PCG Medicaid School-Based Services (SBS) Programmatic Updates

Transcription

1 PCG Medicaid School-Based Services (SBS) Programmatic Updates Wisconsin Association of School Business Officials (WASBO) March 11,

2 Agenda School Based Medicaid in Wisconsin Overview Medicaid Administrative Claiming (MAC) School-Based Annual Medicaid Cost Settlement Tips to Maintain a Compliance District Monitoring Reviews Potential Audit Findings Next Steps Questions? 2

3 School Based Medicaid in Wisconsin Public Consulting Group (PCG) has been under contract with the Wisconsin Department of Health Services (DHS) since 2009 to calculate quarterly Medicaid Administrative Claims (MAC) and facilitate annual Medicaid cost reporting, beginning with the 2009 Fiscal Year reporting period. During this time PCG has completed processing payments for the following school years: 2007/ /2012 (MAC and Annual) 2012/2013 (MAC, with Annual to be processed in May 2015) 2013/2014 (MAC) All school district s are strongly encouraged to check the Forward Health Portal to view payment information 3

4 School Based Medicaid Reimbursement in WI FFS Fee-For Service Billing and payment occurs throughout the year for direct medical services MAC Medicaid Administrative Claiming Annual Cost Settlement Annual Cost Settlement for Direct Medical and Transportation Costs As a reminder, Medicaid Administrative Claiming (MAC) is a quarterly process which reimburses on allowable costs for outreach and coordination of activities related to Medicaid eligible students 4

5 Quarterly Staff Pool List Random Moments Payment sent to districts Quarterly MAC Process Financial Collection CPE Form Completed Claim Generated 5

6 Purpose of the Random Moment Time Study Do your staff fully understand the importance of the RMTS? Random Moment Time Study = Reimbursement Your district RMTS coordinator is responsible for creating and maintaining not only the Staff Pool Roster, but also reiterating to participants the importance of the Time Study The percentages derived from the RMTS are applied to allowable costs for Administrative Claiming and Annual Cost Settlement Do you know who is responsible for coordinating the Staff Pool List at your district?

7 Random Moment Time Study (RMTS) Random Moment Time Study Asks: 1. Who were you with? 2. What were you doing? 3. Why were you doing this activity? 4. Was this activity regarding a special education student? 5. Was the service you provided part of the child s IEP? Participants should enter the exact activity they were doing at that exact minute in time Staff should perform their normal activities during the time of their moment and make note of their activity after it passes

8 MAC Updates 100% of school districts have certified their financials for 2012/2013 and were included in MAC claims processing 99.27% of school districts have certified their financials for 2013/2014 and will be included in MAC claims processing PCG Claiming System: Certification of Public Expenditure forms must be signed and returned to PCG by the deadline in order to receive a payment A delay in signing and returning all four quarterly CPE forms will result in a delay of payment 8

9 CPE Form Medicaid Administrative Claiming (MAC) Certification of Expenditure Form *This form serves as both the invoice and the certification of expenditures of total computable and non-federal funds.* INSTRUCTIONS: Confirm total expenditures, enter source and amount, print, sign, and date below. Complete all fields in YELLOW. This completed form must be faxed to Attn: WIMACS School System Badger School District Medicaid Provider Number Quarter 01/14-03/14 NPI NUMBER Total Expenditures $ 2. Total Claimable Medicaid Administrative Expenditures $ 3. Total Claimable Indirect Costs and Claimable Fixed Fee $ 4. Total Claimable Costs = (#2 + #3) $ 5. Reimbursement Request (#4 x 0.50) $ 1,810,000 42,150 9,150 51,300 25,650 NON-FEDERAL MATCH FUNDS provided by school. Designate the source and amount of funds in your school budget that you are using to match the federal funds you received from Medicaid. The total amount of state funds that you identify must at least equal the amount shown in item #5 above. SOURCE Local funds AMOUNT $ 25,650 Payment VERIFICATION OF FUNDS Signature of School Fiscal Budget Officer Date: 9

10 NON-FEDERAL MATCH FUNDS provided by school. Designate the source and amount of funds in your school budget that you are using to match the federal funds you received from Medicaid. The total amount of state funds that you identify must at least equal the amount shown in item #5 above. SOURCE CPE Form Continued AMOUNT Signature and Date VERIFICATION OF FUNDS Signature of School Fiscal Budget Officer Date: Name (Please Print) Title I certify that (Line 1 above), to the best of my knowledge, the Medicaid Administrative Claiming (MAC) for the Quarter ending represents actual expenditures accumulated under our provider agreement with the Wisconsin Department of Public Instruction (DPI). The claim amount is solely related to our provider agreement with DPI and does not duplicate any federal claims for reimbursement, nor are the funds used to match other federal funds, unless expressly allowed by federal regulations. Printed Name and Title Quarter End Date 10

11 Annual Cost Reporting Overview 11

12 Annual Cost Reporting Overview 404 school districts throughout Wisconsin participated in Annual Cost Settlement for the school year Thank you for your continued effort and due diligence in this process! The purpose of Annual Medicaid Cost Settlement is to reimburse districts (an on annual basis) for the true cost of providing direct medical services and specialized transportation to Medicaid eligible students Upcoming and recent Cost Settlement Payments and Adjustments 08/09-09/10 Transportation Adjustments Adjustments were a result of a statewide DHS memorandum asking districts to verify they had the correct documentation for transportation costs and reported ratios correctly cost settlements will be processed in May cost settlements will be processed in May

13 Annual Cost Reporting Overview 13

14 Forward Health Portal Reminder- districts can view all Medicaid payment information through the Forward Health portal. If you do not have access please contact the Forward Health hotline Information is found on the Dashboard ( of the MCRCS website: 14

15 Tips to Maintain a Compliant District Salary and Benefit Costs Direct Medical Material and Supply Costs Transportation Trip Ratio Detailed Bus Logs and Attendance Records Transportation Payroll Payroll Ledgers Transportation Other Costs System Financial Ledger. IEP Ratio valid IEP for dates of service As a School Business Official, Ask Yourself: Who is responsible for reporting each component? Where is the documentation located at your district? Is your system set up to run the correct reports when needed? Do the individuals reporting fully understand the requirements? 15

16 Relationship between Billing & Reporting Costs Please ensure that your district is billing Medicaid Fee-For-Service throughout the school year on historic and accurate levels for direct medical billable services. This is the foundation of the cost settlement process. Communication and understanding of billing procedures and processes is key! Who oversees your billing processes? How often do you communicate with these individuals? This relation is critical to the cost settlement process. The Wisconsin School Based Services Billing Guide (and other helpful materials ) can be found on the dashboard of the PCG MCRCS website. 16

17 Transportation Reminder Does your transportation department completely understand requirements for reporting specialized transportation costs? This includes using approved methodologies and not making up district specific (back of the envelope) calculations Specialized transportation needs must be documented in a student s IEP, along with another reimbursable service (Speech, Attendant Care, OT, PT, Nursing, Psych., Social Work) that they are receiving that day; and, Documentation must be kept (bus logs, attendance sheets, etc.) to support the student was using transportation and received a service Who keeps this documentation at your school district? 17

18 Transportation Allowable transportation costs are detailed in the Wisconsin Medicaid School-Based Services Handbook (continued): Specialized transportation includes, but is not limited to: A physically modified vehicle with a ramp or lift; A vehicle where an aide is required to assist the child; A specially adapted bus for a child with a disability who is not able to ride a standard school bus; and/or A vehicle following a specialized route. Link to Handbook: Has your staff reviewed the Handbook recently? 18

19 Cost Settlement The Cost Settlement compares the Medicaid Allowable Costs as calculated on the Annual Cost Report to the Interim Payments received throughout the school year 19

20 Monitoring Reviews Breakdown 20

21 Monitoring Reviews PCG conducts on-site and remote Monitoring Review efforts every Spring to ensure compliance for the MAC and Cost Reporting Programs Districts must provide PCG with: Requested salary, benefit, contracted staff costs source data Proper service provider certification/licensure Direct Support Staff evidence (job description) Proof of Annual and Quarterly Other Costs reported Transportation costs source data Back up documentation for Transportation and IEP ratios 21

22 Monitoring Reviews Requested salary, benefit, contracted staff costs source data All salary, benefit, contracted staff costs source data must be in monthly and/or quarterly formats It must support costs reported within MCRCS Proper service provider Certification/Licensure Individuals must be properly licensed during all time periods for which they are active on the Staff Pool List Proof of Annual and Quarterly Other Costs reported District documentation and accounting structure must support the reporting of costs under the Annual and Quarter Other Costs category 22

23 Monitoring Reviews Transportation Costs Payroll Ledgers to support Transportation Payroll Account codes to support the categorization of Transportation Other Costs Transportation Ratios IEP Ratio Bus Logs, Service Logs, Attendance Records, and IEPs to support One-Way Trips Ratio Vehicle Count to support reported Vehicle Ratio, if applicable Active IEPs for all students included in IEP Ratio count Student Roster to show all special education students who have one direct medical service in their IEP 23

24 Monitoring Reviews PCG will be continuing On-site and Remote Monitoring Review efforts in March/April 2015 to ensure compliance for MAC and Annual Cost Reporting Selected districts have been strategically chosen by PCG, DHS, and DPI Districts must provide PCG with: Requested salary, benefit, contracted staff costs source data Proof of Annual and Quarterly Other Costs reported Proper service provider Certification/Licensure Transportation proof Proof of Cost Report ratios (i.e., IEP Ratio, Trips Ratio, and/or Vehicle Ratio) Direct Support proof Report summarizing review findings will be sent to the district and the state All over claiming will be adjusted Corrective Action Plan may be required 24

25 Potential Audit Findings Federal dollars were not properly identified for: Salary and Benefit Costs Materials and Supplies Transportation Costs Costs were claimed for a service provider without current licensure A direct support person was reported without evidence that they actually provided direct support to an individual on the Staff Pool List Source documentation does not align (or can t be found) for the reported information in the system 25

26 Potential Audit Findings- Transportation Bus logs were not kept to support transportation cost and one=way trips Transportation costs are not correctly categorized as either Only Specialized Transportation or Not Only Specialized Transportation What does your documentation support? Calculation of the Specialized Transportation One-Way Trip Ratio How does your district calculate this ratio? If you have any questions about documentation and allowable costs, please contact PCG Is PCG your first point of contact when asking questions? 26

27 Monitoring Reviews WI Monitoring Reviews Elmbrook School District Oconomowoc School District Sun Prairie School District Watertown School District Augusta School District Clinton School District Cumberland School District Colby School District Medford School District Whitnall School District Location Onsite Onsite Onsite Onsite Remote Remote Remote Remote Remote Remote 27

28 Next Steps UPCOMING DEADLINES January-March 2015 MAC Quarterly Financial Submission Due 5/15/2015 April June 2015 MAC Quarterly Financial Submission Due 8/14/2015 FY14 Annual Desk Reviews To be completed two weeks after receipt of (all districts completed by 4/1/15) Districts have already begun receiving s, and additional s will follow up in the upcoming weeks Monitoring Reviews for Select Districts March/April

29 Contacts Help Desk Toll-free Number: RMTS Username or Password Reset: Press 1 RMTS Staff Pool List & MAC Quarterly Financial Submissions: Press 2 Annual Medicaid Cost Report: Press 3 Annual Medicaid Cost Report Questions: wicostreport@pcgus.com RMTS, Staff Pool List, and Quarterly Report Questions: wimacs@pcgus.com 29

30 Questions? 30

31 Public Consulting Group, Inc. 148 State Street, Tenth Floor, Boston, Massachusetts (617) , 31