msar & medicaid rate setting - bkd€¦ · msar rate setting – fbh. planning for the future...

MSAR & Medicaid rate setting

Brian O’Reilly, CPAPartnerboreilly@bkd.com

Presenters

Bryant Macaraeg, CPAPartnerbmacaraeg@bkd.com

2 Planning for the Future of Foster Care

› Introduction› Types of Foster Care Reimbursement› MSAR Rate Setting › Analyzing MSAR Reimbursement› Medicaid Rate Setting

3

Maximum State Aid Rates (MSAR)& Medicaid Rate Setting

Planning for the Future of Foster Care

› Foster Care is Multiple programs & funding Methodologies• Maximum State Aid Rate (MSAR) Programs

› Prospective cost reimbursement & reconciled to actual cost

› FBH (Regular, Special Needs, Therapeutic and Emergency)

› Group (GH, GR, Institution)

› Special Payments

• Medical Services – Prospective cost reimbursed› Can retain surpluses – Rates will drop in future years

• Preventive Services – Contract

• Independent Living – Fee based program

› How you are reimbursed affects how you manage a program

4

Types of Foster Care Reimbursement

Planning for the Future of Foster Care

› Managing within prospective reimbursed

• Spending in the base years

• Spending in categories that will be funded

• Track spending against rate

• Maintain units of service

› Managing within contract reimbursement

• Monitor spending within the contract amount – spend on specific items

› File budget modifications

› Agency Admin and submitting for ICR rates

› Managing within fee based programs

• Keep spending down

• Keep units of service up

5

Managing Within Specific Methodologies

Planning for the Future of Foster Care

› Cost reported on SSOP 2 years earlier• Three basic cost categories (Direct Care, Prop/Maint, Admin)

• Importance of accuracy of reporting by category

› Trended to current year

› Subject to Parameters• These calculations are the key to reimbursement

› Fiscal interchange & Property Cost Transfer Policy

› Reduced by Applied Income

› Divided by Adjusted Care Days

6

MSAR Rate Setting – Basic

Planning for the Future of Foster Care

› Items that impact rate setting• Correct reporting of expenses by cost category

• Correct reporting of Special Payments

• Number and breakdown of care days› Regular, Special, Exceptional, Emergency, AIDS

› Impact on the billing per diem

› Impact on the Parameter calculation

• Social Service and Child Care Parameters

• Number of finalized adoptions› Impact on the parameter calculation

• Program Type

• Location

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MSAR Rate Setting – FBH

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› Items that impact rate setting• Correct reporting of expenses by cost category

• Program Type

• Program Classification

• Number of care days

• Capacity

• Average Unit Size

• County/Location

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MSAR Rate Setting – Group Care

Planning for the Future of Foster Care

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› Check rates received for accuracy• Trace expenses, care days and program capacities to SSOP

• Correct program type and Classification score

› Determine the impact of rates on the agency• Also analyze components of the rate

› Social Services Worker FTE

› Social Services Supervisor FTE

› Compensation standard

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Analyzing MSAR Reimbursement

Planning for the Future of Foster Care

› Track current year expenditures and utilization levels against reimbursement by rate component

• Retroactive settlement

• Calculate impact of current year expenses and Units using MSAR methodology

› Monitor and track program enrollment and type of care day• Impact of different care days on parameters

• Changes in makeup of children served (i.e. regular or exceptional) can impact net reimbursement

• Low enrollments impact of Utilization adjustment

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Analyzing MSAR Reimbursement

Planning for the Future of Foster Care

› Cost from Medical Services Expenditure Report• Three basic cost categories (Direct Medical, Admin, Pass Thru)

› Divided by Care Days

› Trended to current year

› Compared to Standard

› Determines Rate Base

› Determines final Rate Base

› Foster care rates are blended

20

Medicaid Rate Setting – Basics

Planning for the Future of Foster Care

› Items that affect Reimbursement• Correct reporting of expenses by cost category

› Direct Medical vs. Pass Thru› Administration

• Number of care days

• Correct program type › Regular vs. special programs› Hard To Place

• Location

› Impact of Provider’s Per Diem on Transition Payments

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Medicaid Rate Setting – Basics

Planning for the Future of Foster Care

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Brian O’Reilly, CPAPartner | BKD1155 Avenue of the Americas, Suite 1200New York, NY 10036-2711212.867.4000 Ext. 13123boreilly@bkd.com

Bryant Macaraeg, CPAPartner | BKD1155 Avenue of the Americas, Suite 1200New York, NY 10036-2711212.867.4000 Ext. 13122bmacaraeg@bkd.com

bkd.com | @bkdllp

The information contained in these slides is presented by professionals for your information only and is not to be considered as legal advice. Applying specific information to your situation requires careful consideration of facts & circumstances. Consult your BKD advisor or legal counsel before acting on any matters covered.

The information contained in these slides is presented by professionals for your information only and is not to be considered as legal advice. Applying specific information to your situation requires careful consideration of facts & circumstances. Consult your BKD advisor or legal counsel before acting on any matters covered.

BKD, LLP is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.