1
Implementing the New Medicaid SBS Program December 3, 2008, Lansing Sheraton Inn1:30-3:30pmAdapted from PCG Webinars of Aug/Sept/Oct 2008 and a presentation given at MAASE on Oct 15, 2008by Tom Koepke (Macomb), Liz Patrick (Ingham) and Jane Reagan (MDE)
Michigan Medicaid School Based Services Program
2
Agenda Welcome Review Purpose SBS New Program effective July 1, 2008 Legislative Update Evaluation Next meeting date:
Thursday February 26, 2009 Agenda?
3
Purpose of Today’s Meeting This is our meeting We all need to be on the same page Network!
4
New Communication Structure Medicaid Coordinators / Implementers Work Group
Information for you who Implement Medicaid SBS Policy from Policy Work Group
Day-to-day operations, training staff, develop staff pool lists, facilitate financial reports, work with billing companies
Probably meeting up to 6x year after Policy meetings Feedback loop continuous with Policy Work Group
Policy Work Group for Direct Services and AOP Small but representative of Superintendents & Special Ed Directors Likely meet up to 6x year Will be responsible for setting policy and assisting DCH in proper
dissemination of the decisions made by the group. Vendors Work Group
May be revived again by MDCH
5
Overview of Program Changes
1993-2008 Two components
Fee For Service/direct care
AOP--outreach
Statewide fees paid Claims, per kid/per
date/per service
Effective July 1, 2008 Four components
Direct services, AOP, TCM, PC
Mutually Exclusive
Annual Cost Report
6
Time Studies Federal Medicaid agency requires
3000 moments, in EACH of 4 time studies Each quarter (15x more moments/people sampled) Each TS staff can be in only ONE of the 4 (mutually
exclusive) time studies each quarter Only staff who are included in the staff pool
lists can be included on Medicaid Allowable end-of-year Cost/Expenditure Reports
If staff are not in time study pool, you may not ask for Medicaid $$ reimbursement, year end
7
Time Studies – Importance of Staff Pools
Even though some staff do several jobs, each of the 4 RMTS must be unique/ exclusive of other staff pool lists
Direct health care services AOP only Case management/Designated Case Managers Personal Care Many of these staff have never been in SBS time
studies → some seem hard to determine where is best to place them
8
I. STAFF POOL: Direct Services
ASHA certified Speech Language Pathologists Licensed Audiologists Licensed Registered Nurses (RN) Certified and registered Occupational Therapists
(OTR) Licensed Physical Therapists (LPT) Certified Orientation & Mobility Specialists (O&M) Fully Licensed Psychologists (Doctoral level) Licensed Social Workers (Masters level)
9
Staff qualify if:
TSLIs, under the direction of an ASHA certified SLP or audiologist
Speech Language Pathologist and/or Audiology candidates, under the direction of an ASHA certified SLP or audiologist
Certified Occupational Therapy Assistants, under the direction of a currently-Michigan-registered OTR
Certified Physical Therapy Assistants, under the direction of a currently-Michigan-licensed LPT
10
Staff qualify if:
Limited-licensed Psychologists, under the supervision of a licensed psychologist
Limited-licensed Social Workers, under the supervision of a licensed social worker
Licensed Practical Nurses, under the supervision of an RN or Physician
11
II. STAFF POOL: Administrative Outreach (AOP)
The Administrative Outreach staff pool consist of individuals who perform only administrative outreach activities
Administrative Outreach activities may be performed for both General Ed and Special Ed students
Medical staff that no longer meet the Direct Service staff pool qualifications should be included in the AOP list.
12
AOP staff:
Administrators Counselors Early Identification/Intervention Personnel Program Specialists Teacher Consultants = Your choice Speech-Language Pathologist – TSLIs who have no
CCC’s Psychologist – No DCH-License, Not supervised by a
DCH- Licensed Psychologists; (includes many School Psychologists)
Licensed Practical Nurses, Not supervised by a RN
13
III. STAFF POOL:Case Manager
Consist of individuals who perform Targeted Case Management (TCM) Services.
Special Educations Teachers Teacher Consultants = Your choice
14
IV. STAFF POOL: Personal Care
Consist of those who perform Direct Personal Care activities pursuant to the students IEP/IFSP
Personal Care must be indicated on the IEP
15
Personal Care staff :(may have the title of)
Bilingual aide Health aide Instructional aide Paraprofessional Program Assistant Teacher aide Trainable aide
16
Personal CareBilling Requirements:
Documented in the student's IEP. “Authorized” by physician, “other licensed
practitioner…” (RN, PT, OT, MSW, SLP w/CCC Daily log per student – some ISDs have
developed nice templates
17
Time Studies
Very Important to Remember!We need 100% complianceProvide helpful hints to your clinicians
regarding proper terminology in answering the Time Study questions
18
FFS Reimbursement
Reimbursement is now: Cost-based Provider (ISD) specific Annually reconciled
Preliminary payment Final calculation Cost settlement process
19
Preliminary Payment 75% of 2006-07 revenue Monthly payments Claim volume reductions will impact
preliminary payment % (Nov 08 L Letter)
20
Reimbursement Formula
Total Allowable Costs (inc. indirect)
x Direct service % (state-wide)
x SE Med Elig Rate, Hlth Svs (ISD)
x Fed Financial Participation (’09=60.27%)
x ISD Reimbursement Rate (60%)
Net Dollars to ISD
21
SE Medicaid Eligibility Rate (MER)
Medicaid Eligible SE Students w/health-related support service in their IEP**
_______________________________________________________
Total SE Students w/health-related support service in their IEP
** - December 1 count data used – Field 43 & Field 57
22
Financial Reporting Quarterly Financials
AOP Direct Service Personal Care Case Management
Annual reporting = 4 qtrs of financials ISD Certification May Training
23
Reimbursement Formula - Transportation
Total Allowable Allowable one-way trips
Costs Total one way trips
x Fed Financial Participation (60.27% ‘09)
x ISD Reimbursement Rate (60%)
Net Dollars to ISD
X
24
Reimbursement Formula Transportation
Allowable trips Rider attendance logs Documentation of need in IEP Medicaid-covered service provided on same
date
25
2008-09 Cost Settlement
Comparison between approved Medicaid costs vs. interim payments
Oct-Dec 09 - Cost compilation Jan-June 10 – Cost settlements & pymt
adjustments begin Similar to timeline of SE State Aid pymts
26
Legislative Update
Moratorium John Dingell Backcasting
27
Congress’ Moratorium on Proposed Regs– until April 1, 2009
Federal CMS proposed in 2007 to: Eliminate reimbursement in US for
Administrative Outreach (AOP) Transportation
Redefine/limit targeted case management Redefine/ limit rehabilitative services to exclude
reimbursement for “intrinsic elements” of education programs
Limit reimbursement to governmental provider’s costs with narrow definition
28
Questions & Discussion
29
Next Meeting
February 26, 2009, 1:30-3:30
Ingham ISD
Thorburn Education Center, Room AB
2630 W. Howell Rd
Mason, 48854
30
Resources Medicaid SBS Policy Manual online—click on:
www.michigan.gov/mdch Providers (left navigation bar) Providers (under CHAMPS header, scroll down) Medicaid (under ‘hot topics’) (get information about) Policy and Forms Medicaid Provider Manual Medicaid Provider Manual (warns you it’s HUGE file) Three ‘chapters’ labeled “School Based Services”
Totals about 100 pages—eff 12-3-08, print out pages 1350 to 1446
31
Resources Medicaid SBS info online—Provider Inquirer
Newsletters, Letters and Mtg notes—are supplements to official Manual-- click on: www.michigan.gov/mdch Providers (left navigation bar) Providers (under CHAMPS header, scroll down) Medicaid Communications and Training Provider Inquirer Newsletters (sorted by date) Numbered Letters (same page, scroll down) Provider Liaison Meetings (same page, scroll
down) SBS—this loaded with info, mtg summaries
32
Resources Medicaid SBS info online More details about cost-based
reimbursement process, training sessions, forms, documents effective 7-1-08: www.michigan.gov/MedicaidProviders Billing and Reimbursement Provider Specific Information School Based Services
