Student Counts for Medicaid Reporting 2019 PED STARS Data Conference
What is the Medicaid School-Based Services Program? • 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. 2
How is the STARS Coordinator involved? • 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 40 th day counts to 80 th day. • MSBS Coordinator will double check formatting to ensure compliance with HSD requirements. 3
80 Day Count Utilization • The 80 th day reports are used to determine the Medicaid Eligibility Rate (MER) for each District, Charter and REC. Administrative Claiming Cost Settlement o 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 80 th 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. 4
Why are we here today? • 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. 5
Changes for FY20!!! • 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. 6
IEP Template Changes for Nursing • 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. 7
IEP Template Changes for Transportation • Additional fields have been created in the Transportation Section to provide greater detail regarding the need for modifications and their medical necessity. 8
SPED Services Fact Template • 5 new service codes added to Field 5. 9
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 occurs 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. 10
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 11
Future Changes/Improvements • 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. 12
Questions 13
MSBS Program Staff • 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 14
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