tribal medicaid administrative match (mam) tyron nixon tribal mam program manager phone:...

TribalTribal Medicaid Administrative Match (MAM) Medicaid Administrative Match (MAM)

Tyron NixonTyron NixonTribal MAM Program ManagerTribal MAM Program Manager

Phone: 360-725-1894Phone: 360-725-1894E-mail: nixont@hca.wa.govE-mail: nixont@hca.wa.gov

http://www.hca.wa.gov/medicaid/mam/pages/tribal.aspx

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Medicaid Administrative Match (MAM)Medicaid Administrative Match (MAM)

What is it?What is it?

A federal reimbursement program that allows eligible governmental entities the opportunity to receive partial reimbursement for the expenses incurred when staff perform allowable “administrative” activities.

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MAM – What is it?MAM – What is it?

• MAM activities must support the goals and objectives of the Washington State Medicaid Plan

• MAM activities by definition are “administrative” in nature, and can never be a “Direct Service”

• MAM is most commonly applicable for staff who perform “Medicaid outreach and linkage activities”

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MAM - What is it?MAM - What is it? Federal Financial Participation (FFP) = 50%

• 50% is allotted from federal funds received by HCA under Title XIX, Medicaid program, CFDA # 93.778;

• The remaining 50%, otherwise known as “matching funds”is provided by the Tribe.

• 0% is allotted under this agreement from GF-S(General Fund –State) funds

The Tribe Must Provide and Certify the State Matching Funds Allowable Matching Funds may include:

• State matching funds must NOT include federal funds• The only federal dollars that may be used by Tribes as federal

match are Tribal “638” Compact dollars, otherwise known as self-determination dollars or Bureau of Indian Affairs dollars

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Who Can Participate in MAM?Who Can Participate in MAM?

• Federally Recognized Tribes• Schools• Local Health Jurisdictions (LHJ)• Other eligible governmental entities

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MAM Claiming Resources

• Code of Federal Regulation (CFR) Title 42 and 45• Office of Management and Budget (OMB) Circular A-87

Cost Principles• Tribal MAM Cost Allocation Plan (CAP)• Activity Coding and Claiming Methodology Guide• The CMS School-Based Claiming Guide, Tribal CAP and

all materials included in training packet can be accessed at the HCA Tribal links web-page:

http://www.hca.wa.gov/medicaid/mam/pages/tribal_links.aspx

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Other ResourcesOther Resources

• Low-Cost or Free Health Insurance for Washington’s Kids & Teens…..1-877-KIDS-NOW

https://www.washingtonconnection.org/home/

• Application For Children's Medical Benefits http://www.hca.wa.gov/medicaid/forms/documents/14_380.pdf

• HCA Publication website: http://www.hca.wa.gov/medicaid/publications/Pages/default.aspx

• -- Rack Card #22-391

• -- Application/Brochure #22-394

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Activity CodesActivity Codes

See “Guide to Tribal MAM Coding” in Training Packethttp://www.hca.wa.gov/medicaid/mam/pages/tribal_links.aspx

Activity codes must adhere to the principles of “Parallel Coding”

All activity codes must have a “Medicaid”

and non-Medicaid equivalent.

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Code 0Non-paid unit of time when not being paid by Tribe

•Overtime•Lunches•Breaks•Time off

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CODE 1.a. NON-MEDICAID OUTREACH Activities that inform individuals about non-Medicaid, social, vocational and educational programs and how to access them.

• Scheduling and promoting activities that educate individuals about the benefits of healthy life-styles and practices.

• Conducting general health education programs or campaigns that address life-style changes in the general population (e.g., dental prevention, anti-smoking, alcohol reduction, etc.).

• Conducting outreach campaigns that encourage persons to access social, educational, legal or other non-medical services.

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CODE 1.b. MEDICAID OUTREACH (CLINIC/OFFICE SETTING)

Activities in the clinic/office setting that inform eligible or potentially eligible individuals about Medicaid and how to access the program.

• Describe benefits and availability of Medicaid and managed care services

• Contacting pregnant and parenting teenagers about the availability of Medicaid prenatal, and well baby care programs and services

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CODE 2.a.FACILITATING APPLICATION FOR NON-MEDICAID

PROGRAMS This code should be used by Tribal staff when assisting an

individual in applying for non-Medicaid programs such as Food Stamps; Women, Infants, and Children (WIC); TANF; day care; legal aid; and other social or educational programs not related to or covered by Medicaid.

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CODE 2.b. FACILITATING MEDICAID ELIGIBILITY DETERMINATION (CLINIC/OFFICE SETTING)

• Assisting an individual in the Medicaid eligibility process. This activity does not include the actual determination of Medicaid eligibility.

• Verifying an individual’s current Medicaid eligibility status for purposes of the Medicaid eligibility process.

• Explaining Medicaid eligibility rules and the Medicaid eligibility process to prospective applicants.

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CODE 3. ACTIVITIES NOT RELATED TO MEDICAID-COVERED

OR DIRECT MEDICAL SERVICES This code should be used for activities paid by the Tribe that are

not medical or Medicaid-related, including social services, educational services, teaching services, employment and job training, and other activities.

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CODE 4. DIRECT MEDICAL AND/OR MEDICAID-COVERED

SERVICES

This code is used by Tribal staff when providing direct care, medical/dental treatment, and/or clinical counseling services to an

individual.

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CODE 5.a.ARRANGING TRANSPORTATION FOR NON-MEDICAID SERVICES

Tribal staff should use this code when assisting any individual in obtaining transportation to non-Medicaid related services including

social, vocational, and/or educational programs.

• Arranging transportation to a diabetics’ luncheon, sobriety camp, swimming program, gym, court hearing, GED class, office to make application for food stamps, etc.

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CODE 5.b. ARRANGING TRANSPORTATION IN SUPPORT OF

MEDICAID COVERED SERVICES

• Contacting the Medicaid transportation broker (or the sub-contracted Tribal program) to assist an individual in obtaining transportation services covered by Medicaid.

• Transportation Web site: http://fortress.wa.gov/dshs/maa/Transportation/NewPhone.htm

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CODE 6.a. ARRANGING INTERPRETER SERVICES FOR ACTIVITIES NOT COVERED BY MEDICAID

• Arranging for interpreter services via a Medicaid interpreter broker.

• Developing translation materials that assist individuals to access and understand necessary care or treatment not covered by Medicaid.

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CODE 6.b. ARRANGING INTREPRETER SERVICES FOR ACTIVITIES COVERED BY MEDICAID

• Arranging for interpreter services via a Medicaid Interpreter broker.

• Developing translation materials that assist individuals to access and understand necessary care or treatment covered by Medicaid.

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CODE 7.a. PROGRAM PLANNING, POLICY DEVELOPMENT, AND/OR INTERAGENCY COORDINATION RELATED TO NON-MEDICAID SERVICES

• Identifying gaps or duplication of non-Medicaid services (e.g., social, vocational educational and state mandated medical and general health care programs) available to patients/tribal members, and developing strategies to improve the delivery and coordination of these services.

• Developing strategies to assess or increase the capacity of non-Medicaid programs.

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Activity CodesActivity CodesCODE 7.b. PROGRAM PLANNING, POLICY DEVELOPMENT, AND INTERAGENCY COORDINATION RELATED TO MEDICAID COVERED SERVICES

• Identifying gaps or duplication of medical/dental/mental health/chemical dependency services provided to Tribal members, and developing strategies to improve the delivery and coordination of these services.

• Evaluating the need for medical/dental/mental health/chemical dependency counseling services in relation to specific populations or geographic areas.

• At IPAC or AIHC meeting- discussing Medical/mental health/dental/chemical dependency service issues pertaining to specified populations.

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Activity CodesActivity CodesCODE 8.a.NON-MEDICAID RELATED TRAINING

Tribal staff should use this code when participating in any training activities for outreach staff regarding the benefit of programs other than the Medicaid program:

• that improves the delivery of healthcare programs other than those covered by Medicaid.

• that results in continuing education credits.

• that enhances IDEA child find programs, self-help sobriety groups, WIC, exercise workouts, healthy cooking. parenting classes, etc.

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Activity CodesActivity CodesCODE 8.b. Training related to administrative requirements for Medicaid-covered services

•Training to learn what Medicaid services are available for children and how to apply for coverage (outreach focused);

•Participating in or coordinating training that improves the delivery of Medicaid-related services such as early identification and referral for special health services like EPSDT.

•DOESN’T include training on using Time Study forms.

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Activity CodesActivity CodesCODE 9.a. REFERRAL FOR NON-MEDICAID SERVICES

• Making referrals for and coordinating access to social and educational services such as child care, employment, job training, and housing.

• Making referrals for coordinating, and monitoring the delivery of scholastic, vocational, and other non-health related examinations.

• Participating in a meeting/discussion to coordinate or review a patient/Tribal member’s need for non-health related services not covered by Medicaid.

• Making referrals for and coordinating access to medical and other healthcare services not covered by Medicaid (e.g., flu shots, exercise programs, WIC, childbirth and parenting classes, etc.).

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Activity CodesActivity CodesCODE 9.b. REFERRAL OF MEDICAID COVERED SERVICES

This code should be used when making referrals for Medicaid covered services when the activity is not integral to or an extension of a Medicaid-covered service; this activity typically involves a specific client.

• Identifying and referring a tribal member who may be in need of Medicaid family planning services.

• Referring patient/Tribal member for necessary medical, dental, mental health, or substance abuse services covered by Medicaid.

• Arranging for any Medicaid covered medical/dental/mental health/chemical dependency diagnostic or treatment services that may be required as the result of a specifically identified medical/dental/mental health/chemical dependency condition.

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Activity CodesActivity CodesCODE 10GENERAL ADMINISTRATION

• Paid lunch, breaks, annual leave• Tribal council meetings• Performing managerial, administrative or clerical activities related to

implementation of the Tribe’s MAM contract; (i.e. conducting the MAM time study; compiling time study results; preparing the billing statement;

• Providing or participating in training on MAM, including time study requirements and coding.

(Note that certain Tribal administrative functions that are included in the Tribe’s indirect costs (such as accounting, payroll, executive direction, etc.), are only allowable through the application of the Tribe’s approved indirect cost rate.)

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Tribal MAM Time StudyTribal MAM Time Study

Requirements

1. Parallel coding

2. 15 minute increments

3. One average work week per Quarter -100% of staff’s paid time

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Quarterly Travel LogQuarterly Travel Log

• Track MAM Travel the entire Quarter• Document MAM Activities• Mileage, Meals, Hotel expenses reimbursed at

50% ( MER may be applied)

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Medicaid Eligibility Rate (MER)Medicaid Eligibility Rate (MER)

MER = the % of the population served that is on Medicaid

• MER = the % of the population served that is on Medicaid.

• Documentation to support the MER must be maintained on file by the Contractor for review if requested.

• Partial Medicaid (PM) activities must be discounted by the MER (Exception Codes 1.b. and 2.b. are Total Medicaid (TM)).

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Tribal Billing and InvoiceTribal Billing and Invoice

• Billing Worksheet Completion• Local Match Form and Worksheet• MER Certification Form• Indirect Rate Cost Certification Form• Preparing the A-19• Quarterly Travel Log

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QUESTIONSQUESTIONS

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Getting Ready for an AuditGetting Ready for an Audit

Be Prepared and Organized

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Why Have an Audit File?Why Have an Audit File?

• Federal and State Requirement• Documents needed for an audit must be retained for six

(6) years• Paper file require• Keep an Audit File for each year.

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What to Keep in the Audit FileWhat to Keep in the Audit File

Administrative Documents

Legal agreements

Sub-contracts

CMS Claiming Guide

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What to Keep in the Audit File - What to Keep in the Audit File - ContinuedContinued

Program and Employee Information

Description of the governmental programs participating in MAM

Payroll documents showing the funding source

Position descriptions for staff performing allowable activities (Code 7.b)

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Billing/Claiming Documents

Time Study Forms A-19 Invoices Billing/Claiming WorksheetLocal Match Form and WorksheetTravel Log

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MER FilesNarrative describing the source of client data used to

create the MER file.Total population served?Total Medicaid eligibles?

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What to Keep in the Audit File - What to Keep in the Audit File - Continued Continued

Training Materials

All materials/handouts used in training sessionsSign-in sheets or documentation of training

completion

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What to Keep in the Audit File - What to Keep in the Audit File - Continued Continued

Copies of all audit reports including:

MAM Audit Reports/Corrective Action DocumentsState or Federal Audits/Corrective Action Documents

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QUESTIONSQUESTIONS

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Wrap-upWrap-up

• Evaluation/Feedback Forms

• Email: nixont@hca.wa.gov • Website:

http://www.hca.wa.gov/medicaid/mam/pages/tribal.aspx

• More Questions?

Thank you!

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