Business Associate Agreement and Access to Eligibility Information William Lessard Department of Medical Assistance Services September 14, 2010

2 Purpose of BAA n To safeguard protected health information n To insure it is only used for designated purpose

3 Business Associate Agreement n DMAS is furnishing eligibility data to school division providers n School division providers agree to use this data to –Determine the eligibility percentages for the school cost reports –Assist Medicaid, Medicaid Expansion and FAMIS students in accessing health care

4 Components of BAA n Data Security Plan n Chain of Trust n Scope of Work

5 Data Security Plan n Describes procedures for safeguarding the data n May be a separate plan or part of an existing data security plan n If part of an existing data security plan, review provisions and consider amending to refer to Medicaid eligibility data

6 Personnel Costs n Track accrued salary and benefit costs n No estimates are allowed n Include all contract costs

7 Personnel Costs n Track payroll and contract costs by fund source n Determine % funded by state/local funds, IDEA funds, other federal funds or other funding sources n Only costs funded by state/local funds will be carried forward for reimbursement

8 Non-Personnel Costs Line items n Travel n Materials and Supplies n Capital Costs Indirect Costs

9 Requirements for Non-Personnel Costs n Line items contingent on CMS approval n At option of school division n Directly related to school medical services (not general supplies) n DMAS will provide additional guidance n Documentation required such as a depreciation schedule n Indirect costs only reimbursed to the extent they are in the indirect cost rate

10 Travel Costs n Cost incurred by school n Cost of medical services staff traveling between schools to deliver services n Recommend that school divisions base the cost on mileage using logs

11 Material and Supply Costs n Not the same as material and supply costs for administrative claim n Directly related to the delivery of medical services (not general supplies) n 100% allocated to medical services n DMAS is developing a non-exclusive list based on DOE School Health and Therapy Guidelines n CMS has not yet approved software costs

12 Capital Costs n Major moveables directly related to the delivery of medical services n 100% allocated to medical services n Cost usually over $5,000 and a useful life of at least two years n DMAS is developing a non-exclusive list based on DOE School Health and Therapy Guidelines n Use straight-line method n Separate depreciation schedule n Does not include depreciation for buildings included in the administrative claim

13 Indirect Costs n Use Unrestricted Indirect Cost Rate approved by DOE n No other indirect costs

14 Tentative Cost Reporting and Settlement Schedule n June 30 – End of fiscal year n September 30 – DMAS distributes cost report forms and other reports n November 30 – Deadline to submit cost reports n May 31 – Deadline for DMAS to settle cost reports (180 days from submission)

15 Tentative Cost Reporting and Settlement Schedule n CMS has asked DMAS to specify time frames n Similar to time frames for other cost reporting providers n Open to discuss other time frames

16 DMAS Cost Settlement Contractor Clifton Gunderson 4461 Cox Road, Suite 210 Glen Allen, VA 23060

17 Certification n CMS requires that public providers (school divisions) certify costs n School divisions already certify costs for the administrative claim n Cost report certification replaces the Medicaid/FAMIS Program State/Local Match Quarterly Certification (Med-2A thru Med 2-G) n Final form to be determined by CMS

18 Cost Settlement n If DMAS has made interim payments, then the cost report will determine which party owes the other party

19 Cost Settlement n If DMAS owes the school division, DMAS will pay the difference in the next remittance n If the school division owes DMAS, DMAS can recoup the overpayment either (1) by direct payment or (2) by collecting the overpayment from future payments that otherwise would be made (negative balance) n CMS has not yet approved the negative balance approach

20 Interim Payments n Interim payments will be made for approved claims n Important to school divisions for cash flow n If interim payments are too large, however, school divisions could owe DMAS large amounts

21 Interim Payment Calculations n DMAS has not yet determined appropriate interim rates for the coming fiscal year n DMAS will use administrative claiming information, available survey data and Medicaid claim information to recommend an interim rate n DMAS will make recommendation before the school year begins using conservative assumptions n DMAS will work with school divisions, particularly small school divisions n Large margin of error until first cost report is settled n Future interim rates can be based on prior year settled costs

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23 Interim Rate Calculation Estimated Reimbursement ÷ Estimated Claims = Interim Payment Rate

24 ProForma Cost Report n A school division can prepare a proforma cost report for FY2006 n DMAS can provide estimates of eligibility percentages, direct service time study percentages and claims paid

25 School Division Responsibility n The rate limit will be the current fees n The school division can determine how much it is paid on an interim basis by the charges it submits n A school division can choose to submit charges equal to the current rate, the recommended interim rate or a more conservative interim rate n Interim payments have no impact on final reimbursement

26 Contact Information DMAS n John Jurgens, Health Insurance Reimbursement Specialist, or DOE n Amy Edwards, Medicaid Specialist, or