Arizona Medicaid School Based Claiming Program Regional Information Session Spring 2015
Agenda • For each program component, we will discuss: • Trend Analysis • Back to Basics (B2B) RMTS Quarterly Cost Reporting Annual Cost Settlement Direct Service Claiming
Know-Want-Learn Worksheet • First Column: List what you already know about the MSBC program (Know) • Second Column: List what you want to know about the MSBC program and/or what you hope to learn during today’s RIS information session ( Want) What I Know What I Want to Know What I Learned
RIS Survey • In February 2015, PCG requested feedback from LEA coordinators asking how well they understand the components of Medicaid School Based Claiming (MSBC) program and where more information is needed • Survey sent to 106 LEAs with 19 questions rating level of understanding on a 5 point scale (1 = lowest and 5 = highest) for MSBC program components • RIS survey provided in-depth data on: • Overall average understanding of the MSBC program • Level of understanding of each MSBC program component • Level of understanding of specific program functions
RIS Survey Results • Overall average of the survey results displayed an intermediate understanding (3.18) of all MSBC program components • Area(s) of least level of understanding: Quarterly & Annual Cost Reporting • Area(s) of highest level of understanding: RMTS & Compliance
RIS Survey Results
RIS Survey Questions Areas of strongest understanding: Areas of least understanding: Requirements to participate in the Accurate billing for transportation Random Moment Time Study services (RMTS) Using the Medicaid Cost Which staff should be included on Reporting and Claiming System the RMTS Staff Pool List (MCRCS) Submitting DSC claims only for How to report costs for direct providers listed on the Staff Pool replacements List Calculation and application of Using the RMTS web-based ratios to annual and system transportation costs Securely sending student Determining allowable annual information transportation other costs
Random Moment Time Study
RMTS Results – Direct Medical %
RMTS Results – Direct Medical % • CONCERN: Personal care provider direct service percentage has been consistently declining • What does this mean for your LEA? • Possible variables impacting the decline – Group discussion • What variables do you think have contributed to the decline? • Within your LEA • Within the state • What are ways to address this so the decline doesn’t continue? • How is personal care return rate compliance within your LEA? • Ways to improve return rate
RMTS Results – MAC %
RMTS – Compliance
RMTS – Success Story Strategies Lake Havasu Unified School District • RMTS training occurs one week before the first week of school for all participants, focusing on the RMTS program, importance, and how to complete a moment • Training is available throughout the year for new providers, as well as any teachers who would like to understand the program in order to assist their personal care aides • Follow-up emails are sent to any participants with incomplete moments, with advisor or principal cc’d • Coordinator has “Open door” policy throughout the year, extending time to meet with providers if guidance is needed with RMTS submission
RMTS – Success Story Strategies Alhambra Elementary School District • Late notifications are sent to the participant, and copying the Director of Student Services • Assistance is offered for moment completion and a confirmation email is required once the moment has been completed • If a 3 day late notification is received, the participant receives an email and phone call from the coordinator • Prior to winter and spring breaks, all participants are contacted on the day of their moment to ensure it is completed that day
B2B: RMTS – Cost Pools • The RMTS staff pool list consists of three cost pools that must be updated each quarter: • Cost Pool 1- Direct Service Providers: • Includes all direct service providers who render health care services as prescribed in an IEP • Actively billing • Registered with AHCCCS • Have a unique email address and access to a computer with Internet
B2B: RMTS – Cost Pools • Cost Pool 1- Direct Service Providers Job Job Code Job Category Code Job Category 01 Audiologists 11 Physical Therapy Assistants 02 Certified Occupational Therapy 12 Psychiatrists Assistants 04 Speech-Language Pathologists 13 Psychologists 06 Licensed Marriage and Family 14 Registered Nurses and Licensed Therapists Practical Nurses 08 Licensed Professional 15 Social Workers Counselors LPC 09 Occupational Therapists 28 Speech-Language Pathology Assistants 10 Physical Therapists
B2B: RMTS – Cost Pools • Cost Pool 2- Administrative Service Providers Only • Includes LEA staff who routinely perform administrative and outreach activities to students and/or their families that support health related / Medicaid services • Providers that DO NOT provide direct health care services nor bill for Medicaid reimbursement (e.g. certain psychologists, nurses) • LEA specific job titles that do not have a clear Job Category and Code should be included under the Program and Staffing Specialist or Student Services Personnel job categories • Must have a unique email address and access to a computer with Internet
B2B: RMTS – Cost Pools • Cost Pool 2- Administrative Service Providers Only Job Job Code Job Category Code Job Category 16 Administrators for Exceptional 24 Program and Staffing Specialist* Student Education* 17 Audiology Assistants 25 Special Education Teachers* 18 Augmentative Specialists 27 Student Services Personnel* 19 Bilingual Specialists 29 Non-Billing DSC Providers 20 Dietitians 30 Guidance Counselors* 21 Interpreter 32 School Based Psychologists 22 Liaisons for Exceptional Student *Position Classification Form Education* (PCF) Required
B2B: RMTS – PCF • Position Classification Forms (PCFs) are required for certain job titles listed under RMTS job categories within the Administrative Service Providers Only cost pool that have some ambiguity of job duties • PCFS are required for the following job codes: • Administrators for Exceptional Student Education- Job Code 16 • Liaisons for Exceptional Student Education- Job Code 22 • Program and Staffing Specialists- Job Code 24 • Special Education Teachers- Job Code 25 • Student Services Personnel- Job Code 27 • Guidance Counselors- Job Code 30
B2B: RMTS – PCF • The PCF provides supporting documentation as to why job titles/job duties not clearly identifiable through the title are listed on the staff pool list • Needs to be submitted once during the duration of the LEA’s participation in the program • A new PCF is required when a new job title has been added to the staff pool list or if there has been a change in the responsibilities of the job title • PCF must match exactly the job title on the RMTS staff pool list • PCFs are available on PCG website and RMTS dashboard
B2B: RMTS – Cost Pools • Cost Pool 3- Personal Care Providers • Health Aide staff registered with AHCCCS and billing Medicaid for Activities of Daily Living (ADL) services prescribed in the IEP • Do not include instructional aides that provide educational services only • Must have a unique email address and access to a computer with Internet Job Code Job Category 31 School Health Aides
B2B: RMTS – Compliance • Managing RMTS participant changes and LEA compliance • It is important to communicate changes (leave of absence, direct replacements, term dates) to PCG for participants with sampled moments so the moments can be justified • PCG enters the term date and leave information for the moment. PCG does not update the staff pool list. LEA coordinators are responsible for inactivating participants and adding (new) direct replacements to the SPL for the upcoming quarter in the RMTS system • “Justified” moments will not be counted against compliance when a participant: • Terms before the moment • Changes to a position that does not participate in the time study • Is on leave and not returning within the 5 days to complete the moment timely
B2B: RMTS – Compliance • Notify PCG when participants with sampled moments falls into one of the scenarios below : • Participant has termed: prior to the moment, send an email to azrmts@pcgus.com with the participant’s name, sampled moment, and the date the participant left the LEA • Participant is on a leave of absence: prior to the moment, send an email azrmts@pcgus.com with the participant’s name, sampled moment, start and end date of the leave, and whether the leave is paid or unpaid • This is for extended leave where the leave covers the moment assigned and the 5 working days after the moment
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