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Medicaid and Education Data and Reports Overview

This document provides an overview of Medicaid reimbursement to school districts, member and provider identification, Medicaid billing screens and edit reports, special education eligibility codes, certification of Medicaid eligibility, and the random moment time study.

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Medicaid and Education Data and Reports Overview

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  1. Office of Special Programs WV Department of Education June 2014 Medicaid and Education Data and Reports

  2. Overview • Medicaid Reimbursement to School Districts • Member ID • Provider ID • Medicaid Billing Screens • Medicaid Billing Edit Report • Report Format – Writer • Special Education Eligibility Codes • Miscellaneous Screen • Certification of Medicaid Eligibility • How the information will be used (Cost Reports) • Random Moment Time Study

  3. 1990 West Virginia Legislature enacted WV Code 18-2-5b for Direct Services : • Audiological • Speech • Physical • Occupational • Psychological • Nurse • 2000 West Virginia submitted State Plan adding: • Treatment Plans • Care Coor. • Personal Care Aide • Special Trans. – Vehicle • Special Trans. - Aide Medicaid Reimbursement to Schools • 1988 U.S. Congress amended the Social Security Act

  4. Medicaid Reimbursement to School Districts

  5. Member Identification If the RESA has staff assigned solely to Medicaid billing, the RESA Medicaid Specialist will look up Medicaid numbers for their respective counties.

  6. Member Identification If given access to the Medicaid number look-up, there will be CFM.MMI MMIS In their menu. To look up Medicaid numbers, county Medicaid staff will need permission from their Special Education Director to have access to the Medicaid number look-up.

  7. Member Identification

  8. Special Education Basic Information Member Identification

  9. Member Identification Member Identification

  10. Member Identification Address Medicaid

  11. Member Identification Diagnosis Code

  12. Member Identification Page Down Diagnosis Code

  13. Provider Identification Individual Providers must be enrolled with Medicaid under the County’s Provider Number.

  14. Provider Identification Provider Identification

  15. Provider Identification

  16. Provider Identification Medicaid Billing Screens Enter new billing For care coordination, personal care aides, sp. Transportation - select County Name. For Speech and other therapies, select the name of the provider.

  17. Medicaid Billing Screens

  18. Medicaid Billing Screens

  19. Medicaid Billing Edit Report

  20. Medicaid Billing Edit Report Medicaid Billing Edit Report

  21. Report Writer Format

  22. Report Writer Format Report Writer Format

  23. Report Writer Format Page down

  24. Report Writer Format

  25. Report Writer Format Report Writer Format

  26. Report Writer Report Writer Format

  27. Report Writer

  28. Report Writer

  29. Report Writer

  30. Special Education Eligibility Codes

  31. Special Education Eligibility Codes

  32. Special Education Eligibility Codes

  33. Special Education Eligibility Codes

  34. Special Education Miscellaneous Screen

  35. Special Education Transportation

  36. Special Education Certified Medicaid Count

  37. Special Education Certified Medicaid Count

  38. Special Education Certified Medicaid Count

  39. Cost Reporting District’s Costs of Providing $3,000,000 Less the results of the RMTS - 2.52% Total Costs less RMTS results $75,600 Vendors/contracted costs $0 Total Costs with Contracted $75,600 District’s IEP ratio reduction Medicaid eligible 50% All Special Ed Students Total Costs less IEP ratio $37,800 District’s Medicaid Reimbursement $195,000 Cost Settlement Difference between Costs and Reimbursement $157,200

  40. Random Moment Time Studies

  41. Random Moment Time Study What is the purpose of the time study? The Random Moment Time Study (RMTS) is designed to identify the portion of time spent providing services covered by Medicaid.

  42. Annual Costs District’s Costs of Providing $3,000,000 Less the results of the RMTS - 2.52% Total Costs less RMTS results $75,600 Vendors/contracted costs $0 Total Costs with Contracted $75,600 District’s IEP ratio reduction Medicaid eligible 50% All Special Ed Students Total Costs less IEP ratio $37,800 District’s Medicaid Reimbursement $195,000 Cost Settlement Difference between Costs and Reimbursement $157,200

  43. https://easyrmts.pcgus.com/RMTSv2/LoginCheck.aspx RMTS Reports

  44. Random Moment Time Study

  45. Compliance Report

  46. Review • Medicaid Reimbursement to School Districts • Member ID • Provider ID • Medicaid Billing Screens • Medicaid Billing Edit Report • Report Format – Writer • Special Education Eligibility Codes • Miscellaneous Screen • Certification of Medicaid Eligibility • How the information will be used (Cost Reports) • Random Moment Time Study

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