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Medicaid Reimbursement

Medicaid Reimbursement. Trade Secrets Revealed!. Technical Assistance. $$$. Helping Kids. Rewards. We Survived. Cooperation. MTS 3.0. We Survived. School districts just came through a really bad hurricane season

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Medicaid Reimbursement

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  1. Medicaid Reimbursement Trade Secrets Revealed!

  2. Technical Assistance $$$ Helping Kids Rewards We Survived Cooperation MTS 3.0

  3. We Survived • School districts just came through a really bad hurricane season • Several rules formulated by the Centers for Medicaid & Medicare (CMS) threatened our survival • Congress passed and the President signed a reprieve until April 1, 2009 • Forces are hard at work to make the reprieve permanent

  4. All You Need Is Love …eh… Cooperation • Administrative Support • Technical/Data Support • Coachable Service Providers • An Open Mind • A Willingness to Learn • And Yes, Time (Is On Your Side) • Yes, You Can!

  5. You Also Need To Consider… • FERPA/HIPAA/IDEA Consent Compliance • Audit requirements • Personnel turnover

  6. Technical Assistance • Tallahassee is on your side • Other states are not so lucky • MACS – Seminole County • AHCA • SSN • MTS 3.0

  7. Area 2 – Ann Weichelt (850) 414-9642 weichela@ahca.myflorida.com Area 1 – Dorothy Collins (850) 595-0520 collinsd@ahca.myflorida.com Area 4 - Pat Kelly (904) 798-4687 kellyp@ahca.myflorida.com Area 3 - John Bertholf (386) 418-5350 x112 bertholj@ahca.myflorida.com Area 7 - Millie Chervoni (407) 316-4834 chervonm@ahca.myflorida.com Area 9 - Cindy Barnes (561) 616-1443 barnesc@ahca.myflorida.com Area 6 – Wayne Clark (813) 871-7600 x142 clarkw@ahca.myflorida.com Area 8 – Joe Martinez (239) 338-2831 martinej@ahca.myflorida.com Area 11 - Hector Gutierrez (305) 499-2025 gutierrh@ahca.myflorida.com Area Medicaid School Contacts Holmes Jackson Okaloosa Escambia Santa Rosa Nassau Gadsden Walton Washington Hamilton Jefferson Madison Leon Calhoun Bay Duval Baker Columbia Suwannee Wakulla Taylor Liberty Union Clay Bradford Franklin Lafayette Gulf St. Johns Gilchrist Alachua Putnam Dixie Flagler Levy Marion Volusia Lake Citrus Sumter Seminole Hernando Orange Area 5 - Joyce Carpenter (727) 552-1191 x131 carpentj@ahca.myflorida.com Pasco Brevard Osceola Polk Hillsborough Pinellas Indian River Hardee Manatee Okeechobee St. Lucie Highlands DeSoto Sarasota Martin Area 10 – Joe Mieszkowski (954) 202-3294 mieszkoj@ahca.myflorida.com Glades Charlotte Hendry Palm Beach Lee Broward Collier Miami-Dade Monroe

  8. Rewards • Rewards for you • Rewards for your service providers – They become stakeholders • Rewards for your school district • Rewards for (I saved the best for the last)

  9. Rewards for your … • KIDS! • Medicaid reimbursement helps your kids • It buys supplies • It buys people • It buys good will • It frees up your budget for other things • It enhances school services

  10. How Are Schools Reimbursed ? Schools obtain reimbursement through two funding streams: Fee-for-Service and School District Administrative Claiming (SDAC) • School District Certified Match (Fee-for-Service) Florida Total to date is about $70 million. • Florida SDAC total to date is approximately $488 million. • The average annual fee-for-service reimbursement is from $6 million to $10 million. The potential annual state reimbursement is estimated at $22 million.

  11. Medical Services What medical services do schools provide through the Certified School Match Program? • Therapy Services • Behavioral Services • Nursing Services • AAC Services • Transportation

  12. What are the requirements for Fee-for-Service? • Provider Status • Qualified Personnel • Documentation • Medicaid-Enrolled Students • IDEA/Part B or C (IEP)

  13. Therapy Services -- Speech/Language • Evaluations • Treatment of disorders including speech correction, articulation, interactive communication, auditory and/or visual processing, verbal and written language, phonology, memory comprehension, voice fluency and cognition/communication

  14. Therapy Services -- Occupational Therapy • Evaluations to determine level of function and competencies • Treatment visits including perceptual motor activities, functional performance exercises, kinetic movement, guidance in using adaptive equipment • Wheelchair evaluations and fittings • Application of casts and splints

  15. Therapy Services -- Physical Therapy • Evaluation and treatment for conditions including range-of-motion, muscle strength, functional abilities and the use of adaptive/therapeutic equipment • Rehabilitation through exercise, massage and the use of equipment through therapeutic activities • Wheelchair evaluations and fittings • Application of splints and casts

  16. Behavioral Services Providers • School Psychologists/Psychologists • Certified/Associate Certified Behavior Analysts • School Social Worker/Social Workers • Mental Health Counselors • Marriage and Family Therapists • School Guidance Counselors

  17. Behavioral Services • Testing and evaluations to assess cognitive, developmental, emotional, social, adaptive and behavioral function • Consultation, coordination and follow-up referrals • Therapy and counseling • Crisis Intervention • Interviews, social development studies, and functional assessments

  18. Nursing Services Providers • Registered Nurses • Licensed Practical Nurses • School Health Aides

  19. Nursing Services • Health assessments, monitoring and management • Health care treatments and procedures including crisis intervention • Student health training and counseling • Catheterization, tube feeding, maintenance of tracheostomies, oxygen administration, ventilator care and medication administration • Consultation and coordination

  20. Administrative Activities Which administrative activities qualify schools for Medicaid reimbursement? • Outreach services • Coordination of health services • Health care planning • Assisting with access to Medicaid services • Developing strategies to improve service delivery

  21. How do schools keep track of administrative activities? • Time studies such as Random Moment Sampling are completed each quarter • Claimable costs for qualified personnel along with activity code assessments are used to establish school district claims

  22. Shared Services Network and Medicaid -- A History • Helping school districts bridge the gap between promised and actual IDEA funding • Reimbursement for dollars already spent • Our Web Site -- ssn.usf.edu -- provides information about Medicaid and schools including reimbursement reports and our annual (at least, usually) October Medicaid Conference

  23. Shared Services Network cont… • SSNdeveloped programs so that school districts can access Medicaid funding without using outside consultants • This encouraged reluctant schools to participate by eliminating fees that could amount to 10 to 20 percent of Medicaid reimbursements

  24. SSN & Schools • SSN developed the Medicaid Administrative Claiming System (MACS) in 2002 in conjunction with DOE, AHCA, Seminole, and Orange Counties • About 47 school districts now participate in School District Administrative Claiming (SDAC) through MACS

  25. SSN & Fee-for-Service • SSN developed the Medicaid Tracking System (MTS) in 1999 with the help of AHCA, DOE and pilot school districts • Schools can use MTS to check Medicaid eligibility and bill Medicaid directly through the Medicaid Certified School Match Program (MCSM) • Currently about 55 districts use MTS to check eligibility and 17 use it to bill • Web-based MTS 3.0 will be available soon

  26. Ongoing SSN Medicaid Support • Technical Assistance • Annual Medicaid and Schools Conference • Legislative monitoring • Liaison between AHCA and school districts • Information updates • Regular conference calls

  27. Medicaid Tracking System 3.0 • Medicaid Tracking System (MTS) changes will enhance school districts’ ability to bill for direct services • Web-based MTS enables school-based providers to directly input billing information • This system will reduce the amount of time school districts spend on Medicaid administration • Data will be centrally located • Telephone support through 800 number • All you need is Internet access

  28. MTS 3.0 Demonstration • Sunshine Connectionshttp://www.sunshineconnections.org/Pages/Tools.aspx http://test.fcim.org/medPrj/demo/

  29. It’s All About the … $$$

  30. Resources - Links to TAPS/MCSM Handbook Technical Assistance: Medicaid Certified School Match Program: Therapy Services www.fldoe.org/ese/pdf/y1999-8.pdf Behavioral Services www.fldoe.org/ese/pdf/y2002-6.pdf Nursing Services www.fldoe.org/ese/pdf/y001-12.pdf Charter Schools www.fldoe.org/ese/pdf/tap99-7.pdf Florida Medicaid Agency for Health Care Administration: Provider Handbooks http://portal.flmmis.com/FLPublic/Provider_ProviderSupport/Provider_ProviderSupport_ProviderHandbooks/tabId/42/Default.aspx

  31. Resources – Web Sites • www.gregontheweb.com • www.theleanet.com • www.medicaidforeducation.org

  32. Contact Information Please contact Susan Douglas, Shared Services Network, Medicaid Consultant, for further information and/or technical assistance at sdouglas@coedu.usf.edu or at (850) 487-8716

  33. Questions? Now’s your chance!

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