Municipal Medicaid Program Agenda ? Introduction ? Administrative Activity Claiming > Time Study: Activity Code Descriptions > Claim Calculation ? Direct Service Claiming > MassHealth customer services transition > Charter Schools > Methodology changes Time Study: Activity Code Descriptions Activity Code A: Medicaid Outreach & Training > Activities would include bringing potential eligibles into the Medicaid system for the purpose of determining eligibility & arranging for the provision of Medicaid services. > Coordinating, conducting, or participating in training events and seminars for outreach staff regarding the benefits of the Medicaid program, how to assist families to access Medicaid services. > Related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Talking to other staff, students and families about the Medicaid Program, referral process and health-related services. Time Study: Activity Code Descriptions Activity Code B: Facilitate/Assist in Medicaid Eligibility Process > School staff should use this code when assisting an individual in becoming eligible for Medicaid. Activities would include explaining Medicaid rules and eligibility process. > Include related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Assisting in the completion of the enrollment forms in order to apply for Medicaid Services. Time Study: Activity Code Descriptions Activity Code C: Provider Networking/Program Planning/Interagency Coordination > Performing activities associated with the development of strategies to improve the coordination and delivery of Medicaid covered services to school age children. > Performing collaborative activities with other agencies. > Include related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Building a bridge between community providers and school clinicians in an effort to build resource relationships. Time Study: Activity Code Descriptions Activity Code D: Individual Care Planning, Monitoring, Coordination & Referral > Gathering information in advance of making referrals for Medicaid covered services. > Making referrals or arranging Medicaid covered medical services. > Coordinating or monitoring the delivery of Medicaid covered medical services. > Monitoring and evaluating the Medicaid service components of the IEP. > Providing information on the child’s medical health service plan to other staff and parents. > Coordinating the follow up care on the medical services requested. > Related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: When you contact a family about the medical referral, screening or evaluation process. Time Study: Activity Code Descriptions Activity Code E: Transportation & Translation Related to Medicaid Services > Arranging for or providing transportation services from the school to and/or from Medicaid covered services. > Arranging for or providing translation services (including signing) for students or families regarding Medicaid covered health related issues. > Related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Providing signing services that assist the family in understanding medical treatment. Time Study: Activity Code Descriptions Activity Code F: Family Planning Referral > Identifying and referring adolescents who may be in need of family planning services. > Administrative activities that act to delay or prevent the onset of pregnancy. > Coordinating family planning activities in the school setting. > Include related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Referring an adolescent to an outside agency for the purpose of delaying or preventing the onset of pregnancy. Time Study: Activity Code Descriptions Activity Code G: Direct Service > Providing care or treatment to an individual in order to correct or improve a specific condition. > Providing counseling services to treat health, mental health or substance abuse conditions. > Performing routine or mandated screenings such as vision, hearing, scoliosis etc. > Attending an IEP meeting. > Include related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Providing occupational therapy to a student and recording results in the student’s health record. Time Study: Activity Code Descriptions Activity Code H: General Administrative Activities & Overhead > Performing activities that are not directly assignable to other program activities. > Covers any non-work related time including paid vacation, sick or personal time, lunch or break time and unscheduled non-school days such as snow days . > General supervision of staff. > Include related paperwork, clerical activities or staff travel required to perform these activities. > Written and oral methods may be used. Example: Attending administrative staff meetings. Time Study: Activity Code Descriptions Activity Code I: Non-Health Related Activities > Any other school-related activities that are not health related, such as social services, educational and teaching services, employment and job training. > Providing classroom instruction, correcting papers or compiling report cards. > Providing general supervision of students, such as in the lunchroom or on the playground. > Include the development, coordination, and monitoring of a student’s educational plan. > Include related paperwork, clerical activities or staff travel required to perform these activities. > Both written and oral methods may be used. Example: Preparing lesson plans or correcting papers. Time Study: Activity Code Changes ? Summary of time study methodology changes: > Activity Code D: This code includes all referral &/or follow-up and initial/ongoing coordination of care. This job function used to be activity code E. > Activity Code E: Entire code definition has changed. Code now focuses on time spent facilitating transportation or translation services. > Travel Time: Code your travel time as you would code the purpose of the travel. ? If you travel between schools to perform direct service, then use activity code G. ? If you travel to attend a Medicaid in-service training use activity code A. Time Study: Reminders ? Time study participants must be properly trained. ? Time study can be completed by: > Random sample of personnel in each job grouping. > 100% for all personnel in each job grouping. ? Participation is based on actual job functions that are performed, not on job title. > School district personnel that perform Medicaid administrative activities are eligible to participate in the time study. Time Study: Participants Time Study: Participants Claim Calculation: Steps to Completing a Claim ? Step 1: Calculate Time Study Results ? Step 2: Develop Detailed Expenditure Report > Salaries > Fringe Benefits > Materials and Supplies > Out of District Tuition Payments ? Step 3: Quarterly Claim Calculation ? Step 4: Capital Calculation ? Step 5: Specialized Transportation Calculation ? Step 6: Claim Summary Claim Calculation: Time Study Results Claim Calculation: Detailed Expenditure Report Claim Calculation: Fringe Benefit Calculation Claim Calculation: Fringe Benefit Calculation Claim Calculation: Out of District Tuition Claim Calculation: Detailed Expenditure Report Claim Calculation: Medicaid Eligibility Rate ? Quarterly ratio of Medicaid eligible students in the school district divided by the total number of students registered in the school district served in the Local Education Authority. Number of Medicaid Eligible students in the district for the quarter Total number of students in the district for the quarter Claim Calculation: Medicaid Eligibility Rate ? Steps to calculating Medicaid Eligibility Rate: > Gather quarterly school district enrollment information. > Obtain Medicaid recipient eligibility information from the Office of Medicaid for the same quarter. > Complete a data match utilizing one of the following: ? WebRevs (800-462-7738) ? MassHealth toll-free number (800-554-0042 or 800-833-7582) ? Direct match using the quarterly eligibility lists distributed by MassHealth. Claim Calculation: General Administrative Overhead Factor ? Percentage of time spent on activity codes A-F (C, D, E and F are multiplied by the Medicaid Eligibility Factor) divided by the percentage of time spent on activity codes A-I (excluding H) for each job position grouping. {% of A + % of B + (% of C * Medicaid Eligibility Factor) + (%D * Medicaid Eligibility Factor) + (% of E * Medicaid Eligibility Factor) + (% of F * Medicaid Eligibility Factor)} % of A + % of B + % of C + % of D + % of E + % of F + % of G + % of I Note: If no allowable administrative activities are performed, no time associated with the administrative overhead factor can be claimed. Claim Calculation Claim Calculation: Capital ? Identify the following: > Acquisition costs of the school district’s buildings and improvements. > Acquisition costs of the school district’s equipment that is not included in the amount above (“major movable equipment”). > Current interest expense associated with land, equipment, school building acquisition, construction, fabrication, reconstruction, and remodeling. (See OMB Circular A-87 (B). Claim Calculation: Capital ? Complete the following steps: > Multiply the sum of building and fixed asset acquisition costs and major movable equipment acquisition costs by the annual use allowance. > Add the sum of the above calculation to the net interest expense. > Calculate the capital percentage: Total Capital District–wide salaries and fringe benefits Claim Calculation: Specialized Transportation ? Gather actual quarterly specialized transportation costs for Special Education students. ? Calculate the following percentages: Number of Special Ed. students who have transportation in their IEP for a medical reason Total Number of Special Ed. students who receive specialized transportation Total Number of Medicaid Eligible Special Ed. students in the district for the quarter Total Number of Special Ed. students in the district for the quarter ? Multiply the above factors by the updated state-wide average of time spent receiving Medicaid covered services. Claim Calculation: Specialized Transportation ? Specialized transportation: Transportation in a vehicle used to furnish such transportation service that is specially equipped/staffed to accommodate individuals with specialized medical needs. Claim Calculation: Indirect Cost Rate ? Identify your school district’s most recent unrestricted indirect cost rate for federal grants by contacting the Department of Education at 781-338-3300 or visiting their website, www.doe.mass.edu. Claim Calculation Summary Claim Calculation: Summary of Changes ? Capital Costs/Calculation: > Use acquisition costs instead of Annual Valuation. > Calculate the ratio of capital to total of annual budgeted district wide salaries and fringe benefits. > Apply capital percentage rate to total of gross claim amounts from expenditure reports and specialized transportation. > No longer use square footage percentages. ? Updated Percentages: > Transportation: State-wide average of time spent receiving Medicaid covered services. > Out of District: Room and board discount factor for residential tuition calculation. > Out of District: Percentage of time spent in health-related services. Claim Calculation: Certification ? The accuracy of the quarterly claim must be certified by an authorized district official from the participating LEA and documented on a Quarterly Claim Certification form. > The Quarterly Claim Certification form must be included with the claim at the time of submission. > The Quarterly Claim Certification form must be on school district letterhead. ? Refer to Page 16 of the Claiming Manual. Claim Submission Requirements ? Quarterly Claim Certification ? Quarterly Claim Calculation Summary ? Quarterly Claim Calculation ? Quarterly Specialized Transportation Calculation ? Capital Calculation ? Fringe Benefit Calculation ? Detailed Expenditure Report ? State-wide Summary Worksheet for Out of District Schools ? Time Study Summarization ? Claims are submitted to: Univ. of Mass. Medical School Municipal Medicaid Program 100 Century Drive Worcester, MA 01606 Claim Submission Requirements ? Claims are due to the Center 15 days after the close of the quarter. ? Exception: All claims that are being submitted under the last allowable quarter are due 15 days prior to the close of that quarter. > If you plan to submit a claim for the September 2003 quarter, it is due by September 15, 2005. MassHealth Customer Services Customer Services Transition: Agenda ? Enhanced Customer Service Model ? What it means to you - No change ? What it meant to you - Change ? Future Enhancements ? Next steps ? Questions and Answers Enhanced Customer Service Model ? Consolidated operations ? Flexible staffing models ? Seamless issue resolution (provider/member) ? Enhanced communication and education ? Reduced administrative burden Direct Service Claiming: Charter Schools ? Effective 7/1/03, state legislature approved an amendment to statute to allow Charter schools to enroll as Medicaid providers. > Most charter schools have been submitting claims for charter school students through a contract with an existing Municipal Medicaid provider. ? Effective 7/1/05, charter schools can enter into an agreement directly with EHS to submit Medicaid claims. Direct Service Claiming: Charter Schools ? If a student is attending a charter school, only the charter school is eligible to file a Medicaid claim on behalf of the student. > Public or regional school districts should not submit claims for any such student. Direct Service Claiming: CMS Requirements for a New Rate Structure ? CMS State Medicaid Director Letter, May 21, 1999 > “bundled rates for school-based providers are not related to a specific type of procedure and are generally not available to all qualified providers in the community who might wish to be similarly reimbursed”. > “bundled rate methodologies do not produce sufficient documentation of accurate and reasonable payments, and may result in higher payments than would be reasonable on a fee-for-service basis for each individual service and thus do not meet the statutory intent of the law”. ? Office of Inspector General > Audit of Medicaid Payments for School-Based Health Services. Direct Service Claiming: Potential Rate Structure ? District specific, service specific cost-based rates. ? Annual reconciliation to actual costs. ? In order to participate in direct service claiming, districts must participate in Administrative Activity Claiming. Questions & Answers