Transcript Slide 1

Independent School
Districts
Federal Fiscal Year 2013
1
Agenda

Program Overview
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Random Moment Time Study (RMTS) Overview
Medicaid Administrative Claiming (MAC) - Financial Reporting
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School-based Medicaid programs
Enrollment process
Program contact responsibilities
Allowable costs
Claim submission
Claim calculation
State of Texas Automated Reporting System (STAIRS) Demonstration
Desk Review & Helpful Program Information
School Health and Related Services (SHARS) Overview
Wrap Up
2
Medicaid Overview

Jointly-funded state and federal health-care
program

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An entitlement program that provides health
coverage to people with low-income, people
65 and older, and people with disabilities
School setting
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Enroll eligible children in Medicaid program
Assist children already enrolled in Medicaid
to access the benefits available to them
3
Medicaid Administrative Claiming
(MAC) Program

Federal reimbursement for the costs of Medicaid administrative
activities performed in the school setting
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Linking students to appropriate Medicaid/health-related services
Separate from but complimentary to School Health and Related
Services (SHARS) program
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Centers for Medicare & Medicaid Services (CMS) administers the
MAC program at the federal level and reimburses states for
allowable outreach activity performed under the MAC program.
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The Health & Human Services Commission (HHSC) is the
Medicaid Single State Agency in Texas (responsible for the
administration of the MAC program at the state level).
4
MAC Program

Reimbursement for certain medical and health-related
outreach, case management and administrative activities
surrounding the health services that are delivered.
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Programs are reimbursed for these activities, regardless of
whether the student is Medicaid eligible or not.
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These services may be to a student or family, and are for
activities that include coordinating, referring, or assisting
the student/family to access the health-related services.
5
MAC Activities*
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Activities that improve the access to Medicaid coverage or improve the
use of Medicaid covered services, include but are not limited to…
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Informing Medicaid eligible and potential Medicaid eligible children and
families about the benefits and availability of services provided by
Medicaid (including preventive, treatment, & screening) including
services provided through the Early Periodic Screening, Diagnosis, and
Treatment (EPDST) program.
Assisting individuals or families to complete Medicaid eligibility
application.
Scheduling or arranging transportation to Medicaid covered services.
Providing translation services for the purpose of accessing Medicaid
services.
Developing strategies to assess or increase the capacity of school
medical/dental/mental health programs.
Arranging for any Medicaid covered service that may be required as a
result of a specifically identified medical/dental/mental health condition.
6
*Additional examples can be found on the HHSC MAC website
To Participate in MAC . . .
Complete the following:
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Intergovernmental Cooperation Agreement
Business Associate Agreement
Texas Identification Number Application
Vendor Direct Deposit Form
Vendor Information Form
MAC Program Operating Plan
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Submit original documents.
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Documents are open-ended.
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Documents and instructions can be downloaded from the
HHSC MAC website
7
Intergovernmental Cooperation Agreement
& Business Associate Agreement
ISD Agrees
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To account for activities of staff
providing Medicaid administration
To submit quarterly participation
data through STAIRS
To provide expenditure
information on a quarterly basis
To spend an amount equal to the
federal match received on health
related services for clients
To designate a liaison to work
with HHSC
Comply with HIPAA regulations
HHSC Agrees
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To pass on to the ISD 95% of
Title XIX federal share for
Medicaid Administration
To reimburse allowable
administrative costs at the
appropriate Federal Financial
Participation (FFP) rate (50% or
75%)
To include the ISD expenditures
for Medicaid administration in
the claim it submits to CMS
To designate a liaison to work
with the ISD
Comply with HIPAA regulations
8
Texas Identification
Number Application
Formerly known as the TPIN –
Texas Payee Identification
Number
Assigned by the Comptroller’s
office for the purpose of
identifying any party receiving a
payment from the State of Texas.
The use of this number on all
claims will reduce the processing
time required by the State.
9
Vendor Direct
Deposit Form
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Complete form to:
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Set-up direct deposit for MAC,
Change financial institutions, or
Change account number or type
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Section 2 – Leave the boxes
blank if you do not have your
11 digit Texas Identification
Number
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Select Texas Health & Human
Services Commission as the
agency with which you are
doing business or leave blank
10
VENDOR
INFORMATION FORM

The ISD is the vendor.
Section 2 (Person Who Will Sign the
Contract) must contain the
information of the person that
signed the Intergovernmental
Cooperation Agreement.
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Send the original, signed form
to HHSC.
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11
MAC Program Operating Plan
Cover page must be printed on district letterhead.
All contacts must match in STAIRS.
POP includes only:
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District Contact Information
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RMTS Coordinator Roles & Responsibilities
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Contact will agree to terms by initialing section
MAC Financial Coordinator Roles & Responsibilities
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Primary RMTS Coordinator (district employee)
Primary MAC Financial Coordinator (district employee)
Superintendent
Contact will agree to terms by initialing section
Authorized Signatures
12
Resubmit documents?
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Vendor Direct Deposit Form
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Depository bank, account number, etc changes
Must complete form again & submit to HHSC
MAC Program Operating Plan
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Update only “District Contact Information” page &
submit to HHSC if one of the program coordinators
changes
Must update contacts in STAIRS
Unnecessary to send entire POP again or any additional
documents (organizational chart, description of
coordinator’s job functions & responsibilities, etc.)
13
System Contacts
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Communication is critical
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Superintendent
Random Moment Time Study (RMTS)
Coordinator
Medicaid Administrative Claiming (MAC)
Financial Coordinator
School Health & Related Services (SHARS)
Financial Coordinator
14
Primary MAC Financial Contact
Responsibilities
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Must be an employee of the district
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Serve as financial liaison to HHSC and STAIRS
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Communicate with all key stakeholders (RMTS contact, Special Education
department, SSA/Co-op contacts, etc.)
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Attend MAC financial training for each Federal fiscal year
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Ensure that the MAC financial data is certified each quarter in STAIRS
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Ensure the Quarterly Summary Invoice is signed and notarized by the proper
individuals
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Maintain financial documentation and supporting materials
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Must be listed as the primary MAC Financial Contact on the MAC Program
Operating Plan and in STAIRS
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Ensure all contact information is current and accurate
15
Documentation & Recordkeeping
Requirements
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Participation documents (Contract, MAC POP, etc)
 The
following is a checklist of the minimum documents to
collect and maintain quarterly:
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Financial data used to develop the expenditures and revenues for
the claim calculations including state/local match used for
certification
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Copies of computations used to calculate financial costs
All revenues offset from the claim, by source
Quarterly Summary Invoice (signed & notarized)
Roster of eligible individuals, by category, submitted for inclusion
of RMTS (Participant List)
16
Documentation & Recordkeeping
Requirements (cont.)
 Information
must be available upon request by federal or state
 Documents
must be stored in a readily accessible location &
entities.
format.
 Records
should be maintained for a period of no less than five
(5) years or if an audit has started, the records shall be retained
until the audit is completed and all issues are resolved.
17
Training
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Primary and secondary contacts should be trained for every Federal fiscal
year (FFY).
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Initial and Refresher training options
Having more than one trained MAC financial contact is highly
recommended.
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MAC Financial Contact Role
Training is from FFY to FFY.
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Not retro-active
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Switching Districts
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Full Access vs. View Only
18
Random Moment Time Study
(RMTS) Overview
19
MAC Quarterly Process
1
2
3
4
Participant
Identification
Random
Moment Time
Study
MAC Financial
Data Collection
MAC Claim
Calculation
Determine who
performs MAC
activities
Determine how
much
reimbursable
activity is
performed
Enter actual
costs associated
with these
activities
Reimbursement
rates applied to
calculate a claim
Today’s Main Focus
20
Participant List = Allowable Salary Costs
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The district identifies eligible participants at the beginning
of each quarter via the “Participant List” (PL).
Costs reported are “position-specific” not “personspecific.”
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Substitutes - Individual replacing a provider on leave
Direct replacement - Individual hired to fill a vacant
position
These are the only positions for which financial data can
be reported.
Positions and categories left off the Participant List
cannot report their costs for that quarter.
21
Participant List (cont.)
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The Participant List drives the number of eligible MAC
participants and determines the MAC financial cost
eligible.
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If a Participant List is not certified for a quarter by a
district, that district will not be able to participate in
RMTS and will not be able to report MAC costs for that
quarter.
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The results of the time study are the basis for the
calculation of the administrative time study percentage
that is used during the MAC financial process to
allocate costs to the Medicaid program.
22
Ineligible Participants:
MAC Only Category
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Overhead costs/indirect costs are captured in the
Indirect Cost Rate (IDCR) on the claim
Salaries for staff in accounting, budgeting,
payroll, human resources, purchasing, and
employee relations are generally indirect costs
Ineligible participants include:
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Function 41- General administration
Function 53- Data processing services
23
MAC Participation Requirements
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MAC financial quarters will not be opened unless the
following requirement are met:
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Active contract with HHSC
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Approved MAC Program Operating Plan
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Received MAC / RMTS training for the FFY
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Certified Participant List for that quarter
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An Intergovernmental Cooperation Agreement must be filed and executed with
HHSC in order to enter financial expenditure information.
Required RMTS participation must be satisfied for the quarter in which the claim
is filed.
If you are unable to access the quarter, please contact the
MAC team.
24
Important Dates for MAC
Federal Fiscal Year 2013
Federal Fiscal Quarter
1st Quarter (Oct – Dec)
2nd Quarter (Jan – Mar)
3rd Quarter (Apr – Jun)
4th Quarter (July – Sept)
Financials Open
Financials Close
February 18, 2013
May 27, 2013
August 19, 2013
November 25, 2013
(6 p.m. CST)
April 5, 2013
July 12, 2013
October 4, 2013
January 10, 2014
**Claim must be certified and must upload QSI in
the system by deadline.**
25
MAC Financial Data Collection
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Interim billing is not a MAC requirement
Where to enter financial data?
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Electronic Reporting
MAC financial reporting will be completed entirely
online via the State of Texas Automated Information
Reporting System (STAIRS) located on the
Fairbanks LLC website.
Who can enter data?
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Trained MAC Financial Contacts
26
Financial Data
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District Employee Salaries/Wages
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Position must be included on the Participant List for that quarter
Perform MAC activities
Payroll Taxes & Benefits
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“actual” costs only
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Contractor Payments
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Set aside/reserved funds are not actual costs
TRS on behalf of payments are not actual costs
Position must be included on the Participant List for that quarter
Perform MAC activities
Federal Revenues (Federal revenues offset expenditures)
27
District Employees
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Compensation of employees
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Wages and salaries
Subject to federal withholdings
Reconcile back to general ledger
Example of 9 Month Versus 12 Month Reportable Salary
9
Annual Salary
$
30,000
If paid over 9 months
=$30,000/9
=$3,333 x 3
If paid over 12 months
=$30,000/12
=$2,500 x 3
$
$
3,333 Actual Monthly Cost
10,000 Actual Reportable Cost
$
$
2,500 Actual Monthly Cost
7,500 Actual Reportable Cost
28
District Employees (cont.)

Quarterly salaries/wages for the individuals
on the participant list
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Federal Fiscal Quarters: October-December,
January-March, April-June, July-September
Example of 9 Month Versus 12 Month Reportable Salary
9
Annual Salary
$
30,000
If paid over 9 months
=$30,000/9
=$3,333 x 3
If paid over 12 months
=$30,000/12
=$2,500 x 3
$
$
3,333 Actual Monthly Cost
10,000 Actual Reportable Cost
$
$
2,500 Actual Monthly Cost
7,500 Actual Reportable Cost
29
Position Specific Example
Example: Position #85 had the following employee changes
throughout the quarter:
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Employee A works Jan 1st thru Jan 19th, earns $800.
Substitute A works Jan 20th thru Feb 28th, earns $1,200.
Employee B works March 1st thru March 31st, earns $1,500.
The Total MAC Reportable Expenditure for Position #85 is
$800 + $1,200 + $1,500 = $3,500.
30
Detailed Reporting:
Payroll Taxes & Benefits
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Examples of Employer-Paid Benefits:
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Health Insurance
Life Insurance
Medicare
Employer 403(b) Contribution
Liability Insurance
Worker’s Compensation
Unemployment Compensation
Social Security
31
Payroll Taxes & Benefits (cont.)
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Only Report “True” Expenditures
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If your district incurs an insurance cost (premium paid), the district is
entitled to report the cost incurred during the quarter.
If your district is self-insured and pays a third party administrator for
claim administration, the district is entitled to report the cost incurred
for administrative fees and claims paid during the quarter.
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Teacher’s Retirement System (TRS)
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The district should not report any assumed liability such as set-aside funds, the
cost should reflect the true expenditures of the district.
Only costs to the district are allowable
“On behalf of” retirement payments cannot be claimed
Please ensure that you maintain documentation that the costs
were actually paid by the ISD.
32
Employee vs. Contracted Staff
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Employee – Full-time and Part-time
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Providers hired by the district – On payroll
Listed on participant list as Full-time employee or Part-time employee
Report costs under: “Employee Salaries” and “Payroll Taxes and
Benefits” columns and “Federal Revenue” column if appropriate
Contracted Staff
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Not employees of the district – on Accounts Payable
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Either outside vendor or through SSA/Co-op (fiscal agent)
Listed on participant list as Contract
Report costs under “Contracted Staff Costs” column and “Federal
Revenue” column if appropriate
33
Contracted Staff (cont.)
34
Contracted Staff (cont.)

Ensure participant list is up-to-date
(employment type is correct)
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Request breakdown of costs on invoice from
the contractor to ensure the number of
positions you are claiming and to place the
costs in the correct categories
35
Federal Revenues

Identify ALL federal funded positions on the participant list.

Report (state, local, & federal) position costs in the Employee Salary, Payroll
Taxes & Benefits and Contracted Staff columns as appropriate.

The Federal Revenue column is used to subtract the Federal portion of
costs that were included in the Employee Salary, Payroll Taxes & Benefits
and Contracted Staff columns.

Example:
36
Federal Revenues (cont.)

Federal funds include, but are not limited to:
 Federal Grants
 Matching Funds
 ARRA/Stimulus Funds

NOTE: MAC and/or SHARS funds are considered
“reimbursement” funds and are not required to be
backed out of the MAC financial claim as revenue
offset.
37
Federal Revenues (cont.)

To maximize federal revenue sources, it is
recommended that MAC providers are funded
with state/local funds.

The system will automatically calculate the
Local/State Net Expenditures (Gross Salaries less
Federal Revenue).
38
What if my ISD is in an SSA/Co-op?
The fiscal agent can only report costs for the students “enrolled” in the district
serving as the fiscal agent. All ‘shared’ costs must be allocated to each of the
member districts.
For example, if a member district contributed 15.75% of the budget, that
district would be allocated 15.75% of the paid hours and payroll costs for
each staff person.
Allocation of costs based on budget contribution is only one way in which a
fiscal agent may choose to allocate costs.
IMPORTANT: Allocation methodologies used to distribute shared costs to
member districts of an SSA/Co-op must be documented and presented to HHSC
upon request.
Allocation methodologies should appropriately reflect the level of direct service
costs associated with the students enrolled in each district.
39
What if my ISD is in an SSA/Co-op?
Determination of ‘enrolled’ per TEA …
“While it is true that multiple districts may be involved in the provision of special
education and related services to a student with disabilities, only one district can report
Public Education Information Management System (PEIMS) data on a student, so it is
our position that the SHARS-related billing should be through the district that is
reporting PEIMS data.”
Additional information may be found in the Student Attendance Accounting
Handbook (SAAH) at:
http://www.tea.state.tx.us/index4_wide.aspx?id=7739&menu_id=645&menu_id2=789
40
Regional Day School Program
for the Deaf (RDSPD)

If host district reports all the students on their
PEIMS data:
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Host district will report 100% of the salary and
benefits of the providers for the RDSPD.
Allocation of costs not required
Member districts will not report any costs
associated with the RDSPD.
Contact HHSC regarding district-specific
questions.
41
Functional Reporting

There are two options to enter
financial data:
1. Participant Details
• Detailed basis by individual position
2. Group Summary Schedule
Detailed Worksheet
Psychologists and Interns
Bob
Employee
Joe
Employee
Mary
Contract Staff
• Summary of costs by category
•
Refer to the participant list
• Financial detail by position/individual
must be kept on file
• Enter Total Employees & Total
Contractors claimed that quarter
Category Summary
Registered Nurse (RN)
Salaries
30,000
Benefits
6,000
Purchased Svcs.
8,000
42
Financial Tips
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Refer back to the certified participant list for the quarter.
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Do NOT make adjustments from prior quarter with current
quarter.
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The participant list is available in advance.
Contact HHSC to correct a prior quarter.
Not necessary to mail the MAC financial supporting
documentation each quarter. However, the district is required
to maintain the financial data; and the records must be made
available upon request from state or federal entities.
43
Detailed Explanations – System Edits
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STAIRS is designed to perform various edits checks
depending on the data entered.
Explanation of variances are required.
Provide a concise explanation as to why a costs increased or
decreased, etc.
Helps find possible errors and allows ISD to correct the
current financial report before certifying the data.
Contact HHSC if a data entry error occurred in a previous
quarter.
44
Example:
Quarterly
Summary
Invoice
(QSI)
45
Quarterly Summary Invoice (QSI)

Signing the Quarterly Summary Invoice certifies that the following items
are true and correct:

I am the officer authorized to submit this form; I have examined this
statement and to the best of my knowledge and belief, the expenditures
included in this statement are based on the actual cost of recorded
expenditures;

The required amount of State and/or local funds were available and used to
pay for total computable allowable expenditures;

This statement is of expenditures that the undersigned certifies are allocable
and allowable to the State Medicaid program;

I understand that this information will be used as a basis for claims for
Federal funds and falsification and concealment of material fact may be
prosecuted under Federal or State civil or criminal law.
46
Quarterly Summary Invoice (cont.)

Have the proper employee of the district sign the Quarterly
Summary Invoice (QSI).

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Per the RMTS/MAC Implementation Guide effective April 25, 2007
pg. 17; Certifier must have signature authority which includes
the Chief Executive Officer (CEO), Chief Financial Officer (CFO)
Executive Director (ED), Superintendent (SI) or other individual
(district employee) designated as the financial contact for the ISD.
Printing on letterhead is not necessary.
Ensure that the Signer and Notary dates are the same. The notary
language on the QSI reads “This instrument was acknowledged
before me.” This means that the date signed by the Signer and the
Notary must be the same.
The Notary should not be writing his/her name in the field marked
“Printed Name of Officer of Provider”.
The district must keep the QSI onfile.
47
MAC
Claim Calculations
Cost Pool
Cost Pool
#1
Cost Pool
#2
Net
Expenditures
Claimable
Percentage
Claim
Amount
Total
Federal
Share
5%
Retention
Net Claim
Direct Service & Admin
Administrative Only
48
Claimable Percentage
 RMTS Results
•
•
State-wide, quarterly
Ratio developed for Cost Pool #1 and Cost Pool #2
 Medicaid Eligibility Rate (MER)
•
•
District-specific, quarterly
Percent of students in district who are Medicaid eligible
 Unrestricted Indirect Cost Rate (IDCR)
•
•
District-specific, annually
Developed by TEA
49
Random Moment Time Study
(RMTS) Results

Identifies reimbursable and non- reimbursable time.

Used to identify the percent of time providers are
participating in MAC activities (as well as
participating in direct medical services). Each cost
pool has separate and different time study
percentages. The MAC financial claim is calculated
for Cost Pool # 1 and Cost Pool # 2 using their
relevant cost and time study percentages.
50
Medicaid Eligibility Rate (MER)


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

The Public Education Information Management System (PEIMS)
enrollment data for the current school year is submitted to TEA by each
district.
The Medicaid eligibility files for each quarterly period is gathered by
HHSC.
The Medicaid eligibility data is sent to TEA for use in the developing the
MER.
TEA develops an unduplicated Medicaid eligibility file from the quarterly
files provided by HHSC.
The unduplicated Medicaid eligibility file is matched against the PEIMS
enrollment data. There are 2 matches performed – 1) first is a match based
on Social Security Number (SSN), 2) for those who do not match based
on SSN, a second run is performed based on first name, last name and
date of birth.
The total number of matches divided by the total number of enrolled
students (by district) becomes the district’s quarterly MER.
51
Indirect Cost Rate (IDCR)

Must have an approved IDCR from the Texas
Education Agency (TEA)

How can your district get an IDCR?

Submit an Exhibit J-2, Schedule of Expenditures for
Computation of Indirect Costs





Located in district’s official audited Annual Financial Report
(AFR)
A new indirect cost rate must be obtained every fiscal year.
Helps ISD recover some of indirect costs
CMS approved use of unrestricted IDCR
Charter schools that need an IDCR should contact
TEA – Division of Federal Program Compliance
52
STAIRS (Fairbanks)
System Demonstration
53
MAC Claim Desk Review

Utilized to ensure integrity and accuracy of
the claim data

Discrepancies brought to the attention of
primary MAC financial contact identified in
the system

HHSC will contact ISD requesting explanation,
clarification, and/or correction of discrepancies
54
MAC Reimbursement

Timeframe for reimbursement

MAC reimbursements are Title XIX Medicaid administrative
reimbursement funds



Not considered ARRA funds
Are subject to the Single Audit Act
MAC reimbursement is recommended to be used to enhance
the provision of health services and/or improve and/or expand
the level and quality of health/medical services provided to
all students within the district.
55
STAIRS Reminders







Passwords will not change each school year.
If you forget your password, you can reset it at the log-in
screen.
Fairbanks can consolidate username/passwords for contacts
with multiple ISDs.
You will be able to access historical data.
Messages (Warnings) are highlighting areas where there may
be an issue.
All reference material is on the website.
Contact Fairbanks regarding system issues.
56
Allowing E-mail Messages

Communication is done predominantly via e-mail.

Role in Fairbanks dictates what messages you
receive.

Critical that your district authorize your e-mail
system to accept emails from Fairbanks.

Confirm with your IT staff to make sure that e-mails
with [email protected], @hhsc.state.tx.us, and
@tea.state.tx.us extensions pass through firewalls
and spam filters.
57
Managing Contacts in STAIRS

Primary contacts can…




Only one primary contact per role


Add and/or delete contacts
Assign additional roles to contacts
Restrict access of trained contacts
Unlimited number of secondary contacts
Contact Fairbanks if you are having any issues
58
School Health & Related Services
(SHARS) Overview
59
Wrap Up

If you are not listed in STAIRS as a contact, then you cannot
receive credit for completing this training.


There are no certificates for training.




You will receive an email thanking you for attending today’s training;
however, this does not mean that you received training credit.
Training credit can be viewed in STAIRS.


Primary contact at the district can add you to STAIRS
MUST filter appropriately
Can print screen to keep for your records
A maximum of 7 days processing time is required after
attending training before the session attended will be listed
next to the contact’s name and the “status” column will then
show full access.
Once full access is indicated, you will be able to
update/certify the MAC financial data.
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MAC Website
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http://www.hhsc.state.tx.us/rad/
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Select:
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Medicaid Administrative Claiming (MAC)
Independent School Districts (ISD)
MAC Guide
Participation Documents
Frequently Asked Questions
Training Materials
Important Notices
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Additional Resources…

CMS Medicaid School-Based Administrative Claiming Guide
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Office of Management & Budget (OMB) Circular A-87
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Title 45 Code of Federal Regulation (CFR) Part 74 and 95
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Title 42 CFR 430.1 and 42 CFR 431.15
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Title 19 of the Social Security Act, section 1903(a)(7)

General information regarding Texas Medicaid Program

http://www.hhsc.state.tx.us/medicaid/
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Common Acronyms
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MAC – Medicaid Administrative Claiming
SHARS – School Health & Related Services
CMS – Centers for Medicare & Medicaid Services
HHSC – Health & Human Services Commission
TEA – Texas Education Agency
HIPAA – Health Insurance Portability and Accountability Act
FFP – Federal Financial Participation
TIN – Texas Identification Number (formerly known as TPIN – Texas Payee Identification Number)
POP – Program Operating Plan
RMTS – Random Moment Time Study
TS – Time Study
PL – Participant List
STAIRS – State of Texas Automated Information Reporting System (formerly known as Fairbanks)
FFY – Federal Fiscal Year
MER – Medicaid Eligibility Rate
IDCR – Indirect Cost Rate
PEIMS – Public Education Information Management System
RDSPD – Regional Day School Program for the Deaf
QSI – Quarterly Summary Invoice
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Contact Information
Medicaid Administrative Claiming
Ph: (512) 491-1802
Email: [email protected]
Yvonne Moorad (Team Lead)
Jessica Makdsi
Texas Education Agency – Division of Federal
Program Compliance
Ph: (512) 463-9127
Email: [email protected]
STAIRS (Fairbanks, LLC. )
Ph: (888) 321-1225
Email: [email protected]
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