1. Medicaid Allowable Expenditure Report- MAER Amy Kanter, SBS Auditor Michigan Department of Health and Human Services 2015 MDHHS SBS Conference – Traverse City, MI August 17 & 18, 2015 1

2. Background (MI Medicaid Provider Manual) The Medicaid Allowable Expenditure Report (MAER) is modeled after the SE 4096 & SE 4094 Used to collect allowable medical and transportation costs Targeted Case Management (TCM) and Personal Care (PC) costs are collected from the financial accounting system and sent to MDHHS by the State Contractor Template retrieved from the SBS website each year  November 1st for the LEA’s

3. MAER The MAER is the key component of the School Based Services (SBS) cost reconciliation and cost settlement process  Old method: SBS providers would submit bills for services rendered and received reimbursement for the bills based on various service rates  New method: SBS providers are reimbursed for the actual cost of providing services  Is used only for Direct Medical Staff and Transportation Costs 3

4. Completing the MAER Salary and benefits, purchased services, and other expenditure data will come from LEA payroll and/or finance system(s)  Data will represent Annual Staff Pool Summary Lists for each provider category  Totals will not exceed SE4096/SE4094 line item totals for each function and object code Quarterly financials cannot be used to complete the MAER as they are on a cash basis MAER must be completed on an annually and is on an accrual basis 4

5. Timeline

6. Medicaid Eligibility Rate (MER) The Medicaid special education health-related rate is:  Children and students with Medicaid eligibility who have an IEP or IFSP AND who are also receiving at least one health related service (numerator)  Total number of children and students who have an IEP or IFSP and receiving at least one health related service (denominator)

7. MER Calculation Cont. Around April of each year, the ISD’s receive an email from MDHHS that requests updates to the contacts, LEA’s, and PSA’s New change- all of the LEA’s will automatically be included according to a list retrieved from CEPI. ISD’s are required to provide me only the PSA’s that they want included in the calculation and on the MAER

8. MER Calculation Cont. CEPI supplies MDHHS with a large file that contains all of the Special Education information taken from the student count in the fall MDHHS runs a query to determine all of the Medicaid eligible students in Michigan during the month of the student count (this year was October). The filter criteria for this query  Up to age 26 on the date of collection  They are receiving a health related service These 2 files are compared to determine the number of Medicaid eligible special education students per ISD for the month of the student count

9. MER Calculation Cont. When the files are compared, a point system is used to determine full matches If the files are compared but they only received partial points, a partial match file is created and the ISD is given time to provide the Medicaid number *** It is very important that when the ISD receives the partial match files, no changes are made to the formatting, headers, columns, etc.

10. Sample Partial Match File

11. MER Calculation Cont. Once the partial match files are returned back to MDHHS, they are imported into the program The formula for calculating the MER is: Medicaid eligible IEP & IFSP students Total IEP & IFSP students After MDHHS reviews and ensures accuracy, a letter is issued via File Transfer to notify the ISD’s of the MER that will be applied

12. MER Notification Letter

13. Reimbursement For Transportation A cost per trip is calculated taking the total transportation costs and dividing by the number of one-way trips submitted by the ISD on the MAER  From bus logs  Calculated: # of special education students X 2 trips per day X # of school days The cost per trip is multiplied to the allowable transportation claims with a paid medical claim associated and retrieved from CHAMPS

14. Tips For Reviewing the MAER The costs reported on the MAER cannot exceed what was reported to MDE on the SE4094 and SE4096 Staff costs that are included on the MAER must reflect the staff that are reported on the Staff Pool List One way bus trips Ensure that all rates are accurate PCG online MAER training each year in the fall

15. MMF Summary Software Deadline for MAER submission is December 31 st Settlements are processed in the order in which they are received Costs are imported into the MMF for review of accuracy A.mer file is created for upload into File Transfer Signed and dated provider certification is required for each and every submission.

16. Initial Settlement Initial settlements completed 90 days after MAER submission Cost comparison for prior year MAER costs compared to current year MAER costs Must be under a 120% total increase threshold (bus trips have a cost per trip threshold of $50/trip) If above the threshold, documentation/explanation will be required to support

17. Sample Initial Settlement Letter 17

18. Final Settlement Cannot be completed prior to one year after the ISD’s FYE (June 30 th of the prior year) Can be processed without an initial settlement ***No settlement is processed until MDHHS is reasonable confident that figures presented in the MAER accurately reflect the ISD’s expenditures Comparison report is run on the MAER costs and costs reported on the SE4094 & SE4096  Ensure that cost on MAER do not exceed the SE4094 & SE4096  Nursing costs are an exception

19. Sample Medical Comparison Report

20. Sample Transportation Comparison Report

21. Sample SE4096

22. Sample SE4094 22

23. Michigan Public School Accounting Manual The Michigan School Accounting Manual (Bulletin 1022) serves as a mandatory guide to the uniform classification and recording of accounting transactions for Michigan public school districts The general classification of objects and expenditures are those which are found in Bulletin 1022, the Accounting Manual for school districts http://www.michigan.gov/mde/0,1607,7-140-6530_6605- 21321--,00.html 23

24. Nursing General Ledger Nursing costs can also be reported under general education and still be allowable on the MAER General ledger support documentation required 24

25. Support Documentation-G/L 25

26. Federal Funds 26

27. Function Code Example 27

28. Object Code Example 28

29. Amendment Letters Issued If Costs Exceed Comparison report reflects MAER costs above what was reported on the SE4094 & SE4096 Amendment letters are issued Cost will need to be amended and resubmitted 29

30. Steps To Revise MAER Locate the original.csv files that the LEA’s had submitted to the ISD’s Locate the MAER for the appropriate FYE It is important to put the appropriate MAER and the.csv files into a folder Open up the MAER and it should pull the.csv files stored in the folder and allow you to make changes Import the amended files into the MMF and check the costs for accuracy Do a save as and it will create a.mer file to upload into File Transfer A new provider certification page is required for each submission 30

31. Final Settlement Letters Final settlement letters are issued after the review ISD’s have 30 days to appeal the costs Can send a signed copy of the reconciliation page in the settlement if approved within the 30 days Notice of Program Reimbursement (NAPR) 31

32. Sample Final Settlement Letter 32

33. Sample NAPR Letter 33

34. Your Role Be proactive  Ensure the figures presented are accurate Take corrective actions  Respond to amendments in a timely manner Stress importance Ask questions 34

35. Questions? Contact Information – Email: kantera@michigan.gov Phone: 517-373-4522 Fax: 517-241-7408 35