Student Counts for Medicaid Reporting 2019 PED STARS Data - PowerPoint PPT Presentation

Student Counts for Medicaid Reporting 2019 PED STARS Data Conference

What is the Medicaid School-Based Services Program? • 97% of LEAs and 30+ Charter schools participate in the Medicaid School-Based Services (MSBS) Program. • This Program allows them to receive Medicaid reimbursement for IEP-related ancillary services provided to Medicaid-enrolled students. – Provides over $40M annually. • Districts are required to provide several student lists to HSD for calculation of Medicaid Eligibility Rates (MERs) that are utilized in claims. 2

How is the STARS Coordinator involved? • Requests for the student lists come from HSD to each district’s MSBS Coordinator. – MSBS Coordinators can include SPED, Health Services and/or Financial staff depending on the district. • MSBS Coordinator will communicate with STARS Coordinator to request student lists. – FY19 transitioned from 40 th day counts to 80 th day. • MSBS Coordinator will double check formatting to ensure compliance with HSD requirements. 3

80 Day Count Utilization • The 80 th day reports are used to determine the Medicaid Eligibility Rate (MER) for each District, Charter and REC.  Administrative Claiming  Cost Settlement o Transportation Reimbursement • List totals are compared to what was reported to PED through STARS.  Ensure the staff providing the lists are utilizing the “Snapshot” and not the “Template” to capture enrollment on the 80 th day  Reconciliation assures CMS that we are utilizing accurate data to calculate the MER ⇒ accurate payment • Lists should include ALL students; the match process determines those who are Medicaid enrolled. 4

Why are we here today? • Over the last several years, HSD has improved our auditing processes to include verification of the student data utilized in the MER calculations. • We began auditing these lists in FY16, including a reconciliation of the lists submitted by the district and what was reported through STARS. – Numerous errors have been encountered. • FY19 began collaboration between HSD and PED to streamline the data collection and reporting in STARS to improve accuracy and efficiency. 5

Changes for FY20!!! • We have been working with the PED SPED and IT Bureaus on changes for Nursing and Specialized Transportation reporting in STARS. – Changes to the IEP Templates – Changes to the STARS SPED Services Fact Template – The goal is to streamline the STARS reports so that less validation is required for Nursing Services and Transportation. • Nursing Only students will be captured • Wheelchair transportation will be easily identified • Validation will still be necessary for seatbelts, etc. 6

IEP Template Changes for Nursing • IHP/Nursing Services as a related service is now a mandatory field. This should capture any students that are Nursing Only and the service may not be listed on the Schedule of Services. 7

IEP Template Changes for Transportation • Additional fields have been created in the Transportation Section to provide greater detail regarding the need for modifications and their medical necessity. 8

SPED Services Fact Template • 5 new service codes added to Field 5. 9

Transportation on the IEP • Due to student's diagnosis of epilepsy, student requires the use of a seatbelt/harness on the special education bus in the event that a seizure occurs while en-route to/from school. • Due to Cerebral Palsy, student requires assistance to guide her in the gait trainer to/from the bus, assistance to enter/exit the bus and a harness while riding the bus. 10

Transportation on the IEP • Student is not independently mobile and non- verbal. He needs total physical assistance for all of his daily needs and transfers.  Prior Written Notice – It is agreed that student would require a SPED bus with a lift for his wheelchair • The SPED bus has seat belts and a bus aide.  Prior Written Notice – Student rides the SPED bus to and from school -It will benefit him to ride the regular education bus home so that he can remain in class until 3:05 11

Future Changes/Improvements • We are continuing to work with PED on these next steps – PED IT to create STARS report templates for 80 day that contain the desired data specified by SHO. – Populating STARS with the Medicaid ID from the 2018-2019 match lists. • A field already exists in STARS that can be designated and utilized for Medicaid ID #s. • This field will then populate on the 80 day lists that will be submitted in January. • If successful, SHO will provide PED with an annual update list to populate STARS. • This will eliminate the need for districts/RECs to manually populate this field & phase out use of SSNs. 12

Questions 13

MSBS Program Staff • Christie Guinn, SHO Manager 505-827-3117 christie.guinn@state.nm.us • Vanessa Skrehot, MSBS/FIT Program Manager 505-827-7288 vanessa.skrehot@state.nm.us • Ashley Garcia, MSBS/Health Services Coordinator 505-827-1421 ashley.garcia@state.nm.us 14