medicaid funding changes and it’s impact on budgeting april 24, 2012
TRANSCRIPT
Medicaid Funding Changes and It’s Impact
on Budgeting
April 24, 2012
COST-BASED APPROACHMedicaid Reimbursement
Medicaid is a jointly funded, federal/state program.
Managed at the federal level
Managed at the 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
WV: Introduction to Medicaid Cost Based School Based Health Services 5
Educational, Admin and Medical Costs
by Time Study %
Include Total Cost for All Providers of Medicaid-covered services:Speech, Physical,
Occupational Therapies, Psychologists, School Nurses, Audiologists, Care Coordinators (Special Ed Teachers
State and locally funded
Total Cost
Apply Direct Time Study Percentage Random Moment
Time Study - activities coded to direct medical services provided per IEP
Apply Indirect Cost Rate (ICR)
Discount FactorsApply LEA Special
Education Medicaid
Eligibility Ratio (MER) to Subtotal
Cost
Total Medicaid Allowable Cost
Each fiscal year the CR compares total Medicaid allowable cost to total
Medicaid reimbursement received
Overview of FFS Cost Reporting Process Allowable Cost Allocation
WV: Introduction to Medicaid Cost Based School Based Health Services 6
Educational, Admin and Medical Costs
by Time Study %Include Total Cost for All Licensed Clinicians that are: Included on MAC roster Eligible to bill FFS State and locally funded
Total Cost
Apply Direct Medical Time Study Percentage Represents percentage of
activities coded to direct medical services provided per IEP
Apply Indirect Cost Rate (ICR)
Discount Factors Apply LEA Special Education Medicaid Eligibility Ratio (MER) to Subtotal Cost
MER based on total number of Medicaid eligible/SPED students
Total Medicaid Allowable Cost
Each fiscal year the CR compares total Medicaid allowable cost to total Medicaid reimbursement received
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.
WV: Introduction to Medicaid Cost Based School Based Health Services 7
IEP Ratio =
Total Number of Medicaid Eligible FFS Students Receiving Direct Medical Services
with an IEP
Total Number of Students Receiving Direct Medical Services with an IEP
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 Health Services 8
Cost Settlement Calculation Example
WV: Introduction to Medicaid Cost Based School Based Health Services 9
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
Cost Settlement Calculation 2nd Example – Pay Back
WV: Introduction to Medicaid Cost Based School Based Health Services 10
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
Cost Settlement Calculation 3rd Example – Neutral
WV: Introduction to Medicaid Cost Based School Based Health Services 11
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
$ County’s costs for
billable services – excluding IDEA
Results of RMTS
(statewide)
#Medicaid Eligible/
#Special Ed.
Rate billed for SLP, PT, OT, PSY,
RN, AUD
Rate billed for Care
Coordination
Rate billed for Personal Care
Aides
Match
$ County’s costs for
billable services – excluding
IDEA
Results of RMTS
(Direct billable)
#Medicaid Eligible/ Special
Education
Medicaid-covered services
•Audiological Services•Speech therapy services•Physical therapy services•Occupational therapy services•Psychological evaluation•RN – Specialized Procedures
Care Coordination activities
Personal care activities•Communication;•Safety;•Mobility;•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
#Medicaid Eligible/ #Special Education
Drawing from Basic Information Page – Special Education screen WVEIS
Medicaid Administrative Claiming (MAC)
WV: Introduction to Medicaid Cost Based School Based Health Services 17
MACAdditional $
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 costs for
billable services – excluding IDEA
Results of RMTS
(statewide) –
% #Medicaid Eligible/
#Special Ed.
Rate billed for SLP, PT, OT,
PSY, RN, AUD
Rate billed for Care Coor. – (Treatment Planning?)
Rate billed for Personal Care
Aides
Same participants
ENTER ALLOCATIONS $997,309.00 $45,215.00 $103,471.00 $1,145,995.00
5 Digit Program Function
Code
3 Digit Object Code
Description IDEA School Age (3-
21) IDEA Preschool
(3-5)State Aid
Total Budget for This Line Item
SPECIAL EDUCATION - PERSONNEL 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 $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
$545,055.00 $28,255.00 $34,000.00 $607,310.00
5 Digit Program Function
Code
3 Digit Object Code
Description IDEA School Age (3-
21) IDEA Preschool
(3-5)State Aid
Total Budget for This Line Item
SPECIAL EDUCATION - SERVICES
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 341 occupational therapy services $70,135.60 $2,536.71 $16,890.00 $89,562.31
22162 341 physical therapy services $15,000.00 $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!
Sub Total Special Education Personnel
COUNTY BUDGET FOR IDEA and State Aid - FY 2012_ _
Don’t bill Med.
Don’t bill Med.
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.