Embed Size (px)
Citation preview
0
Ben Appling Georgia Department of Community Health
August 28, 2014
Medicaid in Education
1
Mission The Georgia Department of Community Health
We will provide Georgians with access to affordable, quality health care through
effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
2
Title or Chapter Slide (use as needed; feel free to delete)
Medicaid in Education (Background) CISS and ACE Requirements
Financial Process Documentation
How to Enroll in the Program
3
Title or Chapter Slide (use as needed; feel free to delete)
CISS and ACE Requirements
Financial Process Documentation
How to Enroll in the Program
Medicaid in Education (Background)
4
Medicaid in Education (Background)
– Joint federal/state medical assistance program established by Title XIX of the Social Security Act. All Medicaid programs in Georgia are administered by the Georgia Department of Community Health (DCH).
– Funding for the Medicaid program comes from federal and state sources, with the largest share provided by the federal government.
5
Medicaid in Education (Background)
Two School-Based Medicaid programs:
– Children’s Intervention School Services (CISS) • Direct Medical Service Costs
– Administrative Claiming for Education (ACE)
• Administrative Costs
6
Medicaid in Education (Background)
Two Medicaid programs:
– Managed Separately
– Operated Separately
– Reporting Separately
7
Medicaid in Education (Background)
Bottom Line: Provides reimbursement for medical services delivered to Medicaid-eligible students, as well as the administrative activities that support the delivery of these services
8
Title or Chapter Slide (use as needed; feel free to delete)
Financial Process Documentation
How to Enroll in the Program
Medicaid in Education (Background) CISS and ACE Requirements
9
CISS and ACE Requirements
• For CISS: – School system must be registered with DCH as a
Medicaid-provider – Student must be Medicaid-eligible – Services must be Medically necessary and authorized
by PCP – Services must be documented in the Individualized
Education Program (IEP)
10
CISS and ACE Requirements
• For CISS: – Limited to these service categories:
• Audiology • Counseling • Nursing • Nutrition • Occupational Therapy • Physical Therapy • Speech Therapy
11
CISS and ACE Requirements
• For CISS: – Must be provided by Certified personnel
• Licensed Speech Language Pathologist; • Licensed Audiologists; • Licensed Physical Therapists; • Licensed Registered Professional Nurses, etc.
– LEAs must bill Medicaid throughout the year – Must report costs and IEP data on annual basis – Must participate in an annual Cost Settlement process
12
CISS and ACE Requirements
• For ACE: – Must also participate in CISS – Must submit CISS billing on a quarterly basis – Must report costs on a quarterly basis
• Payroll • Other Costs • Direct Support Staff Costs
13
CISS and ACE Requirements
• For ACE: – Eligible positions include:
• Administrators; • Speech Therapy Assistants; • School Counselors, etc.
– Eligible activities include: • Medicaid outreach and related training; • Facilitating Medicaid eligibility application; • Medical service program planning; etc.
– Two hours weekly
14
Title or Chapter Slide (use as needed; feel free to delete)
CISS and ACE Requirements
Documentation
How to Enroll in the Program
Medicaid in Education (Background)
Financial Process
15
Financial Process
• For CISS and ACE: – Provide staff list quarterly
• Basis for conducting a Random Moment Time Study • Basis for determining reimbursement amounts
– Employees must participate in RMTS • Sample of employees report their activities at certain pre-
selected moments • Each quarter except July-September
16
Financial Process
• For CISS: – Bill throughout year and receive interim payments – Submit cost report at end of year – Participate in Cost Settlement process annually
• Calculates final eligible reimbursement amount • “Settle” the difference between the amount paid and the
amount eligible
17
Financial Process
• For ACE: – Bill within the same quarter – Submit costs quarterly – Quarterly reimbursements
18
Financial Process
• For CISS and ACE: – Each LEA will receive a validation review at least once
every 3 years • Payroll costs – salary and benefits and contracted staff costs • Other costs • IEP data • Licensure/Certification
– Many occur onsite
19
Title or Chapter Slide (use as needed; feel free to delete)
CISS and ACE Requirements
Financial Process
How to Enroll in the Program
Medicaid in Education (Background)
Documentation
20
Documentation
• For CISS and ACE: – Payroll records for all CISS/ACE employees – IEP records for all Medicaid students – Itemized records of purchase (Invoices) for equipment
and supplies – Licensure/Certification for the review time period – 5 years retention
21
Title or Chapter Slide (use as needed; feel free to delete)
CISS and ACE Requirements
Financial Process Documentation
Medicaid in Education (Background)
How to Enroll in the Program
22
How to Enroll
Three Things to Enroll:
Obtain a Medicaid provider ID www.mmis.georgia.gov
23
How to Enroll
Three Things to Enroll:
Obtain a National Provider Identifier (NPI) number: https://nppes.cms.hhs.gov/NPPES/Welcome.do
24
How to Enroll
Three Things to Enroll:
Contact DCH’s Partner, Public Consulting Group (PCG)
[email protected] 1-888-805-0498
25
How to Enroll
• Will be eligible at the beginning of the next quarter • Regular trainings • Step-by-Step process guides • Georgia-based staff to assist you with compliance
26
How to Enroll in the Program
• For CISS and ACE: – Log on to www.xxxxxxx.gov and sign up for a Medicaid
Provider ID – Log on to www.xxxxxxx.com to get an NIP number – Call the DCH Medicaid service provider (PCG) at 1-888-
805-0498 or [email protected] and notify them that your LEA wants to enroll in the program
Questions ?
27
How to Enroll in the Program
• For CISS and ACE: – Log on to www.xxxxxxx.gov and sign up for a Medicaid
Provider ID – Log on to www.xxxxxxx.com to get an NIP number – Call the DCH Medicaid service provider (PCG) at 1-888-
805-0498 or [email protected] and notify them that your LEA wants to enroll in the program
Ben Appling Department of Community Health
404-463-4012 [email protected]
