Medicaid Administrative Claiming Program

1. Medicaid Administrative Claiming Program Pierre, SD September 28, 2011 Matrix Pointe LLC

2. Presenters • Bob Seiffert • Steve Curtiss

3. The Medicaid Program • Provides health care coverage for low-income families, persons with disabilities, and elderly persons with limited income and assets • Currently, 115,000 South Dakotans are eligible for Medicaid. 58,000 were eligible in 1993 • 79,000 children (age 0-18 ) are eligible. 32,000 were eligible in 1993 • Within South Dakota Public Schools, approximately 33% of children are eligible

4. Medicaid Service Payment vs. Medicaid Administration • The Medicaid Program pays service providers for most health services, such as hospital care, nursing facility care, and practitioner services. • Currently, most South Dakota school districts participate as service providers, by offering PT, OT and Speech, Hearing and Language services to students.

5. Medicaid Administration • Pays schools for their costs incurred in arranging and monitoring of health care services for Medicaid Eligible Children • Outreach and eligibility determination • Arrangement of transportation and translation • Health care policy development • Medical training • Referral, coordination and monitoring of health care services

6. Funding Formula • Costs, by personnel category X • Time study results, by category X • District Medicaid Eligibility Rate X • Federal Medicaid matching of 50% = • District quarterly Payment • Total statewide federal claims this year will be approximately $6.0 million

7. Personnel Costs – Employee Categories • District Personnel costs are segregated into four categories: • (A) Therapists, including audiology, OT, PT and Speech • (B) Other Medical, such as RNs, LPNs, mental health professionals, social workers and counselors • (C) Program Support, including teachers, paras, aides, and other student services • (D) Administration, including principals, special ed. administrators and assistants

8. Time Studies • Random Moment Time Studies are conducted for five days each school quarter. • The time studies are used to determine the amount of time spent on health care activities for ALL students, by each respective personnel category. • Time studies must meet federal confidence level of 95%, thus small personnel categories, such as therapists and administrators require high percentages of the group to be sampled.

9. Confidence Levels • Federal Gov’t requires 95% • Approximately 350 therapists in SD requires a minimum of 184 due time study • If there were three times the number of therapists (1050) only 100 more would need to complete the study

10. Time Study Training • State is divided into three areas--Northeast, Southeast and Central/West • Training for staff selected for time studies is done the week prior to the time study • Northeast area completed late October to mid-November • Southeast area completed late January to mid-February • Central/Western areas completed March/April

11. Time Study Training Continued • Training conducted live at larger school districts • Training via the DDN system for the smaller districts • Most training times begin at 3:30 p.m. and last approximately 30 minutes • Emphasis placed on understanding time spent in IEP and IFSP meetings arranging and monitoring health care issues

12. School Years 2006-2009 Time Study Summary • Percent of time spent on arranging and monitoring health care activities for all children • Therapists 13% • Other Medical Personnel 13% • Teachers and other program support 2.5% • Administrators 12%

13. Medicaid Eligibility by District • Eligibility varies considerably by respective school district • Higher income districts have Medicaid Eligibility rates as low as 15% • Lower income districts have Medicaid Eligibility rates as high as 90% • Medicaid Administrative payments are directly proportional to the Medicaid Eligibility Rate of the district

14. Educational Cooperatives • Most of the Ed Coops are participating in the program • Selected staff participate in the time studies • Coop costs are allocated to participating school districts in their area, to enhance the districts’ claims

15. Time Study Reviews • Business Officials will be given a summary sheet of issues to watch for • Make sure all time sheets are signed • Make sure all ”b” codes are documented

16. On-Site Financial Reviews • 7 Districts each year • Must be able to document claimed costs • Must be able to document other federal revenue • Financial summary information from your accounting system is accepted