Medicaid Funding Changes and It’s Impact on Budgeting

1. Medicaid Funding Changes and It’s Impact on Budgeting April 24, 2012

2. Medicaid Reimbursement Cost-Based Approach

3. Medicaid is a jointly funded, federal/state program. Managed at the federal level Managed at the state level

4. The federal CMS is requiring state to adopt a cost settlement approach for school-based Medicaid reimbursement beginning July 1, 2012.

5. 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 Discount Factors Apply LEA Special Education Medicaid Eligibility Ratio (MER) to Subtotal Cost Educational, Admin and Medical Costs Apply Direct Time Study Percentage • Random Moment Time Study - activities coded to direct medical services provided per IEP Apply Indirect Cost Rate (ICR) Total Medicaid Allowable Cost by Time Study % Total Cost Overview of FFS Cost Reporting Process Allowable Cost Allocation Each fiscal year the CR compares total Medicaid allowable cost to total Medicaid reimbursement received WV: Introduction to Medicaid Cost Based School Based Health Services

6. Discount Factors Include Total Cost for All Licensed Clinicians that are: • Included on MAC roster • Eligible to bill FFS • State and locally funded Apply LEA Special Education Medicaid Eligibility Ratio (MER) to Subtotal Cost • MER based on total number of Medicaid eligible/SPED students Apply Direct Medical Time Study Percentage • Represents percentage of activities coded to direct medical services provided per IEP Apply Indirect Cost Rate (ICR) Educational, Admin and Medical Costs Total Medicaid Allowable Cost by Time Study % Total Cost Overview of FFS Cost Reporting Process Allowable Cost Allocation Each fiscal year the CR compares total Medicaid allowable cost to total Medicaid reimbursement received WV: Introduction to Medicaid Cost Based School Based Health Services

7. 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. Total Number of Medicaid Eligible FFS Students Receiving Direct Medical Services with an IEP IEP Ratio = Total Number of Students Receiving Direct Medical Services with an IEP WV: Introduction to Medicaid Cost Based School Based Health Services

8. 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

9. Cost Settlement Calculation Example WV: Introduction to Medicaid Cost Based School Based Health Services

10. Cost Settlement Calculation 2ndExample – Pay Back WV: Introduction to Medicaid Cost Based School Based Health Services

11. Cost Settlement Calculation 3rd Example – Neutral WV: Introduction to Medicaid Cost Based School Based Health Services

12. Rate billed for SLP, PT, OT, PSY, RN, AUD Rate billed for Care Coordination Rate billed for Personal Care Aides $County’s costs for billable services – excluding IDEA Match Results of RMTS (statewide) #Medicaid Eligible/ #Special Ed.

13. 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 $County’s costs for billable services – excluding IDEA Results of RMTS (Direct billable) #Medicaid Eligible/ Special Education

14. 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.

15. 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.).

16. $County’s costs for billable services Results of RMTS Drawing from Basic Information Page – Special Education screen WVEIS #Medicaid Eligible/ #Special Education

17. Additional $ MAC Medicaid Administrative Claiming (MAC) WV: Introduction to Medicaid Cost Based School Based Health Services

18. 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

19. Rate billed for SLP, PT, OT, PSY, RN, AUD Rate billed for Care Coor. – (Treatment Planning?) Rate billed for Personal Care Aides $County’s costs for billable services – excluding IDEA Same participants Results of RMTS (statewide) – % #Medicaid Eligible/ #Special Ed.

20. Don’t bill Med. Don’t bill Med.

21. Online Strategic Plan Maintenance Of Effort (MOE) State/Local

22. In a cost-based system, Medicaid reimbursement will cover the costs of providing special education and health-related services to Medicaid eligible students.