Medicaid Administrative Claiming (MAC) Public Consulting Group 5/31/2018 Medicaid Administrative Claiming (MAC) Wisconsin Association of School Business Officials (WASBO) March 19, 2014 www.publicconsultinggroup.com www.publicconsultinggroup.com

Public Consulting Group 5/31/2018 Agenda School Based Medicaid in Wisconsin MAC Components & Updates Monitoring Reviews Common Review Findings Contacts Questions? www.publicconsultinggroup.com

School Based Medicaid in Wisconsin Public Consulting Group 5/31/2018 School Based Medicaid in Wisconsin Public Consulting Group (PCG) has been under contract with the Wisconsin Department of Health Services (DHS) since 2009 to calculate quarterly Medicaid Administrative Claims (MAC) and facilitate annual Medicaid cost reporting, beginning with the 2009 Fiscal Year reporting period. During this time PCG has completed processing MAC for the following school years: 2007/2008, 2008/2009, 2009/2010, 2010/2011, 2011/2012, and most recently 2012/2013 (payment received in the last 30 days) The program has grown from 394 districts participating in 2008/2009 to 417 in 2013/2014. As a reminder: MAC: Quarterly Administrative Medicaid Cost Report: Annual Direct Medical Cost Settlement FFS: Fee For Service Interim Billing for Direct Medical Services www.publicconsultinggroup.com

School Based Medicaid Reimbursement in Wisconsin Fee-For Service Billing and payment occurs throughout the year for direct medical services FFS Medicaid Administrative Claiming MAC Annual Cost Settlement for Direct Medical and Transportation Costs Annual Cost Settlement

MAC Components Quarterly Staff Pool List Quarterly Random Moment Time Study Quarterly Financial Collection Quarterly Financial Edit Checks Claim Generation Payment Sent to Districts

MAC Updates Since January of 2009, PCG has processed claims totaling a district share of over 60 million dollars Certification of Public Expenditure forms must be signed and returned to PCG by the deadline in order to receive a payment 96.2% of all CPE forms were received on time for the 2012-2013 claims 99.04% of school districts have certified their financials for 2012/2013 and were included in MAC claims processing Approximately 96% of all random moments were completed on time for the Oct-Dec 2013 quarter

Accurate RMTS Process Increased Follow-up Updated & Accurate Staff Pool Lists Detailed Reporting Enhanced District Involvement MAC Improvements Wisconsin MAC has seen significant progress statewide since January, 2009. What changed? .

Monitoring Reviews PCG will be continuing On-site and Remote Monitoring Review efforts in April/May 2014 to ensure compliance for MAC and Annual Cost Reporting. Selected districts have been strategically chosen by PCG, DHS, and DPI. Districts must provide PCG with: Requested salary, benefit, contracted staff costs source data Proof of Annual and Quarterly “Other Costs” reported Proper service provider Certification/Licensure Transportation proof Proof of Cost Report ratios (i.e., IEP Ratio, Trips Ratio, and/or Vehicle Ratio) Direct Support proof (NEW) Report summarizing review findings will be sent to the district and the state. All over claiming will be adjusted. Corrective Action Plan may be required.

Common Review Findings The district claimed federal dollars Salary and benefits Materials and Supplies The district claimed costs for a service provider without current licensure The district can’t find their bus logs The district reported a direct support person without evidence that they actually provide direct support The district can’t find where the reported number came from

Next Steps UPCOMING MAC DEADLINES January-March 2014 MAC Quarterly Financial Submission Due 5/16/2014 April –June 2014 MAC Quarterly Financial Submission Due 8/15/2014 Monitoring Reviews for Select Districts April/May 2014

Contacts Help Desk Toll-free Number: 1-877-395-5019 PCG Education Contacts DSC Annual Cost Report Transportation Training Help Desk Toll-free Number: 1-877-395-5019 Press 1: Username and password for RMTS sampled participant Press 2: Questions about the Staff Pool Lists, RMTS process, or MAC Program Press 3: Questions about MCRCS/Medicaid Cost Report Press 4: General Questions Cost Reporting Questions: wicostreport@pcgus.com MAC Questions: wimacs@pcgus.com WI Medicaid Cost Reporting and Claiming System (MCRCS): https://costreporting.pcgus.com/wi RMTS Website: https://easyrmts.pcgus.com/rmtsv2 www.pcgeducation.com

Public Consulting Group 5/31/2018 Questions? www.publicconsultinggroup.com

Public Consulting Group 5/31/2018 Public Consulting Group, Inc. 148 State Street, Tenth Floor, Boston, Massachusetts 02109 (617) 426-2026, www.publicconsultinggroup.com www.publicconsultinggroup.com