Student Counts for Medicaid Reporting 2019 PED STARS Data - - PowerPoint PPT Presentation

2019 PED STARS Data Conference

Student Counts for Medicaid Reporting

• 97% of LEAs and 30+ Charter schools participate

in the Medicaid School-Based Services (MSBS) Program.

• This Program allows them to receive Medicaid

reimbursement for IEP-related ancillary services provided to Medicaid-enrolled students.

– Provides over $40M annually.

• Districts are required to provide several student

lists to HSD for calculation of Medicaid Eligibility Rates (MERs) that are utilized in claims.

What is the Medicaid School-Based Services Program?

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• Requests for the student lists come from HSD to

each district’s MSBS Coordinator.

– MSBS Coordinators can include SPED, Health Services and/or Financial staff depending on the district.

• MSBS Coordinator will communicate with STARS

Coordinator to request student lists.

– FY19 transitioned from 40th day counts to 80th day.

• MSBS Coordinator will double check formatting to

ensure compliance with HSD requirements.

How is the STARS Coordinator involved?

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• The 80th day reports are used to determine the Medicaid

Eligibility Rate (MER) for each District, Charter and REC.

• Administrative Claiming
• Cost Settlement
• Transportation Reimbursement
• List totals are compared to what was reported to PED

through STARS.

• Ensure the staff providing the lists are utilizing the “Snapshot” and

not the “Template” to capture enrollment on the 80th day

• Reconciliation assures CMS that we are utilizing accurate data to

calculate the MER ⇒ accurate payment

• Lists should include ALL students; the match process

determines those who are Medicaid enrolled.

80 Day Count Utilization

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• Over the last several years, HSD has improved our

auditing processes to include verification of the student data utilized in the MER calculations.

• We began auditing these lists in FY16, including a

reconciliation of the lists submitted by the district and what was reported through STARS.

– Numerous errors have been encountered.

• FY19 began collaboration between HSD and PED

to streamline the data collection and reporting in STARS to improve accuracy and efficiency.

Why are we here today?

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• We have been working with the PED SPED and IT

Bureaus on changes for Nursing and Specialized Transportation reporting in STARS.

– Changes to the IEP Templates – Changes to the STARS SPED Services Fact Template – The goal is to streamline the STARS reports so that less validation is required for Nursing Services and Transportation.

• Nursing Only students will be captured
• Wheelchair transportation will be easily identified
• Validation will still be necessary for seatbelts, etc.

Changes for FY20!!!

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• IHP/Nursing Services as a related service is now a

mandatory field. This should capture any students that are Nursing Only and the service may not be listed on the Schedule of Services.

IEP Template Changes for Nursing

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• Additional fields have been created in the

Transportation Section to provide greater detail regarding the need for modifications and their medical necessity.

IEP Template Changes for Transportation

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• 5 new service codes added to Field 5.

SPED Services Fact Template

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Transportation on the IEP

• Due to student's diagnosis of epilepsy, student

requires the use of a seatbelt/harness on the special education bus in the event that a seizure

• ccurs while en-route to/from school.
• Due to Cerebral Palsy, student requires assistance

to guide her in the gait trainer to/from the bus, assistance to enter/exit the bus and a harness while riding the bus.

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Transportation on the IEP

• Student is not independently mobile and non-
• verbal. He needs total physical assistance for all of

his daily needs and transfers.

• Prior Written Notice – It is agreed that student would

require a SPED bus with a lift for his wheelchair

• The SPED bus has seat belts and a bus aide.
• Prior Written Notice – Student rides the SPED bus to

and from school -It will benefit him to ride the regular education bus home so that he can remain in class until 3:05

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• We are continuing to work with PED on these next

steps

– PED IT to create STARS report templates for 80 day that contain the desired data specified by SHO. – Populating STARS with the Medicaid ID from the 2018-2019 match lists.

• A field already exists in STARS that can be designated and

utilized for Medicaid ID #s.

• This field will then populate on the 80 day lists that will

be submitted in January.

• If successful, SHO will provide PED with an annual update

list to populate STARS.

• This will eliminate the need for districts/RECs to

manually populate this field & phase out use of SSNs.

Future Changes/Improvements

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Questions

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• Christie Guinn, SHO Manager

505-827-3117 christie.guinn@state.nm.us

• Vanessa Skrehot, MSBS/FIT Program Manager

505-827-7288 vanessa.skrehot@state.nm.us

• Ashley Garcia, MSBS/Health Services Coordinator

505-827-1421 ashley.garcia@state.nm.us

MSBS Program Staff

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