Diversifying AAA/ADRCs Funding Streams: How states and their local partners can draw down federal Medicaid Administrative Match for ADRC/NWD Systems July 30, 2017 n4a Conference
Agenda What is the value of Medicaid Claiming? For the ADRC/NWD System/for my organization How is this done? Implementation Process and Steps Maryland & Hawaii s Medicaid Claiming Infrastructure How to get buy in? State Leadership Perspective Colorado s Planning Experience What s Happening Now? ACL Support and Resources 2
What is Medicaid Claiming? Administrative Medicaid Claiming (aka Federal Financial Participation (FFP)) is a way in which Medicaid reimburses agencies doing work that supports Medicaid programs. This is not a fee-for-service; agencies are not paid per activity. FFP reimbursement is calculated based on the results of a time study or daily time documentation 3
Strengthens the case for State and local funding: Local money goes twice as far Demonstrates that the ADRC/NWD network is a core infrastructure supporting the Medicaid program Ongoing source of funding: What is the Value? Once approved, funding will continue Medicaid claiming covers about 40% of costs for Wisconsin s ADRC/NWD Does not require major changes to regular operations 4
Claiming and Reimbursement Process Operating agency adds all participating staff into "cost pool" State Medicaid agency submits claiming report, receives federal funds, and allocates funds to operating agency for disbursement Operating agency runs time studies to capture staff time Operating agency calculates the Medicaid %, documents costs within the cost pool, and requests reimbursement from state Medicaid Local sites submit quarterly documentation of actual expenditures to operating agency 5
Maryland s Medicaid Claiming Maryland uses a random moment time study (RMTS) methodology Staff code activity at a randomly selected time Less burdensome, more accurate reporting compared to 100% time tracking Uses a web-based RMTS software system Automatically generates the samples each quarter Adapted codes that correspond to staff work Level 1 Screen Person Centered Counseling Coordination of services with individuals at risk of Medicaid spend-down 6
Maryland s Claiming Totals 2500 samples generated per quarter 150 staff total Statewide Average for State Fiscal Year 2017: Medicaid Claimable Percent = 47.65% Total Claiming Reimbursement = $3,303,000 7
Deborah Stone-Walls Maui AAA, Hawaii 8
Hawaii s Steps for Implementing Medicaid Claiming 9
Simply put. Identify the work that we do Tease out if the activities are related to Medicaid Document time spent on Medicaid activities 10
Medicaid Claiming Codes Codes should support operations Ordered to make choice of code clearer Negotiated with direct staff Training on the coding process Random Moments pilots Survey Monkey Analysis/testing of codes Provides estimates of claimable time 1. Reimbursed by another source 2. Medicaid Choice Counseling 3. Call Log/Intake 4. Facilitating Program Applications 5. Assessment/Support Plan Development 6. Referral, Coordination, & Monitoring 7. Outreach 8. Training or Program Admin. 9. General Admin. 10. Other 11
Pilot Testing Conduct Pilot A Evaluate codes during pilot 3 weeks Update codes Conduct Pilot B Develop cost and time estimates Establish a baseline 3 weeks Implement FFP State and Federal approval Ongoing time study 12
Establishing the Cost Pool Personnel: salaries, taxes, fringe for direct, supervisory and support staff Operations: Lease/rental, program activities, printing/publications/advertisement, staff training, supplies, travel, etc. Equipment and motor vehicle costs Report actual costs quarterly 13
Getting Staff On Board 14
1. Reimbursed Directly by Another Source No 2. Quest Integration Choice Counseling No 3. Call Log/ Intake No 4. Facilitating Application 5. Assessment 6. Referral, 8. Training 9. General No /Support Plan No Coordination, or No 7. Outreach No or Program No No Administration Development Monitoring Administration 10. Other Yes Yes Yes Yes Yes Yes Yes Code 1 Code 2 Code 3 Medicaid an option? Tied to a specific program No Code 9 Code 10 Yes No Yes Yes Yes Code 5a At risk for spenddown & institutionalization Code 5c Yes Medicaid related Code 7c Code 5b Yes No Code 7a Code 7b Not Medicaid related General administration Medicaid related Further evaluation required Code 4a Yes Medicaid related No Code 4b Yes Code 6a Medicaid an option? At risk for spenddown & institutionalization No Code 6c Tied to a specific program Yes Medicaid related No Code 8c Code 6b Yes No Code 8a Code 8b 15
What s in it for me? Increase available funding to support activities and STAFF members Decrease ongoing funding/employment anxiety and burnout 16
Staff Training and Ongoing Monitoring Engage ALL types of learners Staff trainings Training should have lots of examples and scenarios, not just code definitions.practice, practice, practice FFP Time Study Guide Bi-weekly quizzes to keep code definitions fresh for staff Ensures accuracy in coding 17
Helpful Hints Talk with other states to learn from their experiences Early collaboration between State and local staff and preliminary mini-pilots can improve the accuracy of codes and need for further refinement Provide thorough training and develop mechanism for answering ongoing questions 18
Helpful Hints, cont. Set realistic goals for data collection and time study duration Smaller agencies may need more time to gather data Don t over complicate!! Staff are already performing tasks; not looking to change day to day operations Collect complete costs for staff participating in FFP claiming (e.g., rent, utilities, etc.) The greater the associated costs, the higher the return 19
Roger Auerbach Lewin Group 20
What does the ADRC/NWD System do for Medicaid? Outreach and consumer education Intake, triage, application assistance Planning for future needs Person Centered Counseling Delaying or preventing Medicaid eligibility Triage and screening to prevent Medicaid spenddown, including diversion away from long-term institutionalization by providing resources and support in the community 21
What s in it for Medicaid? Reduce Medicaid costs by counseling individuals about non-medicaid community services and developing person-centered plans Streamlining enrollment into Medicaid for services not provided by other programs Integrate and coordinate access to Medicaid services 22
Developing Draft Codes, Testing and Approval Develop and pilot test draft codes Evaluate and refine codes Design a quality management process Secure final Medicaid approval of the proposal Develop an MOU Receive approval from CMS 23
Tim Cortez Colorado Department of Health Care Policy and Financing 24
Colorado s Background ADRC grant awarded in 2005 16 ADRCs operating in Colorado ADRCs are partially financed by the Older Coloradans Act and may have local funds Colorado received a NWD planning grant in 2014 and the implementation grant in 2015 The SUA requested approval to set aside a portion of state general fund 25
Colorado Background, Cont. The SUA (CDHS) and Medicaid State Agency (HCPF) began engagement with the ADRCs in 2016 PCG in 2017 developed time study codes and draft amendment for the Medicaid Cost Allocation Plan Currently in review by state staff HZA modified the online time study platform to allow ADRCs to respond to random time study surveys ADRCs are currently piloting after initial pilot 26
How Can I Position My Organization? Understand what contributions you make or can make to support the Medicaid Program Engage with state agencies to identify reimbursable activities and develop time study codes Participate in time study pilots Understand your responsibilities for cost reporting and participating in time study surveys 27
Return on Investment New funds for work ADRCs are already doing Depends on a few factors: Availability of funds for state match Amount of Medicaid related activities per quarter Local funds available If the costs attributable to Medicaid outweigh the administrative strings, then probably a positive ROI. 28
State Level Agreements MOU between State Medicaid Agency (HCPF) and State Unit on Aging (CDHS) SUA agrees amount of state funds to set aside SUA submits report to HCPF requesting how much FFP to cover program costs allocated by time HCPF agrees to seek reimbursement and transfer funds to SUA 29
Local Level Agreements Contracts between ADRC and SUA ADRC submits ADRC cost reports to SUA ADRC identifies staff to participate in Time Study Surveys ADRC agrees to carry out ADRC functions 30
Ami Patel ACL 31
ADRC/NWD System Medicaid Claiming AK WA ME CA OR NV ID AZ MT WY CO NM ND SD NE KS MN WI IA IL MO OK AR MS NY MI PA OH IN WV VA KY NC TN SC GA AL VT NH MA RI CT NJ DE MD DC HI TX LA FL Currently Claiming 11 states currently claiming for ADRC/NWD activities 13 in the planning phase Planning 32
What s Happening Now? CMS recently issued the No Wrong Door System Reference Document for Medicaid Administrative Claiming Guidance to assist NWD states with implementing Medicaid claiming. ACL Workbook and Guidance: - ACL has drafted a workbook that includes various tools and guidance documents for states to use as they develop a claiming infrastructure. These tools include: - PowerPoint presentations for engagement of NWD partners and stakeholders - Cost simulator - Claiming code guidance - Cost allocation spreadsheets, and more 33
Resources https://nwd.acl.gov https://www.medicaid.gov/medicaid/financi ng-and-reimbursement/admin-claiming/nowrong-door/index.html 34
Contacts Administration for Community Living The Lewin Group Ami Patel ami.patel@acl.hhs.gov Roger Auerbach roger.auerbach@yahoo.com Maui, Hawaii Area Agency on Aging Deborah Stone-Walls, deborah.stone-walls@co.maui.hi.us Colorado Dept. of Health Care Policy and Financing Tim Cortez Timothy.cortez@state.co.us 35