Brought Brought to to you you by: by: October 2013 Public Focus. Proven Results. General Updates and Reminders JM14 RMTS system officially opens: 10/28 JM14 staff roster certification dude: 11/22 Comprehensive Staff Pool list webinar: 11/5 JS13 financials certification due: 11/15 General Cost Settlement Questions Have we finalized the FY12 cost settlement results yet? FY12 cost settlement results have not yet been finalized. Errors that have been identified in transportation reported by LEAs, has delayed the anticipated settlement timeline. The cost settlement deadline is June 30, 2013. Have all LEAs that were selected to be sampled for the transportation review been notified? Yes. There were originally seventeen LEAs undergoing a transportation review, due to the results of those selected all LEAs will be required to participate in a mandatory transportation review call. During this call PCG will verify all costs and the reporting methodologies associated with each to ensure every LEA is compliant and reported transportation costs correctly. We have several students in private schools, can we report their tuition? LEAs are not allowed to report tuition costs. Do you need to receive paid claims for all service categories reported? In order to have a costs for a particular service category included in cost settlement, you must have received a paid claim for the service category. Pg 1
Brought to you by: General Cost Settlement Questions Continued When a claim is submitted to PCG will the claim s provider type get compared to the staff pool list that was provided by the LEA? No. Claim does not hit against any staff pool list at the time of submittal. The LEA is responsible to monitor claiming activity and should not bill for provider type services that are not listed on their staff pool roster. What type of pay do you include in payroll? Payroll includes regular wages, paid time off, overtime, bonuses or longevity, stipends, and cash bonuses or cash incentives. Salaries are those payments from which payroll taxes are deducted. As a reminder you are reporting the total gross earnings for the individual. You will also identify the portion of salaries that are federally funded separately. What is the deadline for a LEA to payback money to AHCCCS if they are in a payback situation? The LEA will have 60 days from the date of notification by PCG to return any overpayment as identified during the cost settlement process. Please review the Participant Agreement form for specific details. Cost Reporting What is the direct medical percentage? The direct medical percentage is the amount of time that was spent administering direct medical services to students and is determined by the random moment time study. The direct medical percentage is applied to your total expenditures to help determine the portion of your costs that are reimbursable. How do you calculate the IEP ratio? The IEP ratio is determined using your October 1 st student roster that each LEA submits to PCG and that identifies the total number of students who were enrolled on October 1 st and had a reimbursable related service prescribed in their IEP. The total number of Medicaid eligible students is determined by PCG by performing a match using your claiming history and is then divided by the number submitted by the LEA to determine your IEP ratio. Pg 2
Brought to you by: Cost Reporting Continued In regards to the IEP ratio, should we check for DSC consent for non-medicaid students? Are they still counted in the denominator? For the purposes of the October 1 st count, you do not need to verify that information. They should still be included in the denominator count if they reimbursable related service prescribed in their IEP. In our IEP software we have the parents sign a form for FERPA, do you look for this? PCG does not look at the FERPA form to satisfy MSBC program requirements, but please be sure that your LEA is satisfying compliance with ADE, IDEA, or other pro grams and agencies. Should employee stipends be included or excluded when reporting costs? Transportation They should be included as long as they are not associated with non reimbursable functions such as coaching or other extra-curricular activities not associated with their primary job functions. What type of documentation do we need for transportation equipment depreciation? Documentation should include system financial ledger detail to support the reported cost and years of useful life. You should also have documentation supporting the date the vehicle was placed into service. Should we include our transportation director on the RMTS staff pool list? Only if they regularly provide Medicaid outreach and coordination. Typically, LEAs should not include the transportation director on the roster. Why are bus drivers not on the staff pool list? Bus driver are not included on the staff pool list because they do not regularly perform activities to support Medicaid in the administrative sense and are not direct service providers. Bus drivers do not have to be on the staff pool to report their costs annually. Pg 3
Brought to you by: Transportation continued When do you count the one-way trips for the trips ratio denominator? The trip ratio includes all trips that occurred within the fiscal year for when you are reporting costs. Once each fiscal year comes to a close you could then count the trips from July 1 st of the previous year through June 30 th. Alternatively, you can also keep a running total of trips throughout the year as trip logs are turned in. What are the requirements around what is considered a modified vehicle? A modified vehicle is any vehicle that has been physically modified to transport special needs students (harness, seat belts, wheelchair lift, etc.) or is a vehicle that is exclusively used to transport students with behavioral need as outlined within their IEP. Can you count a bus as specialized that is exclusively used for SPED students but not all of the SPED students have transportation prescribed within in their IEP? All students on that particular adapted bus route would have to specialized transportation prescribed in their IEP. What is the vehicle ratio? The vehicle ratio is the total number of specialized vehicles divided by the total number of vehicles included in the LEAs fleet. Remember for a vehicle to categorize as specialized, it must be adapted and have at least one route that exclusively carries special education students with specialized transportation in their IEP. How do you calculate the denominator of the trip ratio? There are only two ways to calculate the trips ratio de nominator: Method 1: Count the number of actual one way trips taken by students with specialized transportation in their IEP by utilizing bus logs and attendance records. The LEA must have all documentation to support this method. Method 2: Take the total number of students with specialized transportation prescribed in their IEP and multiply it by the total number of school days and multiply the product by two (the maximum number of trips allowed per day). This is the only accepted estimation of the denominator. Pg 4
Transportation Continued Is it ok to Pad the number for the transportation trip ratio when you don t know how to calculate the actual total? No. LEAs should never increase the number for any of the reporting requirements to avoid being in a payback situation. The LEA should always report an actual number, or in the case of the trip ratio, the second method option if trip logs are unavailable. Which method to identify a LEAs denominator for one way trips will allow for a potentially higher trips ratio percentage? The actual number of trips counted using the trip logs will result in a higher trips ratio percentage. The second method outlined above is the most conservative approach and results in a larger denominator, thus a lower percentage when divided by the actual number of paid claims. If transportation is being contracted to a company, who should attend the mandatory trainings in order to gain access and report annual costs? LEAs must determine who is actually reporting the transportation costs to decide who must attend the trainings. Transportation services may be contracted, but the transportation director within your district is the one who will be reporting the costs within the Medi- Direct Service Claiming Is the first priority for billing to make sure the claim is submitting within six months? Timely filing should be your first priority for claiming because you cannot correct or resubmit a denied claim that has been denied for timely filing. How do we estimate the amount we receive in claiming/ interim payments? LEAs are provided an interim payment report on the 15 th of the month following the close of every quarter that outlines the amount the LEA has received in interim claiming by service type. It is important that LEAs are reviewing their remittance advices and reports provided by PCG. Pg 5
RMTS What happens to moments for staff that are not scheduled to work (outside of school day)? Are they applied to the direct medical percentage and MAC percentage? If a moment occurs when the participant is not scheduled to work (as long as the moment is responded to stating that they were not working within the five working day time limit) the moment is not counted against compliance but it is not coded as a reimbursable activity either. If we have a provider that left the district and we are in the process of hiring a replacement but the sample is about to be generated and the position is not filled, can we still include the position on the roster? No, vacant positions are not permitted on the roster. The new staff member must be added the next quarter. Health Aides Can a health aide prepare food for the g-tube feeding? How do you document this? A health aid is allowed to prepare the food for the g-tube feeling, however for the purpose of reimbursement for this program cannot administer the feeding. The IEP must have the time broken out clearly and document which portion of the g-tube feeding the health is doing and which portion the LEA is requesting for reimbursement. How do you document feeding by mouth separate from the g-tube? Each activity of the feeding process must have time broken out and clearly associated with the corresponding activity. The LEA should only request the amount of time associated with oral feeding for reimbursement, leaving out the time associated with g-tube feeding. Can an LEA use a form that gets populated from IEP software for the updated for Health aide prepayment review process? Unfortunately only the IEP will be accepted into the electronic portal so unless the populated form is part of the IEP, it will not be allowable as part of the health aide prepayment review. I am currently uploading HA prepayment to the FTP site, does the HA portal replace that? Yes, the HA portal will be the central portal for uploading Health Aide Reviews. Pg 6