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Medicaid Funding Powered By Docstoc
					  Medicaid Funding
Changes and It’s Impact
    on Budgeting

    April 24, 2012
Medicaid Reimbursement

COST-BASED APPROACH
Medicaid is a jointly funded, federal/state program.




  Managed at the                 Managed at the
   federal level                   state level
The federal CMS is requiring state to
adopt a cost settlement approach for
school-based Medicaid reimbursement
beginning July 1, 2012.
 Overview of FFS Cost Reporting Process
  Allowable Cost Allocation

                     Educational, Admin and Medical Costs
Include Total Cost for All                                        Apply LEA Special
 Providers of Medicaid-             Discount Factors                   Education
                                    by Time Study %                    Medicaid
 covered services:
                                                                    Eligibility Ratio
 Speech, Physical,               Apply Direct Time Study
                                                                   (MER) to Subtotal
  Occupational                     Percentage
                                                                          Cost
  Therapies,                       Random Moment
  Psychologists, School              Time Study - activities
  Nurses, Audiologists,              coded to direct
  Care Coordinators                  medical services
  (Special Ed Teachers               provided per IEP               Total Medicaid
 State and locally               Apply Indirect Cost Rate          Allowable Cost
  funded                           (ICR)

                                                 Each fiscal year the CR compares total
                                                    Medicaid allowable cost to total
           Total Cost                              Medicaid reimbursement received
WV: Introduction to Medicaid
Cost Based School Based                    5
Health Services
 Overview of FFS Cost Reporting Process
  Allowable Cost Allocation

                                 Educational, Admin and Medical Costs

  Include Total Cost for
                                                 Discount Factors                  Apply LEA Special
                                                 by Time Study %
    All Licensed Clinicians                                                         Education Medicaid
    that are:                                                                       Eligibility Ratio (MER)
     Included on MAC roster              Apply Direct Medical Time                 to Subtotal Cost
     Eligible to bill FFS                 Study Percentage                         MER based on total number
     State and locally funded               Represents percentage of              of Medicaid eligible/SPED
                                              activities coded to direct medical    students
                                              services provided per IEP
                                          Apply Indirect Cost Rate (ICR)

        Total Cost                                                                    Total Medicaid
                                                                                      Allowable Cost


          Each fiscal year the CR compares total Medicaid allowable cost to total
                             Medicaid reimbursement received
WV: Introduction to Medicaid
Cost Based School Based                                     6
Health Services
   Important LEA Data Collection Needs
 IEP Ratio must be maintained and tracked for Medicaid cost allocation
  purposes
       Medicaid-allowable costs are determined by multiplying
        total direct medical services times the IEP ratio.
                                 Total Number of Medicaid Eligible FFS
                               Students Receiving Direct Medical Services
          IEP
                                              with an IEP
                          =
         Ratio
                                  Total Number of Students Receiving
                                  Direct Medical Services with an IEP



WV: Introduction to Medicaid
Cost Based School Based                      7
Health Services
                           Cost Report Process
 Cost Reports will be submitted through a web based
  software system
         More comprehensive cost report training will be provided in the future




WV: Introduction to Medicaid
Cost Based School Based                          8
Health Services
   Cost Settlement Calculation Example
 1.0       Total Costs of Eligible SBHS Provider Costs (County’s costs)      $1,000,000

 2.0       Indirect Cost Rate                                                  115.00%

 3.0       Total Costs of Eligible SBHS Provider Costs                       $1,150,000

 4.0       RMTS Direct Medical Percentage Results (Statewide results)           65.00%

 5.0       Direct Medical Services Costs                                      $747,500

 6.0       Application of Medicaid Eligibility Rate (IEP Ratio) (County’s)      50.00%

 7.0       Medicaid Direct Medical Services Costs (for the quarter)           $373,750

 8.0       Medicaid Interim Payments Received (for the quarter)               $200,000

 9.0       Medicaid Cost Settlement (at the end of the year – July 2013)      $173,750


WV: Introduction to Medicaid
Cost Based School Based                        9
Health Services
            Cost Settlement Calculation 2nd
                  Example – Pay Back
 1.0       Total Costs of Eligible SBHS Provider Costs (county’s cost)       $1,000,000

 2.0       Indirect Cost Rate                                                  115.00%

 3.0       Total Costs of Eligible SBHS Provider Costs                       $1,150,000

 4.0       RMTS Direct Medical Percentage Results (Statewide results)           65.00%

 5.0       Direct Medical Services Costs                                      $747,500

 6.0       Application of Medicaid Eligibility Rate (IEP Ratio) (county’s)      50.00%

 7.0       Medicaid Direct Medical Services Costs (for the county)            $373,750

 8.0       Medicaid Interim Payments Received (by the county)                 $500,000

 9.0       Medicaid Cost Settlement (at the end of the year – July 2013)     -$126,250


WV: Introduction to Medicaid
Cost Based School Based                        10
Health Services
           Cost Settlement Calculation 3rd
                 Example – Neutral
 1.0       Total Costs of Eligible SBHS Provider Costs (county’s cost)       $1,000,000

 2.0       Indirect Cost Rate                                                  115.00%

 3.0       Total Costs of Eligible SBHS Provider Costs                       $1,150,000

 4.0       RMTS Direct Medical Percentage Results (Statewide results)           65.00%

 5.0       Direct Medical Services Costs                                      $747,500

 6.0       Application of Medicaid Eligibility Rate (IEP Ratio) (county’s)      50.00%

 7.0       Medicaid Direct Medical Services Costs (for the county)            $373,750

 8.0       Medicaid Interim Payments Received (by the county)                 $373,750

 9.0       Medicaid Cost Settlement (at the end of the year – July 2013)            $0


WV: Introduction to Medicaid
Cost Based School Based                        11
Health Services
$ County’s
 costs for
billable services            Rate billed for
– excluding IDEA
                            SLP, PT, OT, PSY,
                    Match      RN, AUD
 Results of                 Rate billed for
   RMTS                         Care
  (statewide)
                            Coordination

                            Rate billed for
                            Personal Care
 #Medicaid
                                Aides
  Eligible/
 #Special Ed.
        $
    County’s        Medicaid-covered services
    costs for
     billable       •Audiological Services
    services –
    excluding
                    •Speech therapy services
      IDEA          •Physical therapy services
                    •Occupational therapy services
                    •Psychological evaluation
 Results of         •RN – Specialized Procedures

   RMTS             Care Coordination
(Direct billable)   activities
                    Personal care activities
                    •Communication;
    #Medicaid       •Safety;
     Eligible/      •Mobility;
      Special
    Education
                    •Behavior;
                    •Medical/health
RMTS Responses (Direct Services)
Inappropriate Response: I was not providing direct
services to students.
Appropriate Response: I was working on writing new
IEP goals regarding transition for a student.


Inadequate Response: Who was with you? Some
students and an adult.
Appropriate Response: Five students and an aide.
                 PCG’s Advice

When indicating that you were participating in or
preparing for an IEP Meeting,

please indicate the portion of the IEP on which you
were working during your moment

(i.e., health related services goals, transition, state
assessments, etc.).
 $ County’s
  costs for
  billable
  services


  Results of
    RMTS

               Drawing from Basic
               Information Page –
               Special Education
#Medicaid      screen WVEIS
 Eligible/
 #Special
Education
                Medicaid Administrative Claiming (MAC)
                                                         Additional $
                                             MAC




WV: Introduction to Medicaid
Cost Based School Based           17
Health Services
Medicaid Administrative Claiming (MAC)

•Medicaid Outreach
•Facilitating Medicaid Eligibility Determination
•Direct Medical Services
•Translation Related to Medicaid Services
•Program Planning, Policy Development and
Interagency Coordination Related to Medicaid Services
•Medicaid related training
•Referral, Coordination, and Monitoring of Medicaid
Services and Documentation
$ County’s
                    Same
 costs for          participants   Rate billed for
billable services
– excluding IDEA
                                    SLP, PT, OT,
                                   PSY, RN, AUD

 Results of                        Rate billed for
   RMTS                             Care Coor. –
 (statewide) –                      (Treatment
                                     Planning?)

                                   Rate billed for
% #Medicaid                        Personal Care
  Eligible/                            Aides
 #Special Ed.
                                                      COUNTY BUDGET FOR IDEA and State Aid - FY 2012_ _

                                           ENTER ALLOCATIONS                                             $997,309.00          $45,215.00      $103,471.00 $1,145,995.00
 5 Digit
           3 Digit
Program                                                                                              IDEA School Age (3-   IDEA Preschool                       Total Budget for
           Object                                     Description                                                                             State Aid
Function                                                                                                    21)                (3-5)                             This Line Item
            Code
  Code
                     S PECIAL EDUCATION - PERS ONNEL
                     List each position by FTE and type of position, including exceptionality if
                     applicable; and program function code. Fixed charges may be aggregated.               43-2-1             43-2-2           02-2-1


 21210      111      1.0 multi-catagorical teacher           Don’t bill Med.                                  $54,584.00                                              $54,584.00
 21210      121      5 1.0 primary paraprofessionals                                                         $143,916.00                                             $143,916.00
 21210      121      5 1.0 middle paraprofessionals                                                          $124,315.00                                             $124,315.00
 21210      121      3 1.0 high school paraprofessionals                                                      $85,200.00                                              $85,200.00
 21282      121      1.0 pre-school special needs paraprofessionals                                                              $28,255.00                           $28,255.00
 21271      111      .5 1.0 teacher of the gifted                                                                                                  $34,000.00         $34,000.00
 22721      121      1.0 bus aide                                                                             $34,130.00                                              $34,130.00
 22134      111      .10 school nurse                                                                          $5,065.00                                               $5,065.00
 22142      111      3 0.50 school psychologists                                                              $97,845.00                                              $97,845.00
                                                           S ub Total S pecial Education Personnel           $545,055.00         $28,255.00        $34,000.00        $607,310.00
 5 Digit
           3 Digit
Program                                                                                              IDEA School Age (3-   IDEA Preschool                       Total Budget for
           Object                                     Description                                                                             State Aid
Function                                                                                                    21)                (3-5)                             This Line Item
            Code
  Code
                     S PECIAL EDUCATION - S ERVICES
 2xxxx                                                                                                                                                                     $0.00
 22150      151      contracted speech                                                                        $15,000.00                                              $15,000.00
 21273      341      orientation & mobility trainer                                                            $2,000.00                                               $2,000.00
 21223      341      vision specialist                                                                        $10,000.00                                              $10,000.00
 22161
 22162
            341
            341
                     occupational therapy services
                     physical therapy services
                                                                    Don’t bill Med.                           $70,135.60
                                                                                                              $15,000.00
                                                                                                                                  $2,536.71        $16,890.00         $89,562.31
                                                                                                                                                                      $15,000.00
 21219      112      extended school year services                                                             $8,000.00                                               $8,000.00
                                                                                                                                                                           $0.00
                                                                                                                                                                           $0.00
                                                                                                                                                                           $0.00
                                                                 REMAINING IN ALLOCATION                   #REF!              #REF!            #REF!                 #REF!
Online Strategic Plan




     Maintenance Of Effort (MOE)
     State/Local
 In a cost-based system, Medicaid
reimbursement will cover the costs
of providing special education and
     health-related services to
    Medicaid eligible students.

				
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