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Medicaid Administrative Claiming (MAC) – Random Moment Time Study and Financial Reporting Training New York State Department of Health January 2013.

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Presentation on theme: "Medicaid Administrative Claiming (MAC) – Random Moment Time Study and Financial Reporting Training New York State Department of Health January 2013."— Presentation transcript:

1 Medicaid Administrative Claiming (MAC) – Random Moment Time Study and Financial Reporting Training New York State Department of Health January 2013

2 Agenda Introduction to Medicaid Administrative Claiming (MAC) Random Moment Time Study (RMTS) for MAC MAC Claim Calculation Important Dates Contacts and Questions 2

3 Introduction to Medicaid Administrative Claiming (MAC) 3

4 Overview Schools provide an array of health-related (medical) services in addition to traditional “educational services” to ensure that students are able to fully participate in the school environment. These direct medical services form the basis for the Medicaid School Supportive Health Services Program (SSHSP). As school staff work with students on a daily basis, they are uniquely positioned to assist in enrollment of eligible students in Medicaid, to assist them in receiving the medical services and supporting administrative and outreach services they require, and to provide medically-necessary services. These administrative services form the basis for the Medicaid Administrative Claiming (MAC) Program. Currently, school districts only receive Medicaid reimbursement for direct services based on a fee for service model with an annual cost settlement process. School districts do not currently receive any reimbursement for the administrative functions associated with providing these services. 4

5 Medicaid Administrative Claiming (MAC) Overview Through the MAC program, school districts can receive reimbursement for the costs of administrative and outreach activities that support the Medicaid program Allowable MAC activities include: Facilitating Medicaid Outreach Facilitating Medicaid Eligibility Enrollment Translation Services Related to Medicaid Services Medical Program Planning, Policy Development, and Interagency Coordination Medicaid-Related Training and Professional Development Referral, Coordination and Monitoring of Medicaid Services 5

6 MAC Participation Requirements School districts can receive MAC reimbursement by meeting 3 main program requirements: Participate in SSHSP. Participate in the quarterly Random Moment Time Study (RMTS) (a requirement to participate in SSHSP). Submit quarterly financial data to be used in calculating the MAC claim. Most school districts are already meeting the requirements of participation in SSHSP and in the quarterly RMTS. School districts meeting the first two requirements need only to complete and submit quarterly financial data in order to access MAC reimbursement. 6

7 Participating in MAC School districts that are currently participating in SSHSP and in the quarterly RMTS are eligible to receive MAC reimbursement for their direct service practitioners. These school districts will need to complete a quarterly MAC financial submission in order to generate a MAC claim for their district. MAC claims for the October – December 2012 and January – March 2013 will only include direct service practitioners included on the quarterly RMTS rosters. School districts that are currently eligible to receive MAC reimbursement will have the opportunity to add new, Administrative Only staff to a new RMTS roster starting with the April 1, 2013 quarter. MAC claims starting with the April – June 2013 quarter may include both direct service practitioners and administrative staff included on that quarter’s RMTS roster. School districts not currently participating in SSHSP and the quarterly RMTS are not eligible to receive MAC reimbursement at this time. These school districts will need to begin participating in SSHSP and the quarterly RMTS prior to claiming for MAC reimbursement. 7

8 Random Moment Time Study (RMTS) for MAC 8

9 Random Moment Time Study for MAC School Districts with employees that provide direct services to students are currently included in the Random Moment Time Study. They are included in two pools: Direct Services – Therapy Direct Services – All Other These cost pools measure the amount of time spent on providing direct services to students with an IEP as well as time spent performing MAC eligible activities. In the April-June 2012 quarter, a third pool will be added to the RMTS for employees that conduct Medicaid administrative activities to measure the amount of time that employees spend conducting Medicaid administrative and outreach activities. Employees can only be included in one cost pool. Employees should be included in the cost pool that best represents the person’s primary function and licensure/credentials. 9

10 Random Moment Time Study for MAC The RMTS allows for capturing the percentage of time spent on administrative activities for the both the MAC pool and the direct services pools. 10 DS-Therapy % = Cost Settlement MAC % - MAC Claim MAC % = MAC Claim DS - All Other % = Cost Settlement MAC% = MAC Claim RMTS

11 Administrative Staff Pool The following staff categories can be added to the Administrative Staff Pool List: 11 AdministratorsProgram Specialists CounselorsNon-licensed Psychologists NursesNon-licensed Social Workers Interpreters & Interpreter AssistantsNon-licensed Orientation & Mobility Specialist Pupil Support Services AdministratorsResource Specialist/Family Liaisons Pupil Support – TechniciansSpecial Education – Support Technicians Psychologist InternsSpecial Education Teachers Special Education AdministratorsSpecial Education Teacher’s Aide School Bilingual Assistants

12 Non-Allowable Staff The following staff categories are examples of staff that are Not Eligible to participate in MAC because they are included in the unrestricted indirect cost rate calculation: 12 Board of Education StaffPhysical Plant Staff Legal StaffSecurity Staff Office of the Superintendent StaffCommunications Staff Executive Administration StaffInformation Technology Staff Chief Business Office StaffProgramming Staff Budgeting/Finance Accounting StaffTelecommunications Staff

13 Non-Allowable Staff Staff included in the calculation of the school district’s unrestricted indirect cost rate cannot be included on the staff pool list. The cost of these functions are not allowed because they unrestricted indirect cost rate is used in the calculation of the MAC claim and in the calculation of the direct services indirect costs for determining Medicaid- allowable costs Staff paid entirely for these functions should not be included on the staff pool list Staff paid partially for the functions can be included on the staff pool list, as long as their other functions are on the allowable list. 100% Federally funded staff Should Not be included on any of the staff pool lists. 13

14 MAC Claim Calculation 14

15 MAC Claim Calculation MAC claims are calculated for each participating district on a quarterly basis The claim is based on the state-wide time study results for each cost pool. The time study results are applied to district specific information such as costs (e.g. salary and benefits), Medicaid Eligibility Ratio (MER) ratio and the unrestricted indirect cost rate to calculate the MAC claim. Each cost pool will be summarized into one total claim for each participating district. 15 DS Therapy Cost Pool - MAC Claim DS Other Cost Pool - MAC Claim MAC Cost Pool -MAC Claim Total District MAC Claim

16 MAC Claim Calculation – Allowable Costs Only Medicaid-allowable costs can be included in the MAC claim. CMS has narrowly defined what costs can be reported as Medicaid- allowable costs eligible for MAC reimbursement: Personnel Services - Salaries Include all costs paid to the participant including any additional compensation Employee Benefits Include all benefits paid to staff. Some examples include Dental Insurance Health and Accident Insurance Life Insurance Long-term Disability Insurance FICA Medicare Tuition Reimbursement Worker’s Compensation Teachers Retirement or Other Retirement Payments 16

17 MAC Claim Calculation – Allowable Costs Materials & Supplies Materials & Supplies must be identified as used by the staff for which they are included Materials & Supplies can be identified using a “reasonable allocation method” Some methods include – headcount or FTE Staff Travel Costs for specific staff related travel Examples include: Mileage Conference related travel expenses Staff Professional Dues and Fees Report by service the total costs for professional dues and fees associated with the staff listed in the Quarterly Financial Report. 17

18 MAC Claim Calculation – Non-allowable Costs Non-allowable costs include: Federal funds The web-based system requires that total costs be reported, with a separate column for reporting costs paid with federal funds. The system calculates the Medicaid-allowable costs. State flow-through funds are funds received from the Federal government by the State of New York and then distributed to local districts. Non-federal funds that have been committed as local match for other Federal or State funds or programs. Costs included in the calculation of the Unrestricted Indirect Cost Rate. Staff who are paid entirely from these area should not be included in the staff pool list. Direct costs related to staff that are not identified as eligible time study participants 18

19 MAC Claim Calculation – Additional Data Elements In addition to the allowable costs, the MAC claim relies on three additional data elements to determine the claim amount: Administrative RMTS Percentage Calculated based on the results of the quarterly RMTS. Statewide percentage for each cost pool applied to allowable costs to determine what portion of the allowable costs are for performing MAC activities. Indirect Cost Rate Each school district has its own indirect cost rate. The indirect cost rate is applied to net direct costs (total costs less amount paid with federal funds) in order to allow for proper identification of indirect costs. Medicaid Eligibility Ratio (MER) School district specific ratio used to apportion costs to the Medicaid program. MER is calculated based on the October student count data reported by the school districts. MER = Total Number of Medicaid Eligible Students / Total Number of Students 19

20 MAC Claim Calculation Example 20 Calculation Gross MAC costs$500,000 MAC % (from RMTS)15% Subtotal$75,000 Indirect Costs1.15 Subtotal$86,250 MER Ratio50% MAC Claim Gross FFP$43,125 FFP50% MAC Claim Net FFP$21,563

21 Important Dates 21

22 Important Dates 22 February 28, 2013 MAC Quarterly is Due for the Period October-December 2012 March 1, 2013 Administrative employees are to be added to RMTS rosters April 1, 2013 MAC pool will be included in the time study

23 Contacts and Questions 23

24 Contacts 24 Public Consulting Group Joe Weber Leslie Tremberth Ben Cormack Katie Crowley Kirsys Cruz Kyle Stanley Megan Shaughnessy Eric Miller Sean Huse

25 Questions? 25

26 26 Public Consulting Group, Inc. 148 State Street, Tenth Floor, Boston, Massachusetts (617) ,


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