PAIU Workgroup Meeting School-Based ACCESS Program February 7,

Agenda 2  Accomplishments  SBAP Update o Service Logs o Billing volumes o Exception Report Update o Claiming Update  RMTS Update  MCRCS Update  Medicaid Eligibility  Next Steps – Action items

SBAP Service Log Activity (through 2/5/2013) 3 Jan 30 DATA UPDATE: 488 LEAs have submitted 1,434,075 service logs Feb 6 DATA UPDATE: 491 LEAs have submitted 1,571,233 service logs Services

PA SBAP – Billing History (July, Aug, Sept)* 4 Service Logs Processed * Only months of July, Aug, Sept were processed, awaiting 2013 rates to be approved to process logs Oct 1 or later

Claiming Update The FY13 district-specific billing rates have been established and approved by DPW Claims will be generated and submitted by 2/14/13 for all services, all districts for the months of October – December 2012 Claims will also be submitted for July – September, 2012 by 2/15/13 Next claim run will be during the week of February 28,

PA SBAP – Exception Report Detail 6

Exception Report Process Part of PCG standard process for school-based billing programs is to conduct automated compliance/edit checks on all data prior to claim submission to DPW Services that do not pass all checks are not claimed for, reports are generated illustrating why services did not pass Reports are then distributed to LEAs Initial exception reports were distributed first week of January, 2013 o Response has been strong o 2 nd claiming cycle showed vast improvements This process ensures that districts have the documentation and data necessary to file compliant claims, reducing and eliminating audit risk 7

Random Moment Time Study (RMTS) Q1 results (Oct – Dec, 2012) Total moments 6,000 (both cost pools) Total responses: 4,943 Response rate: 82.38% Roster update for Q2 (Jan – March, 2013) Roster updates for Q2 completed December 7, LEAs have rosters in RMTS 54 LEAs do not have rosters in RMTS -- No EI programs Roster update for Q3 (Apr – June, 2013) Four week , live webex campaign begins Feb 1 Weekly s, weekly Q&A live webex’s Roster updates must be completed by March 8,

RMTS Discussion Items RMTS Calendars are obtained from each entity for the entire year Calendar is updated with unscheduled days off (snow days, emergencies, etc.) Calendars are all entered into the system, an algorithm is run on the calendars and the most consistent/common days/times result in a uniform/average PA calendar No moments are distributed on days off based on this average calendar RMTS Participants are all trained to answer system questions clearly and in a straightforward manner Lunch time is an appropriate answer Time off is an acceptable answer Travel time between schools is an acceptable answer 9

Medicaid Cost Reporting & Claiming System (MCRCS) Web-based tool for capturing allowable, actual costs from LEAs Training dates have been announced via & SBAP website o 1/31, 2/1, 2/4, 2/5, 2/6, and 2/8 o Dates & times posted on Training Calendar for registration o ACCESS Coordinators & Business Managers are registering MCRCS deadline for cost data entry is March 8, 2013 MCRCS is the web-based system created by PCG for school-based Medicaid programs. The purpose of the system is to: o Capture all allowable, reimbursable costs for both quarterly administrative claiming and annual cost reporting o If costs aren’t entered MAC claims and the cost report cannot be completed, impacting ACCESS reimbursement for districts 10

Medicaid Matching PCG conducts a monthly Medicaid match on all students in EasyTrac o Match consists of ‘exact’ matches on name, DOB, and gender and secondary matches using parts of the first name, parts of the last name, DOB and gender o For secondary, or enhanced, matches PCG staff evaluate the detailed records from both files to determine if a match truly exists o If last name from the district records is completely different than last name from DPW records, match is not accepted Significant audit risk exists if names between the two files don’t match or closely resemble one another o Worst case scenario with an auditor is to have a Medicaid ID assigned to wrong student and claims are being submitted o Nicknames, shortened names, hyphens, apostrophes, middle initials, etc are all causes for matches to fail o Process is for district to engage parent and have misspelling or name changes updated in DPW or district files, whichever is incorrect 11

PCG Representative Assignments 12 Name & IU’s (and their districts) Patrick Cassidy 5, 6, 7, 8, 9, 10, 16, 28 Don Seidel 1, 2, 3, 4, 17, 19, 27 Andy Martin 24, 25, EIwyn Shawn DeVito 18, 20, 22, 23 Jennifer Taylor 13, 14, 21 Brittany St. Amand 26 Miguel Salaman 11, 12, 15, 29

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