School Health Services Transitioning from Fee for Service to - - PowerPoint PPT Presentation

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School Health Services Transitioning from Fee for Service to - - PowerPoint PPT Presentation

Jun 28, 2023 312 likes •610 views

School Health Services Transitioning from Fee for Service to Cost-Based Reimbursement: Lessons Learned 1 School Health Services History 2 School Health Services History FFS rate rebasing work done in 2005 required a SPA. CMS

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Transitioning from Fee for Service to Cost-Based Reimbursement: Lessons Learned

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History

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History

  • FFS rate rebasing work done in 2005 required a
  • SPA. CMS responded requiring Colorado to move to a

cost-based rates methodology.

  • Colorado worked with program stakeholders and CMS

from 2005-2008 to develop new FFS methodology which became effective July 1, 2008

  • October 1, 2009 the MAC Program was added
  • For FY12 Colorado moved to a 1/12 interim payment

methodology.

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Our Program Before

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Our Program Today

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Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7

Cost

Cost-Based Reimbursement

  • Salary,

Benefits and Contracted Costs for RMTS Participants Add Unrestricted Indirect Costs Reduce by Annual Average Statewide Allowable DS & TCM RMTS % Reduce by IEP Student Utilization Ratio Add Supplies, Materials and Other Costs Add Transportation Costs Apply Federal Medical Assistance Percentage (FMAP) 50%

DS, TCM, Transportation Reimbursement Amount

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Results

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Results

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779,826 793,269 801,838 817,605 831,633 842,598 853,360 760,162 763,307 770,074 781,197 786,561 728,216 719,296 650,000 700,000 750,000 800,000 850,000 900,000 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Student Population Reached

Total Student Population State Wide Participating District Student Population

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33,301 33,831 33,563 35,523 36,967 38,579 39,674 4,506 3,966 3,443 1,013 1,238 1,278 1,258

  • 5,000

10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Student Population Reached by Medicaid for Aurora Public School District 28

Student Population Unduplicated Medicaid Students Reached

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$306,927 $358,108 $458,800 $344,352 $344,415 $511,120 $483,938 $320,294 $411,830 $516,853 $403,801 $326,102 $425,101 $383,078 $460,564 $- $200,000 $400,000 $600,000 $800,000 $1,000,000 $1,200,000 $1,400,000 $1,600,000 $1,800,000 $2,000,000 2009-10 2010-11 2011-12 2012-13

Fiscal Year by Quarters

Medicaid Administrative Claiming Net Reimbursement (Federal Share Only less State Withhold)

July-September October-December January-March April-June

$990,748 $1,488,273 $1,769,159 $1,807,103

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$32,628 $33,594 $39,781 $43,882 $25,893 $42,794 $31,098 $29,680 $31,278 $45,109 $30,236 $30,964 $33,461 $32,002 $36,452 $- $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 $180,000 2009-10 2010-11 2011-12 2012-13

Fiscal Year by Quarters

Medicaid Administrative Claiming Net Reimbursement For Aurora Public School District 28J (Federal Share Only less State Withhold)

July-September October-December January-March April-June

$123,260 $153,499 $137,567 $104,526

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Challenges

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Challenges

  • Learning curve
  • RMTS
  • Financial Reporting
  • Communication
  • Paybacks
  • State Plan
  • Provider Buy In
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What We Figured Out

Finish

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What We Figured Out

  • Online System for RMTS and Financial Reporting
  • Interim Rates
  • Administrative Withhold
  • Eligibility Ratio
  • Training
  • Relationships
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How We Got There

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How We Got There

  • Collaboration/Communication
  • Stakeholder Group
  • Outreach efforts
  • Program Reviews
  • Training
  • Newsletters
  • Help Desks
  • Program Manual
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What is Next?

  • Constant Improvement
  • Stakeholder Group
  • Trainings
  • Community Partners
  • Internal Partners
  • Outreach to Non-Participating Districts
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What is Next?

Colorado Student Medicaid Population and District Participation

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What is Next?

Colorado Population by County 2010

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779,826 793,269 801,838 817,605 831,633 842,598 853,360 760,162 763,307 770,074 781,197 786,561 728,216 719,296 650,000 700,000 750,000 800,000 850,000 900,000 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Student Population Reached

Total Student Population State Wide Participating District Student Population

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Everybody Wins

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Contact Information

Colorado Department of Health Care Policy and Financing

  • Shannon Huska
  • Shannon.Huska@state.co.us / 303-866-3131

Colorado Department of Education

  • Jill Mathews
  • Mathews_J@cde.state.co.us / 303-866-6978

Public Consulting Group (PCG)

  • Michelle Simmons
  • msimmons@pcgus.com / 847-567-1109

Aurora Public Schools

  • Judy Weaver
  • jaweaver@aps.k12.co.us / 303-326-2000 x 28535
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Questions