pa school based access program 2013 statewide training sessions
TRANSCRIPT
PA School Based ACCESS Program 2013 Statewide Training Sessions
www.pcgeducation.com
Agenda
2
School-Based ACCESS Program - Changeso PDE Goals – Improved Efficiency & Compliance
o CMS Audit – Mandated Changes
o Impact of CMS Changes to SBAP Performance
o Training & Support
Cost Settlement
Third Party Liability (TPL) Denials
Looking Forward – Optimizing Your Revenueo Revenue Drivers
o Reimbursement Estimating Tool
o Operational Efficiency – Best Practices
SBAP Program Changes
3
School-Based ACCESS Program – Changes
PDE – new SBAP program goalso Paperless environmento Enhanced compliance-checks
EasyTrac• Web-based & paperless system• Exception reports (compliance)• Monthly Management Reports
4
School-Based ACCESS Program – Changes
PDE – new SBAP directionso Paperless environmento Enhanced compliance-checks
CMS audit – mandated changeso New time study methodologyo Voluntary time study now mandatory
o Budget costs no longer accepted o Now, must provide actual costs,
quarterly
o New annual cost reconciliation
EasyTrac• Web-based & paperless system • Exception reports (compliance)• Monthly Management Reports
RMTS - Random Moment Time Study
MCRCS – Medicaid Cost Reporting & Claiming System
Cost Settlement
5
School-Based ACCESS Program – Changes
New SBAP policies
New software (EasyTrac)
New web-based systems (RMTS, MCRCS)
New business processes (Cost Settlement)
MEAN TWO THINGS…
TRAINING
CUSTOMER SUPPORT
EasyTrac• Web-based & paperless system • Exception reports (compliance)• Monthly Management Reports
RMTS - Random Moment Time Study
MCRCS – Medicaid Cost Reporting & Claiming System
Cost Settlement
6
Onsite Training
EasyTrac trainings mid-July and August 2012 Over 900 people attended 35 initial onsite sessions
(July- August 2012)
Over 450 people attended 16 additional onsite sessions (Sept - Oct – Nov 2012)
Statewide PaTTAN sessions - late August, 2012
Over 1,000 people attended 3 onsite sessions
Statewide PDE/DPW sessions - November, 2012
Over 600 people attended 6 onsite sessions
7
Live WebEx Training (Sept, Oct, Nov 2012)
EasyTrac training
• Trained over 1,200 people in 61 sessions
Data Upload training
• Trained over 580 people in 20 sessions
RMTS Overview training
• Trained over 245 people in 4 sessions
RMTS Administrator training
• Trained over 620 people in 4 sessions
8
WebEx Training
From August 2, 2012 to July 3, 2013
o 142 Live WebEx Presentations
o 3,221 registered individuals
Recorded WebEx training on SBAP website (available 24x7)
o EasyTrac Administratoro EasyTrac User (PCA, Nurse, and Speech)o Data Importo RMTS Overviewo RMTS Administratoro MCRCS o SBAP Overview for Early Intervention
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Live WebEx Training (August, Sept, 2013)
Weekly live webex training sessions
EasyTrac Administrator training
EasyTrac User training
Exception Reports training
Monthly Management Reports training
Intensive scheduling of training sessions (as needed)
MCRCS training
MCRCS Q&A sessions
RMTS training
RMTS Q&A sessions
10
Customer Support
Customer Support Volumes: Service level goal: return call or email within 48 hours (2 business days)
FY13: 5,000+ customer contacts (phone & emails) per month
Some weeks, activity spikes to 2,500 customer contacts, per week
Customer Support channels: PA SBAP Website: www.publicconsultinggroup.com/client/paaccess
Toll free #: 866-912-2976
SBAP questions & support: [email protected]
EasyTrac questions & issues: EasyTrac Message Board (secure email)
11
Impact of Mandated CMS Changes
12
CMS Mandated Changes that Impacted Performance
• Elimination of reimbursement for
o IEP meetings
o Collateral services
• Overhead capped at 25%
o Reduction in Billing Rates
o Reduction in Medicaid Administrative Claims
13
14
Total FY12 Total FY130
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Statewide SBAP Performance - Fee For ServiceService Units, FY12 vs. FY13
Except FY13
TPL denials FY13
Paid FY13
Paid FY12
Se
rvic
e U
nits
15
Total FY12 Total FY130
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Statewide SBAP Performance - Fee For ServiceService Units, FY12 vs. FY13
Except FY13
TPL denials FY13
Paid FY13
Paid FY12
Se
rvic
e U
nits
NO IEP services
NO IEP servicesNO Collateral services
16
Total FY12 Total FY130
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Statewide SBAP Performance - Fee For ServiceService Units, FY12 vs. FY13
Except FY13
TPL denials FY13
Paid FY13
Paid FY12
Se
rvic
e U
nits
-15%
If collateral services were 15% of total service units in FY12, then, without them the total FY12 service units would have been 16,830,000
NO IEP services
17
Total FY12 Total FY130
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Statewide SBAP Performance - Fee For ServiceService Units, FY12 vs. FY13
Except FY13
TPL denials FY13
Paid FY13
Paid FY12
-25%
If collateral services were 25% of total service units in FY12, then, without them the total service units would have been 14,850,000
NO IEP services
Statewide PerformanceHow did participating schools do?
18
19
55%
10%
35%
FY13 SBAP FFS Performance as of July, 2013Includes FY12 and FY13 Dates of Service – Paid in
FY13
75%+
60-74%
less than 60%
FY13 Projection based on 75% of FY11 Actual
Despite CMS mandates that apply equally to ALL participating SBAP schools…
20
Despite CMS mandates that apply equally to ALL participating SBAP schools…FY13 performance among participating schools varied with some experiencing better results than others in a challenging year
21
Individual School Performance
22
23
Total FY12 Total FY13 -
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
24
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
25
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
26
Total FY12 Total FY13 -
20,000
40,000
60,000
80,000
100,000
120,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
27
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
28
Total FY12 Total FY13 -
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
29
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
30
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
31
Total FY12 Total FY13 -
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
32
Total FY12 Total FY13 -
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
33
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
34
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
35
Total FY12 Total FY13 -
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
36
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
37
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
38
Total FY12 Total FY13 -
5,000
10,000
15,000
20,000
25,000
Except FY13
Denied FY13
Paid FY13
Paid FY12
FY13 Cost Settlement
39
Cost Settlement timeline for 2012-13
• Detailed training begins Sept, Oct 2013
• Cost Settlement process closes Jan, 2014
• Cost Settlement financial close-out March, 2014
SBAP Performance for FY13 will not be finalized until Cost Settlement has been completed
40
OCTOBER TO DECEMBER – QUARTER 1
JANUARY TO MARCH – QUARTER 2
JULY TO SEPTEMBER – QUARTER 4
PA SBAP 2013-2014 Deadlines
PA School Based ACCESS Program Fiscal Year
Quarterly Financials Q3
July 1st - Aug 1st
New Rosters/Calendars
August 30th
Roster Certifications Q1
September 9th
October to December
Quarterly Financials Q4
October 1st - November 1st
Roster Certifications Q2
December 10th Annual Cost Report Opens
(FY 13 ) TBD
Quarterly Financials Q1
January 2nd - February 2nd
Roster Certifications Q3
March 10th
Annual Cost Report Certification
(FY 13) TBD
APRIL TO JUNE – QUARTER 3Quarterly Financials Q2
April 1st - May 1st
TPL Denied Claims – Update
42
Third Party Denials – Efforts to Turn Off the Edit
• Initial letter sent to 136 insurance companies in July, 2012 then August, 2012• Phone and email follow-up• ZERO responses
• Same letter sent to 136 insurance companies in July, 2013• Phone and email follow-up• 16 “denial” responses
• Sent second version of letter to 120 insurance companies August, 2013• Phone and email follow-up• 12 “denial” responses
• Sent third version of letter to 108 insurance companies September, 2013• 3 “denial” responses
Executive level initiatives
43
Looking Forward
Optimizing SBAP Program
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PA SBAP -- Optimizing Your Performance
What’s important?
o Capture services on a timely basis, making sure they are fully documented in EasyTrac with all necessary compliance data
o Capture all appropriate actual costs incurred
o Ensure that all allowable/eligible and appropriate staff are included in RMTS rosters
o Estimate service log and reimbursement amounts
45
Estimating FFS Reimbursement
46
SY 2012-13 2013-14Draft PA FFS Revenue Projector Estimating tool FMAP 54.28% 53.52%
ServicePrescribed
Mins # of Units # of Whole
Units MER%Hourly
Rate Unit Rate Doc% PC% PA% IEP%Prov
Cert%Gross Total
$ Net FFP $Speech Ind 1,000 66.67 66.00 50% $30.00 $7.50 80% 80% 80% 80% 80% $1,228.80 $657.65Speech Grp 5,000 333.33 333.00 50% $14.00 $3.50 80% 80% 80% 80% 80% $2,867.20 $1,534.53OT Ind 500 33.33 33.00 50% $35.00 $8.75 80% 80% 80% 80% 80% $716.80 $383.63OT Grp 1,500 100.00 100.00 50% $20.00 $5.00 80% 80% 80% 80% 80% $1,228.80 $657.65PT Ind 500 33.33 33.00 50% $40.00 $10.00 80% 80% 80% 80% 80% $819.20 $438.44PT Grp 1,500 100.00 100.00 50% $18.00 $4.50 80% 80% 80% 80% 80% $1,105.92 $591.89PCA Ind 10,000 666.67 666.00 50% $7.50 $1.88 80% 80% 80% 80% 80% $3,072.00 $1,644.13
Transportation RT 300 50% $12.00 $12.00 80% 80% 80% 80% N/A $737.28 $394.59Transportation OW 100 50% $6.00 $6.00 80% 80% 80% 80% N/A $122.88 $65.77
$6,368.28
INPUT THE DATA REQUESTED BELOW:225 ENTER (in box at left) LEA # of Medicaid eligible Special Education students receiving health related services450 ENTER (in box at left) LEA # of Medicaid eligible Special Education students
50.00% LEA MER% (DO NOT ENTER will be calculated from your input above)
Estimating FFS Reimbursement
47
SY 2012-13 2013-14Draft PA FFS Revenue Projector Estimating tool FMAP 54.28% 53.52%
ServicePrescribed
Mins # of Units # of Whole
Units MER%Hourly
Rate Unit Rate Doc% PC% PA% IEP%Prov
Cert%Gross Total
$ Net FFP $Speech Ind 1,000 66.67 66.00 50% $30.00 $7.50 80% 80% 80% 80% 80% $1,228.80 $657.65Speech Grp 5,000 333.33 333.00 50% $14.00 $3.50 80% 80% 80% 80% 80% $2,867.20 $1,534.53OT Ind 500 33.33 33.00 50% $35.00 $8.75 80% 80% 80% 80% 80% $716.80 $383.63OT Grp 1,500 100.00 100.00 50% $20.00 $5.00 80% 80% 80% 80% 80% $1,228.80 $657.65PT Ind 500 33.33 33.00 50% $40.00 $10.00 80% 80% 80% 80% 80% $819.20 $438.44PT Grp 1,500 100.00 100.00 50% $18.00 $4.50 80% 80% 80% 80% 80% $1,105.92 $591.89PCA Ind 10,000 666.67 666.00 50% $7.50 $1.88 80% 80% 80% 80% 80% $3,072.00 $1,644.13
Transportation RT 300 50% $12.00 $12.00 80% 80% 80% 80% N/A $737.28 $394.59Transportation OW 100 50% $6.00 $6.00 80% 80% 80% 80% N/A $122.88 $65.77
$6,368.28
INPUT THE DATA REQUESTED BELOW:225 ENTER (in box at left) LEA # of Medicaid eligible Special Education students receiving health related services450 ENTER (in box at left) LEA # of Medicaid eligible Special Education students
50.00% LEA MER% (DO NOT ENTER will be calculated from your input above)
Enter Your ANNUAL DATA once
Estimating FFS Reimbursement
48
SY 2012-13 2013-14Draft PA FFS Revenue Projector Estimating tool FMAP 54.28% 53.52%
ServicePrescribed
Mins # of Units # of Whole
Units MER%Hourly
Rate Unit Rate Doc% PC% PA% IEP%Prov
Cert%Gross Total
$ Net FFP $Speech Ind 1,000 66.67 66.00 50% $30.00 $7.50 80% 80% 80% 80% 80% $1,228.80 $657.65Speech Grp 5,000 333.33 333.00 50% $14.00 $3.50 80% 80% 80% 80% 80% $2,867.20 $1,534.53OT Ind 500 33.33 33.00 50% $35.00 $8.75 80% 80% 80% 80% 80% $716.80 $383.63OT Grp 1,500 100.00 100.00 50% $20.00 $5.00 80% 80% 80% 80% 80% $1,228.80 $657.65PT Ind 500 33.33 33.00 50% $40.00 $10.00 80% 80% 80% 80% 80% $819.20 $438.44PT Grp 1,500 100.00 100.00 50% $18.00 $4.50 80% 80% 80% 80% 80% $1,105.92 $591.89PCA Ind 10,000 666.67 666.00 50% $7.50 $1.88 80% 80% 80% 80% 80% $3,072.00 $1,644.13
Transportation RT 300 50% $12.00 $12.00 80% 80% 80% 80% N/A $737.28 $394.59Transportation OW 100 50% $6.00 $6.00 80% 80% 80% 80% N/A $122.88 $65.77
$6,368.28
INPUT THE DATA REQUESTED BELOW:225 ENTER (in box at left) LEA # of Medicaid eligible Special Education students receiving health related services450 ENTER (in box at left) LEA # of Medicaid eligible Special Education students
50.00% LEA MER% (DO NOT ENTER will be calculated from your input above)
Enter Your SCENARIO DATA Here
Estimated Revenue
Here
Get Your
PA SBAP -- Optimizing Your Performance
Operational Efficiency
o Establish a timely submission policy for entering service log data Service Providers
ACCESS Coordinators (On Behalf Of)
Third party vendors
o Use the Service Documentation Review Report to ensure service providers are entering service logs on a timely basis
o ACCESS Coordinators should review & approve logs frequently
o Aggressively manage Exception Reports
49
PA SBAP -- Optimizing Your Performance
Use EasyTrac Reports
o EasyTrac standard reports will help you manage your SBAP activities and improve cashflow
o The Active Student Extract Report will show the following Medicaid required Compliance data:
Primary Disability
IEP Dates
PA Secure ID
Parental Consent Dates
50
Back-up Slides
52
Third Party Liability Denials – as of 9/19/2013
Statewide Total TPL denials – $21,945,709 (gross dollars)
TPL denials for all IU’s (above) – $9,293,527 (gross dollars)
53
LANCASTER-LEBANON IU 13 $1,167,142.81BUCKS COUNTY IU 22 $877,344.55LINCOLN IU 12 $795,979.91DELAWARE COUNTY IU25 $787,968.28MONTGOMERY COUNTY IU 23 $731,789.44ALLEGHENY IU 3 $699,129.39CARBON-LEHIGH IU 21 $544,991.29CAPITAL AREA IU 15 $444,768.09BERKS COUNTY IU 14 $403,248.94PHILADELPHIA AREA SD $311,473.98CHESTER COUNTY IU 24 $285,264.63COLONIAL IU20 $256,983.81LUZERNE IU18 $240,659.84SD OF PITTSBURGH $236,775.17NORTHWEST TRI-COUNTY IU5 $194,353.79
MIDWESTERN IU 4 $193,701.58BEAVER VALLEY IU 27 $151,392.34INTERMEDIATE UNIT 1 $137,096.32RIVERVIEW IU 6 $135,490.06APPALACHIA IU 8 $134,273.06NORTHEASTERN EDUC IU 19 $108,720.16CENTRAL IU 10 $104,513.17SCHUYLKILL IU 29 $81,852.07TUSCARORA IU 11 $72,403.17ARIN IU 28 $49,453.92CENTRAL SUSQ IU 16 $48,012.98WESTMORELAND IU 7 $37,121.88SENECA HIGHLANDS $31,219.75BLAST IU 17 $30,403.05
• New process going forward entails the cost reconciliation ensuring providers (districts) are not reimbursed more than their allowable costs
• While the exact PA formula may vary, here is a sample calculation:
Cost Settlement: Sample Calculation
Allowable costs
xTime study
resultsx
Medicaid eligibility
ratex FFP = Reimbursable
Costs
eg., Salaries, Indirect
costsx
Direct Service
%x
Spec Ed students on
Medicaidx
Approx 54% =
$Total amount
$100,000 50% 35% 54% $9,450
>www.education.state.pa.us
RMTS >> MCRCS >> Cost Settlement
55
July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June
x x x
MCRCS Q1
Process MAC claim
MCRCS Q2
Process MAC claim
MCRCS Q3
Process MAC claim
MCRCS Q4
Process MAC claim
Cost Settlement aggregates the costs from MCRCS Q1, 2, 3, and 4 plus annual transportation costs plus out of district tuition costs, plus other costs.
SCHOOL YEAR 2012-13 SCHOOL YEAR 2013-14
RMTS Q1 RMTS Q2 RMTS Q3
COST SETTLEMENT for SY2012-13
RMTS Q1 RMTS Q2 RMTS Q3 RMTS Q4
Open MCRCS for previous RMTS qtr
RMTS Q4
Last day for changes to RMTS roster
MCRCS Q4 uses the roster from Q3 since there is no update to rosters for Q4
MCRCS periods last for 30 days after the close of the RMTS qtr
RMTS Q4 is a "non-active" qtr meaning no moments sent
Quarterly MAC checks are distributed approximately 4-6
weeks after close of MCRCS
Q1 MAC check
Q2 MAC check
Q3 MAC check
Q4 MAC check
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ACCESS COORD
SBAP OPERATIONS
EasyTracSBAP Billing OPERATIONS
ACCESS COORD
EVEN
T QA & APPROVE LOGS
PULL SERVICE LOGS
PRE-EDIT CHECKS
PERFORM EDIT CHECKS
BILL MEDICAID
PROCESS SBAP CLAIMS
SEND PRA TO PDE
FUNDS DEPOSITED INTO LEAs FAI ACCOUNT
MEDICAID/ PROMISE
PDE TREASURY FAI
SERVICE LOGS
SERVICES STUDENTS PROVIDERS
GATHER ANY UNPROCESSED LOGS
IS STUDENT MA ELIGIBLE?
PARENTAL CONSENT DATE
SEND FULLY COMPLIANT SERVICES TO PROMISE SYSTEM
REMOVE DENIED CLAIMS & REDUCE GROSS CLAIMS BY FMAP RATE
APPROVE PAYMENTS
FUNDS NOW ACCESSIBLE BY LEAs
IEP DATES
PHYSICIAN AUTH DATE
PA SECURE ID
PRIMARY DISABILITY
PROVIDER CERTIFICATION DATES
REQUEST APPROVED FUNDS FROM DPW & MOVE TO LEAs RESTRICTED FAI ACCOUNT
THIRD PARTY VENDORS
SERVICE PROVIDERS
DATA INPUT
WH
O IN
ITIA
TES
OR
COM
PLET
ES
EASYTRAC UBS
OU
TCO
MES
& R
EPO
RTS
DPW Promise Eligibility File
Organize and send Exception Reports to LEAs (monthly)
SBAP Claims
Provider Remittance Advice (PRA)
GROSSCLAIMS SUMMARY DATA
PRA NET CLAIMS DATA
NUMBER OF SERVICES IN EASYTR
Exception Data
TOTAL NET PAID CLAIMS DATA
MA eligible students appear in ET with a "Y"
TOTAL NET PAID CLAIMS DATA
Unofficial “life cycle” of service logs
PCG Contacts
57
PCG contact IU’s (and their districts) & schools
Patrick Cassidy
2, 5, 9, 12, 14, 16, 21, 28, Charter Schools
Amy Mirocco
2, 6, 7, 8, 10, 11, 15, 19, 29
Andy Martin
4, 13, 17, 24, 25, APS, Elwyn
Shawn DeVito
1, 18, 20, 22, 23, 27
Jennifer Taylor
3, 26