ARMAC Arkansas Medicaid Administrative Claiming

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ARMACArkansas Medicaid Administrative Claiming

• Where Do We Go From Here?

Medicaid In The Schools (MITS) Summit January 24,
2008 100 PM
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ARMAC

• Arkansas Medicaid Administrative Claiming is a
  federally approved program that allows public
  education agencies to receive reimbursement for
• Medicaid administrative activities being
  performed by school personnel.

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Examples ofMedicaid Administrative Activities

• Notifying parents of benefits covered by Medicaid
  or ARKids First
• Assisting families with completing a Medicaid
  application
• Contacting students physician to complete
  medical necessity paperwork/script for services
• Verifying a students Medicaid eligibility

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Examples ofMedicaid Administrative Activities

• Referring or coordinating health services for
  students (medical, mental health, therapies, or
  substance abuse services covered by Medicaid)
• Participating in or facilitating Medicaid or
  medical training
• Obtaining consents to bill (regardless of current
  Medicaid eligibility status)
• Developing strategies to assess or increase the
  capacity of school medical/mental health programs

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How Districts Participate

• Participants are trained
• Participants respond to random moments

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Sample ARMAC Random Moment
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Sample ARMAC Random Moment
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ARMAC Reimbursement Factors

• Districts Medicaid Eligibility Rate
• Districts incurred cost (based on participating
  staff)
• Statewide of time spent
• on reimbursable activities

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Important Things to Remember

• Staff does not need to know who is Medicaid
  eligible
• The activity being
• performed is measured
• for potential reimbursement
• not the outcome

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Important ARMAC Historical Timelines

• April 1994 Other states began implementing MAC
  (Medicaid Administrative Claiming) programs

• May 2003 CMS issues Medicaid
• Administrative Claiming Guide

• Jan. 2005 Arkansas MAC Implementation
• Plan approved by CMS

• Nov. 2005 59 Arkansas public education
• entities begin participating in ARMAC program

• Sept. 2007 Purposed rule (CMS-2287-P) published
  in Federal Register to eliminate MAC funding

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Important ARMAC Historical Timelines(Continued)

• Oct. 3, 2007 President Bush vetoed 1st SCHIP
  legislation that included language to suspend
  elimination of administrative claiming

• Dec. 12, 2007 President Bush vetoed 2nd SCHIP
  legislation that also contained language to
  suspend
• elimination of administrative claiming

• Dec. 28, 2007 Final Rule (CMS-2287-F) to
• eliminate MAC funding published in Federal
• Register

• Jan. 23, 2008 The House will vote to attempt
  to override President Bushs 2nd SCHIP veto

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SCHIP The MAC Connection

• What is SCHIP?

• SCHIP (State Childrens Health Insurance Program)

• SCHIP Legislation contained language that
  impacted the future of Medicaid Administrative
  Claiming

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SCHIP The MAC Connection
(Continued)

• SCHIP Legislation Medicaid Administrative
  Claiming (The legislation sought to increase
  enrollment of children through program from 6.6
  million children to more than 10 million)

• President vetoed the bill and stated the bill
  would be a step toward federalization of health
  care, and that it would steer the program away
  from its core purpose of providing insurance for
  poor children and toward covering children from
  middle-class families.

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SCHIP MAC Moratorium Language

• SEC. 616. MORATORIUM ON CERTAIN PAYMENT
  RESTRICTIONS. Not withstanding any other
  provision of law, the Secretary of Health and
  Human Services shall not, prior to January 1,
  2010, take any action (through promulgation of
  regulation, issuance of regulatory guidance, use
  of federal payment audit procedures, or other
  administrative action, policy, or practice,
  including a Medical Assistance Manual transmittal
  or letter to State Medicaid directors) to
  restrict coverage or payment under title XIX of
  the Social Security Act for rehabilitation
  services, or school-based administration,
  transportation, or medical services if such
  restrictions are more restrictive in any aspect
  than those applied to such coverage or payment as
  of July 1, 2007.

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SCHIP Moratorium LanguageTranslation

• The federal governments stance states that
  reimbursement under the Medicaid program for the
  costs of certain activities are not necessary for
  the proper and efficient administration of the
  State plan
• - Source CMS-2287-F Federal Register
• Effectively, Arkansas Medicaid Administrative
  Claiming program would cease as a funding source
  for participating public education entities.

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A Closer Look at CMS 2287-F
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Federal Impact

• Elimination of Medicaid Administrative Claiming
  Program
• Final rule published December 28, 2007
  establishes a Secretarial finding that general
  school-based administrative activities are not
  necessary for the proper and efficient
  administration of the State plan.  The rule
  specifies that Federal financial participation
  (FFP) under the Medicaid program will not be
  available for school-based administrative and
  certain transportation costs for home-to-school
  transportation for special education students. 
• Budget Implications
• Estimated to result in 635 million in
  savings during the first year and 3.6 billion in
  savings over the first five years.  These
  estimates are based on recent reviews of State
  reported school-based administrative and direct
  medical service expenditures.   

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State Impact

• 232 districts/early childhood programs would no
  longer receive ARMAC reimbursement
• 10 million in revenue would be lost by
  participating Arkansas public education entities
• Students would lose some additional health
  related services and programs provided by ARMAC
  revenues

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ARMAC Reimbursement Utilization Examples

• Specialized Equipment (for nursing or speech)
• Transportation Modifications (lift installation)
• Facility Modifications (safety seats, ramps,
  etc.)
• Training Fees (CPR, health-related conferences,
  etc.)
• Salaries for health-related staff
• Procurement of health-related services (PT, OT,
  Speech, nursing services, etc.)

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ARMAC FundingUtilization Reporting

• Legislative Requirement
• Reporting vs. Non-governing Funding Utilization
  Language

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Year to Date ARMAC Funding

• FY 2006 3,240,828.38
• FY 2007 6,512,003.09
• FY 2008 4,220.007.60 (to date for 2 Qtrs)
• Total 8 10 million per year

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What Can You Do?...

• Be an active participant
• (You and the students have a vested interest in
  seeing the ARMAC program continue)
• (Reference Contacts List)
• Be patient (things can always change)
• Stay the course (continue as is until
• further notice)

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Advocacy Resource Information(Reference
Handout Available)
Member Name DC Phone DC FAX Email
Senator Blanche Lambert Lincoln (D- AR) 202-224-4843 202-228-1371 http//lincoln.senate.gov/html/webform.html
Senator Mark Pryor (D- AR) 202-224-2353 202-228-0908 http//pryor.senate.gov/contact/
Representative Marion Berry (D - 01) 202-225-4076 202-225-5602 http//www.house.gov/berry/zipauth.shtml
Representative Vic Snyder (D - 02) 202-225-2506 202-225-5903 http//www.house.gov/snyder/contact/email.htm
Representative John Boozman (R - 03) 202-225-4301 202-225-5713 http//www.house.gov/writerep/
Representative Michael A. Ross (D - 04) 202-225-3772 202-225-1314 http//www.house.gov/writerep/
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ARMAC Resource Information

• Medicaid In The Schools (MITS)
• 2402 Wildwood, Suite 172
• Sherwood, AR 72120
• Web Address
• http//arksped.k12.ar.us/sections/medicaid.html
• Tel [phone], option 2 or [phone]
• Rene.Montgomery_at_arkansas.gov
• Armac.support_at_arkansas.gov