Business associate agreement and access to eligibility information
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Business Associate Agreement and Access to Eligibility Information. September 14, 2010. William Lessard Department of Medical Assistance Services. Purpose of BAA. To safeguard protected health information To insure it is only used for designated purpose. Business Associate Agreement.

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Business Associate Agreement and Access to Eligibility Information

September 14, 2010

William Lessard

Department of Medical Assistance Services


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Purpose of BAA Information

  • To safeguard protected health information

  • To insure it is only used for designated purpose


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Business Associate Agreement Information

  • DMAS is furnishing eligibility data to school division providers

  • School division providers agree to use this data to

    • Determine the eligibility percentages for the school cost reports

    • Assist Medicaid, Medicaid Expansion and FAMIS students in accessing health care


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Components of BAA Information

  • Data Security Plan

  • Chain of Trust

  • Scope of Work


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Data Security Plan Information

  • Describes procedures for safeguarding the data

  • May be a separate plan or part of an existing data security plan

  • If part of an existing data security plan, review provisions and consider amending to refer to Medicaid eligibility data


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Personnel Costs Information

  • Track accrued salary and benefit costs

  • No estimates are allowed

  • Include all contract costs


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Personnel Costs Information

  • Track payroll and contract costs by fund source

  • Determine % funded by state/local funds, IDEA funds, other federal funds or other funding sources

  • Only costs funded by state/local funds will be carried forward for reimbursement


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Non-Personnel Costs Information

Line items

  • Travel

  • Materials and Supplies

  • Capital Costs

    Indirect Costs


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Requirements for Non-Personnel Costs Information

  • Line items contingent on CMS approval

  • At option of school division

  • Directly related to school medical services (not general supplies)

  • DMAS will provide additional guidance

  • Documentation required such as a depreciation schedule

  • Indirect costs only reimbursed to the extent they are in the indirect cost rate


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Travel Costs Information

  • Cost incurred by school

  • Cost of medical services staff traveling between schools to deliver services

  • Recommend that school divisions base the cost on mileage using logs


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Material and Supply Costs Information

  • Not the same as material and supply costs for administrative claim

  • Directly related to the delivery of medical services (not general supplies)

  • 100% allocated to medical services

  • DMAS is developing a non-exclusive list based on DOE School Health and Therapy Guidelines

  • CMS has not yet approved software costs


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Capital Costs Information

  • Major moveables directly related to the delivery of medical services

  • 100% allocated to medical services

  • Cost usually over $5,000 and a useful life of at least two years

  • DMAS is developing a non-exclusive list based on DOE School Health and Therapy Guidelines

  • Use straight-line method

  • Separate depreciation schedule

  • Does not include depreciation for buildings included in the administrative claim


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Indirect Costs Information

  • Use Unrestricted Indirect Cost Rate approved by DOE

  • No other indirect costs


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Tentative Cost Reporting and Settlement Schedule Information

  • June 30 – End of fiscal year

  • September 30 – DMAS distributes cost report forms and other reports

  • November 30 – Deadline to submit cost reports

  • May 31 – Deadline for DMAS to settle cost reports (180 days from submission)


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Tentative Cost Reporting and Settlement Schedule Information

  • CMS has asked DMAS to specify time frames

  • Similar to time frames for other cost reporting providers

  • Open to discuss other time frames


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DMAS Cost Settlement Contractor Information

Clifton Gunderson

4461 Cox Road, Suite 210

Glen Allen, VA 23060


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Certification Information

  • CMS requires that public providers (school divisions) certify costs

  • School divisions already certify costs for the administrative claim

  • Cost report certification replaces the Medicaid/FAMIS Program State/Local Match Quarterly Certification (Med-2A thru Med 2-G)

  • Final form to be determined by CMS


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Cost Settlement Information

  • If DMAS has made interim payments, then the cost report will determine which party owes the other party


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Cost Settlement Information

  • If DMAS owes the school division, DMAS will pay the difference in the next remittance

  • If the school division owes DMAS, DMAS can recoup the overpayment either (1) by direct payment or (2) by collecting the overpayment from future payments that otherwise would be made (negative balance)

  • CMS has not yet approved the negative balance approach


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Interim Payments Information

  • Interim payments will be made for approved claims

  • Important to school divisions for cash flow

  • If interim payments are too large, however, school divisions could owe DMAS large amounts


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Interim Payment Calculations Information

  • DMAS has not yet determined appropriate interim rates for the coming fiscal year

  • DMAS will use administrative claiming information, available survey data and Medicaid claim information to recommend an interim rate

  • DMAS will make recommendation before the school year begins using conservative assumptions

  • DMAS will work with school divisions, particularly small school divisions

  • Large margin of error until first cost report is settled

  • Future interim rates can be based on prior year settled costs


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Interim Rate Calculation Information

Estimated Reimbursement

÷

Estimated Claims

=

Interim Payment Rate


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ProForma Cost Report Information

  • A school division can prepare a proforma cost report for FY2006

  • DMAS can provide estimates of eligibility percentages, direct service time study percentages and claims paid


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School Division Responsibility Information

  • The rate limit will be the current fees

  • The school division can determine how much it is paid on an interim basis by the charges it submits

  • A school division can choose to submit charges equal to the current rate, the recommended interim rate or a more conservative interim rate

  • Interim payments have no impact on final reimbursement


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Contact Information Information

DMAS


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