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Michigan Medicaid School Based Services Program. Implementing the New Medicaid SBS Program . December 3, 2008, Lansing Sheraton Inn 1:30-3:30pm

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implementing the new medicaid sbs program

Michigan Medicaid School Based ServicesProgram

Implementing the New Medicaid SBS Program

December 3, 2008, Lansing Sheraton Inn


Adapted from PCG Webinars of Aug/Sept/Oct 2008 and a presentation given at MAASE on Oct 15, 2008by Tom Koepke (Macomb), Liz Patrick (Ingham) and Jane Reagan (MDE)

  • Welcome
  • Review Purpose
  • SBS New Program effective July 1, 2008
  • Legislative Update
  • Evaluation
  • Next meeting date:
    • Thursday February 26, 2009
  • Agenda?
purpose of today s meeting
Purpose of Today’s Meeting
  • This is our meeting
  • We all need to be on the same page
  • Network!
new communication structure
New Communication Structure
  • Medicaid Coordinators / Implementers Work Group
    • Information for you who Implement Medicaid SBS Policy from Policy Work Group
    • Day-to-day operations, training staff, develop staff pool lists, facilitate financial reports, work with billing companies
    • Probably meeting up to 6x year after Policy meetings
    • Feedback loop continuous with Policy Work Group
  • Policy Work Group for Direct Services and AOP
    • Small but representative of Superintendents & Special Ed Directors
    • Likely meet up to 6x year
    • Will be responsible for setting policy and assisting DCH in proper dissemination of the decisions made by the group.
  • Vendors Work Group
    • May be revived again by MDCH
overview of program changes

Two components

Fee For Service/direct care


Statewide fees paid

Claims, per kid/per date/per service

Effective July 1, 2008

Four components

Direct services, AOP, TCM, PC

Mutually Exclusive

Annual Cost Report

Overview of Program Changes
time studies
Time Studies
  • Federal Medicaid agency requires
    • 3000 moments, in EACH of 4 time studies
    • Each quarter (15x more moments/people sampled)
    • Each TS staff can be in only ONE of the 4 (mutually exclusive) time studies each quarter
  • Only staff who are included in the staff pool lists can be included on Medicaid Allowable end-of-year Cost/Expenditure Reports
  • If staff are not in time study pool, you may not ask for Medicaid $$ reimbursement, year end
time studies importance of staff pools
Time Studies –Importance of Staff Pools
  • Even though some staff do several jobs, each of the 4 RMTS must be unique/ exclusive of other staff pool lists
    • Direct health care services
    • AOP only
    • Case management/Designated Case Managers
    • Personal Care
    • Many of these staff have never been in SBS time studies → some seem hard to determine where is best to place them
staff pool direct services
STAFF POOL:Direct Services
  • ASHA certified Speech Language Pathologists
  • Licensed Audiologists
  • Licensed Registered Nurses (RN)
  • Certified and registered Occupational Therapists (OTR)
  • Licensed Physical Therapists (LPT)
  • Certified Orientation & Mobility Specialists (O&M)
  • Fully Licensed Psychologists (Doctoral level)
  • Licensed Social Workers (Masters level)
staff qualify if
Staff qualify if:
  • TSLIs, under the direction of an ASHA certified SLP or audiologist
  • Speech Language Pathologist and/or Audiology candidates, under the direction of an ASHA certified SLP or audiologist
  • Certified Occupational Therapy Assistants, under the direction of a currently-Michigan-registered OTR
  • Certified Physical Therapy Assistants, under the direction of a currently-Michigan-licensed LPT
staff qualify if10
Staff qualify if:
  • Limited-licensed Psychologists, under the supervision of a licensed psychologist
  • Limited-licensed Social Workers, under the supervision of a licensed social worker
  • Licensed Practical Nurses, under the supervision of an RN or Physician
staff pool administrative outreach aop
STAFF POOL:Administrative Outreach (AOP)
  • The Administrative Outreach staff pool consist of individuals who perform only administrative outreach activities
  • Administrative Outreach activities may be performed for both General Ed and Special Ed students
  • Medical staff that no longer meet the Direct Service staff pool qualifications should be included in the AOP list.
aop staff
AOP staff:
  • Administrators
  • Counselors
  • Early Identification/Intervention Personnel
  • Program Specialists
  • Teacher Consultants = Your choice
  • Speech-Language Pathologist – TSLIs who have no CCC’s
  • Psychologist – No DCH-License, Not supervised by a DCH- Licensed Psychologists; (includes many School Psychologists)
  • Licensed Practical Nurses, Not supervised by a RN
staff pool case manager
STAFF POOL:CaseManager
  • Consist of individuals who perform Targeted Case Management (TCM) Services.
    • Special Educations Teachers
    • Teacher Consultants = Your choice
staff pool personal care
STAFF POOL: Personal Care
  • Consist of those who perform Direct Personal Care activities pursuant to the students IEP/IFSP
  • Personal Care must be indicated on the IEP
personal care staff may have the title of
Personal Care staff :(may have the title of)
  • Bilingual aide
  • Health aide
  • Instructional aide
  • Paraprofessional
  • Program Assistant
  • Teacher aide
  • Trainable aide
personal care billing requirements
Personal CareBilling Requirements:
  • Documented in the student's IEP.
  • “Authorized” by physician, “other licensed practitioner…” (RN, PT, OT, MSW, SLP w/CCC
  • Daily log per student – some ISDs have developed nice templates
time studies17
Time Studies
  • Very Important to Remember!
    • We need 100% compliance
    • Provide helpful hints to your clinicians regarding proper terminology in answering the Time Study questions
ffs reimbursement
FFS Reimbursement

Reimbursement is now:

  • Cost-based
  • Provider (ISD) specific
  • Annually reconciled
    • Preliminary payment
    • Final calculation
    • Cost settlement process
preliminary payment
Preliminary Payment
  • 75% of 2006-07 revenue
  • Monthly payments
  • Claim volume reductions will impact preliminary payment % (Nov 08 L Letter)
reimbursement formula
Reimbursement Formula

Total Allowable Costs (inc. indirect)

x Direct service % (state-wide)

x SE Med Elig Rate, Hlth Svs (ISD)

x Fed Financial Participation (’09=60.27%)

x ISD Reimbursement Rate (60%)

Net Dollars to ISD

se medicaid eligibility rate mer
SE Medicaid Eligibility Rate (MER)

Medicaid Eligible SE Students w/health-related support service in their IEP**


Total SE Students w/health-related support service in their IEP

** - December 1 count data used – Field 43 & Field 57

financial reporting
Financial Reporting
  • Quarterly Financials
    • AOP
    • Direct Service
    • Personal Care
    • Case Management
  • Annual reporting = 4 qtrs of financials
  • ISD Certification
  • May Training
reimbursement formula transportation
Reimbursement Formula - Transportation

Total Allowable Allowable one-way trips

Costs Total one way trips

x Fed Financial Participation (60.27% ‘09)

x ISD Reimbursement Rate (60%)

Net Dollars to ISD


reimbursement formula transportation24
Reimbursement Formula Transportation
  • Allowable trips
    • Rider attendance logs
    • Documentation of need in IEP
    • Medicaid-covered service provided on same date
2008 09 cost settlement
2008-09 Cost Settlement
  • Comparison between approved Medicaid costs vs. interim payments
  • Oct-Dec 09 - Cost compilation
  • Jan-June 10 – Cost settlements & pymt adjustments begin
  • Similar to timeline of SE State Aid pymts
legislative update
Legislative Update
  • Moratorium
  • John Dingell
  • Backcasting
congress moratorium on proposed regs until april 1 2009
Congress’ Moratorium on Proposed Regs– until April 1, 2009

Federal CMS proposed in 2007 to:

  • Eliminate reimbursement in US for
      • Administrative Outreach (AOP)
      • Transportation
  • Redefine/limit targeted case management
  • Redefine/ limit rehabilitative services to exclude reimbursement for “intrinsic elements” of education programs
  • Limit reimbursement to governmental provider’s costs with narrow definition
next meeting
Next Meeting

February 26, 2009, 1:30-3:30

Ingham ISD

Thorburn Education Center, Room AB

2630 W. Howell Rd

Mason, 48854

  • Medicaid SBS Policy Manual online—click on:
    • Providers (left navigation bar)
    • Providers (under CHAMPS header, scroll down)
    • Medicaid (under ‘hot topics’)
    • (get information about) Policy and Forms
    • Medicaid Provider Manual
    • Medicaid Provider Manual (warns you it’s HUGE file)
    • Three ‘chapters’ labeled “School Based Services”
      • Totals about 100 pages—eff 12-3-08, print out pages 1350 to 1446
  • Medicaid SBS info online—Provider Inquirer Newsletters, Letters and Mtg notes—are supplements to official Manual-- click on:
    • Providers (left navigation bar)
    • Providers (under CHAMPS header, scroll down)
    • Medicaid
    • Communications and Training
    • Provider Inquirer Newsletters (sorted by date)
    • Numbered Letters (same page, scroll down)
    • Provider Liaison Meetings (same page, scroll down) SBS—this loaded with info, mtg summaries
  • Medicaid SBS info online
  • More details about cost-based reimbursement process, training sessions, forms, documents effective 7-1-08:
    • Billing and Reimbursement
    • Provider Specific Information
    • School Based Services