Wisconsin Medicaid Administrative Claiming (MAC) and School-Based Services (SBS) Program - Wisconsin Association of School Business Officials ...
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Wisconsin Medicaid Administrative Claiming (MAC) and School-Based Services (SBS) Program Wisconsin Association of School Business Officials March 2021
3 Elements of Medicaid Reimbursement in
Schools
Fee-For-Service (FFS) SBS MAC
• Reimbursement for Direct • School Based Services • Medicaid Administrative
Services Claiming
• Reconciles interim FFS
• Based on estimated cost payment with actual • Reimbursement for
costs indirect costs of
providing direct services
• Interim payments made (coordination of care,
throughout the year Medicaid outreach,
medical training, etc.)
• FFS training provided by
FFS vendor
www.publicconsultinggroup.com 2
Program Components
Staff Pool List Random Moment
Time Study
*Staff pool list updates start in August of each
year when the October-December staff pool list
opens.
Program
Logging and
Components Billing Services;
Cost Receive Interim
Settlement Payments
*SBS settlements are calculated and processed one
year after the conclusion of a school year (i.e. 2018-
19 SBS cost settlements will be processed in Spring
2021).
Quarterly &
Annual Financials
www.publicconsultinggroup.com 3
Revenue Breakdown
Program Reimbursement in State Fiscal Year 2018 (Paid 2020)
SBS Settlement,
$27,098,045 Interim
Payments,
$41,524,978
$86.7 Million
MAC Settlement,
$18,102,262
www.publicconsultinggroup.com 4Staff Pool List & Random Moment Time Study
What is the SPL and RMTS?
Random Moment Time
Staff Pool List (SPL)
Studies (RMTS)
The SPL is the foundation of both programs, The RMTS process is a federally approved
updated three times per year with each district’s technique of polling a statistically valid sampling
“list” of staff employees eligible for the RMTS of randomly selected moments (one moment =
survey. one minute) that are assigned to randomly
selected participants. This study determines
The SPL indicates who at your district provides the portion of time individuals spend doing
services and/or is involved with the coordination reimbursable activities.
of services on behalf of the MAC/SBS program
9200 moments are distributed each quarter.
Everyone included on the SPL is eligible to
receive RMTS moments. MAC – 3000 SBS 1 – 3200 SBS 2 - 3200
www.publicconsultinggroup.com 6RMTS and the Direct Medical Percentage • In addition to providing counseling to students, Sally spends her day doing administrative as well as non- reimbursable tasks. • The purpose of the Random Moment Time Study is to calculate the Direct Medical Percentage and the MAC Reimbursement Percentage, or the average amount of time that Sally spends performing reimbursable activities such as providing services and filling out paperwork. • The Direct Medical Percentage is applied to the total staff costs for each service category on the Annual Cost Report. www.publicconsultinggroup.com 7
Allowable Costs & Apportioning Ratios
MAC/SBS: Direct Medical Services Total Costs
Salary, Benefits, and Contracted Staff Materials and Supplies, Staff Travel & Training and
• Apply to both programs. Professional Dues and Fees
• Direct Medical Service providers are the only • Travel completed to attend a staff training
individuals included on the Annual Cost Report from • Professional dues and fees specific to a provider’s job at the district
the three cost pools – MAC, SBS 1, and SBS 2
• Quarterly materials and supplies must tie back to a service provider
• Direct Service costs roll up from the quarterly to the
annual reports • The CMS List of Allowable Materials and Supplies is only applicable to
annual cost report
www.publicconsultinggroup.com 9
SBHS: Medicaid Cost Report and Cost Settlement TrainingMAC: Administrative Percentage
The purpose of this percentage is to identify the percentage of time providers
spend, on average, on Medicaid Administrative activities
Calculated by PCG from the results of the quarterly Random Moment Time
Study (RMTS)
It is a statewide percentage and is not school district specific
This percentage is applied to the MAC Claim and directly affects the quarterly
reimbursement for every district
www.publicconsultinggroup.com 10
SBHS: Medicaid Cost Report and Cost Settlement TrainingSBS: Direct Medical Percentage
The purpose of this percentage is to identify the percentage of time providers spend,
on average, performing eligible direct medical services
Calculated by PCG from the results of the quarterly Random Moment Time Study
(RMTS) - the average results of the three quarterly time study periods (Oct – Dec,
Jan – Mar, and Apr – Jun) that occurred during the fiscal year
It is a statewide percentage and is not school district specific
This percentage is applied to the Direct Medical Service Costs and directly affects
the cost settlement for every district
www.publicconsultinggroup.com 11
SBHS: Medicaid Cost Report and Cost Settlement TrainingCOVID-19 and the Random Moment Time
Study
• COVID-19, school shut-downs, and remote/hybrid learning has impacted the Random Moment Time
Study
• For the April – June 2020 quarter, Wisconsin received a waiver from CMS to halt the time study
• Note that MAC claims will still be calculated for April – June 2020, and that April – June 2020 costs will still be
included in the Annual Cost Report
• For the AJ20 MAC claim and for the annual Direct Medical Percentages, an average of Oct-Dec 19 and Jan-
Mar 2020 will be used
• The RMTS resumed for Oct-Dec 2020 and for Jan-Mar 2021
www.publicconsultinggroup.comMAC: Medicaid Eligibility Ratio (MER)
Total Number of Total Number of
Students Enrolled
in Medicaid at your ÷ ALL Students
at your district
= MER
district
The MER apportions out the allowable costs submitted by
districts each quarter solely for the MAC program
www.publicconsultinggroup.com 13SBS: Individualized Educational Plan (IEP) Ratio What is the purpose of the IEP Ratio? Identifies the portion of costs that pertain to the delivery of direct medical services specifically to Medicaid-eligible special education students with a prescribed reimbursable direct medical service in their IEP. The ratio is solely applicable to the Annual SBS program. www.publicconsultinggroup.com 14
SBS: Specialized Transportation Costs
Districts may report salary and Districts may report
benefit costs for drivers, sub Districts may report costs for Contracted Services for
drivers, and mechanics Leasing/Renting all vehicles which provide
who provide specialized specialized transportation specialized transportation
transportation services
Districts may Districts may report
Districts may report repairs
depreciate costs for all fuel and oil for all
vehicles which provide and maintenance for all
vehicles which provide
specialized specialized vehicles which provide
transportation transportation specialized transportation
www.publicconsultinggroup.com 1515
SBHS: Medicaid Cost Report and Cost Settlement TrainingFinancial Reviews
Financial Reviews System Edit Checks Desk Reviews Monitoring Reviews Potential Audit Risks www.publicconsultinggroup.com 17
System Edit Checks
✓ Quarterly Edit Checks
▪ No Payroll Information Reported
▪ Salary Exceeds the Expected Threshold
▪ Benefits to Salary Ratio Exceeds
Expected Threshold
• Thresholds – District specific
✓ Additional layer of limiting
audit risk
▪ Resolve edit check by entering
explanation
• High-end of pay scale
• Summer pay
• Retirement payout
• Veteran teacher
www.publicconsultinggroup.com 18Desk Reviews
PCG conducts desk reviews after
all cost reports have been certified
Desk reviews help protect school
districts from federal audits and
potential pay-back situations.
When preparing your cost report,
keep clear & organized
documentation for ease of
reference during the review
Confident statements of understanding
are necessary! Avoid phrases like “I
believe…” or “Somebody told me…”
www.publicconsultinggroup.com 19
SBHS: Medicaid Cost Report and Cost Settlement TrainingMAC/SBS Monitoring Reviews
Monitoring reviews for each participating district examines costs and ratios reported for the most recent
certified annual cost report
School districts are responsible for providing requested documentation by the due date given in the
Letter of Notification
Calls are held before the review is conducted in order to clarify documentation needed and answer any
questions
The validation will include a review of information certified by the school districts in the PCG Claiming
System, direct medical credentials for the period selected for review, and IEP documentation for the
period selected for review
Upon completion of the review of this information, a final report will be provided with details of the
validation. If errors are identified, school districts must complete corrective actions
www.publicconsultinggroup.com 20Overview of Monitoring Review Results
Fall 2020
Credential Direct Annual &
Salary and Contracted Transportation Transportation
School District & Support Quarterly IEP Ratio
Benefits Staff Costs Costs Ratios
Licensing Staff Other Costs
School District #1 X X
Takeaway:
School District #2
A need to focus
School District #3 X on the
importance of
School District #4 X
accurately
School District #5 X reporting
program costs.
School District #6
School District #7
School District #8 X X X
School District #9 X X
School District #10
www.publicconsultinggroup.com 21Potential Audit Risks
1 Calculation of the Specialized Transportation One-Way Trip Ratio
2 Calculation of the IEP Ratio denominator
3 Salary and Benefit documentation does not align with what is reported in the PCG Claiming System
Transportation costs are not correctly categorized as either “Only Specialized Transportation” or “Not
4 Only Specialized Transportation”
What does your documentation support?
5 Calculation of the Vehicle Ratio
If you have any questions about documentation and allowable costs, don’t ever hesitate to reach out to PCG!
PCG should always be your first point of contact!
www.publicconsultinggroup.com 22Calculations
MAC Claim Components
Step 1: Add Costs Salary,
Travel/training,
benefit and
dues/fees,
contracted
material/ supplies
costs
Step 2: Apply Ratios
Federal Indirect
Financial Cost
Participation Rate
Percentage
MAC RMTS
Medicaid
Reimbursement
Eligibility Ratio
Percentage
www.publicconsultinggroup.com 24SBS Cost Settlement Claim Components
Step 1: Add Costs Salary,
Travel/training,
dues/fees,
benefit and material/
contracted supplies from
Step 2: Apply costs CMS list
Ratios
Interim Indirect
Payments Cost
Step 3: Compare to Rate
Interim Payments
SBS RMTS
Federal Medical
Reimbursement
Assistance
Interim Percentage
Percentage
Payments
IEP Ratio
❖ Interim Payments and FMAP
are used to determine cost
settlement
www.publicconsultinggroup.com 252020 – 2021 MAC and SBS Key Dates
PCG Claiming System Start &
Program Action and Reporting Period
Certification Due Date
RMTS (Staff Pool List, Calendars and Shifts)
OD20 8/3/2020 – 9/4/2020
JM21 11/2/2020 – 12/4/2020
AJ21 2/1/2021 – 3/5/2021
Quarterly MAC Financials
AJ20 7/1/2020 – 8/9/2020
JS20 10/5/2020 – 11/13/2020
OD20 1/4/2021 – 2/5/2021
JM21 4/1/2021 – 5/7/2021
AJ21 7/1/2021 – 8/6/2021
Annual SBS Financials
July 1, 2019 – June 30, 2020 10/1/2020 – 12/15/2020
www.publicconsultinggroup.com 26Public Consulting Group Contacts
Quarterly MAC Team Annual SBS Team
Email: wimacs@pcgus.com Email: wicostreport@pcgus.com
Phone: (877) 395-5019, Option 1 or 2 Phone: (877) 395-5019, Option 3
Mark Schoenberg Chris Costa Jon Hartford McKenzie Ratcliff
Nate Erickson Alex Hudgin Molly McDonald Matt Sorrentino
www.publicconsultinggroup.com 27Questions?
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