Status Report to the West Virginia Board of Education

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1 Status Report to the West Virginia Board of Education West Virginia Code b Medicaid Eligible Children FY 2011 Office of Special Programs Division of Curriculum and Instructional Services

2 West Virginia Board of Education L. Wade Linger Jr., President Gayle C. Manchin, Vice President Robert W. Dunlevy, Secretary Michael I. Green, Member Priscilla M. Haden, Member Burma Hatfield, Member Lowell E. Johnson, Member Jenny N. Phillips, Member William M. White, Member Brian E. Noland, Ex Officio Chancellor West Virginia Higher Education Policy Commission James L. Skidmore, Ex Officio Chancellor West Virginia Council for Community and Technical College Education Jorea M. Marple, Ex Officio State Superintendent of Schools West Virginia Department of Education

3 Purpose In March 1990, West Virginia Code b authorized West Virginia local education agencies to become Medicaid providers in order to participate in the federal Medicaid reimbursement for services that are special education or related services. Development of the program was a collaborative effort of the West Virginia Department of Education (WVDE) and the West Virginia Department of Health and Human Resources (WVDHHR). The purpose of this report is to provide information regarding the implementation of West Virginia Code b Medicaid Eligible Children, for the year July 1, 2010 to June 30, The report contains an overview of the activities conducted in order to maximize federal Medicaid funding to the state education system, highlights in FY 2011 and the total reimbursements per county. Overview In 1975, Congress passed the Education for All Handicapped Children Act governing: (1) eligibility for special education services, (2) parental rights, (3) individualized education programs (IEPs), (4) the requirement that children be served in the least restrictive environment and (5) the need to provide related services. When the Act was reauthorized as the Individuals with Disabilities Education Act (IDEA) in 1990, it provided that any non-educational public agency, including Medicaid, is obligated under Federal or State law to pay for any services that are also considered special education or related services. This provision is maintained in IDEA 2004 [ 612(a) (12)(A)(i)]. Accordingly, West Virginia Code b in March 1990 authorized local education agencies (LEAs) to become Medicaid providers in order to maximize federal reimbursement as it relates to the Medicaid program. As Medicaid is a federal/state jointly-funded public insurance program, the federal portion is calculated annually and is based on the state s per capita income. During the first half of the state fiscal year (July 1, 2010 to December 31, 2011), the federal portion for West Virginia was an enhanced rate of percent while the state s match was percent. From January 1, 2011 to March 31, 2011, the federal portion was percent while the state s match was percent. From April 1, 2011 to June 30, 2011, the federal portion was percent while the state s match was percent. For school-based Medicaid reimbursement, the West Virginia Department of Education (WVDE) certifies the state match. School-based Services Federal Medicaid Dollars State Education Dollars July 1 - December 31, 2010 January 1 - March 31, 2011 April 1 - June 30, % 80.23% 78.34% 16.95% 19.77% 21.66% 2011 Status Report 1

4 In developing a system for seeking Medicaid reimbursement for special education or related services on the Individual Education Program (IEP), a system for assisting the LEAs in implementing the code was established through each of the Regional Education Service Agencies (RESAs). These activities are carried out through the employment or assignment of personnel on either a full or part-time basis. The cost of the Medicaid reimbursable functions performed by each RESA is either wholly absorbed by the RESA or partially covered by the RESA and by contributions from the respective LEAs. LEA Supporting Documentation: IEP Progress Notes Attendance Records Billing Form or WVEIS Entry RESA Payment - Direct Deposit Electronic claim Remittance Advice Denial/Pending WVDHHR - Molina Processing Agency: Bureau of Medical Services BMS In submitting claims for Medicaid reimbursement, the LEAs complete paper forms or enter the information in the West Virginia Education Information System (WVEIS) so that the RESA Medicaid Specialists can electronically transmit claims for Medicaid reimbursement. Whether entered at the county level or at the RESA, the billing information in the Medicaid billing system in WVEIS creates an electronic history of billing for tracking purposes. Molina Medicaid Solutions, a service contracted by WVDHHR, processes claims sent by all Medicaid providers in West Virginia. The electronic transmission of claims is handled through a secure web portal. The RESA Medicaid Specialists can access remittance advices with payment and denial information for the billed claims in a PDF document.. The goal of uploading the payment status back to the claim record in WVEIS has not yet been achieved. After Molina Medicaid Solutions processes the received claims, the Bureau for Medical Services remits the federal portion of the Medicaid reimbursement for clean claims to the LEAs. Due to the internal billing process carried out within the WVDE, 100 percent of the federal portion for reimbursable claims is received by the LEAs. 2 Medicaid Eligible Children

5 Annual West Virginia Medicaid Reimbursements $50,000, $37,500, $25,000, $12,500, $0 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY Status Report 3

6 Medicaid Reimbursement for FY 01 through FY 11 In 2001, WVDE began billing for newly developed services under the State Plan for IEP Development, Care Coordination, Personal Care Aides and Specialized Transportation. The rates were based on FY 2000 costs for those services. There was a slight drop in reimbursement in FY 2008 as a result of a transfer to a new system. Once the system became fully operational, reimbursement rebounded in FY 2009 and In 2003, WVDHHR contracted with the Public Consultant Group (PCG) to maximize the capture of federal Medicaid reimbursement to the LEAs. Using FY 2001 special education costs and applying an indirect cost rate, PCG determined interim rates for the cost-based services, and an adjustment was applied to previously paid claims back to The adjustment was reflected in FY In 2005, PCG determined interim rates based on special education costs for FY The adjustment and increased rates were reflected in the reimbursement for FY 2005 and FY Interim rates, based on more recent costs have not been calculated. This is contingent upon results of an audit of the cost methodology used to determine the present interim rates. The federal audit report, in two parts, is not favorable for West Virginia School-based Medicaid reimbursement. West Virginia DHHR is in the process of appealing and disputing the audit findings. Highlights in FY 11 During the first half of the fiscal year, (July 1, 2010 to December 31, 2010) West Virginia was able to access an enhanced rate of percent. During the second half of the fiscal year, (January 1, 2011 to June 30, 2011), the rate decreased to percent. For July 2010 to June 2011, the total federal portion of the payment to LEAs was $50,540, Based on that figure, the West Virginia Department of Education (WVDE) certified that $11,840, was available as the state s match and that this money was not utilized as match for other federal programs. The following pages contain worksheets and charts of the FY 11 Medicaid reimbursement data. Information per county per month is available upon request from the Office of Special Programs. 4 Medicaid Eligible Children

7 Fiscal Year 2011 Federal Medicaid Reimbursement by County and Service County Speech, Physical, Occupational Therapies, Psychological, Nursing, Audiological IEP Process, Care Coordination, Specialized Transportation, Personal Care Aides Total Barbour $32, $319, $352, Berkeley $206, $4,669, $4,875, Boone $13, $1,293, $1,307, Braxton $69, $315, $385, Brooke $66, $647, $714, Cabell $47, $2,321, $2,369, Calhoun $2, $104, $107, Clay $25, $386, $412, Doddridge $20, $164, $185, Fayette $38, $1,122, $1,160, Gilmer $16, $160, $177, Grant $20, $458, $479, Greenbrier $35, $1,168, $1,203, Hampshire $68, $965, $1,034, Hancock $49, $1,038, $1,088, Hardy $35, $349, $384, Harrison $60, $1,503, $1,563, Jackson $46, $626, $673, Jefferson $78, $842, $920, Kanawha $176, $3,518, $3,694, Lewis $26, $462, $488, Lincoln $17, $746, $764, Logan $66, $556, $623, Marion $71, $1,259, $1,330, Marshall $80, $1,311, $1,391, Mason $19, $866, $886, Mercer $115, $1,382, $1,498, Mineral $41, $793, $835, Mingo $100, $1,101, $1,202, Monongalia $61, $1,135, $1,197, Monroe $20, $316, $336, Morgan $42, $495, $537, McDowell $30, $580, $610, Nicholas $44, $741, $785, Ohio $75, $1,133, $1,209, Pendleton $34, $231, $265, Pleasants $20, $172, $193, Pocahontas $15, $207, $223, Preston $40, $743, $784, Putnam $50, $970, $1,020, Raleigh $102, $2,088, $2,190, Randolph $45, $639, $685, Ritchie $20, $369, $389, Roane $11, $575, $587, Summers $11, $139, $150, Taylor $30, $522, $553, Tucker $14, $123, $138, Tyler $34, $460, $494, Upshur $28, $610, $638, Wayne $24, $751, $776, Webster $29, $633, $663, Wetzel $35, $606, $641, Wirt $20, $81, $101, Wood $138, $2,231, $2,370, Wyoming $5, $484, $489, Inst. Ed. $8, $228, $237, WVSDB $43, $111, $154, $2,694, $47,846, $50,540, Status Report 5

8 Fiscal Year 2011 Federal Medicaid Reimbursement by County Chart Barbour Berkeley Boone Braxton Brooke Cabell Calhoun Clay Doddridge Fayette Gilmer Grant Greenbrier Hampshire Hancock Hardy Harrison Jackson Jefferson Kanawha Lewis Lincoln Logan Marion Marshall Mason McDowell Mercer Mineral 1 Mingo Monongalia Monroe Morgan Nicholas Ohio Pendleton Pleasants Pocohontas Preston Putnam Raleigh Randolph Ritchie Roane Summers Taylor Tucker Tyler Upshur Wayne Webster Wetzel Wirt Wood Wyoming WV Inst. Ed. WVSDB $352, $1,307, $385, $714, $107, $412, $185, $1,160, $177, $479, $1,203, $1,034, $1,088, $384, $1,563, $673, $920, $2,369, $488, $764, $623, $1,330, $1,391, $886, $610, $1,498, $835, W $1,202, $1,197, $336, $537, $785, $1,209, $265, $193, $223, $784, $1,020, $2,190, $685, $389, $587, $150, $553, $138, $494, $638, $776, $663, $641, $101, $2,370, $489, $237, $154, $3,694, $4,875, Medicaid Eligible Children

9 Fiscal Year 2011 Federal Medicaid Reimbursement by Type Type FY2011 Total AUDIOLOGY $12, EDUCATION SPECIAL ED PROJECT $47,844, OCCUPATIONAL THERAPY $537, PHYSICAL THERAPY $295, PRIVATE DUTY NURSE, SCHOOL $148, PSYCHOLOGIST $59, SCHOOL PSYCHOLOGIST $261, SPEECH THERAPY $474, SCHOOL SPEECH THERAPY $906, TOTAL $50,540, Utilizaton of Medicaid Reimbursement The position of the West Virginia Department of Education continues to be that the LEAs must assure that all eligible children with disabilities within the district have FAPE available to them. The expectation is that LEAs will use the IDEA funding, Medicaid reimbursement and state and local funding to provide or pay for those services. In a survey of the 55 school districts chief financial officers (CFOs), 41 counties responded that they use their Medicaid reimbursement for the items listed below. The items are listed in order of the number of times they were included in the CFOs responses. (33) Professional personnel nurses; teachers (31) Service personnel aides to support students with disabilities (25) Contracted services speech, occupational and physical therapy services (12) Staff development (12) Balance budget (11) Equipment (9) Transportation specialized buses; transportation aides (6) Buildings or Repair accessibility issues Comments/Explanations Professional Personnel...a nurse to specifically address the medical needs of severely disabled students....teachers for students with special needs not covered under state/federal funding. Employ additional school nurse and alternative education teacher. Substitutes when needed to cover classes for IEP meetings Service Personnel aides are employed to support students with disabilities. Special education aides, Medicaid billing clerk. Contracted Services Speech services. OT/PT services as needed. Transportation Two buses were purchased. We use it for transportation aides. Buildings or Repair Handicapped-accessible bathroom. Other (Specify) Staff development Status Report 7

10 West Virginia Code b Medicaid Eligible Children (a) The state board shall become a Medicaid provider and seek out Medicaid eligible students for the purpose of providing Medicaid and related services to students eligible under the Medicaid program and to maximize federal reimbursement for all services available under the Omnibus Budget Reconciliation Act of one thousand nine hundred eighty-nine, as it relates to Medicaid expansion and any future expansions in the Medicaid program for Medicaid and related services for which state dollars are or will be expended: Provided, That the state board may delegate this provider status and subsequent reimbursement to regional educational service agencies (RESA) and/or county boards: Provided, however, That annually the state board shall report to the Legislature the number and age of children eligible for Medicaid, the number and age of children with Medicaid coverage, the types of Medicaid eligible services provided, the Medicaid dollars reimbursed; and the problems encountered in the implementation of this system and that this report shall be on a county by county basis and made available no later than the first day of January, one thousand nine hundred ninety-two, and annually thereafter. Information by county and by month for FY 2011 may be obtained by contacting: Vickie Mohnacky, Coordinator West Virginia Department of Education Office of Special Programs Division of Curriculum and Instructional Services Building 6, Room Kanawha Blvd. E. Charleston, WV Phone: ext Site: 8 Medicaid Eligible Children

11 Notes 2011 Status Report 9

12 Jorea M. Marple, Ed.D. State Superintendent of Schools

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