Medicaid and Education

Medicaid and Education June 13, 2012

www.cms.gov

State Plan Each state determines its State Plan within the general guidelines of the federal CMS.

Medicaid and Education Timeline 1989 1990 2000 Medicaid State Plan Amended IDEA U.S. Congress WV Code 18-2-5b Medicaid reimbursement for children with IEPs Added IEPs, Care Coor, Sp. Trans. Personal Aides Only OT, PT, Speech, Nursing, and Psychology

IDEA Reduction of Other Benefits.--Nothing in this part shall be construed to permit the State to reduce medical or other assistance available or to alter eligibility under title V of the Social Security Act… or title XIX of the Social Security Act (relating to Medicaid for infants or toddlers with disabilities) within the State.

1990 2000 Each School District – 1st # Therapy Provider # 0 00XXXXXXXX Audiology # OT # PT # SLP # RN # Psychology # Each School District – 2nd # Cost-Based Provider # 15XXXXXXXX - New Initial/Triennial IEP Annual IEP Personal Care (full) Personal Care (part) Sp. Trans. Vehicle Sp. Trans. Aide Care Coordination NPI # - 2009

15 minute = 1 billing unit 7.5 min. may round up

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Billing Form or WVEIS Entry WVDHHR - Molina Processing Agency; Bureau of Medical Services BMS Electronic claim LEA RESA Remittance Advice Denial/pending Payment – Direct Deposit Supporting Documentation: IEP Progress Notes Attendance Records Care Coordination form

Documentation • Student Related Documentation Included in IEP services – related service Notes/log • Billing Documentation - WVEIS

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

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

Cost Settlement Calculation Example WV: Introduction to Medicaid Cost Based School Based Health Services

Cost Settlement Calculation 2ndExample – Pay Back WV: Introduction to Medicaid Cost Based School Based Health Services

Cost Settlement Calculation 3rd Example – Neutral WV: Introduction to Medicaid Cost Based School Based Health Services

Rate billed for SLP, PT, OT, PSY, RN, AUD Rate billed for Care Coordination Rate billed for Personal Care Aides $County’s costs for billable services – excluding IDEA Match Results of RMTS (statewide) #Medicaid Eligible/ #Special Ed.

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 $County’s costs for billable services – excluding IDEA Results of RMTS (Direct billable) #Medicaid Eligible/ Special Education

RMTS Site Preview WV: Introduction to Medicaid Cost Based School Based Health Services

For Additional Support • LEA contact will e-mail files to wvsbhs@pcgus.com • No later than January 2012 • Staff Roster – LEA contact to CREATE • Calendar – LEA contact to CREATE • Reminder • PCG will code using a centralized standard coder • Training will be embedded in the RMTS • For additional assistance, please contact the Public Consulting Group’s West Virginia Hotline at • E-Mail Address: wvsbhs@pcgus.com WV: Introduction to Medicaid Cost Based School Based Health Services

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 Drawing from Basic Information Page – Special Education screen WVEIS #Medicaid Eligible/ #Special Education

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. Total Number of Medicaid Eligible FFS Students Receiving Direct Medical Services with an IEP IEP Ratio = Total Number of Students Receiving Direct Medical Services with an IEP WV: Introduction to Medicaid Cost Based School Based Health Services

Additional $ MAC Medicaid Administrative Claiming (MAC) WV: Introduction to Medicaid Cost Based School Based Health Services

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

Rate billed for SLP, PT, OT, PSY, RN, AUD Rate billed for Care Coor. – (Treatment Planning?) Rate billed for Personal Care Aides $County’s costs for billable services – excluding IDEA Same participants Results of RMTS (statewide) – % #Medicaid Eligible/ #Special Ed.

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.

http://wvde.state.wv.us/osp/medicaid.html

Medicaid and Education