1 / 16

Special Education and Medicaid

Special Education and Medicaid . What Every Administrator Should Know about Medicaid November 2013. Medicaid. Federal/State Program Federal: Centers for Medicare and Medicaid Services (CMS) www.medicaid.gov / State: Executive Office of Health and Human Services (OHHS) in Rhode Island

powa
Télécharger la présentation

Special Education and Medicaid

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Special Education and Medicaid What Every Administrator Should Know about Medicaid November 2013 RITAP November 2013

  2. Medicaid • Federal/State Program • Federal: Centers for Medicare and Medicaid Services (CMS) www.medicaid.gov/ • State: Executive Office of Health and Human Services (OHHS) in Rhode Island • www.eohhs.ri.gov/ RITAP November 2013

  3. LEAs as Medicaid Providers • RIGL 40-8-18 authorizing statute (1992/2000) • Two types of Claiming Opportunities • Direct Services (related to special education) • Individual Provider Number: school staff/employees • Group Provider Number: contractors, including private schools • Submit claims any time (electronically) • Provide Quarterly Certification of Funds • Administrative Claiming • Submit Claims Quarterly • 100% Federal reimbursements  LEAs • Most recent reimbursement reports: www.ritap.org/medicaid RITAP November 2013

  4. Basic Requirements to Implement • The LEA needs to pay for any services for which reimbursement is sought • Direct Services must be funded with state/local $$ • Administrative Claiming activities may be funded with a blend of federal and state/local $$ • LEAs are the responsible entity for any claims submitted on their behalf • All documentation requirements must be met (Guidebooks) • LEAS must receive a one-time parental consent in order to seek reimbursement for direct services RITAP November 2013

  5. Basic Requirements to Implement Excerpts From RIGL 40-8-18 Voluntary participation as an EPSDT provider shall require the local education agency to provide the state match to obtain federal financial participation for EPSDT services and associated administrative costs by certifying to the department of human services that sufficient qualifying local funds (local certified match) have been expended for such services and administrative costs;… Payments made to the local education agency pursuant to this section shall be used solely for educational purposes and shall not be made available to local communities for purposes other than education. RITAP November 2013

  6. Medicaid Parental Consent 2013IDEA 34 CFR 300.154(d) • IDEA Parental Consent Requirements for accessing Medicaid funds: Revised 2013, Effective 10/9/13 • Must give prior notice • Must give annual notice • Must receive one-time informed parental consent to access Medicaid benefit (if consent not received do not submit a claim) • Parents may revoke at any time: revocation effective date LEA receives it • www.ritap.org/medicaid: Model Form (English/Spanish), Parent Brochure, and Implementation Guidance RITAP November 2013

  7. Medicaid Direct Services Guidebook • www.eohhs.ri.gov/Portals/0/Uploads/Documents/GB%20BODY%2007-29-2010_1.doc.pdf • Connection between Special Education and Medicaid • Certification of Funds • Direct Services Claiming • Quality Assurance • Claims Reconciliation • Services Description • Roles and Responsibilities School Administrators RITAP November 2013

  8. Medicaid Direct Services Guidebook Addenda • www.eohhs.ri.gov/Portals/0/Uploads/Documents/GB%20Addenda%2007-29-2010_1.doc.pdf • Addendum D: Quality Assurance-Matrix • Addendum G: Sample Certification Funds Letter • Addendum I: Claims Reconciliation • Addendum J: Diagnosis & Procedure Codes • Addendum J: Services descriptions • Addendum K: Expanded Behavioral Health Treatment Plan RITAP November 2013

  9. Childhood Medicaid Eligibility in Rhode Island www.eohhs.ri.gov/Consumer/ConsumerInformation.aspx • RIte Care and RIte Share • Supplemental Security Income (SSI) • Katie Beckett • Foster Care • Adoption Subsidy One Stop for Families with Children www.eohhs.ri.gov/Consumer/FamilieswithChildren/OneStopforFamilieswithChildren.aspx RITAP November 2013

  10. Medicaid Administrative Claiming Guidebook www.eohhs.ri.gov/Portals/0/Uploads/Documents/admin_clm_guide.pdf • Claims submitted quarterly • Typically overseen by special education: selected staff time studies • Typically overseen by business/finance: selected staff salary and fringe data; other financial data RITAP November 2013

  11. LEA Oversight Claiming • Executive Office of Health and Human Services-EOHHS (state Medicaid agency) conducts biennial reviews of each LEA • Review includes claims for Direct Services and Administrative Claiming • Guidebooks • www.eohhs.ri.gov/ProvidersPartners/GeneralInformation/ProviderDirectories/LocalEducationAgency.aspx RITAP November 2013

  12. Direct Services Billing Options • District may self-bill • District staff maintains documentation, prepares claims, submits claims, reconciles claims-RA- process • District may contract with a billing vendor • District staff maintains documentation, prepares claims, may reconcile claims; vendor may prepare, reconcile and submits claims Regardless of method, District is responsible for claims submitted! RITAP November 2013

  13. Administrative Claiming Billing Options • District may self-bill (train staff, oversee time studies, collect fiscal records, enter data into formula to formulate a claim, review processed claim, forward to EOHHS for processing) • District may contract with a vendor • District oversees time studies, collects fiscal records • Vendor trains staff, may oversee time studies process, receives documentation (staff and fiscal) from district, enter data to formulate a claim, review processed claim, forward to EOHHS for processing Regardless of method, District is responsible for claims submitted! RITAP November 2013

  14. On-Line Resources • RIDE: www.ride.ri.gov • Special Education www.ride.ri.gov/StudentsFamilies/SpecialEducation.aspx • Office of Student Community and Academic Supports (OSCAS) www.ride.ri.gov/InsideRIDE/RIDEOffices/StudentCommunityAcademicSupports.aspx • RITAP: www.ritap.org (Autism, ELL, IEP, Medicaid, RTI, Transition) • Federal Medicaid: www.medicaid.gov/ • Centers for Medicare and Medicaid Services (CMS) www.cms.gov/ • Health Source RI: www.healthsourceri.com/ • Kids Count: www.rikidscount.org/matriarch/default.asp • Economic Progress Institute at RIC: www.economicprogressri.org/ RITAP November 2013

  15. On-Line Resources • EOHHS: www.eohhs.ri.gov • Families with children www.eohhs.ri.gov/Consumer/FamilieswithChildren.aspx • CEDARR Family Centers & Katie Beckett www.eohhs.ri.gov/Consumer/ConsumerInformation/Healthcare/PeoplewithSpecialNeedsandDisabilities/Children.aspx • Health Care (children and adults) www.eohhs.ri.gov/Consumer/ConsumerInformation/Healthcare/HealthcareOverview.aspx • LEA Medicaid Guidebooks www.eohhs.ri.gov/ProvidersPartners/GeneralInformation/ProviderDirectories/LocalEducationAgency.aspx • The Departments (DCYF, DHS, BHDDH, DOH) www.eohhs.ri.gov/Home/EOHHSDepartments.aspx RITAP November 2013

  16. Key Medicaid Contacts • RITAP/Special Education: Denise Achin • 401-222-8997, denise.achin@ride.ri.gov • EOHHS/Medicaid: Shauna Jackson • 401-462-6351, sjackson@ohhs.ri.gov • Hewlett Packard/Billing Issues: Karen Murphy • 401-784-8004, karen.murphy2@hp.com RITAP November 2013

More Related