Transcript www.hhsc.state.tx.us

Independent School
Districts
1
Agenda

Program Overview





Random Moment Time Study Overview
Medicaid Administrative Claiming - Financial Reporting







School-based Medicaid programs
Enrollment process
Program contact responsibilities
Allowable costs
Claim submission
Claim calculation
Fairbanks (STAIRS) System Demonstration
Desk Review & Helpful Program Information
School Health and Related Services Overview
Wrap Up
2
Medicaid Overview

Jointly-funded state and federal health-care
program


An entitlement program that provides health
coverage to people with low-income, people
65 and older, and people with disabilities
School setting


Enroll eligible children in Medicaid program
Assist children already enrolled in Medicaid
to access the benefits available to them
3
Medicaid Administrative Claiming
(MAC) Program

Federal reimbursement for the costs of Medicaid administrative
activities performed in the school setting


Linking students to appropriate Medicaid/health-related services
Separate from but complimentary to SHARS program

Centers for Medicare & Medicaid Services (CMS) administers the
MAC program at the federal level and reimburses states for
allowable outreach activity performed under the MAC program.

The Health & Human Services Commission (HHSC) is the
Medicaid Single State Agency in Texas (responsible for the
administration of the MAC program at the state level).
4
MAC Program

Reimbursement for certain medical and health-related
outreach, case management and administrative activities
surrounding the health services that are delivered.

Programs are reimbursed for these activities, regardless of
whether the student is Medicaid eligible or not.

These services may be to a student or family, and are for
activities that include coordinating, referring, or assisting
the student/family to access the health-related services.
5
MAC Activities

Activities that improve the access to Medicaid coverage or improve the
use of Medicaid covered services, include but are not limited to…






Informing Medicaid eligible and potential Medicaid eligible children and
families about the benefits and availability of services provided by
Medicaid (including preventive, treatment, & screening) including
services provided through the EPDST program.
Assisting individuals or families to complete Medicaid eligibility
application.
Scheduling or arranging transportation to Medicaid covered services.
Providing translation services for the purpose of accessing Medicaid
services.
Developing strategies to assess or increase the capacity of school
medical/dental/mental health programs.
Arranging for any Medicaid covered service that may be required as a
result of a specifically identified medical/dental/mental health condition.
6
To Participate in MAC . . .
Complete the following:






Intergovernmental Cooperation Agreement
Business Associate Agreement
Texas Identification Number Application
Vendor Direct Deposit Form
Vendor Information Form
MAC Program Operating Plan

Submit original documents.

Documents are open-ended.

Documents and instructions can be downloaded from the
HHSC MAC website
7
Intergovernmental Cooperation Agreement
& Business Associate Agreement
ISD Agrees






To account for activities of staff
providing Medicaid administration
To submit quarterly participation
data through the cost reporting
system
To provide expenditure
information on a quarterly basis
To spend an amount equal to the
federal match received on health
related services for clients
To designate a liaison to work
with HHSC
Comply with HIPAA regulations
HHSC Agrees





To pass on to the ISD 95% of
Title XIX federal share for
Medicaid Administration
To reimburse 50% of allowable
administrative costs
To include the ISD expenditures
for Medicaid administration in
the claim it submits to CMS
To designate a liaison to work
with the ISD
Comply with HIPAA regulations
8
Texas Identification
Number Application
Formerly known as the TPIN –
Texas Payee Identification
Number
Assigned by the Comptroller’s
office for the purpose of
identifying any party receiving a
payment from the State of Texas.
The use of this number on all
billings will reduce the time
required to process billings to the
State of Texas.
9
Vendor Direct
Deposit Form





If not currently on direct
deposit with the State, to
change financial institutions,
change account number or type,
complete sections 1 - 5
Section 2: Leave the boxes
blank if you do not have your
11 digit Texas Identification
number
Section 3: Recommended to be
completed by the district’s
financial institution
Section 6 – Advance Payment
Notification
Completed form is sent to
Texas Health & Human
Services Commission
10
VENDOR
INFORMATION FORM
 Form # CPP0430

The ISD is the vendor.
Section 2 (Person Who Will Sign the
Contract) must contain the
information of the person that
signed the Intergovernmental
Cooperation Agreement.

Send the original, signed form
to HHSC.

11
MAC Program Operating Plan
Cover page must be printed on district letterhead.
POP includes only:

District Contact Information




RMTS Coordinator Roles & Responsibilities


Contact will agree to terms by initialing section
MAC Financial Coordinator Roles & Responsibilities


Primary RMTS Coordinator (district employee)
Primary MAC Financial Coordinator (district employee)
Superintendent
Contact will agree to terms by initialing section
Authorized Signatures
12
Resubmit documents?

Vendor Direct Deposit Form



Depository bank, account number, etc changes
Must complete form again & submit to HHSC
MAC Program Operating Plan



Update only “District Contact Information” page &
submit to HHSC if one of the program coordinators
changes
Must update contacts in Fairbanks
Unnecessary to send entire POP again or any additional
documents (organizational chart, description of
coordinator’s job functions & responsibilities, etc.)
13
Accessing Payment Information

Vendor Direct Deposit Form




Advance Payment Notification
Authorization Form



http://www.window.state.tx.us/taxinfo/taxforms/74-176.pdf
Section 6
Sent to HHSC
http://www.window.state.tx.us/taxinfo/taxforms/74-193.pdf
Sent to Comptroller’s office via mail or fax
Comptroller’s Website

https://fmx.cpa.state.tx.us/fm/payment/pin/pininstruct.php
14
System Contacts

Communication is critical…




Superintendent
Random Moment Time Study (RMTS)
Coordinator
Medicaid Administrative Claiming (MAC)
Financial Coordinator
School Health & Related Services (SHARS)
Financial Coordinator
15
Primary MAC Financial Contact
Responsibilities

Must be an employee of the district

Serve as financial liaison to HHSC & Fairbanks LLC (cost reporting system)

Attend MAC financial training for each Federal fiscal year

Ensure that the MAC financial data is certified each quarter on the cost
reporting system

Ensure the Quarterly Summary Invoice is signed and notarized by the
proper individuals

Maintain financial documentation and supporting materials

Must be listed as the primary MAC Financial Contact on the MAC
Program Operating Plan & in the cost reporting system

Ensure all contact information is current and accurate
16
Documentation & Recordkeeping
Requirements

Participation documents (Contract, MAC POP, etc)
 The
following is a checklist of the minimum documents to
collect & maintain quarterly:

Financial data used to develop the expenditures and revenues for
the claim calculations including state/local match used for
certification




Copies of computations used to calculate financial costs
All revenues offset from the claim, by source
Quarterly Summary Invoice (signed & notarized)
Roster of eligible individuals, by category, submitted for inclusion
of RMTS (Participant List)
17
Documentation & Recordkeeping
Requirements (cont.)
 Information
must be available upon request by federal or state
 Documents
must be stored in a readily accessible location &
entities.
format.
 Records
should be maintained for a period of no less than five
(5) years or if an audit has started, the records shall be retained
until the audit is completed and all issues are resolved.
18
Training

Primary & secondary contacts should be trained every Federal fiscal year
(FFY).

Initial & refresher trainings are available.

It is the responsibility of each ISD to ensure one or more of their designated
MAC Financial contacts attend training. HHSC strongly recommends that each
ISD require at least two MAC Financial contacts attend the required training to
ensure compliance should employee turnover occur.

Training is from FFY to FFY.


Ex: If you take training for FFY 2012, does NOT grant you access to FFY 2011.
Training is not retro-active.

Switching Districts

Full Access vs. View Only
19
Random Moment Time Study
(RMTS) Overview
20
MAC Quarterly Process
1
2
3
4
Participant
Identification
Time Study
MAC Financial
Data Collection
MAC Claim
Calculation
Determine who
performs MAC
activities
Determine how
much
reimbursable
activity is
performed
Determine
actual costs
associated with
these activities
Apply
reimbursement
rates (TS, MER,
IDCR) to
calculate a claim
Today’s Main Focus
21
Participant List = Allowable Salary Costs


The district identifies eligible participants at the beginning
of each quarter via the “Participant List” (PL).
Costs reported are “position-specific” not “personspecific.”




Substitutes - Individual replacing a provider on leave
Direct replacement - Individual hired to fill a vacant
position
These are the only positions for which financial data can
be reported.
Positions and categories left off the Participant List
cannot report their costs for that quarter.
22
Participant List (cont.)

The Participant List drives the number of eligible MAC
participants and determines the MAC financial cost
eligible.

If a Participant List is not certified for a quarter by a
district, that district will not be able to participate in
RMTS and will not be able to report MAC costs for that
quarter.

The results of the time study are the basis for the
calculation of the administrative time study percentage
that is used during the MAC financial process to
allocate costs to the Medicaid program.
23
Ineligible Participants:
MAC Only Category



Overhead costs/indirect costs are captured in the
Indirect Cost Rate (IDCR) on the claim
Salaries for staff in accounting, budgeting,
payroll, human resources, purchasing, and
employee relations are generally indirect costs
Ineligible participants include:


Function 41- General administration
Function 53- Data processing services
24
MAC Participation Requirements

MAC financial quarters will not be opened unless the
following requirement are met:

Active contract with HHSC


Approved MAC Program Operating Plan

Received MAC / RMTS training for the FFY

Certified Participant List for that quarter


An Intergovernmental Cooperation Agreement must be filed and executed with
HHSC in order to enter financial expenditure information.
Required RMTS participation must be satisfied for the quarter in which the claim
is filed.
If you are unable to access the quarter, please contact the
MAC team.
25
Important Dates for MAC
Federal Fiscal Year 2012
Federal Fiscal Quarter
1st Quarter (Oct – Dec)
2nd Quarter (Jan – Mar)
3rd Quarter (Apr – Jun)
4th Quarter (July – Sept)
Financials Open
Financials Close
February 13, 2012
May 14, 2012
August 13, 2012
November 12, 2012
(6 p.m. CST)
April 6, 2012
July 6, 2012
October 5, 2012
January 11, 2013
**Claim must be certified and must upload QSI in
the system by deadline.**
26
MAC Financial Data Collection



Allowable Costs for Reporting
Who can enter data?
Electronic Reporting


MAC financial reporting will be completed entirely
online via the State of Texas Automated Information
Reporting System (STAIRS) located on the
Fairbanks LLC website.
Upload Quarterly Summary Invoice
27
Financial Data

District Employee Salaries


Position must be included on the applicable RMTS Participant
List
Payroll Taxes & Benefits

“actual” costs only



Contractor Payments


Set aside/reserved funds are not actual costs
TRS on behalf of payments are not actual costs
Position must be included on the applicable RMTS Participant
List
Federal Revenues (Federal revenues offset expenditures)
28
District Employee Salaries


Report 100% of the quarterly salaries for the
individuals on the participant list
Report salary expenditures paid during the
quarter
Example of 9 Month Versus 12 Month Reportable Salary
9
Annual Salary
$
30,000
If paid over 9 months
=$30,000/9
=$3,333 x 3
If paid over 12 months
=$30,000/12
=$2,500 x 3
$
$
3,333 Actual Monthly Cost
10,000 Actual Reportable Cost
$
$
2,500 Actual Monthly Cost
7,500 Actual Reportable Cost
29
Position Specific Example

The participants submitted on the participant list at the
beginning of the quarter are an exact match to the positions
that are reported on the MAC financials.
Example: Position #85 had the following employee changes
throughout the quarter:




Employee A works Jan 1st thru Jan 19th, earns $800.
Substitute A works Jan 20th thru Feb 28th, earns $1,200.
Employee B works March 1st thru March 31st, earns $1,500.
The Total MAC Reportable Expenditure for Position #85 is
$800 + $1,200 + $1,500 = $3,500.
30
Detailed Reporting:
Payroll Taxes & Benefits

Examples of Employer-Paid Benefits:








Health Insurance
Life Insurance
Medicare
Social Security
Employer 403(b) Contribution
Liability Insurance
Worker’s Compensation
Unemployment Compensation
31
Payroll Taxes & Benefits (cont.)

Only Report “True” Expenditures



Teacher’s Retirement System



If your district sets funds aside for future Workers Comp claims then
these “set aside” funds are not true expenditures.
If your district is self-insured & pays a Third Party Provider for
Workers Comp claims or if the “set aside” fund are used to pay a
Workers Comp claim, then these are true expenditures.
Only costs to the district are allowable
“On behalf of” retirement payments cannot be claimed
Please ensure that you maintain documentation that the costs
were actually paid by the ISD.
32
Employee vs. Contracted Staff


Providers hired by the district are classified as employees of
the district - Report salary as “Employee Salaries” and
identify the employees “Payroll Taxes and Benefits”
Providers contracted through the SSA/Coop (fiscal agent) Report cost as “Contracted Staff”
33
Contracted Staff (cont.)

Ensure PL is up-to-date (employment type is
correct)

Request breakdown of costs on invoice from
the contractor to ensure the number of
positions you are claiming and to place the
costs in the correct categories
34
Federal Revenues

Identify ALL federal funded positions on the participant list.

Report (state, local, & federal) position costs in the Employee Salary, Payroll
Taxes & Benefits and Contracted Staff columns as appropriate.

The Federal Revenue column is used to subtract the Federal portion of
costs that were included in the Employee Salary, Payroll Taxes & Benefits
and Contracted Staff columns.

Example:
35
Federal Revenues (cont.)

Federal funds include, but are not limited to:
 Federal Grants
 Matching Funds
 ARRA/Stimulus Funds

NOTE: MAC and/or SHARS funds are considered
“reimbursement” funds and are not required to be
backed out of the MAC financial claim as revenue
offset.
36
Federal Revenues (cont.)

To maximize federal revenue sources, it is
recommended that MAC providers be funded
with state/local funds.

The system will automatically calculate the
Local/State Net Expenditures (Gross Salaries less
Federal Revenue).
37
Functional Reporting

There are two options to enter
financial data:
1. Participant Details
• Detailed basis by individual position
2. Group Summary Schedule
Detailed Worksheet
Psychologists and Interns
Bob
Employee
Joe
Employee
Mary
Contract Staff
• Provider category summary
•
Categories as entered on the
participant list
• Financial detail by position/individual
must be kept on file
• Enter Total Employees & Total
Contractors claimed that quarter must
be provided
Category Summary
Registered Nurse (RN)
Salaries
30,000
Benefits
6,000
Purchased Svcs.
8,000
38
Financial Tips

Enter data in the correct column

Refer back to the certified participant list for the quarter

Do not make adjustments from prior quarter with current
quarter


Contact us if a correction is necessary
Not necessary to mail the MAC financial supporting
documentation each quarter. However, the district is required
to maintain the financial data; and the records must be made
available upon request from state or federal entities.
39
Variances – System Edits





The cost reporting system is designed to flag various edits
depending on the data entered.
Explanation of variances are required in some cases if a large
variance exists.
Provide a succinct explanation as to why a costs increased or
decreased, etc.
Helps find possible errors and allows ISD to correct current
financial report as necessary.
Contact HHSC if a data entry error occurred on a closed
quarter.
40
Example:
Quarterly
Summary
Invoice
(QSI)
41
Quarterly Summary Invoice (QSI)

Signing the Quarterly Summary Invoice certifies that the following items
are true and correct:

I am the officer authorized to submit this form; I have examined this
statement and to the best of my knowledge and belief, the expenditures
included in this statement are based on the actual cost of recorded
expenditures;

The required amount of State and/or local funds were available and used to
pay for total computable allowable expenditures;

This statement is of expenditures that the undersigned certifies are allocable
and allowable to the State Medicaid program;

I understand that this information will be used as a basis for claims for
Federal funds and falsification and concealment of material fact may be
prosecuted under Federal or State civil or criminal law.
42
Quarterly Summary Invoice (cont.)

Have the proper employee of the district sign the Quarterly
Summary Invoice (QSI).





Per RMTS/MAC Implementation Guide effective April 25, 2007 pg.
17; Certifier must have signature authority which includes the
Chief Executive Officer (CEO), Chief Financial Officer (CFO)
Executive Director (ED), Superintendent (SI) or other individual
(district employee) designated as the financial contact for the ISD.
Printing on letterhead is not necessary.
Ensure that the Signer and Notary dates are the same. The notary
language on the QSI reads “This instrument was acknowledged
before me.” This means that the date signed by the Signer and the
Notary must be the same.
The Notary should not be writing his/her name in the field marked
“Printed Name of Officer of Provider”.
The district must keep the QSI in their files.
43
MAC
Claim Calculations
Cost Pool
Cost Pool
#1
Cost Pool
#2
Net
Expenditures
Claimable
Percentage
Claim
Amount
Total
Federal
Share
5%
Retention
Net Claim
Direct Service & Admin
Administrative Only
44
Claimable Percentage
 RMTS Results
•
•
State-wide, quarterly
Ratio developed for Cost Pool #1 & Cost Pool #2
 Medicaid Eligibility Rate (MER)
•
•
District-specific, quarterly
Percent of children in district who are Medicaid eligible
 Unrestricted Indirect Cost Rate (IDCR)
•
•
District-specific, annually
Developed by TEA (Exhibit J-2 Annual Financial Report)
45
Random Moment Time Study
(RMTS) Results



Percent of time claimable to Medicaid administration
Percent of time identified as reimbursable
Used to identify the amount / percent of time
providers are participating in Medicaid
administrative and outreach activities. Each cost
pool have separate and different time study
percentages. The MAC financial claim is calculated
for Cost Pool # 1 & Cost Pool # 2 using their
relevant cost and time study percentages.
46
Medicaid Eligibility Rate (MER)






The Public Education Information Management System (PEIMS)
enrollment data for the current school year is submitted to TEA by each
district.
The Medicaid eligibility files for each quarterly period is gathered.
The Medicaid eligibility data is sent to TEA for use in the developing the
MER.
TEA develops an unduplicated Medicaid eligibility file from the quarterly
files provided by HHSC.
The unduplicated Medicaid eligibility file is matched against the PEIMS
enrollment data. There are 2 matches performed – 1) first is a match based
on Social Security Number (SSN), 2) for those who do not match based
on SSN, a second run is performed based on first name, last name and
date of birth.
The total number of matches divided by the total number of enrolled
students (by district) becomes the district’s quarterly MER.
47
Indirect Cost Rate (IDCR)

Must have an approved IDCR the Texas Education
Agency (TEA)

How do you get one?

Submit an Exhibit J-2, Schedule of Expenditures for
Computation of Indirect Costs





Located in district’s official audited Annual Financial Report
(AFR) filed annually
A new indirect cost rate must be obtained every fiscal year.
Helps ISD recover some of indirect costs
CMS approved use of unrestricted IDCR
Charter schools that need an IDCR should contact
the Division of Financial Audits (TEA)
48
Fairbanks (STAIRS)
System Demonstration
49
MAC Claim Desk Review

Utilized to ensure integrity & accuracy of the
claim data

Discrepancies brought to the attention of
primary MAC financial contact identified in
the system

HHSC will contact ISD requesting explanation,
clarification, and/or correction of discrepancies
50
MAC Reimbursement

Timeframe

MAC reimbursements are Title XIX Medicaid administrative
reimbursement funds



Not considered ARRA funds
Are subject to the Single Audit Act
MAC reimbursement is recommended to be used to enhance
the provision of health services and/or improve and/or expand
the level and quality of health/medical services provided to
all students within the district.
51
Fairbanks (STAIRS)
System Reminders







Passwords will not change each school year.
If you forget your password, you can reset it at the log-in
screen.
Fairbanks can send log-in information to multiple contacts.
You will be able to access historical data.
Messages (Warnings) are just for your reference. They are
highlighting areas where there may be an issue - they are not
saying there is an issue.
All reference material is on the website.
Contact Fairbanks regarding system issues.
52
Allowing E-mail Messages

Communication is managed predominantly via e-mail, i.e.




MAC Financial notifications and follow-ups
RMTS moment notifications and follow ups
Participant list updates
Compliance follow-ups

Role in Fairbanks dictates what messages you receive

Critical that your district authorize your e-mail system to
accept emails from Fairbanks.

Confirm with your IT staff to make sure that e-mails with
[email protected], @hhsc.state.tx.us, and
@tea.state.tx.us extensions pass through firewalls and spam
filters.
53
Managing Contacts in Fairbanks

Primary contacts are the only ones with the
capability to add/delete contacts and assign
additional roles to contacts listed in Fairbanks

Only one primary contact per role

Contact Fairbanks if you are having any issues
54
School Health & Related Services
(SHARS) Overview
55
Wrap Up

If you are not listed in the Fairbanks system as a Contact,
then you cannot receive credit for completing this training.


Must be added to the system
There are no certificates for training.





You will receive an email thanking you for attending today’s training;
however, this does not mean that you will receive training credit.
Contacts can view attendance information via Fairbanks by clicking
the “Training” tab on the top far right portion of the screen.
A maximum of 7 days processing time is required after attending
training before the session attended will be listed next to the contact’s
name and the “status” column will then show full access.
Once “full access” is indicated, you will be able to update/certify the
MAC financial data.
You can print this screen using the printer icon located on the top
right corner of your screen for your records.
56
MAC Website

http://www.hhsc.state.tx.us/rad/

Select:


Medicaid Administrative Claiming (MAC)
Independent School Districts (ISD)
General Information
Guide
Training Materials
ALL notices
Participation Documents
57
Additional Resources…

Centers for Medicare & Medicaid Services (CMS) Medicaid SchoolBased Administrative Claiming Guide


Office of Management & Budget (OMB) Circular A-87





https://www.cms.gov/medicaidrf/Downloads/2003_School_Based_Admin_Claiming_
Guide.pdf
http://www.whitehouse.gov/omb/circulars_a087_2004
Title 19 of the Social Security Act, section 1903(a)(7)
Title 42 Code of Federal Regulation (CFR) 430.1 and 42 CFR 431.15
Office of Management and Budget (OMB) Circular A-87, 45 CFR Part 74
and 95
General information regarding Texas Medicaid Program

http://www.hhsc.state.tx.us/medicaid/
58
Contact Information
Medicaid Administrative Claiming
Ph: (512) 491-1802
Email: [email protected]
Yvonne Moorad (Team Lead)
Jessica Makdsi
Texas Education Agency – Division of Financial Audits
Ph: (512) 463-9095
Email: [email protected]
Fairbanks, LLC. (Cost Report System)
Ph: (888) 321-1225
Email: [email protected]
59