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Medicaid Administrative Claiming Program Pierre, SD September 28, 2011 Matrix Pointe LLC.

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Presentation on theme: "Medicaid Administrative Claiming Program Pierre, SD September 28, 2011 Matrix Pointe LLC."— Presentation transcript:

1 Medicaid Administrative Claiming Program Pierre, SD September 28, 2011 Matrix Pointe LLC

2 Presenters Bob Seiffert Steve Curtiss

3 The Medicaid Program Provides health care coverage for low-income families, persons with disabilities, and elderly persons with limited income and assets Currently, 115,000 South Dakotans are eligible for Medicaid. 58,000 were eligible in 1993 79,000 children (age 0-18 ) are eligible. 32,000 were eligible in 1993 Within South Dakota Public Schools, approximately 33% of children are eligible

4 Medicaid Service Payment vs. Medicaid Administration The Medicaid Program pays service providers for most health services, such as hospital care, nursing facility care, and practitioner services. Currently, most South Dakota school districts participate as service providers, by offering PT, OT and Speech, Hearing and Language services to students.

5 Medicaid Administration Pays schools for their costs incurred in arranging and monitoring of health care services for Medicaid Eligible Children Outreach and eligibility determination Arrangement of transportation and translation Health care policy development Medical training Referral, coordination and monitoring of health care services

6 Funding Formula Costs, by personnel category X Time study results, by category X District Medicaid Eligibility Rate X Federal Medicaid matching of 50% = District quarterly Payment Total statewide federal claims this year will be approximately $6.0 million

7 Personnel Costs – Employee Categories District Personnel costs are segregated into four categories: (A) Therapists, including audiology, OT, PT and Speech (B) Other Medical, such as RNs, LPNs, mental health professionals, social workers and counselors (C) Program Support, including teachers, paras, aides, and other student services (D) Administration, including principals, special ed. administrators and assistants

8 Time Studies Random Moment Time Studies are conducted for five days each school quarter. The time studies are used to determine the amount of time spent on health care activities for ALL students, by each respective personnel category. Time studies must meet federal confidence level of 95%, thus small personnel categories, such as therapists and administrators require high percentages of the group to be sampled.

9 Confidence Levels Federal Gov’t requires 95% Approximately 350 therapists in SD requires a minimum of 184 due time study If there were three times the number of therapists (1050) only 100 more would need to complete the study

10 Time Study Training State is divided into three areas--Northeast, Southeast and Central/West Training for staff selected for time studies is done the week prior to the time study Northeast area completed late October to mid-November Southeast area completed late January to mid-February Central/Western areas completed March/April

11 Time Study Training Continued Training conducted live at larger school districts Training via the DDN system for the smaller districts Most training times begin at 3:30 p.m. and last approximately 30 minutes Emphasis placed on understanding time spent in IEP and IFSP meetings arranging and monitoring health care issues

12 School Years 2006-2009 Time Study Summary Percent of time spent on arranging and monitoring health care activities for all children Therapists 13% Other Medical Personnel 13% Teachers and other program support 2.5% Administrators 12%

13 Medicaid Eligibility by District Eligibility varies considerably by respective school district Higher income districts have Medicaid Eligibility rates as low as 15% Lower income districts have Medicaid Eligibility rates as high as 90% Medicaid Administrative payments are directly proportional to the Medicaid Eligibility Rate of the district

14 Educational Cooperatives Most of the Ed Coops are participating in the program Selected staff participate in the time studies Coop costs are allocated to participating school districts in their area, to enhance the districts’ claims

15 Time Study Reviews Business Officials will be given a summary sheet of issues to watch for Make sure all time sheets are signed Make sure all ”b” codes are documented

16 On-Site Financial Reviews 7 Districts each year Must be able to document claimed costs Must be able to document other federal revenue Financial summary information from your accounting system is accepted

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