fee for service program alabama medicaid program changes
TRANSCRIPT
Fee For Service ProgramAlabama Medicaid Program Changes
2
Agenda
1
4
3
2
School Based Medicaid Background
Current Claiming Processes
FFS Cost Reporting
FFS Opportunity
5 Program Changes
6 Questions
3
Medicaid School Based Services
Medicaid School Based Services
Federal Medicaid Reimbursement for administrative activities such as:• Coordination of medical and mental health
related services covered by Medicaid
• Linking students to Medicaid services
• Monitoring the delivery of medical and mental health services performed in the school system
Federal Medicaid Reimbursement for direct medical services such as:
• Speech Therapy• Physical Therapy• Occupational Therapy
Medicaid Administrative Claiming (MAC)
Fee For Service(FFS)
There are two distinct Medicaid reimbursement programs that school systems may participate in:
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
Current Claiming Overview
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MAC FFS
• Quarterly time study to collect activities
• Quarterly expenditures collected from school systems
• Quarterly claims calculated based on actual costs and time study results
• Ongoing service tracking and submission via STI SETSWeb
• Services paid using statewide rates set by Medicaid
• Current FFS Claim calculation = #services x $service rate
• Claim determined by number of service tickets at statewide rate rather than actual costs
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
The method to obtain FFS reimbursement is changing, removing Medicaid documentation and paperwork requirements from the school system’s therapists.
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Program Overview
• The Alabama MAC Program was implemented in October 1999– 131 school systems currently participate– MAC generates ~$25-30M annually in claims for Alabama schools– Program has matured so that reimbursement levels can be anticipated and
participation requirements using web-based system are streamlined
• The Alabama FFS (Direct Service) Program is less mature– 15-20 school systems currently participate– FFS generates ~$1M annually in claims for Alabama schools– Ongoing service documentation requirements can be cumbersome requiring:
• Parental consent• Medicaid lookups• Robust audit documentation
– Claiming levels are unpredictable and participation requirements can be time consuming
– As a result, Alabama Medicaid is changing to a new method of FFS reimbursement!
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
6
Claim Opportunity
Program Projected Annual Claim
ADM Represented $Claim/ADM
MAC $25-30M 740,000 $33-40/student
FFS* $15-20M 740,000 $20-30/student
Total $40-50M 740,000 $53-70/student
• The FFS claim amount listed above is provided as an estimated range. Individual school system claiming levels will be determined based on eligible staff, time study results, Medicaid eligibility rates and actual costs incurred.
• Final CMS approval is pending and may impact these estimates.
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Current Quarterly MAC Process
QuarterlyParticipant
List
QuarterlyMAC Claim
QuarterlyRMTS
Quarterly MAC CostCollection
Systematic quality checks, Fairbanks monitoring, and independent audit.
• MAC claims are currently generated based on time study results being applied to actual quarterly costs reported by each school system
• The quarterly MAC claiming process can be slightly modified to incorporate changes to also calculate a FFS claim
• As a result, efficiencies can be gained utilizing the MAC process to increase FFS participation
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
• Continue to document various activities using the Random Moment Time Study (RMTS)– This process already occurs quarterly, so this does not represent new work!– Activities are collected using RMTS throughout the quarter– Results will also be used for FFS Cost Report & Reconciliation
• Implement a Quarterly FFS Cost Report– School system finance personnel report staff and other related costs– These costs can be collected AT THE SAME TIME that MAC costs are collected
and utilizing the same Fairbanks web-based system
• Conduct a Cost Settlement/Determine FFS Payment– FFS billing rates will be set to zero by Alabama Medicaid so that all FFS
reimbursement will be based upon the Cost Report going forward– A final cost report review and calculation will occur to determine the portion
of reported costs that are reimbursable under FFS
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How FFS Cost Reporting Works
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
9
MAC & FFS Process Efficiencies
QuarterlyFFS
Payment
DocumentServices*
QuarterlyParticipant
List
QuarterlyMAC ClaimQuarterly
RMTS
Quarterly MAC CostCollection
QuarterlyFFS Cost Report
Systematic quality checks, Fairbanks monitoring, and independent audit.
*School systems are no longer required to document each service for Medicaid billing purposes, however providers should continue to follow any licensing board policies and procedures related to service documentation.
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
10
Important Program Changes• The implementation of FFS Cost Reporting requires the following
programmatic changes Alabama Medicaid:– Participant List Category Changes
• Schools now report providers based on licensing• Several new categories were added
– RMTS Sample Size Changes• School system staff will be sampled at increased level• Overall sample size will increase from 920 to 3,320 sampled
moments each quarter
– RMTS Compliance Requirements• 85% compliance requirement is now MANDATORY• Time studies must be completed within 7 calendar days• Non-compliance may jeopardize Medicaid funding
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
11
FAQ – How Do I Begin Participation?
• Your school system does not have to do anything new to begin participation in the new FFS cost report program.
• Since FFS reimbursement will now be based on costs, therapists will no longer need to document services for Medicaid purposes.
• Since the required participation items are similar to MAC, your school system needs to continue its participation in the MAC program and meet all minimum program requirements.– Report staff correctly in the MAC program– Ensure staff participation in the time study
• Your school system’s MAC contract already includes the FFS program, so there are no new contract requirements.
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FAQ – Time Study Survey
• Will the Time Study Survey questions change?– The time study survey will not be changing. However, it is
important to be aware that with an increased sample size the staff may be selected multiple times in a quarter.
– Many times a participant who has been sampled multiple times in a quarter believes it is an error or that they only need to complete one of the time studies. They should complete all times studies they have been selected for in the quarter as it is a valid sample and does impact the school system’s time study compliance if they choose not to respond.
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FAQ – School System Already Bills FFS
• If my school system currently bills FFS what does this mean?– As of October 1, 2011, FFS tickets will no longer be
reimbursed by Alabama Medicaid.– Service providers will no longer need to document FFS
service tickets in SETSWeb for Medicaid reimbursement.– Going forward, payments for direct services will be made
via the quarterly FFS Cost Report for each school system.– If you have service tickets dated prior to 10/1/11 that need
to be processed via the former methodology, please contact Fairbanks for further assistance.
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FAQ – School Has Not Billed FFS
• If my school system does NOT currently bill FFS what does this mean?– All school systems that participate in MAC will
automatically be included in the FFS Cost Report and realize these additional monies.
– Your system can begin participation in FFS Cost Report reimbursement immediately with little additional effort.
– Providers will no longer need to meet specific Medicaid documentation requirements, however should still meet whatever school system and/or licensing board policies and procedures that exist related to documentation.
15
Program Training
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.
• Fairbanks has been providing school system trainings over the past two weeks.
• The training has included an overview of the new FFS cost report and associated changes to the MAC program.
• We encourage all school systems to participate in a training session or contact Fairbanks for one-on-one assistance.
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Additional Information
Lisa [email protected]
Fairbanks Client Information [email protected]
This material and the concepts contained within are considered confidential, trade secret, and the sole property of Fairbanks LLC and cannot be reproduced or distributed without the written consent
of Fairbanks LLC.