Student Counts for Medicaid Reporting

1. Student Counts for Medicaid Reporting 2018 PED STARS Data Conference

2. What is the Medicaid School-Based Services Program? • 97% of LEAs and 30+ Charter schools participate in the Medicaid School-Based Services (MSBS) Program. • This Program allows them to receive Medicaid reimbursement for IEP-related ancillary services provided to Medicaid-enrolled students. • Provides over $40M annually. • Districts are required to provide several student lists to HSD for calculation of Medicaid Eligibility Rates (MERs) that are utilized in claims.

3. How is the STARS Coordinator involved? • Requests for the student lists come from HSD to each district’s MSBS Coordinator. • MSBS Coordinators can include SPED, Health Services and/or Financial staff depending on the district. • MSBS Coordinator will communicate with STARS Coordinator to request student lists. • Previously 40 day count lists were requested in November and due to HSD in December. • MSBS Coordinator will ensure formatting is correct per HSD instructions and make additions to the file for Medicaid ID #s and other information not captured through STARS.

4. Why are we here today? • Over the last several years, HSD has improved our auditing processes to include verification of the student data utilized in the MER calculations. • We began auditing these lists in FY16, including a reconciliation of the lists submitted by the district and what was reported through STARS. • Numerous errors have been encountered. • Our fear is that there has not been clear communication of the requirements for the data that is needed from the MSBS Coordinator to STARS Coordinator.

5. Changes for FY19!!! • We recently received approval from CMS to make a change to the MER calculations. We will now be utilizing 80 day count lists! • Since 40 day is no longer included in the State Equalization Guarantee (SEG) formula, the data has become increasingly unreliable (no reason for districts and/or PED to ensure 100% accuracy). • SHO staff spends a significant amount of time reconciling lists with STARS reports (which aren’t always accurate).

6. 80 Day Count Utilization • The 80th day reports are used to determine the Medicaid Eligibility Rate (MER) for each District, Charter and REC. • Administrative Claiming • Cost Settlement • Transportation Reimbursement • List totals are compared to what was reported to PED through STARS. • Ensure the staff providing the lists are utilizing the “Snapshot” and not the “Template” to capture enrollment on the 80th day • Reconciliation assures CMS that we are utilizing accurate data to calculate the MER ⇒ accurate payment • Lists should include ALL students; the match process determines those who are Medicaid enrolled.

7. 80 Day Count Requirement • All districts need to submit three (3) reports by January 30thof each year. According to Governmental Services Agreements (GSAs), Section II. Responsibilities of the Parties, Section B ,#18 “Provide to HSD annually reports of 80th day enrollments to be utilized in calculating Medicaid Eligibility Rates (MERs) for use in the annual direct medical service cost report and administrative claims. These reports should be submitted in the HSD requested format no later than January 30each year.” • Total 80 Day • SPED 80 Day w/Related Services • Specialized Transportation 80 day

8. Total 80 Day • Total 80 Day Count is ALLstudents enrolled in the district on the 80th day of the school year, INCLUDING SPED w/related services students. • RECs should submit a worksheet for each individual district. • The SHO no longer needs a worksheet for the combined 80 day for each REC

9. SPED 80 Day • SPED 80 Day Count is SPED students with Related Rervices enrolled in the district on the 80th day of the school year. • Students receiving Speech Only MUST be pulled as a separate list and combined with the main list • Students that receive non-billable Recreational Therapy or Orientation & Mobility or Rehabilitation Counseling ONLY should be removed (if these are their only services) • Students receiving Nursing Services ONLY should be identified and added to the main list (if they only receive services from the RN) • Exclude charters if the district does not provide their related services • Again, RECs should only submit worksheets for each individual district, the combined list is no longer needed.

10. Transportation 80 Day • 80Day Count of SPED students receiving Specialized Transportation enrolled in the district on the 80th day of the school year. • Specialized Transportation = the student requires a modification to the bus for a medical reason in order to attend school. • Modifications include seatbelts/harnesses, wheelchair lifts, etc. • Aides and/or seatbelts for behavior reasons DO NOT QUALIFY. • RECs should only submit a worksheet for the individual districts that plan to bill transportation. • Can submit even if district does not claim transportation throughout the year.

11. Review of IEPs for Transportation Services • Districts MUST review the IEPs of each student that they submit on the transportation list. • Transportation need should be clearly listed in the appropriate section; including the need and required modification. • IEP should cover the 80th day (Dec. 1 or 1st working day of December) – DO NOT send expired IEPs or those dated after 80th day. Please send 1 file per child.

12. Transportation on the IEP Due to student's diagnosis of epilepsy, student requires the use of a seatbelt/harness on the special education bus in the event that a seizure occurs while en-route to/from school. Student requires curb-to-curb transportation on a bus with a wheelchair lift, wheelchair anchor and supervision on the bus and at the pickup and drop off sites. Due to Cerebral Palsy, student requires assistance to guide her in the gait trainer to/from the bus, assistance to enter/exit the bus and a harness while riding the bus.

13. Transportation on the IEP • Student is not independently mobile and non-verbal. He needs total physical assistance for all of his daily needs and transfers. • Prior Written Notice – It is agreed that student would require a SPED bus with a lift for his wheelchair • The SPED bus has seat belts and a bus aide. • Prior Written Notice – Student rides the SPED bus to and from school -It will benefit him to ride the regular education bus home so that he can remain in class until 3:05

14. Formatting • The report must be formatted with the following fields: • Note: Nursing Services are the only services that Mickey Mouse receives; indicated by “Y” in the Nursing Column. If a student receives other services, no indicator is necessary.

15. Formatting Cont’d • SSN must not contain any punctuation, only numbers. Ensure there are all nine numbers. • Middle initials or Jr., Sr., or III should not be included; unless verified on Conduent Web Portal. • Do Not include any nicknames. • First Name and Last Name should be in all CAPS. • Date of Birth must be in the format of MM/DD/YYYY (02/05/1990 or 2/5/1990) – four digits for the year, • Student ID MUST be included & should be the same in all files – it is being utilized to match SPED & Transportation files from the total list.

16. Formatting Cont’d • Name the files as follows: DistrictName_Total80day_date ⇒ Albuquerque_Total80day_10152018 DistrictName_SPED80day_date ⇒ LasCruces_SPED80day_10182018 DistrictName_Trans80day_date ⇒ Cobre_Trans80day_10212018 • If unable to supply the SSN, please leave the field blank. • If children have two last names or hyphenated last names, check the way they are listed on the Medicaid Web Portal. • Names only need to be checked on the total 80th day list since it is the only one that is going to be run through the Medicaid database

17. Formatting Issues with SY 17-18 40th Day Files • Not reviewing the files that the district is receiving from their district STARS Coordinator – the district could potentially eliminate many of the errors prior to submission to the SHO. • SSN contains less or more than nine digits • Same SSN is reported for multiple students • First and last name are not in CAPS • There are students listed several times within each file. The student should only be listed once even though the student maybe receiving multiple direct services. • Ensure the last and first name are spelled correctly. ex: Beatriz vs. Beatrice Rodriguez vs. Rodriquez Mathew vs. Matthew

18. Incorrect Info Submitted in Files • Total 80 Day • Duplicates and formatting issues. • SPED 80 Day • Including ALL SPED students. The SHO only needs SPED students that are receiving related services. • Transportation 80 Day • Included all SPED students that are using the bus. This list should only include students that are receiving transportation because they have a medical need to use a modified bus to receive related services listed within their IEP.

19. 80 Day and MER • The 80 day counts, their subsequent match lists and the Medicaid Eligibility Rates (MERs) are an essential part of MAC and Cost Settlement calculations. • Total 80 Day Count – MAC • Total SPED w/Related Services – Cost Settlement • Total Specialized Transportation – Cost Settlement • Inaccurate lists can greatly impact the MER and final claim amounts. • MER decreases, claim can decrease. • MER ↓ - 63.4% to 60.82% ⇒ $58,255 decrease in cost settlement • MER increases, claim can increase

20. Future Possibilities HSD has been in contact with PED’s Information Technology Bureau to discuss the possibility of creating a report in STARS that will simplify the process for STARS Coordinators. HSD provides Medicaid ID# information in an Excel spreadsheet that could be utilized to populate a field in your SIS for use on future reports.

21. Questions

22. MSBS Program Staff Christie Guinn, SHO Manager 505-827-3117 christie.guinn@state.nm.us Vacant, MSBS/FIT Program Manager 505-827-7288 Erica Roybal, Financial Analyst 505-827-6233 erica.roybal@state.nm.us