NHASEA August Academy Summer 2012 School Based Medicaid Updates Presenters: Dan Courter & Steve Courter

1. NHASEA August Academy Summer 2012 School Based Medicaid Updates Presenters: Dan Courter & Steve Courter

2. Topics • US Department of Health and Human Services Office of Inspector General (OIG) Manchester School District audit • List of Excluded Individuals / Entities “LEIE” • NH Re-enrollment with ACS • Reassignment

3. Manchester OIG Audit • Finding • “We [OIG] disagree [with the State of NH] that specialized transportation is a “stand alone” covered service. Pursuant to 42 CFR § 440.170(a), the CMS technical guide, the CMS letter, and the New Hampshire State plan, specialized transportation services are allowable only if used by the student to obtain a Medicaid-covered service.” • --Review of Medicaid Payments for School-Based Health Services Made to Manchester, NH, A-01-10-00014, January 19, 2012, p. 9

4. Manchester OIG Audit • Finding • “Attendance reports did not document adequately that students actually received transportation services. Attendance logs demonstrate only that the students attended school and do not verify the method of transportation. Even if the State agency provided guidance to the contrary, we maintain that attendance reports alone would not verify that a student rode the bus on a particular day.” • --Review of Medicaid Payments for School-Based Health Services Made to Manchester, NH, A-01-10-00014, January 19, 2012, p. 9

5. Manchester OIG Audit • Expectations for the Future • “The State agency stated that it is currently reviewing and revising its rules and procedures. The State agency stated that although it was compliant during the audit period based on its understanding of CMS guidance, our review has brought to its attention the need for improvement in certain areas. For example, it plans to require that a specialized transportation service billed to Medicaid must include another Medicaid-covered service provided on the transportation date.” • --Review of Medicaid Payments for School-Based Health Services Made to Manchester, NH, A-01-10-00014, January 19, 2012, p. 12

6. Manchester OIG Audit • Recommended Next Steps – Transportation • Begin requiring trip logs from transportation providers (contractually) • Be prepared for possible revenue reductions • Monitor timely submission of other health-related services

7. List of Excluded Individuals / Entities • “LEIE” • OIG has the authority to exclude individuals and entities from Federally Funded health care programs, and maintains a list of all currently excluded individuals and entities on the LEIE. Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties, should reimbursement occur to or on behalf of the excluded individual or entity. • Fraud detection and enforcement is projected to account for $40 billion in savings to the US government over the next 10 years • --Complying with federal and State Employee Screening Requirements – Besler Consulting, Spring 2011

8. List of Excluded Individuals / Entities • “LEIE” • MSB believes LEAs will rarely have providers who appear on the exclusions list • What is most important is maintaining documentation that indicates the list was checked monthly

9. List of Excluded Individuals / Entities • “LEIE” • Best Practice: • While the exclusion regulation (42 CFR §1001.1901) does not specify frequency, CMS has indicated that “. . . states should require providers to search the HHS-OIG website [LEIE] monthly . . .” • --CMS letter to State Medicaid Directors - January 16, 2009 SMDL #09-001

10. List of Excluded Individuals / Entities • “LEIE” • Medicaid providers have access to the LEIE online database • Initially, the providers can be checked by name, and if there is a “hit,” SSNs can be used to confirm

11. List of Excluded Individuals / Entities • “LEIE” • MSB intends to assist districts with the responsibility of checking the LEIE

12. Re-Enrollment with ACS • NH has contracted with Affiliated Computer Services, Inc. (ACS) as its Medicaid fiscal agent as of July 1, 2012. Our understanding is that the State is migrating to a new MMIS to meet the following: • State-Initiated Medicaid Managed Care • HIPAA requirements • Affordable Care Act • Web-based system

13. Re-Enrollment with ACS • Pursuant to 42 CFR §455.104 Medicaid providers (including districts) must provide the Name, DOB and SSN of the “Managing Employee” as part of the re-enrollment process

14. Re-Enrollment with ACS • Managing Employee means “general manager, business manager, administrator, director or other individual who exercises operational or managerial control over or who directly or indirectly conducts the day-to-day operation of an institution, organization or agency” (42 CFR §455.101)

15. Re-Enrollment with ACS • Practical take-aways • MSB has contacted its districts to assist them in completing the re-enrollment process • Districts should be prepared to provide Name, DOB and SSN of the “Managing Employee”

16. Re-Enrollment with ACS • Update on efforts to raise concerns about: • School District “Managing Employees” personal information being provided to DHHS • Security of information once in the hands of the State

17. Reassignment • Prohibition against reassignment of provider claims  42 CFR §447.10 • Exceptions to §447.10:  Payment may be made to: • the employer of the individual practitioner 447.10(g)(1) • the facility in which the service is provided by the contracted practitioner 447.10(g)(2)

18. Reassignment • Reassignment applies when:  The employed or contracted practitioner is independently enrolled as a Medicaid provider • Best Practice:  The contracting parties have a written agreement that makes it clear that the contracting practitioner will not independently bill for his/her services rendered under the contractual agreement with the school district