1. Medicaid Administrative Claiming (MAC)
Public Consulting Group
5/31/2018
Medicaid Administrative Claiming (MAC)
Wisconsin Association of School Business Officials (WASBO)
March 19, 2014

2. Public Consulting Group
5/31/2018
Agenda
School Based Medicaid in Wisconsin
MAC Components & Updates
Monitoring Reviews
Common Review Findings
Contacts
Questions?

3. School Based Medicaid in Wisconsin
Public Consulting Group
5/31/2018
School Based Medicaid in Wisconsin
Public Consulting Group (PCG) has been under contract with the Wisconsin Department of Health Services (DHS) since 2009 to calculate quarterly Medicaid Administrative Claims (MAC) and facilitate annual Medicaid cost reporting, beginning with the 2009 Fiscal Year reporting period.
During this time PCG has completed processing MAC for the following school years: 2007/2008, 2008/2009, 2009/2010, 2010/2011, 2011/2012, and most recently 2012/2013 (payment received in the last 30 days)
The program has grown from 394 districts participating in 2008/2009 to 417 in 2013/2014.
As a reminder:
MAC: Quarterly Administrative
Medicaid Cost Report: Annual Direct Medical Cost Settlement
FFS: Fee For Service Interim Billing for Direct Medical Services

4. School Based Medicaid Reimbursement in Wisconsin
Fee-For Service Billing and payment occurs throughout the year for direct medical services
FFS
Medicaid Administrative Claiming
MAC
Annual Cost Settlement for Direct Medical and Transportation Costs
Annual Cost Settlement

5. MAC Components Quarterly Staff Pool List
Quarterly Random Moment Time Study
Quarterly Financial Collection
Quarterly Financial Edit Checks
Claim Generation
Payment Sent to Districts

6. MAC Updates
Since January of 2009, PCG has processed claims totaling a district share of over 60 million dollars
Certification of Public Expenditure forms must be signed and returned to PCG by the deadline in order to receive a payment
96.2% of all CPE forms were received on time for the claims
99.04% of school districts have certified their financials for 2012/2013 and were included in MAC claims processing
Approximately 96% of all random moments were completed on time for the Oct-Dec 2013 quarter

7. Accurate RMTS Process
Increased Follow-up
Updated & Accurate Staff Pool Lists
Detailed Reporting
Enhanced District Involvement
MAC Improvements
Wisconsin MAC has seen significant progress statewide since January, 2009.
What changed? .

8. Monitoring Reviews
PCG will be continuing On-site and Remote Monitoring Review efforts in April/May 2014 to ensure compliance for MAC and Annual Cost Reporting.
Selected districts have been strategically chosen by PCG, DHS, and DPI.
Districts must provide PCG with:
Requested salary, benefit, contracted staff costs source data
Proof of Annual and Quarterly “Other Costs” reported
Proper service provider Certification/Licensure
Transportation proof
Proof of Cost Report ratios (i.e., IEP Ratio, Trips Ratio, and/or Vehicle Ratio)
Direct Support proof (NEW)
Report summarizing review findings will be sent to the district and the state.
All over claiming will be adjusted.
Corrective Action Plan may be required.

9. Common Review Findings
The district claimed federal dollars
Salary and benefits
Materials and Supplies
The district claimed costs for a service provider without current licensure
The district can’t find their bus logs
The district reported a direct support person without evidence that they actually provide direct support
The district can’t find where the reported number came from

10. Next Steps UPCOMING MAC DEADLINES
January-March 2014 MAC Quarterly Financial Submission
Due 5/16/2014
April –June 2014 MAC Quarterly Financial Submission
Due 8/15/2014
Monitoring Reviews for Select Districts
April/May 2014

11. Contacts Help Desk Toll-free Number: 1-877-395-5019
PCG Education
Contacts
DSC Annual Cost Report Transportation Training
Help Desk Toll-free Number:
Press 1: Username and password for RMTS sampled participant
Press 2: Questions about the Staff Pool Lists, RMTS process, or MAC Program
Press 3: Questions about MCRCS/Medicaid Cost Report
Press 4: General Questions
Cost Reporting Questions:
MAC Questions:
WI Medicaid Cost Reporting and Claiming System (MCRCS):
RMTS Website:

12. Public Consulting Group
5/31/2018
Questions?

13. Public Consulting Group
5/31/2018
Public Consulting Group, Inc.
148 State Street, Tenth Floor, Boston, Massachusetts 02109
(617) ,