Kevin T. Bauer, MBA Michigan SBS Policy 517-241-8398

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Presentation transcript:

Kevin T. Bauer, MBA Michigan SBS Policy

SBS OIG Audit Update Entrance interview October, 2013 Initial focus – RMTS MDHHS & 2 ISDs Proposed completion – April, 2014

SBS OIG Audit (cont.) Progress Delays Other higher priority audits Auditor education Expansion 2 ISDs Settlements for all ISDs 100 random claims

SBS OIG Audit (cont.) Current Status Currently at both the original ISDs Request for documentation supporting RMTS responses MDHHS is looking to CMS for Assistance Not CMS intent of RMTS methodology Not Required Most importantly, violates the confidentiality of RMTS Next steps

SBS OIG Audit (cont.) What does all this mean? Who? What? When?

Recent Policy Bulletins MSA School Based Services Audit and Recovery Procedures Purpose: Provide audit policy & recoupment clarification Content Breaks audit into 3 separate areas (AOP, direct service/ transportation, & student claims) Provides recoupment criteria MAER – material errors require an amended MAER Student claim error rate < 15%, no action required > 15%, recoupment of the amount greater than 15%

Recent Policy Bulletins (cont.) MSA Telepractice for Speech-Language and Audiology Services Purpose: Establish policy regarding telepractice for speech-language and audiology services Effective: July 1, 2015 Content Outlines basic requirements for telepractice Represents a new method of delivery, not a new type of service Provides billing instructions

Trending Issues Free Care Massachusetts is looking to allow “Free Care” reimbursement Benefit for Free Care/504 reimbursement for Michigan is being examined Applied Behavioral Analysis (ABA) therapy Expansion of Autism Spectrum Disorder (ASD) services directed by CMS New ASD policy goes into effect January 1, 2016 Currently collecting information from other states regarding Medicaid reimbursement for ABA therapy CMS to address reimbursement of ASD services at the NAME conference in October, 2015