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Arizona Medicaid School Based Claiming Regional Information Session- RMTS/ Compliance May 15, 2014 www.pcgeducation.com
Arizona Medicaid School Based Claiming
Regional Information Session- RMTS/ Compliance
May 15, 2014
www.pcgeducation.com
Agenda
Random Moment Time Study………………………... 3
Compliance Review…………………………………… 15
Quarterly Cost Reporting……………………….......... 23
Resources……………………………………………… 31
2
Random Moment Time Study (RMTS)
3
• RMTS Results Comparison
• RMTS and Cost Settlement
• A Closer Look at Personal Care
• Tips for Constructing an Accurate SPL
• RMTS Compliance
• Questions
RMTS – Reflection QuestionsHow did your LEA do over the last year?
• Evaluate how your LEA did over the last year and how you can improve
your participation in RMTS by checking the boxes below
Did your district meet and/or exceed the minimum 85% return rate
compliance requirement for the past two quarters (OD13 and JM14)?
Did you make the necessary staff pool list updates and certify your roster by
the established deadline?
Did you have a representative from the Human Resource Department and
Business Office validate the staff on your roster before certifying?
Do you communicate to district staff the importance of responding to their
RMTS moments?
Do you provide district staff on the staff pool list with general MSBC
program information?
4
RMTS MAC Percentage Comparison
• FY13 and FY14 MAC Percentages
• Percentage of time participants spend providing Medicaid administrative and
outreach services to students
• The MAC percentage is applied to the quarterly costs used to create the MAC
claim
• July – September quarter is an average of the 3 previous RMTS quarters
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FY13 FY14
JS12 OD12 JM13 AJ13 JS13 OD13 JM14*
Direct Service
Providers 9.63% 12.61% 11.26% 12.41% 12.08% 9.78% 10.61%
Administrative
Service
Providers Only
3.56% 3.61% 3.37% 3.93% 3.81% 3.30% 2.62%
*Preliminary
RMTS Direct Medical Percentage Comparison
• FY13 and FY14 direct medical percentages
• Percentage of time participants spend providing direct medical services to
students
• The average of the quarterly percentages for a fiscal year are applied to annual
costs in the DSC Annual Cost Settlement
6
FY13 FY14
OD12 JM13 AJ13 OD13 JM14*
Direct Service
Providers
46.59% 47.36% 43.22% 46.89% 48.80%
Personal Care
Providers
19.77% 19.30% 18.88% 17.18% 15.50%
*Preliminary
RMTS and Cost Settlement
• Example of how RMTS percentages impact cost settlement
• The average RMTS percentage for direct medical services from each quarter in
the fiscal year is applied to the total costs reported for cost settlement
*Percentage used for example only, not actual
7
FY12
Service Type Total Costs
Direct Medical
Percentage
Total Allowable
Costs
OT Services 500,000$ 39.82% 199,100$
Personal Care 100,000$ 20.18% 20,180$
FY13
Service Type Total Costs
Direct Medical
Percentage *
Total Allowable
Costs
OT Services 500,000$ 45.72% 228,600$
Personal Care 100,000$ 18.18% 18,180$
A Closer Look at Personal Care
• The personal care cost pool is showing a steady decline in the percentage
of time spent providing direct medical services
• Factors that may contribute to the decline in the percentage time spent
providing direct medical services
• Participants not accurately completing the time study questions
• Time study moments document what the participant is doing in their job at
the specific sampled time
• Cost pool includes aides that are not providing health related/ADL services to
students
• Participants not responding or providing adequate detail in follow-up requests8
FY12 FY13 FY14
OD11 JM12 AJ12 OD12 JM13 AJ13 OD13 JM14*
18.53% 20.21% 22.04% 19.77% 19.30% 18.88% 17.18% 15.50%
*Preliminary
A Closer Look at Personal Care
• Factors LEAs can control to help increase the RMTS percentage
• Participant training
• Ensure the participants understand the program, their role in the program,
and how to complete the RMTS moments
• Training resources
• AZ RMTS participant’s guide
• Online training in the RMTS system prior to completing the moment
• Staff pool list
• Only include health aides that are registered with AHCCCS and that provide
health related/ADL services prescribed in the IEP
• Do not include aides that are paid 100% from federal funds
• Remove aides who are no longer employed or no longer provide health
related/ADL services to students
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Tips for Constructing an Accurate SPL
• Staff Pool List
• Work with your Business Office and Human Resource department to remove
staff who are:
• No longer employed or terminated
• 100% federally funded
• Not providing health related services or outreach for health related services
• Verify that all providers billing for DSC services are included on the staff pool list
• DSC service costs cannot be reimbursed for providers not listed on the staff
pool list
• Verify participant listed in the Direct Service and the Personal Care cost pools
are registered with AHCCCS and meet the requirement for participation
• Work with your IT department and private placement agencies / providers to
verify e-mail addresses
• All participants must have access to a unique e-mail address that they
access regularly10
RMTS Compliance
• Many of the participating LEAs have done a great job in meeting and
exceeding the minimum 85% return rate compliance percentage over the
last year (JM13 through JM14)
• Each quarter an average of 98 of the 107 participating LEAs (approximately
92%) are exceeding well beyond the minimum compliance requirement
• 76 LEAs achieved 90% to 99% compliance in all four quarters reviewed
• 23 LEAs achieved 100% compliance in all four quarters reviewed
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RMTS Compliance
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100% RMTS Return Rate Compliance (JM13-JM14)
Alhambra
Elementary
Fort Thomas
Unified
Littleton
Elementary
St. Johns
Unified
Altar Valley
Elementary
Fredonia-Moccasin
Unified
Maricopa
Unified
Stanfield
Elementary
Ash Fork Joint
Unified
Heber-Overgaard
Unified
Miami
Unified
Toltec
Elementary
Camp Verde
Unified
Joseph City
Unified
Nadaburg
Unified
Wickenburg
Unified
Deer Valley
Unified
Liberty Traditional
Charter
Queen Creek
Unified
Winslow
Unified
Flowing Wells
Unified
Littlefield
Unified
Snowflake
Unified
Frequently Asked RMTS Questions
• Can I include a health aide in the personal care cost pool that does not work
with Medicaid students?
• Yes. If the aide is registered with AHCCCS and is providing health related/ADL
services prescribed on an IEP.
• How often should I monitor my staff’s participation in the time study?
• Daily. Coordinators have 24/7 access to the RMTS system. Compliance can be
monitored using the moment screen or by pulling a compliance report under the
report tab within the RMTS system. In addition, the CC contact is copied on the
24-Hour and 3-Day late notifications.
• How can we increase the RMTS percentage?
• You can help to increase the RMTS percentage by making sure you have the
appropriate staff participating in the time study, staff is trained on the program,
and by meeting quarterly return rate compliance.
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End of School Year Reminders
• With the end of the school year and summer break fast approaching, here
are reminders to help you achieve RMTS compliance
• Check your moments list to see if any moments are assigned the last weeks of
school and follow up on the compliance reports daily
• Remind participants that all moments need to be completed before they leave for
break
• Follow up on 24 hour late notifications for timely completion
• Notify PCG of any replacements, termed participants, or employees on leave
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Compliance
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• Comprehensive Review
• DSC Reviews
• MAC Quarterly Cost Reporting Reviews
• Annual Cost Settlement Reviews
Compliance – Reflection Questions
How did your LEA do over the last year?
• Evaluate how your LEA did over the last year and how you can improve
your participation in compliance by checking the boxes below
Have you attended a DSC compliance requirements webinar?
Did you attend the last Annual Regional Compliance Training?
Are you familiar with all documentation requirements for program
compliance?
Do you conduct self-reviews?
Do you review a ‘checklist’ for completed IEPs prior to billing?
Do you have an internal process for accepting incoming IEPs from
other LEAs?
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Comprehensive Review Overview
• Periodic compliance reviews
• PCG conducts periodic compliance reviews to verify that appropriate supporting
documentation is maintained by LEAs
• All participating LEAs will be reviewed at least once every three years
• Effective April – June 2014 quarter
• All program components will be reviewed concurrently
• LEAs will receive one notification
• LEAs will participate in one entrance meeting to start the review, and one
exit meeting at the finalization of the review to share findings in all areas
• All reports will be comprehensive
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Effective April – June 2014
• Comprehensive review to include an integration of the following program
components:
• Annual cost settlement documentation and reporting
• Direct service claiming
• MAC quarterly cost reporting
• Interdepartmental participation and communication
• Key LEA personnel involvement from inception to conclusion of review process is
essential
• Department representation should include the following: finance, program
coordinator, and special education
• Proactive and strategic trainings
• LEA responsibility
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DSC Reviews
• PCG reviews the supporting documentation that is maintained by the LEA to
substantiate interim payments for approved direct service, personal care,
and transportation claims
• PCG pulls a sample of paid claims for a selected period of time
• PCG verifies supporting documentation for paid claims
Supporting Documentation
IEP with a valid prescription of service Clinical Notes/Service Logs
Certification or Licensure Evaluation Report (if the claim is an
evaluation)
Summary Report Attendance Records
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MAC Quarterly Cost Reporting Reviews
• MAC Quarterly cost reporting reviews verify that the LEA’s certified costs
reported for the quarter under review are accurate using system generated
or substantiating reports for the following:
• Salaries
• Purchased Professional Service (PPS) provider costs
• Employer paid benefits
• Cost data from the documentation is entered into compliance review tool
and used to regenerate that quarter’s claim
• Variances identified between the original and regenerated claim result in
either additional reimbursement to LEA or recoupment in the form of a prior
period adjustment made to a future claim submission
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Annual Cost Settlement Reviews
• Assess the accuracy and maintenance of documentation to validate LEA
reported annual costs and other data used in the reconciliation and
settlement process for the following:
• Financial reporting
• Transportation ‘other costs’
• Trip ratio
• IEP ratio
• Vehicle ratio
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Annual Cost Settlement Reviews
• Cost settlement review documentation examples
• Desk Review Validation
• Ensure that all edits resolved during the desk review process have
documentation on file to support ‘revised’ information
• May occur with every annual cost report – not just once every three years
• At any time, PCG can request documentation to support claims / costs
Supporting Documentation
IEP with a valid prescription of service Trip logs
System generated financial records Vehicle inventory reports
Student rosters Invoices
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Quarterly Cost Reporting
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• Timeline
• Teamwork
• Tips and Reminders
Quarterly Cost Reporting – Reflection
QuestionsHow did your LEA do over the last year?
• Evaluate how your LEA did over the last year and how you can improve
your participation in quarterly cost reporting by checking the boxes
below
Are you familiar with financial reporting requirements?
Do you maintain an ‘audit folder’ to support reported costs each
quarter?
Do your vendor invoices clearly identify participant by name?
Does your supporting documentation include fund(s)/function(s),
participant names, and pay dates?
Are your system generated reports pulling the correct data?
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Timeline – Quarterly Cost Reporting• Quarterly costs are reported for all staff that were included in the Random
Moment Time Study (RMTS) for that quarter excluding the personal care
provider cost pool
• Staff are identified prior to quarter start
• During the quarter, several changes may occur
• Staff funding source may change
• Participant may terminate and/or take a leave of absence
• Costs are reported after quarter close
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October – December
Sample Timeline
Quarterly Cost Reporting
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Teamwork – Quarterly Cost Reporting• Interdepartmental Coordination
• It is important to communicate between various departments to ensure all
required information is up-to-date and accurate
• Verify with Human Resources termination dates
• Verify with RMTS coordinator to see if there is a replacement
• Work with your RMTS coordinators to accurately update rosters going
forward and to supply replacement information if applicable
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Tips and Reminders – MAC Quarterly Cost
Reporting• PPS invoices supplied must identify participant by first and last name as
listed on the staff roster
• Coordinate with vendor to obtain invoices that display participant’s full name as
listed on the staff roster
• Report federal and non-federal revenues correctly within the MCRCS
system
• Make sure all federal funds are reported accurately within the cost reporting
system
• All reports must be system generated and display the report parameters on
the header
• Consecutive page numbers
• Consistent time/date stamps
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Tips and Reminders – Reports• It is important to know what information is required for reporting and
that your reports are displaying correct, all-inclusive data
• For cost reporting:
• Quarterly cost reporting financial data should display all salaries, benefits, and
PPS costs on a cash-basis which is associated with date(s) of payment
• Reports should display 100% of all paid amounts and SHOULD NOT filter out
any non-allowable functions or federally funded amounts
• All benefits data should be employer paid portions of benefits
• All reports must clearly display report parameters on the header
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Tips and Reminders – Certification of Cost
Data• All cost data must be verified for accuracy prior to certification from District
Administrator for your LEA
• Each LEA needs to make sure that they have identified the appropriate
individual(s) to have ‘Administrator’ and ‘Editor’ rights within the MCRCS system
• Verification on information entered is an important step in entering cost data that
results in a quarterly MAC claim payment for your LEA
• Certification language includes:
• I hereby certify, under penalty of perjury, that the LEA’s expenditures
reported above are accurate, complete and identify all federal sources
appropriately
• I also certify that the LEA’s certified expenditures were incurred in
accordance with provisions of Arizona policies
• These certified expenditures are separately identified and supported in our
accounting system and the appropriate financial documentation is
maintained30
Resources
• PCG program website: https://web.pcgus.com/azschools/
• Program Handbook
• Trainings: recorded trainings available
• PCG Post Newsletters
• Compliance Review Tools
• Medicaid Cost Reporting and Claiming System (MCRCS):
https://costreporting.pcgus.com/az
• Cost Reporting Guide
• Deadlines
• AHCCCS website: www.azahcccs.gov
• AMPM
• Provider Registration information and forms
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Help Desk – 1-877-877-8011
DSC - [email protected]
RMTS - [email protected]
Cost Reporting - [email protected]
