Increasing Revenue: SBAP Funding Procedures

1. Increasing Revenue: SBAP Funding Procedures PASBO

2. Looking for Revenues? SBAP & ACP $ You’re in the right place! PASBO

3. SBAP & ACP $ PASBO

4. Carlisle Recently Jump Started their SBAP Billing ProgramMay 2010Added 1 FTE – Dedicated Access Billing CoordinatorUpdated Leader Services Software SetupBilling Form/File ManagementJune 2011Revenues increased > $100,000Year 1 PASBO

5. 14 Buildings4,800 StudentsGeneral Fund Budget: $64m Carlisle Area School District Special Ed – 15.5% population of that: 32.2 % MA Eligible 30% Free & Reduced Lunch Spec Ed Budget $7m + Pupil Health $5m PASBO

6. How did we do it? • Billed by Service Category: • IEP’s and Transportation • Speech, OT, PT, and Psych Svc • And various smaller categories • Year 2-3: need to add: • PCA Services • Social Work Services YEAR 3 GOAL: $300,000 PASBO

7. School-Based ACCESS Program (SBAP)

8. SBAP-Direct Services overview SBAP affords schools the opportunity to receive federal Medicaid funds for providing certain health-related services to special education students who are enrolled in the MA Program. The program began in 1992 and is jointly operated by the PA Department of Education (PDE) and Department of Public Welfare (DPW).

9. Eligible schools • School Districts • Intermediate Units • MAWAs • Charter Schools • Approved Private Schools Currently, over 600 schools participate.

10. Covered services Assistive Devices Audiology IEP Development Nursing (RN) Nursing (LPN) Occupational Therapy Orientation and Mobility Personal Care Assistant Physical Therapy Physician Psychiatry Psychology Social Work Speech/Language Teacher of Hearing Impaired Special Transportation

11. Reimbursements by specialty For the 2010-2011 school year: Total = $145,233,580 PCA $44,794,541 Speech, Language $28,274,559 OT $15,252,994 Transportation $12,362,406 IEP Development $15,132,210 Physical Therapy $8,596,718 Psychology $7,539,680 RN Nursing $5,191,279 Teacher of HI $2,925,027 Social Work $1,870,712 LPN Nursing $1,533,872 O&M $676,106 Physician $774,464 Asst. Devices $151,314 Psychiatry $56,713 Audiology $100,985

12. Considerations for participation • Do you have: • Sufficient staff and resources? • Accessibility of records? • Ability to maintain internal compliance programs? • Commitment to keep current on program regulations? • Commitment to training and conducting self-audits?

13. Reimbursement factors • Special education population • MA population • Health-related services provided by school staff and/or contracted services • Number of MA-qualified service providers • Number of parents providing consent • Level of management

14. Eligible students • Student must: • Be entitled to services under IDEA. • Be three years of age and under 21. • Be enrolled in MA. • Have an IEP that defines the MA-covered service.

15. Eligible students • Student must: • Have written Parental Consent. • Have Medical Authorization. • Receive the MA-covered service by a school employee or contractor who meets MA Provider qualifications.

16. Documentation • Must be maintained for six years. • Must fully disclose the nature and extent of the service rendered. • Must be legible. • Must be readily available for an audit.

17. Reimbursements • Reimbursements are made to PDE’s Comptroller’s Office and deposited into an LEA-restricted account. • Leader provides monthly Financial Reports. • LEAs must ensure the availability of funds prior to making a withdrawal request. • Funds must be used for special education programs and services.

18. Administrative Claiming Program (ACP)

19. ACP overview In meeting students’ educational needs, LEA staff members often find themselves delivering services that help ensure students are healthy and ready and able to learn. The school setting provides an opportunity to enroll potentially eligible children in the MA Program or to assist children and their families who are already enrolled to access the MA services that are available to them.

20. ACP overview ACP allows LEAs to receive federal Medicaid funds in addition to the School-Based ACCESS Program(direct services revenue). Federal matching funds are available for certain administrative activities that are in support of the state’s Medicaid program.

21. Eligible schools • School districts • IUs • Charter schools • Approved Private Schools Participating LEAs must also participate in the Direct Services Program. Currently, over 150 schools participate.

22. ACP time studies One-week quarterly time studies held three times per year capture staff time. The time study must: • represent tasks as they relate to the participants’ job descriptions. • capture 100 percent of participants’ time.

23. ACP claimable activities Examples of administrative claimable activities: • Informing individuals about the MA Program. • Assisting individuals with the MA-application process. • Monitoring, referring, or coordinating MA-covered services.

24. Reimbursements by quarter • For the 2010-2011 fiscal year: • July-Sept. 2010 $3,979,820 • Oct.-Dec. 2010 $3,753,608 • Jan.-March 2011 $4,016,334 • April-June 2011 $4,104,988 Total = $15,854,750

25. Reimbursements • LEAs receive a check from DPW. • Reimbursement is calculated at the Federal Financial Participation rate of 50 percent. • DPW retains 50 percent of the reimbursement. • Funds should be spent within health-care services.