1 School Based Services Medicaid Provider Liaison Meeting Michigan Department of Community Health February 25, 2010

2 Agenda Introduction School Based Services Administrative Outreach Program –Program Status –Back-casting Settlement and Recovery Finalized School Based Services Direct Medical Services –Program Status –First Year Issues Significant Events of 2009 (Direct Medical Services) –New Reimbursement Methodology Effective July 1, 2008 –Personal Care Services Coverage Added –New SBS Specialized Contacts

3 Agenda (cont.) What’s New for 2010 (Direct Medical Services) –New Medicaid Allowable Expenditure Report (MAER) Software Improvements –New Summer Time Study Quarter Start Date (the date the students return to school) –New Training on Cost Report Adjustment Process –Reconciliations and Initial Settlements Begin March 2010 Timeline slide –On-site Audits Begin March 2010 –On-line Staff Pool List Updates Demonstration by Public Consulting Group CHAMPS Update Contact Information School Based Services Provider Specific Web Page Questions and Answers

4 School Based Services Administrative Outreach Program (AOP) Program Status –RMTS results holding constant Back-casting Settlement and Recovery Finalized

5 School Based Services Direct Medical Services Program Status First Year Issues –Effective July 1, 2008 – New Reimbursement Methodology Two part process –Cost reports –Procedure specific billing through Community Health Automated Medicaid Processing System (CHAMPS) – Medicaid Allowable Expenditure Report (MAER) Issues Downloading and saving the MAER (cost report) Transportation MAER –Staff pools issues –CHAMPS issues

6 Significant Events of 2009 (Direct Medical Services) New Reimbursement Methodology Effective July 1, 2008 –Cost Reporting Personal Care Services Coverage Added New SBS Specialized Staff –Provider Support SBS Contact – Lynn Hicks –SBS Provider Training Specialist – Lisa Trumbell –SBS Internal Auditor – Matt Hiatt –SBS Cost Settlement Auditor – Vaughn Allen Cost Reconciliation Update

7 What’s New For 2010 (Direct Medical Services) New MAER Software Improvements –MAER modifications to utilize buttons instead of menu selection –Per CMS mandate object codes 4120 and 4220 will be removed from the cost reports New Summer Time Study Quarter Start Date –Supported by the schools to improve RMTS accuracy and results –Date students return to school –How this impacts time study results On-site Audits Begin March 2010 –The purpose of the internal audit function is to work as a partner with the ISDs and LEAs to assure system and internal controls are in place –L Letter outlines the process (copies available) Reconciliation and Initial Settlements Begin March 2010 –Reconciliations and settlements processed in the order they are received New Training on Cost Report Adjustments Process –WebEx training beginning in April, 2010 On-line Staff Pool List Updates –Demonstration by Public Consulting Group

8 Timeline October MAER Template available for download on MDCH website November LEAs and ISDs complete MAER November 30th MAER due to ISD Summary Software Application available for download from MDCH website December ISDs compile summary reports December 31 st Summary reports due to MDCH (Extended to January 31 st for first year only) January Initial ISD settlements begin (March for first year only) Spring Revisions to MAER and Summary Reports, as necessary July Final ISD Settlements may begin OctNovDecJanFebMarchAprilMayJune Timeline for School Year Reconciliation and Settlement

9 CHAMPS Update CHAMPS Implementation September 18, 2009 Changes and Issues –New data format –Claims rejecting –Change from scope and coverage to “Benefit Plan” –Now able to check eligibility in CHAMPS New claims processing & adjudication system Replaced old Invoice Processing System –Old MMIS system was over 30 years old Provider Able to See Claim Status Direct Data Entry On-line Claim Adjustments/Voids Outstanding CHAMPS Issues –Prior Authorization (affects only V2799) – est. fix date Feb –Diagnosis Code (affects all codes, CHAMPS error code 1307) – est. fix date Feb –T1024 still rejecting

10 Policy and Audit Contacts Direct Medical School Based Services (Fee-for-service) –Linda Sowle Administrative Outreach Program (AOP) –Penny Dipple Cost Reporting and Cost Settlement –Vaughn Allen Internal Audit –Matthew Hiatt

11 Provider Relations Contacts Contacts Billing issues: Provider Inquiry: Provider Consultants: Conduct research of complex claim issues. Provider Outreach: Offer educational seminars regarding billing and CHAMPS.

12 Provider Relations Contacts Provider Enrollment For questions regarding enrolled providers. Telephone: (517) CHAMPS Helpline: For issues regarding navigating the CHAMPS on-line enrollment system

13 School Based Services Provider Specific Webpage The Michigan Department of Community Health maintains a webpage of SBS specific documents This webpage houses: –Compliance reports –Time study reports –MAER download –Training documents for the MAER, Staff Pool Lists, State Single Sign On and File Transfer To access this webpage go to: – click on “Billing and Reimbursement”, click on “Provider Specific Information”, click on “School Based Services” (see screen prints on the following pages)

14

15 Click here

16 Click here

17 Click here

18

19 Conclusion Questions & Answers