name survey nugget 9.28.12 final · o becky stoddard, chair of education and research committee,...

9/28/12

1

The Changing Tides of Medicaid

in Education: NAME National Survey Results

Education and Research Commi3ee Nugget Presentation October 10, 2012

Agenda •  Introductions

o  Becky Stoddard, Chair of Education and Research Committee, Medicaid Liaison, Kentucky Department of Education

o  Jim T. Donoghue, Educational Program Consultant, Medicaid, Iowa Department of Education

o  Rick Jacobs, Principal, Fairbanks LLC o  Alicia Neumann, Director MAC Programs, Paradigm Healthcare Services o  Rena Steyaert, Montana Medicaid Program Officer

•  Overview of Survey Results •  Preliminary Takeaways •  Next Steps

o  Final Report o  CMS o  California Survey of Medicaid

•  Questions

Education and Research Committee 2


Red: Health and Education Green: Health Only Blue: Education Only Yellow: Finance

States Responding to 2011 Biennial NAME Survey by Agency

9/28/12

2

Direct Services

4 Education and Research Committee


!$#!!

!$100!!

!$200!!

!$300!!

!$400!!

!$500!!

!$600!!

!$700!!

!$800!!

2008! 2009! 2010!

Millions'

Total'Federal'Reimbursement'for'Direct'Services'

Total!Direct!Services!


!$#!!!!

!$5.00!!

!$10.00!!

!$15.00!!

!$20.00!!

!$25.00!!

!$30.00!!

!$35.00!!

2008! 2009! 2010!

Millions'

Average'Direct'Services'Federal'Reimbursement'

Average!Direct!Service!Billing!

Median!Direct!Service!Billing!

9/28/12

3


0%#

21%#

17%#

58%#

4%#

Percent'of'State's'LEAs'Billing'for'IEP'Services'(Direct'Services)'

1*25%#

26*50%#

51*75%#

76*100%#

Unknown#


39%$

61%$

Do#LEAs#Retain#100%#of#the#Federal#of#Reimbursement#for#IEP<related#services?#

(Direct#Services)$

Yes$

No$

Total$:$23$No:$14$$$$$$$$$$$$$$$$$$$$$$$$$$$$Yes:$9$


!$#!!!!

!$0.50!!

!$1.00!!

!$1.50!!

!$2.00!!

!$2.50!!

!$3.00!!

!$3.50!!

!$4.00!!

!$4.50!!

IN! MT! NE! KY!

Millions'

Direct'Services'Billing'by'State'(<'$5'Million)'

2008!

2009!

2010!

9/28/12

4


!$#!!!!

!$2.00!!

!$4.00!!

!$6.00!!

!$8.00!!

!$10.00!!

!$12.00!!

!$14.00!!

!$16.00!!

VA! CO! FL! NC!

Millions'

Direct'Services'Billing'by'State'(>$5'<'$20'Million)'

2008!

2009!

2010!


!$#!!!!

!$5.00!!

!$10.00!!

!$15.00!!

!$20.00!!

!$25.00!!

!$30.00!!

!$35.00!!

!$40.00!!

NJ! OH! KS! IA! RI! AZ! LA! MN!

Millions'

Direct'Services'Billing'by'State'(>$20'<'$35'Million)'

2008!

2009!

2010!


!$#!!!!

!$20.00!!

!$40.00!!

!$60.00!!

!$80.00!!

!$100.00!!

!$120.00!!

!$140.00!!

!$160.00!!

WV! MA! MI! CA! NY!

Millions'

Direct'Services'Billing'by'State'(>'$35'Million)'

2008!

2009!

2010!

9/28/12

5


0" 5" 10" 15" 20" 25"

Interpreter'Services'

IEP'Mee0ngs'

Orienta0on'and'Mobility'

Assis0ve'Technology'Services'

Case'Management'

Assis0ve'Technology'Devices'

Personal'Care'Assistance'

Special'Transporta0on'

Health'Related'Evalua0ons'

Audiology'

Nursing'

Behavioral'Health/Mental'Health/Psychological'Counseling'

Speech'

Physical'Therapy'

Occupa0onal'Therapy'

Number'of'States'

Total'Number'of'States'that'Allow'Direct'Services''to'be'Billed'by'Type'of'Service''


0"

2"

4"

6"

8"

10"

12"

MA" OH" NY" RI" NJ" KS" KY" IN" LA"

State%Changes%to%Services%That%Can%Be%Billed%By%Type%of%Change%(Eliminated,%Significantly%Changed,%Added)%%

Added" Significantly"Changed" Eliminated"


0"

2"

4"

6"

8"

10"

12"

14"

16"

VA" KS" IA" MI" OH" KY" WV"

Percent'of'Students'Enrolled'in'Special'Educa3on'by'State'

2008"

2009"

2010"

9/28/12

6


0"

2"

4"

6"

8"

10"

12"

14"

CA" NV" NC" MT" AZ" FL" NY"

Percent'of'Students'Enrolled'in'Special'Educa3on'by'State'

2008"

2009"

2010"


!"!!!!

!2,000!!

!4,000!!

!6,000!!

!8,000!!

!10,000!!

!12,000!!

!14,000!!

!16,000!!

!18,000!!

IN! KS! IA! RI! MT! MN!

Student'Count'For'Which'Direct'Services'Were'Billed'By'State'

2007"2009! 2008"2009! 2009"2010!


!"!!!!

!10,000!!

!20,000!!

!30,000!!

!40,000!!

!50,000!!

!60,000!!

OH! AZ! NJ! CO!


2007"2008! 2008"2009! 2009"2010!

9/28/12

7


!"!!!!

!50,000!!

!100,000!!

!150,000!!

!200,000!!

!250,000!!

NY! VA! CA!


2007"2008! 2008"2009! 2009"2010!


$0.00$

$1,000.00$

$2,000.00$

$3,000.00$

$4,000.00$

$5,000.00$

$6,000.00$

$7,000.00$

$8,000.00$

VA$ MT$ NJ$ IN$ OH$ CA$ NY$ AZ$ CO$ KS$ RI$ IA$ MN$

Federal'Direct'Services'Revenue''Per'Billed'Student'

2008$ 2009$ 2010$


!$#!!!!

!$10.00!!

!$20.00!!

!$30.00!!

!$40.00!!

!$50.00!!

!$60.00!!

!$70.00!!

IN! VA! FL! KY! NJ! OH! NC!

Direct'Services'Revenue/Special'Educa4on'Student'Count'

2008!

2009!

2010!

9/28/12

8


!$#!!!!

!$50.00!!

!$100.00!!

!$150.00!!

!$200.00!!

!$250.00!!

!$300.00!!

MT! CA! AZ! MN! KS! IA! LA!

Direct'Services'Revenue/Special'Educa4on'Student'Count'

2008!

2009!

2010!


18%$

26%$52%$

4%$

Methodology*Used*by*State*for*Medicaid*Reimbursement*of*Direct*Services*

Other$

Fee$For$Service$

Cost$Report$

Unknown$

Cost$Report:$12$$$$$$$$$$$$$$$$$$Fee$For$Service:$6$$$$$$$$$$$$$$$$$$$$Other:$4$$$$$$$$$$$$$$$$$$$$$$$Unknown:$1$


61%$

39%$

What%Time%Study%Methodology%is%Used%for%Direct%Services%Rates/Reimbursement?%

Actual$documented$service$6me$

RMTS$

Actual$Documented$Service$Time:$14$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$RMTS:$9$

9/28/12

9


45%$

14%$

32%$

9%$

Which%agency%performs%Direct%Services%program%training?%

Both:$10$

Educa4on:$3$

Medicaid:$7$

Other:$2$

35%$

56%$

9%$

Which%agency%performs%Direct%Services%program%reviews?%

Both:$8$

Medicaid:$13$

Other:$2$


59%$

41%$

Does%State%Provide%Web0based%Technical%Support%for%Direct%Service%Program?%

Yes$

No$

91%$

9%$

Does%State%Provide%a%Manual%or%Guidebook%for%Direct%Service%Program?%

Yes$

No$


0" 1" 2" 3" 4" 5" 6" 7" 8" 9"

Unresolved*State*Plan*Amendment*

Free*Care*Issue*

Medical*Necessity*

Medical*Orders*

We*have*no*major*issues*at*this*>me*

Understanding/integra>ng*requirements*of*both*IDEA*and*Medicaid*

Parental*Consent*

Third*Party*Liability*

Rates*

Provider*Creden>als*

IEPs*that*meet*the*test*for*both*IDEA*and*Medicaid*

Documenta>on*of*Services*

Number*of*States*

Top*Issues*Related*to*Direct*Services*Billing*

9/28/12

10

Administrative Claiming

28 Education and Research Committee


17%$

13%$

0%$

48%$

13%$

9%$

Percent'of'LEA's'Par0cipa0ng'in'MAC'

1*25%$

26*50%$

51*75%$

76*100%$

NA$

Unknown$

1*25%:$$$$$$4$$$$26*50%:$$$$3$51*75%:$$$$0$$$$$$$$76*100%:$$11$Unknown:$2$NA:$3$


$320.00&

$325.00&

$330.00&

$335.00&

$340.00&

$345.00&

$350.00&

$355.00&

2008& 2009& 2010&

Millions'

Aggregate'MAC'Reimbursement'by'Year'

MAC&Reimbursement&

9/28/12

11


67%$

33%$

Do#State's#LEAs#retain#100%#of#MAC#Reimbursement?#

No$

Yes$

No:$12$Yes:$6$


$0.00$

$0.50$

$1.00$

$1.50$

$2.00$

$2.50$

$3.00$

$3.50$

$4.00$

$4.50$

$5.00$

NJ$ MT$ LA$ KS$ OH$ RI$

Millions'

Federal'MAC'Dollars'(<'$5'Million)'

2008$

2009$

2010$


$0.00$

$5.00$

$10.00$

$15.00$

$20.00$

$25.00$

$30.00$

$35.00$

$40.00$

AZ$ MI$ NC$ VA$ NE$

Millions'

Federal'MAC'Dollars'(>'$5'<'$50'Million)'

2008$ 2009$ 2010$

9/28/12

12


$0.00$

$20.00$

$40.00$

$60.00$

$80.00$

$100.00$

$120.00$

$140.00$

$160.00$

$180.00$

MA$ FL$ CA$

Millions'

Federal'MAC'Dollars'(>'$50'Million)'

2008$ 2009$ 2010$


5%#

11%#

84%#

Time%Study%Methodology%Used%for%MAC%Claiming%

Combina.on#

Other#

RMTS#

RMTS:#16##Other:#2#Combina.on:#1#


35%$

26%$

39%$

State%used%the%same%methodology%for%Direct%Service%&%MAC%Programs%

No$

Not$Applicable$

Yes$

Yes:$9$$$$$$$$$$$$$$$$$$$$$$$$$$$$No:$8$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$NA:$6$

9/28/12

13


61%$18%$

13%$

4%$ 4%$

Agency'that'provides'program'reviews'of'the'MAC'program'

Medicaid:$14$

NA:$4$

Both:$3$

Other:$1$

Unknown:$1$

39%$

9%$22%$

9%$

17%$

4%$

Agency'that'provides'Training'for'the'MAC'program'

Medicaid:$9$

Educa2on:$2$

Both:$5$

Other:$2$

NA:$4$

Unknown:$1$


44%#

30%#

17%#

9%#

Does%State%Provide%Web0Based%Technical%Support%for%MAC%Program?%

Yes:#10#

No:#7#

NA:#4#

Not#Sure:#2#

70%$

9%$

17%$

4%$

Does%State%Provide%Manual%or%Guidebook%for%MAC%Program?%

Yes:$16$

No:$2$

NA:$4$

Not$Sure:$1$


0" 1" 2" 3" 4" 5" 6" 7" 8" 9" 10"

MER$

Compiling$data$

Time$Study$Methodology$

Understanding$Guidebooks$

Staff$Training$

We$have$no$issues$at$this$?me$

Par?cipants$

Number$of$States$

Top$Issues$Related$to$Medicaid$Administra?ve$Claiming$$by$Number$of$States$

9/28/12

14

Next Steps & Questions

•  Final Report Posted to NAME Website •  California Data Set •  CMS Data Set •  Who to Contact

Questions?


name survey nugget 9.28.12 final · o becky stoddard, chair of education and research committee,...

Documents