Transcript Medicaid In The Schools (MITS)

Medicaid In The Schools
(MITS)
National Picture of School-Based
Medicaid Programs
January 2008
Why Be Concerned with The
National Picture?
Centers for Medicare and Medicaid Services
(CMS) establishes policy on federally
funded, public health programs.
 Makes recommendations to cut or increase
funds for specific programs.
 Acts on own without input from others.
 CMS, through its current philosophy, is
trying to relieve federal funds (state
obligation).
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CMS Influence in Arkansas
Any major additions or changes to current
Arkansas Medicaid policy requires the
approval of CMS.
 We fall under the supervision of the Dallas
region.
 Each region has different ways of
regulating policy, thus no real consistency
exists from state-to state.
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MITS Experience with CMS
Wrote and submitted state ARMAC plan in
2004 and 2005.
 Submitted several provisions.
 Had visit from CMS regional representative
to review ARMAC program.
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Current Issues
CMS-2287, final rule published December
28, 2007.
 CMS-2262, proposed rule related to
appeals process. Attempting to make their
decisions appeal proof.
 Many others.
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CMS-2287-F Language
Under the Medicaid program, Federal payment is available for the costs
of administrative activities “as found necessary by the Secretary for the
proper and efficient administration of the State plan.” The final rule
would eliminate reimbursement under the Medicaid program for the
costs of certain activities based on a Secretarial finding that these
activities are not necessary for the proper and efficient administration
of the State plan, nor do they meet the definition of an optional
transportation benefit. Based on these determinations, under the final
rule, Federal Medicaid payments would no longer be available for
administrative activities performed by school employees or
contractors, or anyone under the control of a public or private
educational institution, and transportation from home to school and
back for school-aged children.
Impact of 2287 on Arkansas
ARMAC will be eliminated at end of current
school year.
 Loss of revenues for school districts,
upwards of $8-10 million a year.
 Potential loss of staff positions, student
health programs, etc.
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What has been done?
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Countless contacts have been made with CMS,
members of Congress, Senate.
Strategic national meetings with other states,
agencies, and associations.
Different moratoria on cuts have been proposed
through Congress.
Currently operating on one that ends June 28,
2008.
What We Will Do
Continue to monitor at the federal level,
advise with appropriate people at state and
local level.
 Work to get any state information to the
federal level.
 Continue with time study and data
collection next year.
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What Can You Do?
Continue to keep in contact with members
of Congress, Senators, etc.
 Keep the faith.
 Share experiences and/or urge parents to
do the same.
 Follow SCHIP and other legislation.
 Look for sign on letter soon.
 Possible impact statement.
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Importance of SCHIP Legislation
SCHIP(State Children’s Health Insurance
Program) continues to be a point of
contention.
 Contains moratorium language for all MAC
programs.
 Proposal to include several moratoria into
one bill or own bill.
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SCHIP Moratorium Language
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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.
Potential Scenarios
ARMAC and other potential cuts will
continue being funded at current rate with
current structure through January 1, 2010.
 Could continue to be funded for a shorter
period of time, possibly March 2009
 May not be funded any more.
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Other Business
Be sure to get consent signed during IEP
meetings.
 May want to look at adding general consent
language to the student handbook for the
purpose of vision and hearing billing.
 Maximizing funds available to district.
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