Introduction to Medicaid Cost Based School Based Health Services

1. Introduction to Medicaid Cost Based School Based Health Services State of New York Department of Health School/Pre-School Supportive Health Services Program (SSHSP) www.pcghealth.com

2. Agenda Introductions SSHSP Cost Reimbursement Process Overview Staff Pool List Development and Quarterly Update Process Random Moment Time Study (RMTS) Site Preview Contacts Questions? NY: Introduction to Medicaid Cost Based School Based Health Services

3. Public Consulting Group, Inc. – Who We Are Public Consulting Group, PCG, is an international management consulting firm headquartered in Boston, Massachusetts. We focus on achieving outstanding results and adding value for our public sector clients every day PCG has 5 practice areas: PCGEducation PCGHealth PCG Human Services PCG Technology Consulting Public Partnerships, LLC (PPL) PCG has worked with 13 states to implement school-based Medicaid cost reporting and settlement procedures NY: Introduction to Medicaid Cost Based School Based Health Services

4. Schools and Medicaid Schools provide an array of services beyond traditional “educational services” to ensure that students arrive at school healthy and ready to learn Since school staff work with students on a daily basis, they are uniquely positioned to assist in enrolling eligible students in Medicaid, ensuring receipt of required medical services and supporting administrative services, and providing medically necessary services The Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) Program is Medicaid’s provision for providing preventative child health services for individuals under the age of 21 Periodic health screening Vision services Dental services Hearing services NY: Introduction to Medicaid Cost Based School Based Health Services

5. Overview of Project The New York State Department of Health intends to utilize a revised reimbursement methodology to reimburse school districts, § 4201 schools and counties for school supportive health services furnished to Medicaid-eligible students with disabilities PCG has been engaged to conduct a cost study of all school districts, § 4201 schools, and counties (including the City of New York), and to implement an annual cost reconciliation and settlement model As part of this process, school districts, § 4201 schools, and counties will be required to participate in quarterly Random Moment Time Studies (RMTS) and to file an annual cost report NY: Introduction to Medicaid Cost Based School Based Health Services

6. Overview of SSHSP Cost Reimbursement Process NY: Introduction to Medicaid Cost Based School Based Health Services

7. Overview of SSHSP Cost Reimbursement Process The purpose of the Medicaid Fee-For-Service (FFS) Program is to provide reimbursement for medically necessary services that are received in schools and provided or arranged by a school system for Medicaid-eligible students with an Individualized Education Program (IEP) Services are currently reimbursed according to a fee schedule and cost based for transportation Effective for dates of services beginning October 1, 2011, services will be cost reimbursed and an annual Medicaid cost report must be filed by each school district/§ 4201 school/county NY: Introduction to Medicaid Cost Based School Based Health Services

8. Overview of SSHSP Cost Reimbursement Process Each school district/§ 4201 school/county’s Medicaid cost will be calculated through a series of calculations including a Cost Report, a Random Moment Time Study (RMTS) methodology, Cost Reconciliation and Cost Settlement Medicaid cost will be compared to Medicaid interim payments and a settlement will be calculated for each school district/§ 4201 school/county When Medicaid costs exceed Medicaid interim payments, a settlement will be due to the school district/§ 4201 school/county When Medicaid costs are less than Medicaid interim payments, the school district/§ 4201 school/county will return the overpayment to Medicaid NY: Introduction to Medicaid Cost Based School Based Health Services

9. Overview of SSHSP Cost Reimbursement Process Role of the School District/§ 4201 School/County Participate in Random Moment Time Study Submit participant list for inclusion in random moment time study Ensure all Medicaid-eligible providers are included on the cost report The list of Medicaid-eligible providers on the cost report must be the same as the participant list submitted for the random moment time study Provide backup documentation as requested by DOH/OMIG or CMS Prepare and submit completed annual cost report Print and Sign Certification Page of finalized report Role of PCG and DOH Desk review cost reports Complete Medicaid cost report audits Process Medicaid cost settlements NY: Introduction to Medicaid Cost Based School Based Health Services

10. Overview of SSHSP Cost Reimbursement Process Cost report process “drills down” to Medicaid Eligible Medical Cost Educational, Admin and Medical Costs Medical Cost Identified by Time Study % Medicaid Cost Identified by Medicaid Eligibility % NY: Introduction to Medicaid Cost Based School Based Health Services

11. Overview of SSHSP Cost Reimbursement Process • IEP Ratio must be maintained and tracked for Medicaid cost allocation purposes • Medicaid-allowable costs are determined by multiplying total direct medical services times the IEP ratio. Total Number of Medicaid Eligible FFS Students Receiving Direct Medical Services with an IEP IEP Ratio = Total Number of Students Receiving Direct Medical Services with an IEP NY: Introduction to Medicaid Cost Based School Based Health Services

12. Overview of SSHSP Cost Reimbursement Process • Cost Reports will be submitted through a web based software system • More comprehensive cost report training will be provided in the future NY: Introduction to Medicaid Cost Based School Based Health Services

13. Cost Settlement Calculation Example NY: Introduction to Medicaid Cost Based School Based Health Services

14. Staff Pool List Development and Quarterly Update Process NY: Introduction to Medicaid Cost Based School Based Health Services

15. Staff Pool List Development • Staff should be included on the staff pool list if they perform direct medical services that are eligible to bill under the SSHSP program • Two staff pools will be established, including: • Direct Service Staff Pool - Therapy • Direct Service Staff Pool – All Other • The RMTS results will determine the amount of Medicaid reimbursement generated through the SSHSP program • School districts/§ 4201 schools/counties that participate and bill services under SSHSP MUST participate in the RMTS process • Staff on the list, who have the potential to be selected for the RMTS, should include those clinicians, salaried and contracted, that meet the qualified provider requirements as defined by NYS DOH • IF the school district/§ 4201 school/county provider wants to recover reimbursement for eligible clinicians, THEN the clinicians are required to be included on the quarterly RMTS roster NY: Introduction to Medicaid Cost Based School Based Health Services

16. New York Job Categories – Direct ServiceTherapy • Sample job categories and job titles include: • OTAs are eligible Under the Direction of an Occupational Therapist • PTAs are eligible Under the Direction of a Physical Therapist • TSLD and TSHH are eligible Under the Direction of a Speech-Language Pathologist NY: Introduction to Medicaid Cost Based School Based Health Services

17. New York Job Categories – Direct Service All Other • Sample job categories and job titles include: • LMSWs are eligible Under the Supervision of a LCSW, psychiatrist, or psychologist • LPNs are eligible Under the Direction of a Licensed RN, or other licensed health care provider authorized under the Nurse Practice Act NY: Introduction to Medicaid Cost Based School Based Health Services

18. Quarterly Staff Pool List Updates • Staff can only be added once a quarter - no one can be added for the quarter after the staff pool list has been submitted • Once RMTS is implemented, the staff pool list from the previous quarter should be updated every quarter • Participant information may be added, removed, or changed at this time • If questions arise about the update, PCG will contact the school district/§ 4201 school/county to get clarification • After all staff pool lists have been returned and quality checks completed, PCG will generate the state-wide Random Moment Time Study (RMTS) sample NY: Introduction to Medicaid Cost Based School Based Health Services

19. Current Quarter RMTS Process • PCG is sending each RIC or school district/§ 4201 school/county a roster compiled from the most recent Medicaid Compliance Trainings • Please ensure your staff pool list is accurate – the list will include each participant’s: • First and Last Name • Job Title • E-mail Address • School District/County/Section 4201 School • PCG will manage the moments using the 2011-2012 NYSED School Calendar • If changes are made to the calendar (e.g., bad weather: flooding, snow day, etc.; or other unexpected closure), please update PCG when they occur NY: Introduction to Medicaid Cost Based School Based Health Services

20. RMTS Preview NY: Introduction to Medicaid Cost Based School Based Health Services

21. Example: How the E-mail Looks E-mail text: Hello, This is to notify you that you have been randomly selected to complete a random moment time study (RMTS) for the New York School Supported Health Services Program. The date and time of your moment is: (April 9 2012 9:52AM). Please respond to your moment as soon as possible. You will receive a reminder of your sample moment 24 hours before it occurs. Please logon to https://easyrmts.pcgus.com/rmtsv2/LoginCheck.aspx?Client_Id=171015 to access your moment after the selected time. You can click on the website link or type the address into your web browser. Your username is JWilson171072 Your password is 29153627 If you have any questions, please call 1-866-912-2974. Thank you for your response! NY: Introduction to Medicaid Cost Based School Based Health Services

22. Example: Login Page Enter User Name and Password (contained in the initial moment email) and press “Login” NY: Introduction to Medicaid Cost Based School Based Health Services

23. Example: Welcome Screen The welcome screen will contain any important messages regarding the time study. Please select Next to Continue. NY: Introduction to Medicaid Cost Based School Based Health Services

24. Example: Example Responses The next screen gives specific examples of how to respond appropriately to your assigned moment. Please select Next to Continue. NY: Introduction to Medicaid Cost Based School Based Health Services

25. Example: Instructions Screen The next screen provides you with particular instructions for how to respond to your moment. Please select Next to Continue. NY: Introduction to Medicaid Cost Based School Based Health Services

26. Example: Moment List Any Moment that a participant has “open” (not answered within 5 days) will be listed here. *Note: Participants can only respond to one moment at a time. Select Respond to answer a moment. NY: Introduction to Medicaid Cost Based School Based Health Services

27. Example: Responding in EasyRMTS™ Select your answer to the initial question and hit the Next button. NY: Introduction to Medicaid Cost Based School Based Health Services

28. Example: Responding in EasyRMTS™ Fill in answers for each subsequent question and select the Next button. NY: Introduction to Medicaid Cost Based School Based Health Services

29. Example: Moment Response Summary This screen will allow the participant to view their response. If the response is not accurate the participant can return to the previous screen by selecting the Edit button. NY: Introduction to Medicaid Cost Based School Based Health Services

30. Example: Moment Submission If the response is accurate, check the box and select Submit. NOTE YOU MUST SELECT SUBMIT TO COMPLETE THE SURVEY NY: Introduction to Medicaid Cost Based School Based Health Services

31. Example: Confirmation This screen confirms that the moment has been submitted. If the participant has more than one moment they can return to the “moment list” screen to answer any other outstanding moments. NY: Introduction to Medicaid Cost Based School Based Health Services

32. Action Items and Support • School districts/§ 4201 schools/counties will update rosters to reflect current staffing and e-mail the updated files to NYSSHSP@pcgus.com on or before March 20, 2012 • Reminder • PCG will code using a centralized standard coder • Training will be embedded in the RMTS • For additional assistance, please contact Public Consulting Group’s New York Hotline at • E-Mail Address: NYSSHSP@pcgus.com • Phone: 1-866-912-2974 NY: Introduction to Medicaid Cost Based School Based Health Services

33. Public Consulting Group, Inc. 148 State Street, Tenth Floor, Boston, Massachusetts 02109 (617) 426-2026, www.publicconsultinggroup.com