1. ARMAC Arkansas Medicaid Administrative Claiming Where Do We Go From Here? Medicaid In The Schools (MITS) Summit January 24, 2008 1:00 PM

2. ARMAC Arkansas Medicaid Administrative Claiming is a federally approved program that allows public education agencies to receive reimbursement for 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.

3. Examples of “Medicaid Administrative Activities” Notifying parents of benefits covered by Medicaid or ARKids First Notifying parents of benefits covered by Medicaid or ARKids First Assisting families with completing a Medicaid application Assisting families with completing a Medicaid application Contacting student’s physician to complete medical necessity paperwork/script for services Contacting student’s physician to complete medical necessity paperwork/script for services Verifying a student’s Medicaid eligibility Verifying a student’s Medicaid eligibility

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

5. How Districts Participate… Participants are trained Participants are trained Participants respond to random moments Participants respond to random moments

6. Sample ARMAC Random Moment

8. ARMAC Reimbursement Factors District’s Medicaid Eligibility Rate District’s Medicaid Eligibility Rate District’s incurred cost (based on participating staff) District’s incurred cost (based on participating staff) Statewide % of time spent Statewide % of time spent on reimbursable activities on reimbursable activities

9. Important Things to Remember Staff does not need to know who is Medicaid eligible Staff does not need to know who is Medicaid eligible The activity being The activity being performed is measured performed is measured for potential reimbursement for potential reimbursement not the outcome not the outcome

10. Important ARMAC Historical Timelines April 1994 – Other states began implementing MAC (Medicaid Administrative Claiming) programs April 1994 – Other states began implementing MAC (Medicaid Administrative Claiming) programs May 2003 – CMS issues Medicaid May 2003 – CMS issues Medicaid Administrative Claiming Guide Administrative Claiming Guide Jan. 2005 – Arkansas’ MAC Implementation Jan. 2005 – Arkansas’ MAC Implementation Plan approved by CMS Plan approved by CMS Nov. 2005 – 59 Arkansas public education Nov. 2005 – 59 Arkansas public education entities begin participating in ARMAC program entities begin participating in ARMAC program Sept. 2007 – Purposed rule (CMS-2287-P) published in Federal Register to eliminate MAC funding Sept. 2007 – Purposed rule (CMS-2287-P) published in Federal Register to eliminate MAC funding

11. Important ARMAC Historical Timelines Important ARMAC Historical Timelines (Continued) Dec. 28, 2007 – Final Rule (CMS-2287-F) to Dec. 28, 2007 – Final Rule (CMS-2287-F) to eliminate MAC funding published in Federal eliminate MAC funding published in Federal Register Register Oct. 3, 2007 – President Bush vetoed 1 st SCHIP legislation that included language to suspend elimination of administrative claiming Oct. 3, 2007 – President Bush vetoed 1 st SCHIP legislation that included language to suspend elimination of administrative claiming Jan. 23, 2008 – The House will vote to attempt to override President Bush’s 2 nd SCHIP veto Jan. 23, 2008 – The House will vote to attempt to override President Bush’s 2 nd SCHIP veto Dec. 12, 2007 – President Bush vetoed 2 nd SCHIP legislation that also contained language to suspend Dec. 12, 2007 – President Bush vetoed 2 nd SCHIP legislation that also contained language to suspend elimination of administrative claiming elimination of administrative claiming

12. What is SCHIP? What is SCHIP? SCHIP & The MAC Connection SCHIP (State Children’s Health Insurance Program) SCHIP (State Children’s Health Insurance Program) SCHIP Legislation contained language that impacted the future of Medicaid Administrative Claiming SCHIP Legislation contained language that impacted the future of Medicaid Administrative Claiming

13. 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) 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.” 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.”

14. 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. 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.

15. The federal government’s 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”* The federal government’s 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. Effectively, Arkansas Medicaid Administrative Claiming program would cease as a funding source for participating public education entities. SCHIP Moratorium Language Translation

16. A Closer Look at CMS 2287-F

17. Federal Impact Elimination of Medicaid Administrative Claiming Program 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. 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 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. 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.

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

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

20. Legislative Requirement Legislative Requirement Reporting vs. Non-governing Funding Utilization Language Reporting vs. Non-governing Funding Utilization Language ARMAC Funding Utilization Reporting

21. Year to Date ARMAC Funding FY 2006 – $3,240,828.38 FY 2006 – $3,240,828.38 FY 2007 – $6,512,003.09 FY 2007 – $6,512,003.09 FY 2008 – $4,220.007.60 (to date for 2 Qtrs) FY 2008 – $4,220.007.60 (to date for 2 Qtrs) Total: $8 – 10 million per year

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

23. Advocacy & Resource Information (Reference Handout Available) Member NameDC PhoneDC FAXEmail Senator Blanche Lambert Lincoln (D- AR)202-224-4843202-228-1371http://lincoln.senate.gov/html/webform.html Senator Mark Pryor (D- AR)202-224-2353202-228-0908http://pryor.senate.gov/contact/ Representative Marion Berry (D - 01)202-225-4076202-225-5602http://www.house.gov/berry/zipauth.shtml Representative Vic Snyder (D - 02)202-225-2506202-225-5903http://www.house.gov/snyder/contact/email.htm Representative John Boozman (R - 03)202-225-4301202-225-5713http://www.house.gov/writerep/ Representative Michael A. Ross (D - 04)202-225-3772202-225-1314http://www.house.gov/writerep/

24. 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: (866) 280-8300, option 2 or (501) 835-2093 Rene.Montgomery@arkansas.govArmac.support@arkansas.gov