medicaid school based services update
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Medicaid School Based Services Update. MAASE October 15, 2008. Presenters:. Thomas Koepke Director, Special Education Management Services, Macomb ISD Jane Reagan Department Specialist, Medicaid, OSE-EIS, Michigan Department of Education - PowerPoint PPT PresentationTRANSCRIPT
Medicaid School Based Services Update
MAASE
October 15, 2008
Presenters: Thomas Koepke Director, Special Education Management
Services, Macomb ISD
Jane Reagan Department Specialist, Medicaid, OSE-EIS, Michigan Department of Education
Liz Patrick Supervisor, Instructional Data Management & Special Education Finance, Ingham ISD
Members, Medicaid School Based Services Workgroup
Outline
Overview
Backcasting
Moratorium
State Plan Amendment Changes Outreach Fee for Service Personal Care Services Reimbursement methodology New Time studies
Medicaid – Overview
Largest payor of health care in US In 2007, $340 billion for over 62 million
individuals (30 million children)
Two types of reimbursement in school settings – Fee for Service and Outreach
Medicaid – Overview
Outreach Provides funds to districts that are working to
identify children that are uninsured and may qualify for Medicaid – involve ALL students
Fee for Service Reimbursement for certain health related
services (PT, OT, Nursing, etc) provided to Medicaid eligible children with IEP or IFSP
Backcasting – Overview
May 2002 Settlement Agreement – between Feds & State Prompted by a disagreement regarding Michigan’s
Outreach claiming methodology Methodology used was State approved Feds did not provide formal guidance on acceptable
claiming methodologies until the issuance of the May 2003 “Medicaid School-Based Services Administrative Claiming Guide”
Backcasting – Overview
Settlement required new program design – effective January 2004
Results of 1st 4 quarters under new plan applied to previous 16 quarters – Jan/Mar 2000 through Oct/Dec 2003
Backcasting – Overview
10/22/07 CMS Final Report $89,848,860 Overpayment
ISD 60% = $53,909,316
State 40% = $35,939,544 “CMS expects the State to refund the
financial amount identified”
Backcasting – Current Status
ISD Reserves ISD $’s held by State = $20,737,997 ISD $’s held by ISD = ??
ISD Max repayment ISD Overpayment $ 53,909,316
ISD Reserve-held by State - 20,737,997
ISD Reserve-held by ISD - ???
$ 33,171,319
Backcasting – Current Status
Breakdown of total by ISD CMS report only addressed total
overpayment MDCH responsible for calculating breakdown State has appealed CMS decision ISDs - wait and see
Congress’ Moratorium on Proposed Regs – until April 1, 2009
Federal CMS proposed in 2007 to: Eliminate reimbursement for Outreach (AOP)
and Transportation Redefine/limit targeted case management Redefine/ limit rehabilitative services to exclude
reimbursement for “intrinsic elements” of education programs
Limit reimbursement to governmental providers’ costs by narrowing definition—impacted schools
Outreach – Current Status
2006-07 Total Statewide Reimbursement = $19,000,000
ISD 60% = $11,400,000
State 40% = $7,600,000 Statewide Vendor - Public Consulting
Group (fees paid by ISDs & State)
No changes for 2008-09
FFS – Current Status
2006-07 Total Statewide Reimbursement
Program Transportation Total
ISD (60%) $64,600,000 $2,300,000 $66,900,000
State (40%) 43,100,000 1,600,000 44,700,000
$107,700,000 $3,900,000 $111,600,000
FFS Reimbursement–Before 7/1/08
Service documentation logs Reimbursement rate per service
type and statewide fee Claim submitted to MDCH ISD Reimbursement based on
what was provided/billed
FFS Reimbursement – After 7/1/08
Cost-based Provider (ISD)-specific Annually reconciled Cost settlement process Service documentation and claim
submission is still required
New Reimbursement Methodology
Total Allowable Costs
+ Indirect Cost Rate (MDE)
x Direct Service % (annual avg from RMTS)
x ISD SE Med Elig Rate, Hlth Svcs (Dec1)
x Fed Medical Assistance % (’08=58.1%)
x ISD Reimbursement Rate (60%)
Net Dollars to ISD
Random Moment Time Study (RMTS)
Previously 1 RMTS for Outreach – 800 moments/quarter
Now 4 RMTS – 3,000 moments/qtr each Outreach Only Staff Direct Medical Service Providers Case Managers Personal Care Providers
Only staff on staff pool lists can be included as part of Medicaid Allowable costs
Interim Payment Process
Estimated based upon prior year 2008-09 = 75% of 2006-07
ISDs may adjust payment MDCH will monitor claim volume
If claiming drops significantly be prepared for questions and/or payment adjustment
SE Medicaid Eligibility Rate for Health Related Services
Medicaid Eligible SE Students with a health-related support service in the IEP
_______________________________________________________
Total SE Students with a health-related support service in their IEP
**Based on December 1 count**
Allowable Direct Service Providers
ASHA certified speech language pathologist TSLIs under the direction of an ASHA certified SLP or
audiologist Audiologist LPN/RN OT/COTA PT/PTA Orientation & Mobility Specialist Psychologist (full license only or limited under the direction
of a fully licensed psychologist) – (Not School Psych’s) Licensed Master’s Social Worker
Under the Direction of:
Supervising the individual’s careFace to face contact initially and periodicallyPrescribing the type of careReviewing the need for continued services
throughout treatmentAssuring professional responsibility for
services providedEnsuring all services are medically necessary
Personal Care ServicesRange of human assistance services
provided to SE students, enables them to accomplish tasks that they would normally do for themselves if not for the disability
Eating/Feeding/meal preparation Toileting/maintaining continence Personal Hygiene/grooming Transferring/mobility/positioning
Personal Care Services
Providers - Health aides, Instr aides, Parapros, Program assts, Teacher aides, Trainable aides
Require authorization Need for service documented in
IEP Service documentation
Financial Reporting Changes Cost Reporting
Current Outreach = Quarterly financials FFS = n/a
New Methodology Outreach Only = Quarterly financials Direct Medical = Addendum to 4096 Personal Care = Quarterly financials Case Management = Quarterly financials
Fiscal Impact of Changes Will vary from ISD to ISD based on:
Actual state-wide direct service % compared to % of direct services per ISD that are typically logged
Costs – mainly salary & benefits
Medicaid eligibility rate
Indirect cost rate
2008-09 Budget Impact
Medicaid Outreach – 4 quartersMedicaid FFS
- Estimate based on 75% of 2006-07 revenue- 2007-08 claiming- Personal care – no payment in 08-09 (will be part of cost settlement process in 2010)
2008-09 Timeline Cost Reports
June 30, 2009—end of first year Oct 15, 2009—ISDs access Medicaid cost
reports via web, w/ pre-populated fields (time studies, Medicaid elig rate, indirect cost rates)
Oct 31, 2009—LEA and PSA Medicaid cost reports due to their ISD
Dec 31, 2009—ISDs submit summary cost reports to Medicaid
2008-09 Timeline Cost Reports, cont’d
Jan 2010—Initial settlement of ISD costs and adjustments of interim payments begin
Revisions to Medicaid Cost Report may occur until July 2010
July 2010—Final ISD settlement process begins
More Discussion if time
Resources: Medicaid SBS Work Group
At Medicaid agency: Linda Sowle, Medicaid Policy Specialist, Michigan Department of Community [email protected]