1. Medicaid and Education June 13, 2012

2. www.cms.gov

4. State Plan Each state determines its State Plan within the general guidelines of the federal CMS.

5. Medicaid and Education Timeline U.S. Congress IDEA WV Code 18-2-5b Medicaid State Plan Amended 1989 2000 1990 Medicaid reimbursement for children with IEPs Only OT, PT, Speech, Nursing, and Psychology Added IEPs, Care Coor, Sp. Trans. Personal Aides

6. IDEA Reduction of Other Benefits.--Nothing in this part shall be construed to permit the State to reduce medical or other assistance available or to alter eligibility under title V of the Social Security Act… or title XIX of the Social Security Act (relating to Medicaid for infants or toddlers with disabilities) within the State.

7. Each School District – 1 st # Therapy Provider # 0 00XXXXXXXX Audiology # OT # PT # SLP # RN # Psychology # Each School District – 2 nd # Cost-Based Provider # 15XXXXXXXX - New Initial/Triennial IEP Annual IEP Personal Care (full) Personal Care (part) Sp. Trans. Vehicle Sp. Trans. Aide Care Coordination 19902000 NPI # - 2009

8. CodeDescriptionFrequencyFederal match T1001Nursing Assessment/Evaluation2x/year$99.66 T1000Nursing Services (Specialized Procedures) 15 min.$6.02

11. 15 minute = 1 billing unit 7.5 min. may round up

12. Menu

16. RESA LEA WVDHHR - Molina Processing Agency; Bureau of Medical Services BMS Remittance Advice Denial/pending Electronic claim Billing Form or WVEIS Entry Supporting Documentation: IEP Progress Notes Attendance Records Care Coordination form Payment – Direct Deposit

17. Documentation Student Related Documentation Included in IEP services – related service Notes/log Billing Documentation - WVEIS

20. The federal CMS is requiring states to adopt a cost settlement approach for school-based Medicaid reimbursement beginning July 1, 2012.

21. Cost Report Process  Cost Reports will be submitted through a web based software system  More comprehensive cost report training will be provided in the future WV: Introduction to Medicaid Cost Based School Based Health Services 21

22. Cost Settlement Calculation Example WV: Introduction to Medicaid Cost Based School Based Health Services 22 1.0Total Costs of Eligible SBHS Provider Costs (County’s costs)$1,000,000 2.0Indirect Cost Rate115.00% 3.0Total Costs of Eligible SBHS Provider Costs$1,150,000 4.0RMTS Direct Medical Percentage Results (Statewide results)65.00% 5.0Direct Medical Services Costs$747,500 6.0Application of Medicaid Eligibility Rate (IEP Ratio) (County’s)50.00% 7.0Medicaid Direct Medical Services Costs (for the quarter)$373,750 8.0Medicaid Interim Payments Received (for the quarter)$200,000 9.0Medicaid Cost Settlement (at the end of the year – July 2013)$173,750

23. Cost Settlement Calculation 2 nd Example – Pay Back WV: Introduction to Medicaid Cost Based School Based Health Services 23 1.0Total Costs of Eligible SBHS Provider Costs (county’s cost)$1,000,000 2.0Indirect Cost Rate115.00% 3.0Total Costs of Eligible SBHS Provider Costs$1,150,000 4.0RMTS Direct Medical Percentage Results (Statewide results)65.00% 5.0Direct Medical Services Costs$747,500 6.0Application of Medicaid Eligibility Rate (IEP Ratio) (county’s)50.00% 7.0Medicaid Direct Medical Services Costs (for the county)$373,750 8.0Medicaid Interim Payments Received (by the county)$500,000 9.0Medicaid Cost Settlement (at the end of the year – July 2013)-$126,250

24. Cost Settlement Calculation 3rd Example – Neutral WV: Introduction to Medicaid Cost Based School Based Health Services 24 1.0Total Costs of Eligible SBHS Provider Costs (county’s cost)$1,000,000 2.0Indirect Cost Rate115.00% 3.0Total Costs of Eligible SBHS Provider Costs$1,150,000 4.0RMTS Direct Medical Percentage Results (Statewide results)65.00% 5.0Direct Medical Services Costs$747,500 6.0Application of Medicaid Eligibility Rate (IEP Ratio) (county’s)50.00% 7.0Medicaid Direct Medical Services Costs (for the county)$373,750 8.0Medicaid Interim Payments Received (by the county)$373,750 9.0Medicaid Cost Settlement (at the end of the year – July 2013)$0

25. $ County’s costs for billable services – excluding IDEA Results of RMTS (statewide) #Medicaid Eligible/ #Special Ed. Rate billed for SLP, PT, OT, PSY, RN, AUD Rate billed for Care Coordination Rate billed for Personal Care Aides Match

26. $ County’s costs for billable services – excluding IDEA Results of RMTS (Direct billable) #Medicaid Eligible/ Special Education Medicaid-covered services Audiological Services Speech therapy services Physical therapy services Occupational therapy services Psychological evaluation RN – Specialized Procedures Care Coordination activities Personal care activities Communication; Safety; Mobility; Behavior; Medical/health

27. RMTS Site Preview WV: Introduction to Medicaid Cost Based School Based Health Services 27

28. RMTS Site Preview WV: Introduction to Medicaid Cost Based School Based Health Services 28

29. RMTS Site Preview WV: Introduction to Medicaid Cost Based School Based Health Services 29

30. RMTS Site Preview WV: Introduction to Medicaid Cost Based School Based Health Services 30

31. For Additional Support WV: Introduction to Medicaid Cost Based School Based Health Services 31  LEA contact will e-mail files to wvsbhs@pcgus.com  No later than January 2012  Staff Roster – LEA contact to CREATE  Calendar – LEA contact to CREATE  Reminder  PCG will code using a centralized standard coder  Training will be embedded in the RMTS  For additional assistance, please contact the Public Consulting Group’s West Virginia Hotline at  E-Mail Address: wvsbhs@pcgus.com

32. RMTS Responses (Direct Services) Inappropriate Response: I was not providing direct services to students. Appropriate Response: I was working on writing new IEP goals regarding transition for a student. Inadequate Response: Who was with you? Some students and an adult. Appropriate Response: Five students and an aide.

33. PCG’s Advice When indicating that you were participating in or preparing for an IEP Meeting, please indicate the portion of the IEP on which you were working during your moment (i.e., health related services goals, transition, state assessments, etc.).

34. $ County’s costs for billable services Results of RMTS #Medicaid Eligible/ #Special Education Drawing from Basic Information Page – Special Education screen WVEIS

35. Important LEA Data Collection Needs  IEP Ratio must be maintained and tracked for Medicaid cost allocation purposes  Medicaid-allowable costs are determined by multiplying total direct medical services times the IEP ratio. WV: Introduction to Medicaid Cost Based School Based Health Services 35 IEP Ratio = Total Number of Medicaid Eligible FFS Students Receiving Direct Medical Services with an IEP Total Number of Students Receiving Direct Medical Services with an IEP

36. Medicaid Administrative Claiming (MAC) WV: Introduction to Medicaid Cost Based School Based Health Services 36 MAC Additional $

37. Medicaid Administrative Claiming (MAC) Medicaid Outreach Facilitating Medicaid Eligibility Determination Direct Medical Services Translation Related to Medicaid Services Program Planning, Policy Development and Interagency Coordination Related to Medicaid Services Medicaid related training Referral, Coordination, and Monitoring of Medicaid Services and Documentation

38. $ County’s costs for billable services – excluding IDEA Results of RMTS (statewide) – % #Medicaid Eligible/ #Special Ed. Rate billed for SLP, PT, OT, PSY, RN, AUD Rate billed for Care Coor. – (Treatment Planning?) Rate billed for Personal Care Aides Same participants

39. Don’t bill Med.

40. Online Strategic Plan Maintenance Of Effort (MOE) State/Local

41. In a cost-based system, Medicaid reimbursement will cover the costs of providing special education and health- related services to Medicaid eligible students.

42. http://wvde.state.wv.us/osp/medicaid.html