Implementing the New Medicaid SBS Program

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

2. Agenda • Welcome • Review Purpose • SBS New Program effective July 1, 2008 • Legislative Update • Evaluation • Next meeting date: • Thursday February 26, 2009 • Agenda?

3. Purpose of Today’s Meeting • This is our meeting • We all need to be on the same page • Network!

4. 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

5. 1993-2008 Two components Fee For Service/direct care AOP--outreach 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

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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.

12. 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

13. STAFF POOL:CaseManager • Consist of individuals who perform Targeted Case Management (TCM) Services. • Special Educations Teachers • Teacher Consultants = Your choice

14. 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

15. Personal Care staff :(may have the title of) • Bilingual aide • Health aide • Instructional aide • Paraprofessional • Program Assistant • Teacher aide • Trainable aide

16. 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

17. 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

18. FFS Reimbursement Reimbursement is now: • Cost-based • Provider (ISD) specific • Annually reconciled • Preliminary payment • Final calculation • Cost settlement process

19. Preliminary Payment • 75% of 2006-07 revenue • Monthly payments • Claim volume reductions will impact preliminary payment % (Nov 08 L Letter)

20. 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

21. 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

22. Financial Reporting • Quarterly Financials • AOP • Direct Service • Personal Care • Case Management • Annual reporting = 4 qtrs of financials • ISD Certification • May Training

23. 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 X

24. Reimbursement Formula Transportation • Allowable trips • Rider attendance logs • Documentation of need in IEP • Medicaid-covered service provided on same date

25. 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

26. Legislative Update • Moratorium • John Dingell • Backcasting

27. 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

28. Questions & Discussion

29. Next Meeting February 26, 2009, 1:30-3:30 Ingham ISD Thorburn Education Center, Room AB 2630 W. Howell Rd Mason, 48854

30. Resources • Medicaid SBS Policy Manual online—click on: • www.michigan.gov/mdch • 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

31. Resources • Medicaid SBS info online—Provider Inquirer Newsletters, Letters and Mtg notes—are supplements to official Manual-- click on: • www.michigan.gov/mdch • 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

32. Resources • Medicaid SBS info online • More details about cost-based reimbursement process, training sessions, forms, documents effective 7-1-08: • www.michigan.gov/MedicaidProviders • Billing and Reimbursement • Provider Specific Information • School Based Services