ARMAC Arkansas Medicaid Administrative Claiming

1. ARMACArkansas Medicaid Administrative Claiming Where Do We Go From Here? Medicaid In The Schools (MITS) Summit January 24, 2008 1:00 PM

2. ARMAC Arkansas Medicaid Administrative Claiming is a federally approved program that allows public education agencies to receive reimbursement for “Medicaid administrative activities” being performed by school personnel.

3. Examples of“Medicaid Administrative Activities” • Notifying parents of benefits covered by Medicaid or ARKids First • Assisting families with completing a Medicaid application • Contacting student’s physician to complete medical necessity paperwork/script for services • Verifying a student’s Medicaid eligibility

4. Examples of“Medicaid Administrative Activities” • Referring or coordinating health services for students (medical, mental health, therapies, or substance abuse services covered by Medicaid) • Participating in or facilitating Medicaid or medical training • Obtaining consents to bill (regardless of current Medicaid eligibility status) • Developing strategies to assess or increase the capacity of school medical/mental health programs

5. How Districts Participate… • Participants are trained • Participants respond to random moments

6. Sample ARMAC Random Moment

7. Sample ARMAC Random Moment

8. ARMAC Reimbursement Factors • District’s Medicaid Eligibility Rate • District’s incurred cost (based on participating staff) • Statewide % of time spent on reimbursable activities

9. Important Things to Remember • Staff does not need to know who is Medicaid eligible • The activity being performed is measured for potential reimbursement not the outcome

10. Important ARMAC Historical Timelines • April 1994 – Other states began implementing MAC (Medicaid Administrative Claiming) programs • May 2003 – CMS issues Medicaid Administrative Claiming Guide • Jan. 2005 – Arkansas’ MAC Implementation Plan approved by CMS • Nov. 2005 – 59 Arkansas public education entities begin participating in ARMAC program • Sept. 2007 – Purposed rule (CMS-2287-P) published in Federal Register to eliminate MAC funding

11. Important ARMAC Historical Timelines(Continued) • Oct. 3, 2007 – President Bush vetoed 1st SCHIP legislation that included language to suspend elimination of administrative claiming • Dec. 28, 2007 – Final Rule (CMS-2287-F) to eliminate MAC funding published in Federal Register • Dec. 12, 2007 – President Bush vetoed 2nd SCHIP legislation that also contained language to suspend elimination of administrative claiming • Jan. 23, 2008 – The House will vote to attempt to override President Bush’s 2nd SCHIP veto

12. SCHIP & The MAC Connection • What is SCHIP? • SCHIP (State Children’s Health Insurance Program) • SCHIP Legislation contained language that impacted the future of Medicaid Administrative Claiming

13. SCHIP & The MAC Connection(Continued) • SCHIP Legislation & Medicaid Administrative Claiming (The legislation sought to increase enrollment of children through program from 6.6 million children to more than 10 million) • President vetoed the bill and stated “the bill would be a step toward federalization of health care, and that it would steer the program away from its core purpose of providing insurance for poor children and toward covering children from middle-class families.”

14. SCHIP MAC Moratorium Language • SEC. 616. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS. Not withstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to January 1, 2010, take any action (through promulgation of regulation, issuance of regulatory guidance, use of federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to restrict coverage or payment under title XIX of the Social Security Act for rehabilitation services, or school-based administration, transportation, or medical services if such restrictions are more restrictive in any aspect than those applied to such coverage or payment as of July 1, 2007.

15. SCHIP Moratorium LanguageTranslation • The federal government’s stance states that “reimbursement under the Medicaid program for the costs of certain activities are not necessary for the proper and efficient administration of the State plan”* - *Source CMS-2287-F – Federal Register • Effectively, Arkansas Medicaid Administrative Claiming program would cease as a funding source for participating public education entities.

16. A Closer Look at CMS 2287-F

17. Federal Impact • Elimination of Medicaid Administrative Claiming Program Final rule published December 28, 2007 establishes a Secretarial finding that general school-based administrative activities are not necessary for the proper and efficient administration of the State plan.  The rule specifies that Federal financial participation (FFP) under the Medicaid program will not be available for school-based administrative and certain transportation costs for home-to-school transportation for special education students.  • Budget Implications Estimated to result in $635 million in savings during the first year and $3.6 billion in savings over the first five years.  These estimates are based on recent reviews of State reported school-based administrative and direct medical service expenditures.   

18. State Impact • 232 districts/early childhood programs would no longer receive ARMAC reimbursement • $10 million in revenue would be lost by participating Arkansas public education entities • Students would lose some additional health related services and programs provided by ARMAC revenues

19. ARMAC Reimbursement Utilization Examples • Specialized Equipment (for nursing or speech) • Transportation Modifications (lift installation) • Facility Modifications (safety seats, ramps, etc.) • Training Fees (CPR, health-related conferences, etc.) • Salaries for health-related staff • Procurement of health-related services (PT, OT, Speech, nursing services, etc.)

20. ARMAC FundingUtilization Reporting • Legislative Requirement • Reporting vs. Non-governing Funding Utilization Language

21. Year to Date ARMAC Funding • FY 2006 – $3,240,828.38 • FY 2007 – $6,512,003.09 • FY 2008 – $4,220.007.60 (to date for 2 Qtrs) Total: $8 – 10 million per year

22. What Can You Do?... • Be an active participant (You and the students have a vested interest in seeing the ARMAC program continue) (*Reference Contacts List) • Be patient (things can always change) • Stay the course (continue as is until further notice)

23. Advocacy & Resource Information(Reference Handout Available)

24. ARMAC Resource Information Medicaid In The Schools (MITS) 2402 Wildwood, Suite 172 Sherwood, AR 72120 Web Address: http://arksped.k12.ar.us/sections/medicaid.html Tel: (866) 280-8300, option 2 or (501) 835-2093 Rene.Montgomery@arkansas.gov Armac.support@arkansas.gov