Medicaid Allowable Expenditure Report-

MAERAmy Kanter, SBS Auditor

Michigan Department of Health and Human Services

2015 MDHHS SBS Conference – Traverse City, MI

August 17 & 18, 2015

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Background(MI Medicaid Provider Manual)

The Medicaid Allowable Expenditure Report (MAER) is modeled after the SE 4096 & SE 4094

Used to collect allowable medical and transportation costs Targeted Case Management (TCM) and Personal Care (PC) costs

are collected from the financial accounting system and sent to MDHHS by the State Contractor

Template retrieved from the SBS website each year November 1st for the LEA’s

MAER

The MAER is the key component of the School Based Services (SBS) cost reconciliation and cost settlement process Old method: SBS providers would submit bills for services

rendered and received reimbursement for the bills based on various service rates

New method: SBS providers are reimbursed for the actual cost of providing services

Is used only for Direct Medical Staff and Transportation Costs

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Completing the MAER

Salary and benefits, purchased services, and other expenditure data will come from LEA payroll and/or finance system(s) Data will represent Annual Staff Pool Summary Lists for each provider

category Totals will not exceed SE4096/SE4094 line item totals for each function

and object code Quarterly financials cannot be used to complete the MAER as they

are on a cash basis MAER must be completed on an annually and is on an accrual basis

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Timeline

Medicaid Eligibility Rate (MER)

The Medicaid special education health-related rate is: Children and students with Medicaid eligibility who have an IEP

or IFSP AND who are also receiving at least one health related service (numerator)

Total number of children and students who have an IEP or IFSP and receiving at least one health related service (denominator)

MER Calculation Cont.

Around April of each year, the ISD’s receive an email from MDHHS that requests updates to the contacts, LEA’s, and PSA’s

New change- all of the LEA’s will automatically be included according to a list retrieved from CEPI.

ISD’s are required to provide me only the PSA’s that they want included in the calculation and on the MAER

MER Calculation Cont.

CEPI supplies MDHHS with a large file that contains all of the Special Education information taken from the student count in the fall

MDHHS runs a query to determine all of the Medicaid eligible students in Michigan during the month of the student count (this year was October). The filter criteria for this query Up to age 26 on the date of collection They are receiving a health related service

These 2 files are compared to determine the number of Medicaid eligible special education students per ISD for the month of the student count

MER Calculation Cont.

When the files are compared, a point system is used to determine full matches

If the files are compared but they only received partial points, a partial match file is created and the ISD is given time to provide the Medicaid number

***It is very important that when the ISD receives the partial match files, no changes are made to the formatting, headers, columns, etc.

Sample Partial Match File

MER Calculation Cont.

Once the partial match files are returned back to MDHHS, they are imported into the program

The formula for calculating the MER is:Medicaid eligible IEP & IFSP students

Total IEP & IFSP students After MDHHS reviews and ensures accuracy, a letter is

issued via File Transfer to notify the ISD’s of the MER that will be applied

MER Notification Letter

Reimbursement For Transportation

A cost per trip is calculated taking the total transportation costs and dividing by the number of one-way trips submitted by the ISD on the MAER From bus logs Calculated: # of special education students X 2 trips per day X

# of school days The cost per trip is multiplied to the allowable

transportation claims with a paid medical claim associated and retrieved from CHAMPS

Tips For Reviewing the MAER

The costs reported on the MAER cannot exceed what was reported to MDE on the SE4094 and SE4096

Staff costs that are included on the MAER must reflect the staff that are reported on the Staff Pool List

One way bus trips Ensure that all rates are accurate PCG online MAER training each year in the fall

MMF Summary Software

Deadline for MAER submission is December 31st

Settlements are processed in the order in which they are received

Costs are imported into the MMF for review of accuracy A .mer file is created for upload into File Transfer Signed and dated provider certification is required for

each and every submission.

Initial Settlement

Initial settlements completed 90 days after MAER submission Cost comparison for prior year MAER costs compared to current

year MAER costs Must be under a 120% total increase threshold (bus trips have a

cost per trip threshold of $50/trip) If above the threshold, documentation/explanation will be required to

support

Sample Initial Settlement Letter

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Final Settlement

Cannot be completed prior to one year after the ISD’s FYE (June 30th of the prior year)

Can be processed without an initial settlement ***No settlement is processed until MDHHS is

reasonable confident that figures presented in the MAER accurately reflect the ISD’s expenditures

Comparison report is run on the MAER costs and costs reported on the SE4094 & SE4096 Ensure that cost on MAER do not exceed the SE4094 & SE4096 Nursing costs are an exception

Sample Medical Comparison Report

Sample Transportation Comparison Report

Sample SE4096

Sample SE4094

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Michigan Public School Accounting Manual The Michigan School Accounting Manual (Bulletin 1022)

serves as a mandatory guide to the uniform classification and recording of accounting transactions for Michigan public school districts

The general classification of objects and expenditures are those which are found in Bulletin 1022, the Accounting Manual for school districts

http://www.michigan.gov/mde/0,1607,7-140-6530_6605-21321--,00.html

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Nursing General Ledger

Nursing costs can also be reported under general education and still be allowable on the MAER

General ledger support documentation required

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Support Documentation-G/L

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Federal Funds

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Function Code Example

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Object Code Example

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Amendment Letters Issued If Costs Exceed Comparison report reflects MAER costs above what was

reported on the SE4094 & SE4096 Amendment letters are issued Cost will need to be amended and resubmitted

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Steps To Revise MAER

Locate the original .csv files that the LEA’s had submitted to the ISD’s

Locate the MAER for the appropriate FYE It is important to put the appropriate MAER and the .csv files into a

folder Open up the MAER and it should pull the .csv files stored in the

folder and allow you to make changes Import the amended files into the MMF and check the costs for

accuracy Do a save as and it will create a .mer file to upload into File Transfer A new provider certification page is required for each submission

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Final Settlement Letters

Final settlement letters are issued after the review ISD’s have 30 days to appeal the costs Can send a signed copy of the reconciliation page in the

settlement if approved within the 30 days Notice of Program Reimbursement (NAPR)

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Sample Final Settlement Letter

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Sample NAPR Letter

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Your Role

Be proactiveEnsure the figures presented are accurate

Take corrective actionsRespond to amendments in a timely manner

Stress importance Ask questions

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Questions?

Contact Information –

Email: kantera@michigan.govPhone: 517-373-4522Fax: 517-241-7408

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