Medicaid and Education Office of Special Programs WV Department of Education June 2014 Medicaid and Education Data and Reports Modules 1-4

Overview Medicaid Reimbursement to School Districts Member ID Provider ID Medicaid Billing Screens Medicaid Billing Edit Report Report Format – Writer Special Education Eligibility Codes Miscellaneous Screen Certification of Medicaid Eligibility How the information will be used (Cost Reports) Random Moment Time Study

Medicaid Reimbursement to Schools 1990 West Virginia Legislature enacted WV Code 18-2-5b for Direct Services : Audiological Speech Physical Occupational Psychological Nurse 2000 West Virginia submitted State Plan adding: Treatment Plans Care Coor. Personal Care Aide Special Trans. – Vehicle Special Trans. - Aide 1988 U.S. Congress amended the Social Security Act 1988 Congress amended the Social Security Act to prohibit Medicaid from denying payment for covered services to children with Individualized Education Programs (IEPs) or Individualized Family Services Plan (IFSP) under IDEA Part B. Modules 1-4

Medicaid Reimbursement to School Districts

Member Identification If the RESA has staff assigned solely to Medicaid billing, the RESA Medicaid Specialist will look up Medicaid numbers for their respective counties.

Member Identification If given access to the Medicaid number look-up, there will be CFM.MMI MMIS In their menu. To look up Medicaid numbers, county Medicaid staff will need permission from their Special Education Director to have access to the Medicaid number look-up.

Member Identification

Member Identification Special Education Basic Information

Member Identification On the special education screens, the two selections regarding Medicaid are Basic Information and Medicaid Billing.

Member Identification Address Medicaid Basic Information contains the student’s address which is transmitted with the billing. This is entered by the school. If any lines of the mailing address are blank, the claim will be rejected. Also, the Date of Birth is transmitted with the billing. The Medicaid processing agency, Molina Healthcare Solutions, is now requiring that the birth date match the birth date in their database. The Medicaid number is entered here. If the student has a Medicaid number, enter it here, even if the parent does not give parental consent to bill. If the student has a Medicaid number, it will count in the ratio of students eligible as Medicaid to students with IEPs. If the number has closed, enter the date closed. If the parent has/has not given permission to bill, enter Y or N.

Member Identification Diagnosis Code

Member Identification Page Down Diagnosis Code

Provider Identification Individual Providers must be enrolled with Medicaid under the County’s Provider Number.

Provider Identification On the special education screens, the two selections regarding Medicaid are Basic Information and Medicaid Billing.

Provider Identification

Provider Identification Medicaid Billing Screens Enter new billing For care coordination, personal care aides, sp. Transportation - select County Name. For Speech and other therapies, select the name of the provider.

Medicaid Billing Screens

Medicaid Billing Screens

Medicaid Billing Edit Report

Medicaid Billing Edit Report

Report Writer Format

Report Writer Format Report Writer Format

Report Writer Format Page down

Report Writer Format

Report Writer Format Report Writer Format

Report Writer Report Writer Format

Report Writer

Report Writer

Report Writer

Special Education Eligibility Codes

Special Education Eligibility Codes

Special Education Eligibility Codes

Special Education Eligibility Codes

Special Education Miscellaneous Screen

Special Education Transportation

Special Education Certified Medicaid Count

Special Education Certified Medicaid Count

Special Education Certified Medicaid Count

Cost Reporting District’s Costs of Providing $3,000,000 Less the results of the RMTS - 2.52% Total Costs less RMTS results $75,600 Vendors/contracted costs $0 Total Costs with Contracted $75,600 District’s IEP ratio reduction Medicaid eligible 50% All Special Ed Students Total Costs less IEP ratio $37,800 District’s Medicaid Reimbursement $195,000 Cost Settlement Difference between Costs and Reimbursement $157,200

Random Moment Time Studies

Random Moment Time Study What is the purpose of the time study? The Random Moment Time Study (RMTS) is designed to identify the portion of time spent providing services covered by Medicaid.

Annual Costs District’s Costs of Providing $3,000,000 Less the results of the RMTS - 2.52% Total Costs less RMTS results $75,600 Vendors/contracted costs $0 Total Costs with Contracted $75,600 District’s IEP ratio reduction Medicaid eligible 50% All Special Ed Students Total Costs less IEP ratio $37,800 District’s Medicaid Reimbursement $195,000 Cost Settlement Difference between Costs and Reimbursement $157,200

https://easyrmts.pcgus.com/RMTSv2/LoginCheck.aspx RMTS Reports

Random Moment Time Study

Compliance Report

Review Medicaid Reimbursement to School Districts Member ID Provider ID Medicaid Billing Screens Medicaid Billing Edit Report Report Format – Writer Special Education Eligibility Codes Miscellaneous Screen Certification of Medicaid Eligibility How the information will be used (Cost Reports) Random Moment Time Study