Transcript Changes in the State Plan

Medicaid School
Based Services
Update
MAASE
October 15, 2008
Presenters:

Thomas Koepke Director, Special Education Management
Services, Macomb ISD

Jane Reagan Department Specialist, Medicaid, OSE-EIS,
Michigan Department of Education

Liz Patrick Supervisor, Instructional Data Management & Special
Education Finance, Ingham ISD
Members, Medicaid School Based Services Workgroup
Outline

Overview

Backcasting

Moratorium

State Plan Amendment Changes
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Outreach
Fee for Service
Personal Care Services
Reimbursement methodology
New Time studies
Medicaid – Overview

Largest payor of health care in US


In 2007, $340 billion for over 62 million
individuals (30 million children)
Two types of reimbursement in school
settings – Fee for Service and Outreach
Medicaid – Overview

Outreach

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Provides funds to districts that are working to
identify children that are uninsured and may
qualify for Medicaid – involve ALL students
Fee for Service

Reimbursement for certain health related
services (PT, OT, Nursing, etc) provided to
Medicaid eligible children with IEP or IFSP
Backcasting – Overview

May 2002 Settlement Agreement –
between Feds & State

Prompted by a disagreement regarding Michigan’s
Outreach claiming methodology


Methodology used was State approved
Feds did not provide formal guidance on acceptable
claiming methodologies until the issuance of the May 2003
“Medicaid School-Based Services Administrative Claiming
Guide”
Backcasting – Overview

Settlement required new program design
– effective January 2004

Results of 1st 4 quarters under new plan
applied to previous 16 quarters – Jan/Mar
2000 through Oct/Dec 2003
Backcasting – Overview

10/22/07 CMS Final Report

$89,848,860 Overpayment
ISD 60%
State 40%

= $53,909,316
= $35,939,544
“CMS expects the State to refund the
financial amount identified”
Backcasting – Current Status

ISD Reserves



ISD $’s held by State = $20,737,997
ISD $’s held by ISD = ??
ISD Max repayment
ISD Overpayment
ISD Reserve-held by State
ISD Reserve-held by ISD
$ 53,909,316
- 20,737,997
???
$ 33,171,319
Backcasting – Current Status

Breakdown of total by ISD

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CMS report only addressed total
overpayment
MDCH responsible for calculating breakdown
State has appealed CMS decision
ISDs - wait and see
Congress’ Moratorium on Proposed
Regs – until April 1, 2009
Federal CMS proposed in 2007 to:



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Eliminate reimbursement for Outreach (AOP)
and Transportation
Redefine/limit targeted case management
Redefine/ limit rehabilitative services to exclude
reimbursement for “intrinsic elements” of
education programs
Limit reimbursement to governmental providers’
costs by narrowing definition—impacted schools
Outreach – Current Status

2006-07 Total Statewide Reimbursement
= $19,000,000
ISD
State


60% = $11,400,000
40% = $7,600,000
Statewide Vendor - Public Consulting
Group (fees paid by ISDs & State)
No changes for 2008-09
FFS – Current Status

2006-07 Total Statewide
Reimbursement
Program
ISD (60%)
State (40%)
$64,600,000
43,100,000
$107,700,000
Transportation
Total
$2,300,000
1,600,000
$3,900,000
$66,900,000
44,700,000
$111,600,000
FFS Reimbursement–Before 7/1/08

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Service documentation logs
Reimbursement rate per service
type and statewide fee
Claim submitted to MDCH
ISD Reimbursement based on
what was provided/billed
FFS Reimbursement – After 7/1/08

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Cost-based
Provider (ISD)-specific
Annually reconciled
Cost settlement process
Service documentation and claim
submission is still required
New Reimbursement Methodology
Total Allowable Costs
+ Indirect Cost Rate
x Direct Service %
(MDE)
(annual avg from RMTS)
x ISD SE Med Elig Rate, Hlth Svcs
(Dec1)
x Fed Medical Assistance % (’08=58.1%)
x ISD Reimbursement Rate (60%)
Net Dollars to ISD
Random Moment Time Study (RMTS)
Previously 1 RMTS for Outreach – 800
moments/quarter
 Now 4 RMTS – 3,000 moments/qtr each

Outreach Only Staff

Direct Medical Service Providers

Case Managers

Personal Care Providers
 Only staff on staff pool lists can be included as part
of Medicaid Allowable costs

Interim Payment Process

Estimated based upon prior year

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2008-09 = 75% of 2006-07
ISDs may adjust payment
MDCH will monitor claim volume

If claiming drops significantly be prepared for
questions and/or payment adjustment
SE Medicaid Eligibility Rate for
Health Related Services
Medicaid Eligible SE Students with a healthrelated support service in the IEP
_______________________________________________________
Total SE Students with a health-related
support service in their IEP
**Based on December 1 count**
Allowable Direct Service Providers
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ASHA certified speech language pathologist
TSLIs under the direction of an ASHA certified SLP or
audiologist
Audiologist
LPN/RN
OT/COTA
PT/PTA
Orientation & Mobility Specialist
Psychologist (full license only or limited under the direction
of a fully licensed psychologist) – (Not School Psych’s)
Licensed Master’s Social Worker
Under the Direction of:

Supervising the individual’s care
 Face
to face contact initially and periodically
 Prescribing the type of care
 Reviewing the need for continued services
throughout treatment
 Assuring professional responsibility for
services provided
 Ensuring all services are medically necessary
Personal Care Services
Range of human assistance services
provided to SE students, enables them
to accomplish tasks that they would
normally do for themselves if not for
the disability

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Eating/Feeding/meal preparation
Toileting/maintaining continence
Personal Hygiene/grooming
Transferring/mobility/positioning
Personal Care Services

Providers - Health aides, Instr aides,
Parapros, Program assts, Teacher
aides, Trainable aides

Require authorization
 Need for service documented in
IEP
 Service documentation
Financial Reporting Changes

Cost Reporting

Current

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Outreach = Quarterly financials
FFS = n/a
New Methodology

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Outreach Only = Quarterly financials
Direct Medical = Addendum to 4096
Personal Care = Quarterly financials
Case Management = Quarterly financials
Fiscal Impact of Changes
Will vary from ISD to ISD based on:

Actual state-wide direct service %
compared to % of direct services per
ISD that are typically logged

Costs – mainly salary & benefits

Medicaid eligibility rate

Indirect cost rate
2008-09 Budget Impact
Medicaid Outreach – 4 quarters
Medicaid FFS
- Estimate based on 75% of 2006-07
revenue
- 2007-08 claiming
- Personal care – no payment in 08-09
(will be part of cost settlement process
in 2010)
2008-09 Timeline Cost Reports


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June 30, 2009—end of first year
Oct 15, 2009—ISDs access Medicaid cost
reports via web, w/ pre-populated fields (time
studies, Medicaid elig rate, indirect cost rates)
Oct 31, 2009—LEA and PSA Medicaid cost
reports due to their ISD
Dec 31, 2009—ISDs submit summary cost
reports to Medicaid
2008-09 Timeline Cost Reports,
cont’d
Jan 2010—Initial settlement of ISD costs
and adjustments of interim payments
begin
 Revisions to Medicaid Cost Report may
occur until July 2010
 July 2010—Final ISD settlement process
begins

More Discussion if time
Resources:
Medicaid SBS Work Group
At Medicaid agency:
Linda Sowle, Medicaid Policy Specialist,
Michigan Department of Community Health
517-241-8398
[email protected]