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Medicaid Cost-based Reimbursement for Special Education Medical Services

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Medicaid Cost-based Reimbursement for Special Education Medical Services

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    1. Medicaid Cost-based Reimbursement for Special Education Medical Services

    2. 2 AGENDA Overview / Status Fiscal Year 2008 Cost Report Results Medical Services Cost Report Time Study Eligibility Percentages Transportation Cost Report Contact Information

    3. 3

    4. Overview / Status

    5. 5 Summary of Reimbursement Changes Since 2003 DMAS implemented admin claiming in 2003. The Federal Government required DMAS to implement cost-based reimbursement for medical services effective with 2006-2007 school year. State Plan Amendments approved by CMS July 2007 cover new services effective July 1, 2003 (audiology, personal care, medical evaluation, psych services furnished by social workers) and July 1, 2006 (transportation). How many work for schools who do administrative claiming?How many work for schools who do administrative claiming?

    6. 6 Beginning With FY 07: Cost-Based Reimbursement Claims must be filed as evidence that services were provided. Final reimbursement is based on direct service costs factored by the time study (RMTS) and then factored by the percentage of the locality school division percentage of IEP students who are eligible for Medicaid, Medicaid Expansion, and FAMIS. No changes to reimbursement for services provided before July 1, 2006No changes to reimbursement for services provided before July 1, 2006

    7. 7 Rescission of 2287

    8. 8 Fed Funds Reimbursed to Schools for Medical Services, FY04-FY08

    9. 9 Direct Services (Medical) Cost Report Essentially the same cost report as the past year with 3 medical categories: Therapists (physical, occupational, speech), audiologists, personal care assistants, billing personnel Psychologists, psychiatrists, and clinical social workers Nurses, nurse practitioners, physicians, nurse aides

    10. 10 Filing cost reports for Fiscal Year 2009 Same deadline for submitting cost reports - November 30, 2009 Same deadline to file claims - by March 31, 2010 (any claims paid after March 31 will be included in future cost reports)

    11. 11 Interim Payments File claims for all medical services performed for qualified recipients by qualified practitioners. It is a cost based payment system, but claims are required by the Center for Medicare and Medicaid Services (CMS), the federal agency with Medicaid oversight.

    12. 12 Interim Payments Providers should use interim rates consistent with prior year reimbursement after cost settlement. DMAS will be glad to discuss developing billing rates you would be comfortable using for your interim billing. Be sure that you bill at a rate that doesn’t leave you overpaid at cost settlement.

    13. 13 Personnel Costs File quarterly salary costs with UMMS for RMTS. Salary information used in quarterly Admin claims prepared by UMMS. Annual salary lists will be returned for medical reports from UMMS. Include all new hires at the start of each quarter. Add new hires to cost report data after the start of each quarter. Include billing personnel in your time study and cost reports.

    14. 14 Personnel Costs Employee and contract personnel Do not include 100% federally funded positions in time study or cost report. Exclude local funds required to match a federal grant. Cost reports have a column to indicate percentage funded by another federal program.

    15. 15 Capital Costs How many included capital costs in the FY07 cost reports?How many included capital costs in the FY07 cost reports?

    16. 16 Materials and Supplies/ Travel Materials and supplies must be used ONLY for the delivery of medical services. Allocated based on direct IEP hours divided by total medical service hours. Employee travel is only allowable when it is for delivering IEP services. How many providers included materials and supplies employee travel?How many providers included materials and supplies employee travel?

    17. 17 Cost Settlement If DMAS owes the school division additional funds based on the settlement, the amount will be paid in the next weekly remittance cycle. If the school division owes DMAS funds at settlement, the amount can be paid by direct payment or it may be withheld from future payments.

    18. 18 Cost Settlement Schedule for FY 2009 June 30, 2009 - End of fiscal year October 1, 2009 - Deadline for delivering personnel costs to UMMS for FY 2009 October 30, 2009 - UMMS distributes personnel cost summaries, statewide time study results, and payment summaries to be used in the medical service cost reports.

    19. 19 Cost Settlement Schedule for FY 2009 November 30, 2009 - Deadline to submit FY2009 Direct Service Cost Reports March 31, 2010 - Deadline for claims to be included in settlement totals with FY 2009 May 30, 2010 - Deadline for cost settlements if they are complete

    20. 20 Cost Report Data Provided by UMMS Statistical data from the RMTS to be applied to salaries – contained in Job Groups 1, 2 & 3 Salary and Benefits data for the four quarters, for use in salary worksheets. Claims payment summaries furnished by DMAS

    21. 21 Cost Report Data Provided by School District SD Information IEP eligibility percentages by program Additional Salary and Benefits data for new-hires for the four quarters Capital Costs Reconciliation page – Interim payments from each program Certification signatures

    22. 22 IEP Eligibility Percentages of each school district for Medicaid, Medicaid Expansion and FAMIS

    23. 23 IEP Eligibility Percentages of each school district for Medicaid, Medicaid Expansion and FAMIS

    24. 24 Eligibility Percentages of each school district for Medicaid, Medicaid Expansion and FAMIS

    25. 25 Complete the Service Center Agreement to set up FTP Fiscal agent is currently First Health. Go to http://virginia.fhsc.com Provider- Manuals Tab, Look for: Service Center User Manual After set up is complete, follow instructions to download eligibility data. Costs for your system should be minimal (under $100). Password changes at First Health Electronic Media Center at 1-800-924-6741.

    26. 26 Business Associate Agreement (BAA) and FTP Contacts with DMAS DMAS BAA Contact Pat Lawver 1- 804 - 225 - 4042 or pat.lawver@dmas.virginia.gov DMAS FTP Contact Robert Miller 1-804-786-3673 robert.miller@dmas.virginia.gov

    27. Time Study

    28. 28 Bill for Services Bill ALL of your claims. Low claim billings result in high cost per claim. CG asked school divisions with high costs per claim to verify that providers actually billed for services. As a result, costs for some practitioners were disallowed. All providers whose salaries are included in the cost report must bill for services provided to all eligible recipients. No eligible students to see? Include the salaries anyway! Remember there is a one year deadline for submitting claims.

    29. Transportation Cost Report

    30. 30 First Rule: KEEP YOUR HANDS AND ARMS INSIDE THE BUS. SIT DOWN AND BE QUIET OR YOU'RE GOING STRAIGHT TO THE PRINCIPAL'S OFFICE !! I MEAN IT !! SIT DOWN AND BE QUIET !!

    31. 31 Transportation Cost Report Pays for the cost of providing transportation to and from school for the day (and to and from the practitioner if off site), for students with an IEP required service that day.

    32. 32 Different Cost Report from Direct Medical Cost report and instructions are available on the DOE and DMAS websites. DMAS Maternal and Child Health Division will be presenting on transportation at the third breakout session this afternoon.

    33. 33 Transportation Cost Report HISTORY 3 school districts submitted cost reports and settled in FY 2007 - $108,053. 13 school districts submitted cost reports and settled in FY 2008 - $197,615.

    34. 34 FAMIS Transportation Beginning with FY 2008, DMAS can reimburse transportation for FAMIS students, in addition to Medicaid and Medicaid Expansion students.

    35. 35 FAMIS Billing for Transportation You must have billed claims for FY 2008 in order to have met the one year filing deadline. These previously filed claims will be the basis for filing a cost report for FY 2008.

    36. 36 Filing Transportation Cost Reports for FY 2009 Same deadline for submitting cost reports - November 30, 2009 Same deadline to file claims - - March 31, 2010

    37. 37 Reimbursable Percentages Basis for calculation of costs is the “Trip Log” that is kept for each specially adapted bus. RMTS not used for transportation. Eligibility matching not a factor in transportation reimbursement.

    38. 38 Reimbursable Transportation Percentages NUMERATOR - Total Medicaid, Expansion and FAMIS trips billed and paid by DMAS (supported by the logs) DENOMINATOR - Total trips (one way) by students on specially adapted buses for the year.

    39. 39 Cost of the Buses

    40. 40 What qualifies as a specially adapted bus? Must be a bus - Cars and vans don’t qualify. Have a wheelchair lift, tie-downs for wheelchairs, or seat restraints

    41. 41 Daily Trip Log Requirement for Each Specially Adapted Buses Count each one way trip for each child - regardless of IEP status. Usually 2 trips per day per child.

    42. 42 Transportation The Key to success is the matching of student trips with billed medical services. If you didn’t bill the services or match the services to the trips, you can’t include the trips in the numerator.

    43. 43 Contact Information DMAS John Jurgens, Health Care Reimbursement Specialist, 804-371-2446 or john.jurgens@dmas.virginia.gov DOE Amy Edwards, Medicaid Specialist, 804-692-0150 or amy.edwards@doe.virginia.gov

    44. 44 Contact Information Website with cost reports, instructions Transportation Logs and other correspondence: http://www.doe.virginia.gov/VDOE/Instruction/Sped/medicaidmain.html http://www.dmas.virginia.gov/DMAS/Instruction/Sped/medicaidmain.html (TBA) Or just Google VIRGINIA MEDICAID DOE

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