1. Iowa’s School-Based Medicaid Programs: An Interagency Collaboration
NAME Convention
Denver, CO
September 26, 2003

2. Introduction Dann Stevens Medicaid Program Consultant
Iowa Department of Education
Grimes State Office Building
400 East 14th Street
Des Moines, IA
Phone:
Fax:

3. Iowa Department of Education
Medicaid direct service reimbursement was mandated in 1988 by the Iowa State Legislature.
Medicaid Area Education Agency (AEA) program
Medicaid Administrative Claiming (MAC) reimbursement began in 1994.
First year claims were less than $1 million FFP.
Medicaid Local Education Agency (LEA) program for direct service reimbursement began in 2001.

4. Iowa Department of Education
MAC began with a pilot in one county.
Expanded to 20 counties by 1995.
Opened to remaining counties in the state in 1998.
A majority of the counties had local public health as the Lead Agency.
Program structure was introduced by a private consultant.

5. Initial MAC Participation
WORTH
HOWARD
SIOUX
CERRO
GORDO
PALO ALTO
POCAHONTAS
DUBUQUE
BLACK
HAWK
BUCHANAN
CALHOUN
DELAWARE
WEBSTER
LINN
MONONA
GREENE
MARSHALL
CRAWFORD
POLK
SCOTT
Public Health as Lead
LEA as Lead
TAYLOR
Other agency as Lead

6. 2003 MAC Participation Distribution
EMMET
WORTH
HOWARD
KOSSUTH
SIOUX
CERRO
GORDO
PALO ALTO
FLOYD
FAYETTE
CLAYTON
BUENA VISTA
CHEROKEE
DUBUQUE
BLACK
HAWK
BUCHANAN
DELAWARE
CALHOUN
WEBSTER
WOODBURY
IDA
HARDIN
LINN
BENTON
CRAWFORD
STORY
MARSHALL
HARRISON
POLK
JOHNSON
POTTAWATTAMIE
MADISON
MARION
MAHASKA
LOUISA
Public Health as Lead
LEA as Lead
TAYLOR
DECATUR
DAVIS
LEE
Other agency as Lead

7. Iowa Department of Education
Number of school districts participating increased to 135 out of 371 as of 2003.
From the beginning, Department of Public Health has been actively involved with the MAC program.

8. Introduction Janet Beaman Community Health Consultant
Iowa Department of Public Health
Lucas State Office Building
321 East 12th Street
Des Moines, IA
Phone:
Fax:

9. Iowa Department of Public Health
Involvement in MAC was initiated through Medicaid / IDPH Interagency Agreement for the EPSDT Program.
In Iowa, Title V Child Health agencies are responsible for assuring EPSDT informing, care coordination, and screening services for Medicaid enrolled children.
Agreement includes provisions for the MAC program.
To provide consultation, technical assistance, and training for lead agencies and sub-holders.
To participate in the local agency review process.

10. Centers for Medicare and Medicaid Services (CMS)
MAC Organizational Structure
Centers for Medicare and Medicaid Services (CMS)
Iowa Dept. of
Education
Iowa Dept. of
Human Services
Iowa Dept. of
Public Health
Interagency Agreement
Technical Assistance
Lead Agency
Sub-agreement
School
Districts
Public Health
agencies
Private non-profit
agencies

11. Iowa Department of Public Health
Technical assistance is provided through:
Phone conference
Written correspondence
Video conferencing via Iowa Communications Network (ICN)
On-site visits

12. Iowa Department of Public Health
For trainings
Prepare and update training materials and forms
Schedule and coordinate trainings
Typically schedule on-site at local agency
Use ICN with video taping when applicable
Types of trainings
Coding
Fiscal

13. Iowa Department of Public Health
Training Components
Fiscal
Cost pool construction
Indirect costs
Revenue for offset
Determining Medicaid eligible percentage
Required matching funds
Required 10% reserve
Coding
Agency participation
Staff participation
Process for time studies
Coding structure
Audit file
Annual report
Use of reimbursements

14. Iowa Department of Public Health
On-site review process
Developed Reviewer’s Guide to Medicaid Administrative Claiming
Gather information on
Type of agency and scope of programs
Staff involved in coding
Conduct coding interviews with representative staff
Provide verbal feedback on coding interview
Review written summary for lead agency

15. Iowa Department of Public Health
Other supports for MAC
Assist with development of language for interagency agreements with participating agencies
Review annual reports
Develop and disseminate communication with local agencies
Participate in interagency meetings with Department of Human Services and Department of Education
Promote awareness of program (e.g. School Nurse Conference & AEA Special Education Director meetings)

16. Introduction Anieta O’Hair Medicaid Administrative Claiming Auditor
Iowa Department of Human Services
Hoover State Office Building
1305 East Walnut
Des Moines, IA
Phone:
Fax:

17. Iowa Department of Human Services
Audit for MAC
CMS mandated oversight of MAC program.
Medicaid State Agency (Department of Human Services) houses auditor position.
DHS created auditor position in late 2000.
DHS is authorized to retain up to 5% of MAC FFP for program oversight.
Role includes providing fiscal technical assistance.

18. Iowa Department of Human Services
Federal Reviews
Office of Inspector General (OIG) review spanned State Fiscal Years
OIG review resulted in two separate reviews since 2000.
Primary monetary finding due to selected private non-profit agencies lacking public unrestricted funds as match.
No final report issued to date.

19. Iowa Department of Human Services
Desk Reviews
Prior to payment each claim is reviewed for:
Current MAC agreement
Cost pool construction
Time coding percentages
Reporting of revenues for offset
Medicaid eligible percentage
Accuracy

20. Iowa Department of Human Services
Coordinating On-site Reviews
DHS Medicaid Policy Specialist
DHS MAC Auditor
IDPH Community Health Consultant
On-site Reviews consist of
Interviews with fiscal staff
Developing summary reports
Approving corrective action plans

21. Iowa Department of Human Services
Fiscal On-site Review includes:
Administration of time studies
Cost pool construction
Indirect cost rate
Medicaid eligible percentage
Revenue offsets
Application of appropriate FFP
Appropriate matching funds
Retention fees held by lead agencies
Audit file

22. Iowa Department of Human Services
Additional oversight
Tracking of historical data on time study results
Tracking of historical data on Medicaid eligible percentages
Tracking of indirect rates for school districts
Tracking of Medicaid LEA reimbursements
Follow-up on inquiries on program compliance

23. Iowa Department of Human Services
New MAC Implementation Plan
Resulting from CMS Medicaid School-Based Administrative Claiming Guide of May 2003
Participation limited to school districts
Time study methodology: Shift from Continuous Daily or Random Date Sampling to Random Moment Sampling
Time Codes: Adoption of modified CMS time coding structure
Medicaid Provider Percentage: New tracking methodology
Medicaid eligible percentages: Shift from Free and Reduced Lunch percentages to Medicaid enrolled

24. Iowa Department of Human Services
Implications of the Medicaid LEA program for MAC
Revenue Offsets
Time coding

25. Iowa Department of Education
LEA direct services were included in Iowa Medicaid State Plan in 2001.
As of June 2003, 95 of the 371 districts had a Medicaid LEA provider number.
Expect continued growth in participation.
Confusion among local school districts about the differences in the two Medicaid programs.

26. Iowa Department of Education
Department of Education provides the technical assistance for the Medicaid LEA & AEA direct service programs.
This allows each state agency to specialize in their area of expertise.
Both programs address CMS through the Medicaid state agency.
Greatest asset is the communication among the three agencies.