office hours fso medicaid 6.10.14 (slides)
DESCRIPTION
Family Support Organizations Becoming Medicaid ProvidersOffice HoursJune 10, 2014TRANSCRIPT
Family Support Organizations Becoming Medicaid Providers
Office Hours
June 10, 2014
TA Network Core Partners:
The Institute for Innovation & Implementation, University of
Maryland School of Social Work Accountability Solutions, LLC. The Center for Community Learning, Inc. The Center for Health Care Strategies, Inc. The Family-Run Executive Director Leadership Association
(FREDLA) Human Service Collaborative The National Federation of Families for Children’s Mental Health Portland State University The University of South Florida The University of Washington Youth M.O.V.E. (Motivating Others through Voices of
Experience) National
Ask the experts
• Our experts today are:
– Dayana Simons, MEd, LMHC, Senior Program Officer, Center for Health Care Strategies, Inc. (CHCS) [email protected]
– Deborah Harburger, MSW, The Institute for Innovation and Implementation, University of Maryland School of Social Work [email protected]
– Jane A. Walker, LCSW, Executive Director, Family Run Executive Director Leadership Institute (FREDLA) [email protected]
OFFICE
HOURS
3 PM ET
3PM ET
BECOMING A MEDICAID PROVIDER!
Dayana
Simons,
Center for
Health Care
Strategies
CONSIDERATIONS BEFORE
BECOMING A MEDICAID
PROVIDER
MISSION: Alignment with the family -run organization‘s
mission (parent/youth support, education, and advocacy)
SERVICE DELIVERY: Experience and foundation for a
parent/youth peer support practice model and match to
Medicaid service definitions, training, and certification
INFRASTRUCTURE: Business administration experience and
skills for clinical supervision, policies, electronic medical
records, billing, and quality assurance processes
FINANCING: Cash flow, negotiated payment rate, and cost
reimbursement
STAFF TRAINING: Medicaid regulations, documentation
CONSIDERATIONS BEFORE BECOMING A
MEDICAID PROVIDER
State Plan
►Arizona, Kentucky, Massachusetts, Oklahoma
Waiver(s)
►Georgia, Indiana, Kansas, Maryland
FINANCING PARENT SUPPORT
PROVIDER
Medicaid Provider
Direct payment through Medicaid
MCO Network Provider
Payment through managed care organization (MCO)
Subcontractor
Payment through another provider who is paid either by Medicaid or
MCO
Medicaid Administrative Dollars
MEDICAID PAYMENT
Deborah Harburger,
The Inst i tute for Innovat ion and Implementat ion, Univers i ty o f Mar y land School o f Socia l Work
SETTING A RATE FOR
FAMILY SUPPORT
The focus of your rate composition is the peer
support partner.
Assume 1 FTE peer support partner, unless you know
otherwise.
Ideally, use actual costs from your organization or
other similar organizations.
In the absence of actual costs, utilize living or
housing wages and profiles of average costs in your
geographic area.
CALCULATING PERSONNEL COSTS
Fringe Benefits can include:
FICA/Medicare
Retirement
Disability insurance
Life insurance
Unemployment insurance
Dental, prescription and health insurance
Worker's compensation
Other costs that may be par t of your costs, depending on the size of your organization, are separation leave payments, tuition remission, employee assistance, wellness programs, and other employee benefits.
Again, use actual costs i f you have them. I f not, you can use a number l ike 25% as a proxy cost. I f you of fer many benefits, you may want to use a higher figure l ike 30 -40%.
Fringe benefits are calculated as a percent of salary costs
Most organizations use standardized benefit rates for al l employees, regardless of which benefits they take
CALCULATING FRINGE COSTS
Rent/Office Space Costs (per FTE per year)
Cellular Phone, Internet & Communications (per FTE per year)
Mileage Total estimated miles x Privately Owned Vehicle Rate
Unless otherwise prescribed, use the U.S. General Services Administration (GSA) rate for operation of a privately owned vehicle (http://www.gsa.gov/portal/content/100715?utm_source=OGP&utm_medium=print-radio&utm_term=mileage&utm_campaign=shortcuts)
If you have agency cars available, factor in the cost of maintaining those cars and the cost of gasoline and wear & tear on the vehicle instead of using the GSA POV rate
Office supplies and maintenance (include any costs for printing, photocopying, fax machine, postage, IT software and equipment, and routine office supplies; per FTE/year)
Management Information System User Fees (per FTE/year)
Insurance (general l iabil ity, professional l iabil ity) per FTE/year
CALCULATING OTHER COSTS
Personnel
Annual Amount
or Rate %FTE
Salary
Cost
Fringe
Benefits (25%)
Salary +
Fringe Cost
Family Support Partner 39,354$ 1 39,354$ 9,839$ 49,192.50$
Family Support Partner Supervisor 50,000$ 0.10 5,000$ 1,250$ 6,250.00$
Administrative Assistant 39,354$ 0.15 5,903$ 1,476$ 7,378.88$
Billing Support Specialist 39,354$ 0.05 1,968$ 492$ 2,459.63$
Administrator 55,000$ 0.05 2,750$ 688$ 3,437.50$
Total 1.35 54,975$ 13,744$ 68,718.50$
Other Costs
Rent ($200/monthper FTEs) 3,240.00$
Cellular Phone, Internet & Communications (@$110/month per FTE) 1,782.00$
Mileage (10,500 miles per year @ $0.56/mile) 5,880.00$
Office supplies and maintenance (incl printing, copier/fax) @ $750 per FTE 1,013$
Management Information System User Fees (@$150/FTE) 203$
Insurance (general liability, professional liability) @ $1,000 per FTE 1,350$
Indirect Cost (7% of modified total direct costs) 5,526$
Total Cost FTE 87,711.69$
SAMPLE BUDGET FOR 1 PARENT
SUPPORT PROVIDER
The CMS guidance regarding the use of peer supports for peer to peer services for parents, guardians and caregivers can be found at: http://www.medicaid.gov/Medicaid -CHIP -Program-Information/By -
Topics/Benefits/Downloads/Clar i fy ing -Guidance-Suppor t -Pol icy.pdf
Becoming a Medicaid Provider of Family and Youth Peer Support: Considerations for Family Run Organizations http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261625
Joint CMCS and SAMHSA Informational Bulletin http://www.medicaid.gov/federal -policy-guidance/downloads/CIB-05-07-2013.pdf
Medicaid Waivers http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html
Medicaid Financing for Family and Youth Peer Support: A Scan of State Programs: http://www.chcs.org/resource/medicaid -financing-for -
family -and-youth-peer -support -a-scan-of -state-programs-3/
RESOURCES
Your Turn to
ask …
In Fredla’s role with the TA Network, Fredla
has developed an Implementation Exchange
for family-run organizations who are moving to
become Medicaid providers.
Malisa Pearson is coordinating this project:
IMPLEMENTATION EXCHANGE
Dayana Simons, [email protected]
Center for Health Care Strategies
Deborah Harburger, [email protected]
The Institute for Innovation and Implementation,
University of Maryland School of Social Work
Jane A. Walker, [email protected]
Family Run Executive Director Leadership Institute
(FREDLA)
CONTACT US!