Medicaid Funding Changes and It’s Impact

on Budgeting

April 24, 2012

COST-BASED APPROACHMedicaid Reimbursement

Medicaid is a jointly funded, federal/state program.

Managed at the federal level

Managed at the state level

The federal CMS is requiring state to adopt a cost settlement approach for school-based Medicaid reimbursement beginning July 1, 2012.

Overview of FFS Cost Reporting Process Allowable Cost Allocation

WV: Introduction to Medicaid Cost Based School Based Health Services 5

Educational, Admin and Medical Costs

by Time Study %

Include Total Cost for All Providers of Medicaid-covered services:Speech, Physical,

Occupational Therapies, Psychologists, School Nurses, Audiologists, Care Coordinators (Special Ed Teachers

State and locally funded

Total Cost

Apply Direct Time Study Percentage Random Moment

Time Study - activities coded to direct medical services provided per IEP

Apply Indirect Cost Rate (ICR)

Discount FactorsApply LEA Special

Education Medicaid

Eligibility Ratio (MER) to Subtotal

Cost

Total Medicaid Allowable Cost

Each fiscal year the CR compares total Medicaid allowable cost to total

Medicaid reimbursement received

Overview of FFS Cost Reporting Process Allowable Cost Allocation

WV: Introduction to Medicaid Cost Based School Based Health Services 6

Educational, Admin and Medical Costs

by Time Study %Include Total Cost for All Licensed Clinicians that are: Included on MAC roster Eligible to bill FFS State and locally funded

Total Cost

Apply Direct Medical Time Study Percentage Represents percentage of

activities coded to direct medical services provided per IEP

Apply Indirect Cost Rate (ICR)

Discount Factors Apply LEA Special Education Medicaid Eligibility Ratio (MER) to Subtotal Cost

MER based on total number of Medicaid eligible/SPED students

Total Medicaid Allowable Cost

Each fiscal year the CR compares total Medicaid allowable cost to total Medicaid reimbursement received

Important LEA Data Collection Needs IEP Ratio must be maintained and tracked for Medicaid cost allocation

purposes

Medicaid-allowable costs are determined by multiplying total direct medical services times the IEP ratio.

WV: Introduction to Medicaid Cost Based School Based Health Services 7

IEP Ratio =

Total Number of Medicaid Eligible FFS Students Receiving Direct Medical Services

with an IEP

Total Number of Students Receiving Direct Medical Services with an IEP

Cost Report Process Cost Reports will be submitted through a web based

software system More comprehensive cost report training will be provided in the future

WV: Introduction to Medicaid Cost Based School Based Health Services 8

Cost Settlement Calculation Example

WV: Introduction to Medicaid Cost Based School Based Health Services 9

1.0 Total Costs of Eligible SBHS Provider Costs (County’s costs) $1,000,000

2.0 Indirect Cost Rate 115.00%

3.0 Total Costs of Eligible SBHS Provider Costs $1,150,000

4.0 RMTS Direct Medical Percentage Results (Statewide results) 65.00%

5.0 Direct Medical Services Costs $747,500

6.0 Application of Medicaid Eligibility Rate (IEP Ratio) (County’s) 50.00%

7.0 Medicaid Direct Medical Services Costs (for the quarter) $373,750

8.0 Medicaid Interim Payments Received (for the quarter) $200,000

9.0 Medicaid Cost Settlement (at the end of the year – July 2013) $173,750

Cost Settlement Calculation 2nd Example – Pay Back

WV: Introduction to Medicaid Cost Based School Based Health Services 10

1.0 Total Costs of Eligible SBHS Provider Costs (county’s cost) $1,000,000

2.0 Indirect Cost Rate 115.00%

3.0 Total Costs of Eligible SBHS Provider Costs $1,150,000

4.0 RMTS Direct Medical Percentage Results (Statewide results) 65.00%

5.0 Direct Medical Services Costs $747,500

6.0 Application of Medicaid Eligibility Rate (IEP Ratio) (county’s) 50.00%

7.0 Medicaid Direct Medical Services Costs (for the county) $373,750

8.0 Medicaid Interim Payments Received (by the county) $500,000

9.0 Medicaid Cost Settlement (at the end of the year – July 2013) -$126,250

Cost Settlement Calculation 3rd Example – Neutral

WV: Introduction to Medicaid Cost Based School Based Health Services 11

1.0 Total Costs of Eligible SBHS Provider Costs (county’s cost) $1,000,000

2.0 Indirect Cost Rate 115.00%

3.0 Total Costs of Eligible SBHS Provider Costs $1,150,000

4.0 RMTS Direct Medical Percentage Results (Statewide results) 65.00%

5.0 Direct Medical Services Costs $747,500

6.0 Application of Medicaid Eligibility Rate (IEP Ratio) (county’s) 50.00%

7.0 Medicaid Direct Medical Services Costs (for the county) $373,750

8.0 Medicaid Interim Payments Received (by the county) $373,750

9.0 Medicaid Cost Settlement (at the end of the year – July 2013) $0

$ County’s costs for

billable services – excluding IDEA

Results of RMTS

(statewide)

#Medicaid Eligible/

#Special Ed.

Rate billed for SLP, PT, OT, PSY,

RN, AUD

Rate billed for Care

Coordination

Rate billed for Personal Care

Aides

Match

$ County’s costs for

billable services – excluding

IDEA

Results of RMTS

(Direct billable)

#Medicaid Eligible/ Special

Education

Medicaid-covered services

•Audiological Services•Speech therapy services•Physical therapy services•Occupational therapy services•Psychological evaluation•RN – Specialized Procedures

Care Coordination activities

Personal care activities•Communication;•Safety;•Mobility;•Behavior; •Medical/health

RMTS Responses (Direct Services)Inappropriate Response: I was not providing direct services to students.Appropriate Response: I was working on writing new IEP goals regarding transition for a student.

Inadequate Response: Who was with you? Some students and an adult.Appropriate Response: Five students and an aide.

PCG’s Advice

When indicating that you were participating in or preparing for an IEP Meeting,

please indicate the portion of the IEP on which you were working during your moment

(i.e., health related services goals, transition, state assessments, etc.).

$ County’s costs for

billable services

Results of RMTS

#Medicaid Eligible/ #Special Education

Drawing from Basic Information Page – Special Education screen WVEIS

Medicaid Administrative Claiming (MAC)

WV: Introduction to Medicaid Cost Based School Based Health Services 17

MACAdditional $

Medicaid Administrative Claiming (MAC)

•Medicaid Outreach•Facilitating Medicaid Eligibility Determination•Direct Medical Services•Translation Related to Medicaid Services•Program Planning, Policy Development and Interagency Coordination Related to Medicaid Services•Medicaid related training•Referral, Coordination, and Monitoring of Medicaid Services and Documentation

$ County’s costs for

billable services – excluding IDEA

Results of RMTS

(statewide) –

% #Medicaid Eligible/

#Special Ed.

Rate billed for SLP, PT, OT,

PSY, RN, AUD

Rate billed for Care Coor. – (Treatment Planning?)

Rate billed for Personal Care

Aides

Same participants

ENTER ALLOCATIONS $997,309.00 $45,215.00 $103,471.00 $1,145,995.005 Digit

Program Function

Code

3 Digit Object Code

Description IDEA School Age (3-

21) IDEA Preschool

(3-5) State Aid Total Budget for This Line Item

SPECIAL EDUCATION - PERSONNEL List each position by FTE and type of position, including exceptionality if applicable; and program function code. Fixed charges may be aggregated. 43-2-1 43-2-2 02-2-1

21210 111 1.0 multi-catagorical teacher $54,584.00 $54,584.0021210 121 5 1.0 primary paraprofessionals $143,916.00 $143,916.0021210 121 5 1.0 middle paraprofessionals $124,315.00 $124,315.0021210 121 3 1.0 high school paraprofessionals $85,200.00 $85,200.0021282 121 1.0 pre-school special needs paraprofessionals $28,255.00 $28,255.0021271 111 .5 1.0 teacher of the gifted $34,000.00 $34,000.0022721 121 1.0 bus aide $34,130.00 $34,130.0022134 111 .10 school nurse $5,065.00 $5,065.0022142 111 3 0.50 school psychologists $97,845.00 $97,845.00

$545,055.00 $28,255.00 $34,000.00 $607,310.00

5 Digit Program Function

Code

3 Digit Object Code

Description IDEA School Age (3-21)

IDEA Preschool (3-5)

State Aid Total Budget for This Line Item

SPECIAL EDUCATION - SERVICES

2xxxx $0.0022150 151 contracted speech $15,000.00 $15,000.0021273 341 orientation & mobility trainer $2,000.00 $2,000.0021223 341 vision specialist $10,000.00 $10,000.0022161 341 occupational therapy services $70,135.60 $2,536.71 $16,890.00 $89,562.3122162 341 physical therapy services $15,000.00 $15,000.0021219 112 extended school year services $8,000.00 $8,000.00

$0.00$0.00$0.00

REMAINING IN ALLOCATION #REF! #REF! #REF! #REF!

Sub Total Special Education Personnel

COUNTY BUDGET FOR IDEA and State Aid - FY 2012_ _

Don’t bill Med.

Don’t bill Med.

Online Strategic Plan

Maintenance Of Effort (MOE) State/Local

In a cost-based system, Medicaid reimbursement will cover the costs of providing special education and

health-related services to Medicaid eligible students.