1. Medicaid In The Schools (MITS) National Picture of School-Based Medicaid Programs January 2008

2. Why Be Concerned with The National Picture? Centers for Medicare and Medicaid Services (CMS) establishes policy on federally funded, public health programs. Makes recommendations to cut or increase funds for specific programs. Acts on own without input from others. CMS, through its current philosophy, is trying to relieve federal funds (state obligation).

3. CMS Influence in Arkansas Any major additions or changes to current Arkansas Medicaid policy requires the approval of CMS. We fall under the supervision of the Dallas region. Each region has different ways of regulating policy, thus no real consistency exists from state-to state.

4. MITS Experience with CMS Wrote and submitted state ARMAC plan in 2004 and 2005. Submitted several provisions. Had visit from CMS regional representative to review ARMAC program.

5. Current Issues CMS-2287, final rule published December 28, 2007. CMS-2262, proposed rule related to appeals process. Attempting to make their decisions appeal proof. Many others.

6. CMS-2287-F Language Under the Medicaid program, Federal payment is available for the costs of administrative activities “as found necessary by the Secretary for the proper and efficient administration of the State plan.” The final rule would eliminate reimbursement under the Medicaid program for the costs of certain activities based on a Secretarial finding that these activities are not necessary for the proper and efficient administration of the State plan, nor do they meet the definition of an optional transportation benefit. Based on these determinations, under the final rule, Federal Medicaid payments would no longer be available for administrative activities performed by school employees or contractors, or anyone under the control of a public or private educational institution, and transportation from home to school and back for school-aged children.

7. Impact of 2287 on Arkansas ARMAC will be eliminated at end of current school year. Loss of revenues for school districts, upwards of $8-10 million a year. Potential loss of staff positions, student health programs, etc.

8. Countless contacts have been made with CMS, members of Congress, Senate. Strategic national meetings with other states, agencies, and associations. Different moratoria on cuts have been proposed through Congress. Currently operating on one that ends June 28, 2008. What has been done?

9. What We Will Do Continue to monitor at the federal level, advise with appropriate people at state and local level. Work to get any state information to the federal level. Continue with time study and data collection next year.

10. What Can You Do? Continue to keep in contact with members of Congress, Senators, etc. Keep the faith. Share experiences and/or urge parents to do the same. Follow SCHIP and other legislation. Look for sign on letter soon. Possible impact statement.

11. Importance of SCHIP Legislation SCHIP(State Children’s Health Insurance Program) continues to be a point of contention. Contains moratorium language for all MAC programs. Proposal to include several moratoria into one bill or own bill.

12. SCHIP Moratorium Language SEC. 616. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS. Not withstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to January 1, 2010, take any action (through promulgation of regulation, issuance of regulatory guidance, use of federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to restrict coverage or payment under title XIX of the Social Security Act for rehabilitation services, or school-based administration, transportation, or medical services if such restrictions are more restrictive in any aspect than those applied to such coverage or payment as of July 1, 2007.

13. Potential Scenarios ARMAC and other potential cuts will continue being funded at current rate with current structure through January 1, 2010. Could continue to be funded for a shorter period of time, possibly March 2009 May not be funded any more.

14. Other Business Be sure to get consent signed during IEP meetings. May want to look at adding general consent language to the student handbook for the purpose of vision and hearing billing. Maximizing funds available to district.