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

2. 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

3. Medicaid Reimbursement to Schools
1990 West Virginia Legislature enacted WV Code b 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

4. Medicaid Reimbursement to School Districts

5. 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.

6. 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.

7. Member Identification

8. Member Identification
Special Education Basic Information

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

10. 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.

11. Member Identification
Diagnosis Code

12. Member Identification
Page Down
Diagnosis Code

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

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

15. Provider Identification

16. 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.

17. Medicaid Billing Screens

18. Medicaid Billing Screens

19. Medicaid Billing Edit Report

20. Medicaid Billing Edit Report

21. Report Writer Format

22. Report Writer Format
Report Writer Format

23. Report Writer Format
Page down

24. Report Writer Format

25. Report Writer Format
Report Writer Format

26. Report Writer
Report Writer Format

27. Report Writer

28. Report Writer

29. Report Writer

30. Special Education Eligibility Codes

31. Special Education Eligibility Codes

32. Special Education Eligibility Codes

33. Special Education Eligibility Codes

34. Special Education Miscellaneous Screen

35. Special Education Transportation

36. Special Education Certified Medicaid Count

37. Special Education Certified Medicaid Count

38. Special Education Certified Medicaid Count

39. Cost Reporting District’s Costs of Providing $3,000,000
Less the results of the RMTS %
Total Costs less RMTS results $75,600
Vendors/contracted costs $0
Total Costs with Contracted $75,600
District’s IEP ratio reduction Medicaid eligible %
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

40. Random Moment Time Studies

41. 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.

43. Annual Costs District’s Costs of Providing $3,000,000
Less the results of the RMTS %
Total Costs less RMTS results $75,600
Vendors/contracted costs $0
Total Costs with Contracted $75,600
District’s IEP ratio reduction Medicaid eligible %
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

44.
RMTS Reports

45. Random Moment Time Study

46. Compliance Report

47. 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