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

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

3. Business Associate Agreement
DMAS is furnishing eligibility data to school division providers
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
Data Security Plan
Chain of Trust
Scope of Work

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

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

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

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

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

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

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

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

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

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

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

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

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

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

19. Cost Settlement
If DMAS owes the school division, DMAS will pay the difference in the next remittance
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)
CMS has not yet approved the negative balance approach

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

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

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

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

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

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