Medicaid Reimbursement

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Medicaid Reimbursement

• Trade Secrets Revealed!

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Technical Assistance
Helping Kids
Rewards
We Survived
Cooperation
MTS 3.0
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We Survived

• School districts just came through a really bad
  hurricane season
• Several rules formulated by the Centers for
  Medicaid Medicare (CMS) threatened our survival
• Congress passed and the President signed a
  reprieve until April 1, 2009
• Forces are hard at work to make the reprieve
  permanent

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All You Need Is Love eh Cooperation

• Administrative Support
• Technical/Data Support
• Coachable Service Providers
• An Open Mind
• A Willingness to Learn
• And Yes, Time (Is On Your Side)
• Yes, You Can!

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You Also Need To Consider

• FERPA/HIPAA/IDEA Consent Compliance
• Audit requirements
• Personnel turnover

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Technical Assistance

• Tallahassee is on your side
• Other states are not so lucky
• MACS Seminole County
• AHCA
• SSN
• MTS 3.0

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Area Medicaid School Contacts
Holmes
Jackson
Okaloosa
Escambia
Santa Rosa
Nassau
Gadsden
Walton
Washington
Hamilton
Jefferson
Madison
Leon
Calhoun
Bay
Duval
Baker
Columbia
Suwannee
Wakulla
Taylor
Liberty
Union
Clay
Bradford
Gulf
Franklin
Lafayette
St. Johns
Gilchrist
Putnam
Alachua
Dixie
Flagler
Levy
Marion
Volusia
Lake
Citrus
Sumter
Seminole
Hernando
Orange
Area 5 - Joyce Carpenter [phone]
x131 carpentj_at_ahca.myflorida.com
Pasco
Brevard
Osceola
Polk
Hillsborough
Pinellas
Indian River
Hardee
Manatee
Okeechobee
St. Lucie
Highlands
DeSoto
Sarasota
Martin
Area 10 Joe Mieszkowski (954)
202-3294 mieszkoj_at_ahca.myflorida.com
Glades
Charlotte
Hendry
Palm Beach
Lee
Broward
Collier
Miami-Dade
Monroe
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Rewards

• Rewards for you
• Rewards for your service providers They become
  stakeholders
• Rewards for your school district
• Rewards for (I saved the best for the last)

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Rewards for your

• KIDS!
• Medicaid reimbursement helps your kids
• It buys supplies
• It buys people
• It buys good will
• It frees up your budget for other things
• It enhances school services

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How Are Schools Reimbursed ?

• Schools obtain reimbursement through two funding
  streams Fee-for-Service and School District
  Administrative Claiming (SDAC)
• School District Certified Match (Fee-for-Service)
  Florida Total to date is about 70 million.
• Florida SDAC total to date is approximately 488
  million.
• The average annual fee-for-service reimbursement
  is from 6 million to 10 million. The potential
  annual state reimbursement is estimated at 22
  million.

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Medical Services

• What medical services do schools provide through
  the Certified School Match Program?
• Therapy Services
• Behavioral Services
• Nursing Services
• AAC Services
• Transportation

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What are the requirements for Fee-for-Service?

• Provider Status
• Qualified Personnel
• Documentation
• Medicaid-Enrolled Students
• IDEA/Part B or C (IEP)

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Therapy Services -- Speech/Language

• Evaluations
• Treatment of disorders including speech
  correction, articulation, interactive
  communication, auditory and/or visual processing,
  verbal and written language, phonology, memory
  comprehension, voice fluency and
  cognition/communication

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Therapy Services -- Occupational Therapy

• Evaluations to determine level of function and
  competencies
• Treatment visits including perceptual motor
  activities, functional performance exercises,
  kinetic movement, guidance in using adaptive
  equipment
• Wheelchair evaluations and fittings
• Application of casts and splints

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Therapy Services -- Physical Therapy

• Evaluation and treatment for conditions including
  range-of-motion, muscle strength, functional
  abilities and the use of adaptive/therapeutic
  equipment
• Rehabilitation through exercise, massage and the
  use of equipment through therapeutic activities
• Wheelchair evaluations and fittings
• Application of splints and casts

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Behavioral Services Providers

• School Psychologists/Psychologists
• Certified/Associate Certified Behavior Analysts
• School Social Worker/Social Workers
• Mental Health Counselors
• Marriage and Family Therapists
• School Guidance Counselors

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Behavioral Services

• Testing and evaluations to assess cognitive,
  developmental, emotional, social, adaptive and
  behavioral function
• Consultation, coordination and follow-up
  referrals
• Therapy and counseling
• Crisis Intervention
• Interviews, social development studies, and
  functional assessments

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Nursing Services Providers

• Registered Nurses
• Licensed Practical Nurses
• School Health Aides

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Nursing Services

• Health assessments, monitoring and management
• Health care treatments and procedures including
  crisis intervention
• Student health training and counseling
• Catheterization, tube feeding, maintenance of
  tracheostomies, oxygen administration, ventilator
  care and medication administration
• Consultation and coordination

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Administrative Activities

• Which administrative activities qualify schools
  for Medicaid reimbursement?
• Outreach services
• Coordination of health services
• Health care planning
• Assisting with access to Medicaid services
• Developing strategies to improve service delivery

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How do schools keep track of administrative
activities?

• Time studies such as Random Moment Sampling are
  completed each quarter
• Claimable costs for qualified personnel along
  with activity code assessments are used to
  establish school district claims

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Shared Services Network and Medicaid -- A History

• Helping school districts bridge the gap between
  promised and actual IDEA funding
• Reimbursement for dollars already spent
• Our Web Site -- ssn.usf.edu -- provides
  information about Medicaid and schools including
  reimbursement reports and our annual (at least,
  usually) October Medicaid Conference

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Shared Services Network cont

• SSN developed programs so that school districts
  can access Medicaid funding without using outside
  consultants
• This encouraged reluctant schools to participate
  by eliminating fees that could amount to 10 to 20
  percent of Medicaid reimbursements

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SSN Schools

• SSN developed the Medicaid Administrative
  Claiming System (MACS) in 2002 in conjunction
  with DOE, AHCA, Seminole, and Orange Counties
• About 47 school districts now participate in
  School District Administrative Claiming (SDAC)
  through MACS

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SSN Fee-for-Service

• SSN developed the Medicaid Tracking System (MTS)
  in 1999 with the help of AHCA, DOE and pilot
  school districts
• Schools can use MTS to check Medicaid eligibility
  and bill Medicaid directly through the Medicaid
  Certified School Match Program (MCSM)
• Currently about 55 districts use MTS to check
  eligibility and 17 use it to bill
• Web-based MTS 3.0 will be available soon

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Ongoing SSN Medicaid Support

• Technical Assistance
• Annual Medicaid and Schools Conference
• Legislative monitoring
• Liaison between AHCA and school districts
• Information updates
• Regular conference calls

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Medicaid Tracking System 3.0

• Medicaid Tracking System (MTS) changes will
  enhance school districts ability to bill for
  direct services
• Web-based MTS enables school-based providers to
  directly input billing information
• This system will reduce the amount of time school
  districts spend on Medicaid administration
• Data will be centrally located
• Telephone support through 800 number
• All you need is Internet access

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MTS 3.0 Demonstration

• Sunshine Connectionshttp//www.sunshineconnection
  s.org/Pages/Tools.aspx
• http//test.fcim.org/medPrj/demo/

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Its All About the

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Resources - Links to TAPS/MCSM Handbook

• Technical Assistance
• Medicaid Certified School Match Program
• Therapy Services www.fldoe.org/ese/pdf/y1999-8.pdf
  
• Behavioral Services www.fldoe.org/ese/pdf/y2002-6
  .pdf
• Nursing Services www.fldoe.org/ese/pdf/y001-12.pdf
  
• Charter Schools www.fldoe.org/ese/pdf/tap99-7.pdf
• Florida Medicaid Agency for Health Care
  Administration Provider Handbooks
  http//portal.flmmis.com/FLPublic/Provider_Provid
  erSupport/Provider_ProviderSupport_ProviderHandboo
  ks/tabId/42/Default.aspx

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Resources Web Sites

• www.gregontheweb.com
• www.theleanet.com
• www.medicaidforeducation.org

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Contact Information

• Please contact Susan Douglas, Shared Services
  Network, Medicaid Consultant, for further
  information and/or technical assistance at
  sdouglas_at_coedu.usf.edu or at [phone]

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Questions?

• Nows your chance!