Medicaid in Education

Transcription

1 Medicaid in Education Ben Appling Georgia Department of Community Health August 28,

2 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. 1

3 Medicaid in Education (Background) CISS Title and or ACE Chapter Requirements Slide (use as needed; Financial feel Process free to delete) Documentation How to Enroll in the Program 2

4 Medicaid in Education (Background) CISS Title and ACE or Chapter Requirements Slide (use as Financial needed; Process feel free to delete) Documentation How to Enroll in the Program 3

5 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. 4

6 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 5

7 Medicaid in Education (Background) Two Medicaid programs: Managed Separately Operated Separately Reporting Separately 6

8 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 7

9 Medicaid in Education (Background) CISS Title and or ACE Chapter Requirements Slide (use as Financial needed; Process feel free to delete) Documentation How to Enroll in the Program 8

10 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) 9

11 CISS and ACE Requirements For CISS: Limited to these service categories: Audiology Counseling Nursing Nutrition Occupational Therapy Physical Therapy Speech Therapy 10

12 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 11

13 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 12

14 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 13

15 Medicaid in Education (Background) CISS Title and ACE or Chapter Requirements Slide (use as Financial needed; feel Process free to delete) Documentation How to Enroll in the Program 14

16 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 preselected moments Each quarter except July-September 15

17 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 16

18 Financial Process For ACE: Bill within the same quarter Submit costs quarterly Quarterly reimbursements 17

19 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 18

20 Medicaid in Education (Background) CISS Title and ACE or Chapter Requirements Slide (use as Financial needed; Process feel free to delete) Documentation How to Enroll in the Program 19

21 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 20

22 Medicaid in Education (Background) CISS Title and ACE or Chapter Requirements Slide (use as Financial needed; Process feel free to delete) Documentation How to Enroll in the Program 21

23 How to Enroll Three Things to Enroll: Obtain a Medicaid provider ID 22

24 How to Enroll Three Things to Enroll: Obtain a National Provider Identifier (NPI) number: 23

25 How to Enroll Three Things to Enroll: Contact DCH s Partner, Public Consulting Group (PCG) gaace@pcgus.com

26 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 25

27 How to Enroll in the Program For CISS and ACE: Log on to and sign up for a Medicaid Provider ID Questions? Log on to to get an NIP number Call the DCH Medicaid service provider (PCG) at or gaace@pcgus.com and notify them that your LEA wants to enroll in the program 26

28 How to Enroll in the Program For CISS and ACE: Log on to and sign up for a Medicaid Provider ID Ben Appling Department of Community Health Log on to to get an NIP number Call the DCH Medicaid service provider (PCG) at or bappling@dch.ga.gov gaace@pcgus.com and notify them that your LEA wants to enroll in the program 27