Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	
	MassHealth
	Municipally Based Health Services 
	Bulletin 11
	June 2005

	TO:	Municipally Based Health Service Providers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director 

	RE:	Administrative Claiming

Background	Every Local Educational Authority (LEA) participating in the Municipal Medicaid Program must adhere to its provider agreement with MassHealth.  That provider agreement requires LEAs to comply with its terms and conditions, including applicable federal and state laws and regulations.

	The Time Study Manual for School-Based Administrative Activities (“Time Study Manual”) was revised effective January 1, 2005.  This revision resulted in a one-time change in the methodology used to calculate the average of the time study data, used for claiming purposes, for the quarter ending September 30, 2005. 

Reminder about 	The Medicaid Eligibility Factor must be calculated quarterly by dividing the number the Medicaid 	of Medicaid-eligible students in the district, for the quarter, by the total number of
Eligibility Factor	students enrolled in the district, for the same quarter.  Providers should determine
	enrollment and eligibility at the same point in time during each quarter.  Providers can verify eligibility using WebREVS or PC Software, or by matching enrollment data to the list of MassHealth-eligible students distributed to the provider each quarter.  For questions about WebREVS or PC Software, contact EDS at 1-800-462-7738.

If a student is attending a charter or regional school, only the charter or regional school is eligible to include that student in its Medicaid Eligibility Factor calculation.  Public school districts should not include any such student in their count.

All providers should review their Medicaid Eligibility Factor calculations for previously submitted claims.  If the calculation was completed incorrectly, the provider should amend any affected changes and resubmit those claims to the University of Massachusetts Medical School, Municipal Medicaid Program.  Be sure to identify the claim as an amendment to an original submission.  This information will then be submitted to MassHealth for processing.
	
continued on back

	

Reminder about	After the amended claims have been processed, future Municipal Medicaid
the Medicaid		administrative claiming payments will be adjusted until the full amount of the
Eligibility Factor	variance has been reconciled.
(cont.)	
For more information about the calculation of the Medicaid Eligibility Factor, refer to the Claiming Manual for School-Based Administrative Activities. 

Time Study	This section of this Bulletin applies to providers who participate in school-based
Average for	administrative claiming.  For such providers, the Time Study Manual requires that
September 2005	a random sample of direct-service and direct-support personnel participate
Administrative	in an administrative activity claim (AAC) time study for five consecutive days for
Claim 	each of the three quarters of the school year.  Time-study quarters are defined as:

•	October – December;
•	January – March; and 
•	April – June.

Generally, providers must utilize an average of the data from the previous three quarters for claiming purposes for the fourth quarter (July-September).  (Refer to page 3 of the Time Study Manual.)  

	The January 1, 2005, revision of the Time Study Manual changed certain activity code descriptions.  Because the descriptions of some activity codes used in the quarter ending December 2004 are different from descriptions for the same codes used for the quarters ending March 2005 and June 2005, LEAs must average only the time-study results for the quarters ending March and June 2005.  Those results should be applied to the claim for the quarter ending September 2005.

This exception to calculating the average data applies only for the quarter ending September 2005.  For all future calculations, providers should use the original methodology, as defined in the Time Study Manual.

Questions	If you have any questions about the information in this bulletin, please call MassHealth Customer Services at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.  This bulletin and all MassHealth Publications are available on the MassHealth Web site at www.mass.gov/masshealthpubs .  Click on the link for “Provider Library.”