School Health Services Transitioning from Fee for Service to Cost-Based Reimbursement: Lessons Learned 1
School Health Services History 2
School Health Services History • FFS rate rebasing work done in 2005 required a SPA. CMS responded requiring Colorado to move to a cost-based rates methodology. • Colorado worked with program stakeholders and CMS from 2005-2008 to develop new FFS methodology which became effective July 1, 2008 • October 1, 2009 the MAC Program was added • For FY12 Colorado moved to a 1/12 interim payment methodology. 3
School Health Services Our Program Before 4
School Health Services Our Program Today 5
School Health Services Cost-Based Reimbursement Salary, Add Cost Benefits and Unrestricted Reduce by Contracted Add Add Indirect Annual Apply Costs for Supplies, Transportation Costs Average Federal Reduce by RMTS Materials Statewide Costs Medical IEP Student Participants and Other Allowable Assistance Utilization Costs DS & TCM Percentage Ratio RMTS % (FMAP) 50% Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 DS, TCM, Transportation Reimbursement Amount • 6
School Health Services Results 7
School Health Services 8
School Health Services Results 9
School Health Services 10
School Health Services 11
School Health Services 12
School Health Services Student Population Reached 900,000 853,360 842,598 850,000 831,633 817,605 801,838 793,269 800,000 786,561 781,197 779,826 770,074 763,307 760,162 750,000 728,216 719,296 700,000 650,000 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 Total Student Population State Wide Participating District Student Population 13
Student Population Reached by Medicaid for School Health Services Aurora Public School District 28 45,000 39,674 38,579 40,000 36,967 35,523 33,831 33,563 33,301 35,000 30,000 25,000 20,000 15,000 10,000 4,506 3,966 3,443 5,000 1,238 1,278 1,258 1,013 - 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 Student Population Unduplicated Medicaid Students Reached 14
School Health Services Medicaid Administrative Claiming Net Reimbursement (Federal Share Only less State Withhold) $2,000,000 $1,807,103 $1,769,159 $1,800,000 $1,600,000 $1,488,273 $383,078 $460,564 $1,400,000 $425,101 $1,200,000 $403,801 $516,853 $990,748 $1,000,000 $411,830 $326,102 $800,000 $483,938 $511,120 $600,000 $320,294 $344,415 $400,000 $458,800 $200,000 $358,108 $344,352 $306,927 $- 2009-10 2010-11 2011-12 2012-13 Fiscal Year by Quarters July-September October-December January-March April-June 15
School Health Services Medicaid Administrative Claiming Net Reimbursement For Aurora Public School District 28J (Federal Share Only less State Withhold) $180,000 $ 153,499 $160,000 $ 137,567 $140,000 $32,002 $ 123,260 $120,000 $36,452 $104,526 $33,461 $100,000 $45,109 $30,964 $30,236 $80,000 $31,278 $60,000 $29,680 $42,794 $31,098 $25,893 $40,000 $43,882 $20,000 $39,781 $33,594 $32,628 $- 2009-10 2010-11 2011-12 2012-13 Fiscal Year by Quarters July-September October-December January-March April-June 16
School Health Services Challenges 17
School Health Services Challenges • Learning curve • RMTS • Financial Reporting • Communication • Paybacks • State Plan • Provider Buy In 18
School Health Services What We Figured Out Finish 19
School Health Services What We Figured Out • Online System for RMTS and Financial Reporting • Interim Rates • Administrative Withhold • Eligibility Ratio • Training • Relationships 20
School Health Services How We Got There 21
School Health Services How We Got There • Collaboration/Communication • Stakeholder Group • Outreach efforts • Program Reviews • Training • Newsletters • Help Desks • Program Manual 22
School Health Services What is Next? • Constant Improvement • Stakeholder Group • Trainings • Community Partners • Internal Partners • Outreach to Non-Participating Districts 23
School Health Services What is Next? Colorado Student Medicaid Population and District Participation 24
School Health Services What is Next? Colorado Population by County 2010 25
School Health Services Student Population Reached 900,000 853,360 842,598 850,000 831,633 817,605 801,838 793,269 800,000 786,561 781,197 779,826 770,074 763,307 760,162 750,000 728,216 719,296 700,000 650,000 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 Total Student Population State Wide Participating District Student Population 26
School Health Services Everybody Wins 27
School Health Services Contact Information Colorado Department of Health Care Policy and Financing Shannon Huska • • Shannon.Huska@state.co.us / 303-866-3131 Colorado Department of Education Jill Mathews • • Mathews_J@cde.state.co.us / 303-866-6978 Public Consulting Group (PCG) Michelle Simmons • • msimmons@pcgus.com / 847-567-1109 Aurora Public Schools Judy Weaver • • jaweaver@aps.k12.co.us / 303-326-2000 x 28535 28
School Health Services Questions 29
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