Special Education Data Reporting Overview Cost Based Reimbursement Methodology for School-Based Health Services May 2011
May 2011 Page 2 Agenda Overview of Cost Settlement Methodology Special Education Data Reporting Requirements Special Education Medicaid Eligibility Ratio Specialized Vehicle Ratio Specialized Transportation Trip Ratio Next Steps
May 2011 Page 3 Overview of Cost Settlement Methodology Federal Medicaid (CMS) requires that States demonstrate that rates paid for school-based services are no higher than the actual cost of providing medical services. In order to comply with this requirement, AHCCCS will implement a Medicaid cost reconciliation and settlement process effective for SFY 2012. So what does that mean for LEAs? LEAs will go through an annual cost settlement process which will require the submission of a Medicaid cost report. Actual costs of providing Medicaid-covered health related services will be compared to Medicaid reimbursement received. If costs exceed reimbursement received, LEA will receive a settlement. If costs are less than reimbursement received, LEA will payback the difference.
May 2011 Page 4 Overview of Cost Settlement Methodology
May 2011 Page 5 Special Education Data Reporting Requirements There are a number of factors that are used to determine what portion of LEA costs are allocable to Medicaid. These factors will be calculated annually and will require data inputs from LEAs, PCG, and ADE. Special Education Medicaid Eligibility Ratio Used to allocate direct medical service costs to the Medicaid program. Specialized Vehicle Ratio Used to allocate general transportation costs when specialized transportation costs cannot be discretely identified by LEA financial staff (for example, fuel costs). Specialized Transportation Trip Ratio Used to allocate specialized transportation service costs to the Medicaid program.
May 2011 Page 6 Special Education Medicaid Eligibility Ratio The Special Education Medicaid Eligibility Ratio represents the number of special education students with related services who are Medicaid eligible. Total Medicaid Special Education Students with a Related Service Total Special Education Students with a Related Service LEA will be required to submit a data file of all special education students on December 1 st who have at least one reimbursable related medical service prescribed on their IEP. Reimbursable medical service are only those that are covered with the Direct Service Claiming Program, which includes: Speech, Physical Therapy, Occupational Therapy, Audiology Services, Nursing Services, Behavioral Health Service, Personal Care Services.
May 2011 Page 7 Special Education Medicaid Eligibility Ratio If a child receives more than one direct medical service, such as speech and OT, the child should only be listed once within the file. PCG will perform a Medicaid eligibility matching process to determine the # of children with Medicaid eligibility (numerator of the ratio). Both the numerator and denominator will be pre-populated in the Medicaid cost report by PCG. PCG will provide a required template that each LEA will have to follow to facilitate the matching process. This process will build upon the current matching process PCG performs annually on behalf of LEAs. Preliminary required fields will include: Name, date of birth, gender, and identification of related medical services within the IEP. PCG will provide additional information on this reporting process in the future.
May 2011 Page 8 Specialized Vehicle Ratio Total Number of Specialized Vehicles Total Number of Vehicles A specialized vehicle is defined as a special needs school bus that is designed to transport disabled passengers and is constructed with a special-service entrance. The vehicles reported in the numerator should be those that solely transport special educations students (per Medicaid billing requirements) and should NOT include vehicles that transport both special education and general education students. LEA will report these two vehicle counts (total vehicles and total specialized vehicles) on the annual Medicaid cost report.
May 2011 Page 9 Specialized Transportation Trip Ratio Total Paid 1-Way Trips Provided to Medicaid Eligible SpEd Students Total 1-Way Trips Provided to SpEd Students Riding Specialized Vehicles LEAs will report the total number of one-way trips provided for all special education students requiring specialized transportation services during the cost reporting period. Trip count includes all trips for students riding specialized vehicles for the fiscal year. Special education students riding on buses transporting general education students should not be included in this count. LEA will report this count on the annual Medicaid cost report. Medicaid count of trips will be calculated by PCG based on claims data (numerator). Bus logs must be kept and stored by LEAs in order to support reported number of one-way trips, in the event of an audit /review.
May 2011 Page 10 Next Steps Review special education reporting system to determine how student file can be provided for special education students with reimbursable direct medical related services. AHCCCS and PCG to provide additional details on IEP ratio file requirements, including file content and due date. Examine process used for logging student transportation trips in order to accurately report specialized transportation trip count.