch.ga.gov