September 26, 2003 Replacing Silos with Technology: Sharing Data Across Medicaid and Education

Contact Information Roberta Puffer rpuffer@dc.com 847-753-8558 Steve Koruna stkoruna@dc.com 847-753-8515 Please feel free to contact us with any questions you may have about the following presentation, or for further information regarding our solutions and services for school based Medicaid reimbursement

Agenda Challenges facing Education and Medicaid agencies An approach for data sharing across organizations Data and sharing strategies and benefits Data sharing success stories Conclusions Questions

Challenges Facing Medicaid and Education Agencies

Program and policy challenges Implementations are unique from state to state State flexibility CMS regional oversight Schools and states are challenged to keep pace with complex and changing regulations: CMS Guidelines and ongoing program changes Multiple interpretations of Federal policy Schools need ready access to considerable subject matter expertise to participate effectively Staffing and funding shortfalls at both agencies exist; there are insufficient funds to pay for necessary program administration Coordination challenges with related programs, such as No Child Left Behind and proposed IDEA reauthorization

Interagency coordination and communication challenges Where Education and Medicaid both play an active role, challenges surrounding coordination of roles can emerge: Conflicting priorities Communication protocols Specialized expertise When the program is lead by only one of the agencies - Medicaid or Education - , communication challenges may occur LEAs are not a natural constituent of CMS or Medicaid The sheer volume and complexity of program information to be communicated and maintained leads to a host of training issues at all levels CMS State Medicaid Agency State Education Agency Local Education Agency

Data collection and management challenges Direct Service Reimbursement Documentation Data Uses DS or MAC Participation Student Information Special Ed. Status Financial Data Common Data Requirements Medicaid Eligibility Staff Credentials Service Documentation. Transportation Data Administrative Management Systems Student Information System Financial System Special Ed. Solution or Documentation State Medicaid System (s) State Education System (s) Data Sources

Data collection and management challenges Special Education Documentation Data Uses Student Information Special Ed. Status Common Data Requirements Staff Credentials Service Documentation. Transportation Data State Medicaid System (s) State Medicaid System (s) Administrative Management Systems Financial System State Medicaid System (s) Data Sources Student Information System Special Ed. Solution or Documentation State Education System (s) State Education System (s) State Education System (s)

Data collection and management challenges Direct Service Reimbursement Documentation Special Education Documentation Data Uses DS or MAC Participation Student Information Special Ed. Status Financial Data Common Data Requirements Medicaid Eligibility Staff Credentials Service Documentation. Transportation Data State Medicaid System (s) State Medicaid System (s) Administrative Management Systems Financial System State Medicaid System (s) Data Sources Student Information System Special Ed. Solution or Documentation State Education System (s) State Education System (s) State Education System (s)

Data collection and management challenges MAC Documentation Direct Service Reimbursement Documentation Special Education Documentation State/Federal Reporting Data Uses Activities performed DS or MAC Participation Student Information Special Ed. Status Financial Data Common Data Requirements Medicaid Eligibility Staff Credentials Service Documentation. Transportation Data State Medicaid System (s) State Medicaid System (s) Administrative Management Systems Financial System State Medicaid System (s) Data Sources Student Information System Special Ed. Solution or Documentation State Education System (s) State Education System (s) State Education System (s)

Data challenges created by silos Efficiency Data is collected to support programs, rather than as part of natural processes. Technology involved is also typically program specific. As a result: Schools are incurring costs for multiple technology solutions, MAC and DS vendors, and internal costs to develop state reporting. States incur additional costs to process claims and manage state reporting. A primary benefit of technology is not realized due to lack of integration. Effectiveness Data is not as accurate as it could be, as it is not collected at the source. Inability to effectively reconcile information across programs: MAC and DS DS and Special Education Management Inability to manage and monitor programs on a proactive basis. Data does not become information until the claim is filed, yet the building blocks to prevent errors existed long before. Inability to measure program outcomes effectively