1. 1 Implementing the New Medicaid SBS Program December 3, 2008, Lansing Sheraton Inn 1:30-3:30pm Adapted from PCG Webinars of Aug/Sept/Oct 2008 and a presentation given at MAASE on Oct 15, 2008 by Tom Koepke (Macomb), Liz Patrick (Ingham) and Jane Reagan (MDE) Michigan Medicaid School Based Services Program

2. 2 Agenda Welcome Review Purpose SBS New Program effective July 1, 2008 Legislative Update Evaluation Next meeting date:  Thursday February 26, 2009 Agenda?

3. 3 Purpose of Today’s Meeting This is our meeting We all need to be on the same page Network!

4. 4 New Communication Structure Medicaid Coordinators / Implementers Work Group  Information for you who Implement Medicaid SBS Policy from Policy Work Group  Day-to-day operations, training staff, develop staff pool lists, facilitate financial reports, work with billing companies  Probably meeting up to 6x year after Policy meetings  Feedback loop continuous with Policy Work Group Policy Work Group for Direct Services and AOP  Small but representative of Superintendents & Special Ed Directors  Likely meet up to 6x year  Will be responsible for setting policy and assisting DCH in proper dissemination of the decisions made by the group. Vendors Work Group  May be revived again by MDCH

5. 5 Overview of Program Changes 1993-2008 Two components  Fee For Service/direct care  AOP--outreach Statewide fees paid Claims, per kid/per date/per service Effective July 1, 2008 Four components  Direct services, AOP, TCM, PC  Mutually Exclusive Annual Cost Report

6. 6 Time Studies Federal Medicaid agency requires  3000 moments, in EACH of 4 time studies  Each quarter (15x more moments/people sampled)  Each TS staff can be in only ONE of the 4 (mutually exclusive) time studies each quarter Only staff who are included in the staff pool lists can be included on Medicaid Allowable end-of-year Cost/Expenditure Reports If staff are not in time study pool, you may not ask for Medicaid $$ reimbursement, year end

7. 7 Time Studies – Importance of Staff Pools Even though some staff do several jobs, each of the 4 RMTS must be unique/ exclusive of other staff pool lists  Direct health care services  AOP only  Case management/Designated Case Managers  Personal Care  Many of these staff have never been in SBS time studies → some seem hard to determine where is best to place them

8. 8 I.STAFF POOL: Direct Services ASHA certified Speech Language Pathologists Licensed Audiologists Licensed Registered Nurses (RN) Certified and registered Occupational Therapists (OTR) Licensed Physical Therapists (LPT) Certified Orientation & Mobility Specialists (O&M) Fully Licensed Psychologists (Doctoral level) Licensed Social Workers (Masters level)

9. 9 Staff qualify if: TSLIs, under the direction of an ASHA certified SLP or audiologist Speech Language Pathologist and/or Audiology candidates, under the direction of an ASHA certified SLP or audiologist Certified Occupational Therapy Assistants, under the direction of a currently-Michigan- registered OTR Certified Physical Therapy Assistants, under the direction of a currently-Michigan-licensed LPT

10. 10 Staff qualify if: Limited-licensed Psychologists, under the supervision of a licensed psychologist Limited-licensed Social Workers, under the supervision of a licensed social worker Licensed Practical Nurses, under the supervision of an RN or Physician

11. 11 II.STAFF POOL: Administrative Outreach (AOP) The Administrative Outreach staff pool consist of individuals who perform only administrative outreach activities Administrative Outreach activities may be performed for both General Ed and Special Ed students Medical staff that no longer meet the Direct Service staff pool qualifications should be included in the AOP list.

12. 12 AOP staff : Administrators Counselors Early Identification/Intervention Personnel Program Specialists Teacher Consultants = Your choice Speech-Language Pathologist – TSLIs who have no CCC’s Psychologist – No DCH-License, Not supervised by a DCH- Licensed Psychologists; (includes many School Psychologists) Licensed Practical Nurses, Not supervised by a RN

13. 13 III.STAFF POOL: Case Manager Consist of individuals who perform Targeted Case Management (TCM) Services.  Special Educations Teachers  Teacher Consultants = Your choice

14. 14 IV.STAFF POOL: Personal Care Consist of those who perform Direct Personal Care activities pursuant to the students IEP/IFSP Personal Care must be indicated on the IEP

15. 15 Personal Care staff : (may have the title of) Bilingual aide Health aide Instructional aide Paraprofessional Program Assistant Teacher aide Trainable aide

16. 16 Personal Care Billing Requirements: Documented in the student's IEP. “Authorized” by physician, “other licensed practitioner…” (RN, PT, OT, MSW, SLP w/CCC Daily log per student – some ISDs have developed nice templates

17. 17 Time Studies Very Important to Remember!  We need 100% compliance  Provide helpful hints to your clinicians regarding proper terminology in answering the Time Study questions

18. 18 FFS Reimbursement Reimbursement is now:  Cost-based  Provider (ISD) specific  Annually reconciled Preliminary payment Final calculation Cost settlement process

19. 19 Preliminary Payment 75% of 2006-07 revenue Monthly payments Claim volume reductions will impact preliminary payment % (Nov 08 L Letter)

20. 20 Reimbursement Formula Total Allowable Costs (inc. indirect) x Direct service % (state-wide) x SE Med Elig Rate, Hlth Svs (ISD) x Fed Financial Participation (’09=60.27%) x ISD Reimbursement Rate (60%) Net Dollars to ISD

21. 21 SE Medicaid Eligibility Rate (MER) Medicaid Eligible SE Students w/health- related support service in their IEP** _______________________________________________________ Total SE Students w/health-related support service in their IEP ** - December 1 count data used – Field 43 & Field 57

22. 22 Financial Reporting Quarterly Financials AOP Direct Service Personal Care Case Management Annual reporting = 4 qtrs of financials ISD Certification May Training

23. 23 Reimbursement Formula - Transportation Total Allowable Allowable one-way trips CostsTotal one way trips x Fed Financial Participation (60.27% ‘09) x ISD Reimbursement Rate (60%) Net Dollars to ISD X

24. 24 Reimbursement Formula Transportation Allowable trips  Rider attendance logs  Documentation of need in IEP  Medicaid-covered service provided on same date

25. 25 2008-09 Cost Settlement Comparison between approved Medicaid costs vs. interim payments Oct-Dec 09 - Cost compilation Jan-June 10 – Cost settlements & pymt adjustments begin Similar to timeline of SE State Aid pymts

26. 26 Legislative Update Moratorium John Dingell Backcasting

27. 27 Congress’ Moratorium on Proposed Regs– until April 1, 2009 Federal CMS proposed in 2007 to: Eliminate reimbursement in US for Administrative Outreach (AOP) Transportation Redefine/limit targeted case management Redefine/ limit rehabilitative services to exclude reimbursement for “intrinsic elements” of education programs Limit reimbursement to governmental provider’s costs with narrow definition

28. 28 Questions & Discussion

29. 29 Next Meeting February 26, 2009, 1:30-3:30 Ingham ISD Thorburn Education Center, Room AB 2630 W. Howell Rd Mason, 48854

30. 30 Resources Medicaid SBS Policy Manual online—click on:  www.michigan.gov/mdch www.michigan.gov/mdch  Providers (left navigation bar)  Providers (under CHAMPS header, scroll down)  Medicaid (under ‘hot topics’)  (get information about) Policy and Forms  Medicaid Provider Manual  Medicaid Provider Manual (warns you it’s HUGE file)  Three ‘chapters’ labeled “School Based Services”  Totals about 100 pages—eff 12-3-08, print out pages 1350 to 1446

31. 31 Resources Medicaid SBS info online—Provider Inquirer Newsletters, Letters and Mtg notes—are supplements to official Manual-- click on:  www.michigan.gov/mdch www.michigan.gov/mdch  Providers (left navigation bar)  Providers (under CHAMPS header, scroll down)  Medicaid  Communications and Training  Provider Inquirer Newsletters (sorted by date)  Numbered Letters (same page, scroll down)  Provider Liaison Meetings (same page, scroll down) SBS—this loaded with info, mtg summaries

32. 32 Resources Medicaid SBS info online More details about cost-based reimbursement process, training sessions, forms, documents effective 7-1-08:  www.michigan.gov/MedicaidProviders  Billing and Reimbursement  Provider Specific Information  School Based Services