1 Medicaid Administrative Claiming MAC All Direct and Administrative staff Fee For Service PT OT Speech Nurse Psychologist Care Coordination Pers Care 11 aide Specialized Trans ID: 814878
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Slide1
School-Based Medicaid Cost Settlement System
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Slide2Medicaid Administrative Claiming (MAC)
All Direct and Administrative staff
Fee For Service
(PT, OT, Speech, Nurse, Psychologist – Care Coordination, Pers. Care 1:1 aide, Specialized Trans.)
50% District
2012 Approach to School-Based Medicaid Programs
Random Moment Time Study
Cost Settled
RESA admin staff as vendors
Reimbursement from Billing
Quarterly Cost Report
Annual Cost Report
Random Moment Time Study
Medicaid Eligibility Ratio MER
Medicaid Eligibility Ratio
Final costs after reduction
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Slide4West Virginia Job Categories – Administrative Costs
(50% Federal match) Not cost settled
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Allowable staff in the Admin Pool:
1 .
Administrator
Principal
Special
Education Director
Program Specialist Special Education Secretary And ALL staff in any of the other “pools” may also give responses to the time study that are administrative.
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Materials and supplies that relate to Medicaid administrative costs (postage, etc.) - Training related to Medicaid covered services.
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Who support staff in the Admin pool
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Only quarterly ADMIN contractors (RESA Medicaid Specialists)
Slide9County’s Costs of Providing Services
- plus indirect costs $1,000,000Less the results of the RMTS
pilot (all staff who 5% are included in the RMTS Administrative and other rosters)
Total $50,000
MER Medicaid Eligible to Total Enrollment Ratio (per county) 46%
Total $23,000
Add in ADMIN vendors/contracted costs (RESA Med. Specialist) $10,000
Total $33,000Federal match (50% always) $16,500
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Quarterly MAC – Admin Claiming
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Slide11County’s Costs of Providing Services
- plus indirect costs $1,000,000Less the results of the RMTS
Oct – Dec 2012 (all staff who 13.23% are included in the RMTS Administrative and other rosters) Total Costs $132,300
MER Medicaid to Total Enrollment Ratio (per county) 46%
Total $60,858
Add in ADMIN vendors/contracted costs (RESA Med. Specialist) $10,000
Total $70,858
Federal match (50% always) $35,429
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Quarterly MAC – Admin Claiming
Slide12County’s Costs of Providing Services
- plus indirect costs $Less the results of the RMTS
pilot (all staff who 13.23% are included in the RMTS Administrative and other rosters)
Total Costs $
MER Medicaid to Total Enrollment Ratio (per county) 46%
Total $
Add in ADMIN vendors/contracted costs (RESA Med. Specialist) $Total $
Federal match (50% always) $
12
Quarterly MAC – Admin Claiming
Slide13Annual Cost Reporting Cost Settlement
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Slide14Medicaid Administrative Claiming (MAC)
All Direct and Administrative staff
Fee For Service
(PT, OT, Speech, Nurse, Psychologist – Care Coordination, Pers. Care 1:1 aide, Specialized Trans.)
50% District
Random Moment Time Study
Cost Settled
RESA admin staff as vendors
Reimbursement from Billing
Quarterly Cost Report
Annual Cost Report
Random Moment Time Study
Medicaid Eligibility Ratio MER
Medicaid - Special Education Ratio
Final costs after reduction
Slide15West Virginia Job Categories
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Job categories and job titles include – 3 different cost “pools”:
1 Direct Services
.
WV Licensed Audiologist WV Licensed
Occupational Therapist
WV Licensed Physical Therapist Speech Language Therapist WV Licensed Registered
Nurse WV Licensed Psychologist2.Personal Care Aide – Personal Care 1:1
3.Special Education Teacher - Care Coordination or Case Management
Slide16County’s Costs of Providing Services
- plus indirect costs $1,000,000Less the results of the RMTS Oct-Dec 2012 (staff who 49.20%
are included in the direct service pool) Total Costs $492,000
Add in vendors/contracted costs (speech, OT, PT, psychologist) $300,000
Total $792,000
Medicaid Eligible to Direct Services Ratio County’s percentage 46%
(handout)Total $364,320
Reimbursement $300,000Cost Settlement $64,320
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Annual Cost Report - Direct Services
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Slide1818
Handout
Slide19County’s Costs of Providing Special Education Teachers
$1,000,000Less the results of the RMTS - 2.52%
Total Costs of Care Coordination $25,200Vendors/contracted costs $0
Total Costs with Contracted $25,200
District’s IEP ratio reduction
Medicaid eligible
50% All Special Ed StudentsTotal Costs of Care Coordination $12,600District’s Medicaid Reimbursement for Care Coordination $100,000
Cost Settlement Difference between Costs and Reimbursement $87,400
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Care Coordination
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Slide21County’s Costs of Providing Personal Care Services
$39,000Less the results of the RMTS - 14%
Total Costs of Personal Care Aide $5,460Add in vendor/contracted costs $0
Districts IEP ratio reduction
Medicaid eligible
(Handout
) 100% All Special Ed StudentsTotal Costs $5,460District’s Medicaid Reimbursement for Personal Care Aide $28,000
(Ave. 20 days/month for 10 months) Based on current rate Cost Settlement Difference between Costs and Reimbursement ($22,540) for one personal care 1:1 aide
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Personal Care 1:1 Aides
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Slide23DESCRIPTION: Services related to a child’s physical and behavioral
health requirements, including assistance with eating, dressing, personal hygiene, activities of daily living, bladder and bowel requirements, use of
adaptive equipment, ambulation and exercise, behavior modification, and/or other remedial
services necessary to promote a child’s ability to
participate in, and benefit from, the educational
setting.
Personal Care Aide Services
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Slide24Personal Care Aide Services
Not working – paid leave (Snow day or sick leave) Moment is before workday began (2-hour delay)
Monitoring behavior
Assisting with eating, bathroom needs, safety, medication, mobility, communication
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Slide25County’s Costs of Providing Personal Care Services
$Less the results of the RMTS (14% for personal care aides, 2% for care coordination, 49% for direct services) %
Total Costs of Personal Care Aide $
Add in vendor/contracted costs $
Districts IEP ratio reduction
Medicaid eligible %
All Personal Care Aide StudentsTotal Costs $District’s Medicaid Reimbursement for Personal Care Aides $
Cost Settlement Difference between Costs and Reimbursement $
25
Annual Cost Report
Slide26PCG’s Time Study Team – “less than appropriate responses were submitted.”
A number of inappropriate responses were received by staff participating in the RMTS.Two areas of concern:
Incomplete responses
Rudeness/Frustration
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Slide27Inappropriate Responses to RMTSExample 2:
Who was with you?
A group of people charged with carrying out the work of an establishment2. What were you doing?
Inputting the last “moment in time” documentation instead of using my scheduled paperwork time to prepare for the two IEPs that I have next week.
Why were you doing this activity?
You keep sending me these “moments.” I am itinerant and MCS will not provide me with a computer,
IPad, or other internet access to use during treatment blocks of time. Scheduled office time is the only time I can complete these “moments.”4. Is this activity regarding a Special Education student?
NA27
Slide28Inappropriate Responses to RMTSIssues that arise from inappropriate responses:
Creates additional administrative burden.
Moment can be incorrectly coded if information is omitted or misleading.
When clarification is not received, moment is likely to be coded as non-reimbursable.
Reduction in reimbursement
Medicaid reimbursement is tied to the RMTS results
Penalty if 85% response rate isn’t achieved
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