name survey nugget 9.28.12 final · o becky stoddard, chair of education and research committee,...
TRANSCRIPT
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The Changing Tides of Medicaid
in Education: NAME National Survey Results
Education and Research Commi3ee Nugget Presentation October 10, 2012
Agenda • Introductions
o Becky Stoddard, Chair of Education and Research Committee, Medicaid Liaison, Kentucky Department of Education
o Jim T. Donoghue, Educational Program Consultant, Medicaid, Iowa Department of Education
o Rick Jacobs, Principal, Fairbanks LLC o Alicia Neumann, Director MAC Programs, Paradigm Healthcare Services o Rena Steyaert, Montana Medicaid Program Officer
• Overview of Survey Results • Preliminary Takeaways • Next Steps
o Final Report o CMS o California Survey of Medicaid
• Questions
Education and Research Committee 2
Education and Research Committee 3
Red: Health and Education Green: Health Only Blue: Education Only Yellow: Finance
States Responding to 2011 Biennial NAME Survey by Agency
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Direct Services
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!$#!!
!$100!!
!$200!!
!$300!!
!$400!!
!$500!!
!$600!!
!$700!!
!$800!!
2008! 2009! 2010!
Millions'
Total'Federal'Reimbursement'for'Direct'Services'
Total!Direct!Services!
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!$#!!!!
!$5.00!!
!$10.00!!
!$15.00!!
!$20.00!!
!$25.00!!
!$30.00!!
!$35.00!!
2008! 2009! 2010!
Millions'
Average'Direct'Services'Federal'Reimbursement'
Average!Direct!Service!Billing!
Median!Direct!Service!Billing!
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0%#
21%#
17%#
58%#
4%#
Percent'of'State's'LEAs'Billing'for'IEP'Services'(Direct'Services)'
1*25%#
26*50%#
51*75%#
76*100%#
Unknown#
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39%$
61%$
Do#LEAs#Retain#100%#of#the#Federal#of#Reimbursement#for#IEP<related#services?#
(Direct#Services)$
Yes$
No$
Total$:$23$No:$14$$$$$$$$$$$$$$$$$$$$$$$$$$$$Yes:$9$
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!$#!!!!
!$0.50!!
!$1.00!!
!$1.50!!
!$2.00!!
!$2.50!!
!$3.00!!
!$3.50!!
!$4.00!!
!$4.50!!
IN! MT! NE! KY!
Millions'
Direct'Services'Billing'by'State'(<'$5'Million)'
2008!
2009!
2010!
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!$#!!!!
!$2.00!!
!$4.00!!
!$6.00!!
!$8.00!!
!$10.00!!
!$12.00!!
!$14.00!!
!$16.00!!
VA! CO! FL! NC!
Millions'
Direct'Services'Billing'by'State'(>$5'<'$20'Million)'
2008!
2009!
2010!
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!$#!!!!
!$5.00!!
!$10.00!!
!$15.00!!
!$20.00!!
!$25.00!!
!$30.00!!
!$35.00!!
!$40.00!!
NJ! OH! KS! IA! RI! AZ! LA! MN!
Millions'
Direct'Services'Billing'by'State'(>$20'<'$35'Million)'
2008!
2009!
2010!
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!$#!!!!
!$20.00!!
!$40.00!!
!$60.00!!
!$80.00!!
!$100.00!!
!$120.00!!
!$140.00!!
!$160.00!!
WV! MA! MI! CA! NY!
Millions'
Direct'Services'Billing'by'State'(>'$35'Million)'
2008!
2009!
2010!
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0" 5" 10" 15" 20" 25"
Interpreter'Services'
IEP'Mee0ngs'
Orienta0on'and'Mobility'
Assis0ve'Technology'Services'
Case'Management'
Assis0ve'Technology'Devices'
Personal'Care'Assistance'
Special'Transporta0on'
Health'Related'Evalua0ons'
Audiology'
Nursing'
Behavioral'Health/Mental'Health/Psychological'Counseling'
Speech'
Physical'Therapy'
Occupa0onal'Therapy'
Number'of'States'
Total'Number'of'States'that'Allow'Direct'Services''to'be'Billed'by'Type'of'Service''
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0"
2"
4"
6"
8"
10"
12"
MA" OH" NY" RI" NJ" KS" KY" IN" LA"
State%Changes%to%Services%That%Can%Be%Billed%By%Type%of%Change%(Eliminated,%Significantly%Changed,%Added)%%
Added" Significantly"Changed" Eliminated"
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0"
2"
4"
6"
8"
10"
12"
14"
16"
VA" KS" IA" MI" OH" KY" WV"
Percent'of'Students'Enrolled'in'Special'Educa3on'by'State'
2008"
2009"
2010"
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0"
2"
4"
6"
8"
10"
12"
14"
CA" NV" NC" MT" AZ" FL" NY"
Percent'of'Students'Enrolled'in'Special'Educa3on'by'State'
2008"
2009"
2010"
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!"!!!!
!2,000!!
!4,000!!
!6,000!!
!8,000!!
!10,000!!
!12,000!!
!14,000!!
!16,000!!
!18,000!!
IN! KS! IA! RI! MT! MN!
Student'Count'For'Which'Direct'Services'Were'Billed'By'State'
2007"2009! 2008"2009! 2009"2010!
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!"!!!!
!10,000!!
!20,000!!
!30,000!!
!40,000!!
!50,000!!
!60,000!!
OH! AZ! NJ! CO!
Student'Count'For'Which'Direct'Services'Were'Billed'By'State'
2007"2008! 2008"2009! 2009"2010!
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Education and Research Committee 19
!"!!!!
!50,000!!
!100,000!!
!150,000!!
!200,000!!
!250,000!!
NY! VA! CA!
Student'Count'For'Which'Direct'Services'Were'Billed'By'State'
2007"2008! 2008"2009! 2009"2010!
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$0.00$
$1,000.00$
$2,000.00$
$3,000.00$
$4,000.00$
$5,000.00$
$6,000.00$
$7,000.00$
$8,000.00$
VA$ MT$ NJ$ IN$ OH$ CA$ NY$ AZ$ CO$ KS$ RI$ IA$ MN$
Federal'Direct'Services'Revenue''Per'Billed'Student'
2008$ 2009$ 2010$
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!$#!!!!
!$10.00!!
!$20.00!!
!$30.00!!
!$40.00!!
!$50.00!!
!$60.00!!
!$70.00!!
IN! VA! FL! KY! NJ! OH! NC!
Direct'Services'Revenue/Special'Educa4on'Student'Count'
2008!
2009!
2010!
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!$#!!!!
!$50.00!!
!$100.00!!
!$150.00!!
!$200.00!!
!$250.00!!
!$300.00!!
MT! CA! AZ! MN! KS! IA! LA!
Direct'Services'Revenue/Special'Educa4on'Student'Count'
2008!
2009!
2010!
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18%$
26%$52%$
4%$
Methodology*Used*by*State*for*Medicaid*Reimbursement*of*Direct*Services*
Other$
Fee$For$Service$
Cost$Report$
Unknown$
Cost$Report:$12$$$$$$$$$$$$$$$$$$Fee$For$Service:$6$$$$$$$$$$$$$$$$$$$$Other:$4$$$$$$$$$$$$$$$$$$$$$$$Unknown:$1$
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61%$
39%$
What%Time%Study%Methodology%is%Used%for%Direct%Services%Rates/Reimbursement?%
Actual$documented$service$6me$
RMTS$
Actual$Documented$Service$Time:$14$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$RMTS:$9$
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Education and Research Committee 25
45%$
14%$
32%$
9%$
Which%agency%performs%Direct%Services%program%training?%
Both:$10$
Educa4on:$3$
Medicaid:$7$
Other:$2$
35%$
56%$
9%$
Which%agency%performs%Direct%Services%program%reviews?%
Both:$8$
Medicaid:$13$
Other:$2$
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59%$
41%$
Does%State%Provide%Web0based%Technical%Support%for%Direct%Service%Program?%
Yes$
No$
91%$
9%$
Does%State%Provide%a%Manual%or%Guidebook%for%Direct%Service%Program?%
Yes$
No$
Education and Research Committee 27
0" 1" 2" 3" 4" 5" 6" 7" 8" 9"
Unresolved*State*Plan*Amendment*
Free*Care*Issue*
Medical*Necessity*
Medical*Orders*
We*have*no*major*issues*at*this*>me*
Understanding/integra>ng*requirements*of*both*IDEA*and*Medicaid*
Parental*Consent*
Third*Party*Liability*
Rates*
Provider*Creden>als*
IEPs*that*meet*the*test*for*both*IDEA*and*Medicaid*
Documenta>on*of*Services*
Number*of*States*
Top*Issues*Related*to*Direct*Services*Billing*
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Administrative Claiming
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Education and Research Committee 29
17%$
13%$
0%$
48%$
13%$
9%$
Percent'of'LEA's'Par0cipa0ng'in'MAC'
1*25%$
26*50%$
51*75%$
76*100%$
NA$
Unknown$
1*25%:$$$$$$4$$$$26*50%:$$$$3$51*75%:$$$$0$$$$$$$$76*100%:$$11$Unknown:$2$NA:$3$
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$320.00&
$325.00&
$330.00&
$335.00&
$340.00&
$345.00&
$350.00&
$355.00&
2008& 2009& 2010&
Millions'
Aggregate'MAC'Reimbursement'by'Year'
MAC&Reimbursement&
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Education and Research Committee 31
67%$
33%$
Do#State's#LEAs#retain#100%#of#MAC#Reimbursement?#
No$
Yes$
No:$12$Yes:$6$
Education and Research Committee 32
$0.00$
$0.50$
$1.00$
$1.50$
$2.00$
$2.50$
$3.00$
$3.50$
$4.00$
$4.50$
$5.00$
NJ$ MT$ LA$ KS$ OH$ RI$
Millions'
Federal'MAC'Dollars'(<'$5'Million)'
2008$
2009$
2010$
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$0.00$
$5.00$
$10.00$
$15.00$
$20.00$
$25.00$
$30.00$
$35.00$
$40.00$
AZ$ MI$ NC$ VA$ NE$
Millions'
Federal'MAC'Dollars'(>'$5'<'$50'Million)'
2008$ 2009$ 2010$
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Education and Research Committee 34
$0.00$
$20.00$
$40.00$
$60.00$
$80.00$
$100.00$
$120.00$
$140.00$
$160.00$
$180.00$
MA$ FL$ CA$
Millions'
Federal'MAC'Dollars'(>'$50'Million)'
2008$ 2009$ 2010$
Education and Research Committee 35
5%#
11%#
84%#
Time%Study%Methodology%Used%for%MAC%Claiming%
Combina.on#
Other#
RMTS#
RMTS:#16##Other:#2#Combina.on:#1#
Education and Research Committee 36
35%$
26%$
39%$
State%used%the%same%methodology%for%Direct%Service%&%MAC%Programs%
No$
Not$Applicable$
Yes$
Yes:$9$$$$$$$$$$$$$$$$$$$$$$$$$$$$No:$8$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$NA:$6$
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Education and Research Committee 37
61%$18%$
13%$
4%$ 4%$
Agency'that'provides'program'reviews'of'the'MAC'program'
Medicaid:$14$
NA:$4$
Both:$3$
Other:$1$
Unknown:$1$
39%$
9%$22%$
9%$
17%$
4%$
Agency'that'provides'Training'for'the'MAC'program'
Medicaid:$9$
Educa2on:$2$
Both:$5$
Other:$2$
NA:$4$
Unknown:$1$
Education and Research Committee 38
44%#
30%#
17%#
9%#
Does%State%Provide%Web0Based%Technical%Support%for%MAC%Program?%
Yes:#10#
No:#7#
NA:#4#
Not#Sure:#2#
70%$
9%$
17%$
4%$
Does%State%Provide%Manual%or%Guidebook%for%MAC%Program?%
Yes:$16$
No:$2$
NA:$4$
Not$Sure:$1$
Education and Research Committee 39
0" 1" 2" 3" 4" 5" 6" 7" 8" 9" 10"
MER$
Compiling$data$
Time$Study$Methodology$
Understanding$Guidebooks$
Staff$Training$
We$have$no$issues$at$this$?me$
Par?cipants$
Number$of$States$
Top$Issues$Related$to$Medicaid$Administra?ve$Claiming$$by$Number$of$States$
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Next Steps & Questions
• Final Report Posted to NAME Website • California Data Set • CMS Data Set • Who to Contact
Questions?
Education and Research Committee 40