PCG POST. Public Consulting Group, Inc. Important Dates and Reminders RMTS

Transcription

1 June 2015 Volume 7, Issue 4 Brought Brought to to you you by: by: Public Focus. Proven Results. Important Dates and Reminders RMTS Random Moment Time Study (RMTS) updates for the school year! A new PCG Claiming system is coming! PCG will be introducing the new PCG Claiming System that will be used for managing the RMTS program along with reporting costs for the quarterly MAC claim and the DSC annual cost settlement. PCG will be providing training via webinar on the new claiming system to RMTS coordinators later this summer / early fall in preparation for the OD15 time study quarter. The training will walk through key system components to ensure a smooth and successful transition for everyone. Stay tuned as more information becomes available! What s New: Dashboard / Home Screen Calendars The dashboard will have upgraded components, and will house real-time information such as LEA RMTS compliance, available resources, quarterly milestones to monitor various components of the program and reports RMTS coordinators will input Holiday s / Non-Work days in the system instead of submitting a calendar template to PCG Shifts (Work Schedule/Hours) RMTS coordinators will be able to create Shifts to accommodate more than one work schedule. These shifts can have specific days of the week and start times associated with a specific duration for each day in hours and minutes. PCG and AHCCCS are developing best practices and guidelines to assist the RMTS coordinator with creating shifts Completing Time Study Moments Time Study Participants will now be able to respond to their random moments without the use of a username and password! Participants will respond to their moment using a specific link for their moment in time sent via in the moment notification Pg 1

2 RMTS (continued) Preparing for Upcoming Random Moment Time Study (RMTS) System Changes In an effort to align participants who will be included on the upcoming October December 2015 staff pool list, all RMTS coordinators state-wide will be required to identify a shift or work schedule for each participant. Coordinators can begin the process of identifying those shifts right now. By creating more than one shift or work schedule, the LEA will assign all participants to the shift that best aligns with their work schedule. PCG encourages RMTS coordinators to start thinking about your LEA s possible shifts. Depending on LEA size as referenced in the table below, these are the maximum number of shifts that can be created per LEA: small districts (4), medium districts (7), and large districts (10).To Staff Pool List Size Maxi- Shift mum District Size Total Staff Pool List Size Maximum Shifts Small 1 to 30 4 Medium Large To determine what shifts will be created later this fall (training to occur in summer), we suggest the LEA start considering the following: What are the start and end times for your elementary, middle, and high schools? Are all school locations based on a Monday Friday schedule? If not, is there a need for a Monday Thursday schedule? Is there a need for a schedule that is less than 40 hours per week? Please note, PCG is not currently collecting shift data, but rather want RMTS coordinators to start thinking about gathering data to determine their unique shifts. Later this fall and after training is provided, RMTS coordinators will enter shift data directly into the PCG Claiming System and assign a shift to each participant. Access to the RMTS System The new PCG Claiming system will contain the functionality of the current RMTS system and the Medicaid Cost Report and Claiming System (MCRCS). Do to migrating to the new system, access to the current RMTS system will be discontinued at close of business on July 3, All edits, additions, and deletions of participant information effective for the upcoming October December 2015 quarter that occurs on or prior to July 3 rd will be migrated over to the new system. After July 3 rd, all RMTS coordinators will no longer have access to the RMTS system, including reports. If RMTS coordinators want to reference the Active Participant file, please download the file before July 3 rd. The Active Participant file downloaded prior to July 3 rd can be used as a working file to track or highlight any changes. These updates and changes can be made in the new PCG Claiming System once you have been trained and access to the system is granted. Volume 7, Issue 4 Pg 2

3 Quarterly Cost Reporting: Tips and Reminders On a quarterly basis, LEAs enter cost data into the web-based reporting system for the applicable quarter. Once entered, the system analyzes reported cost data and reviews it for common errors. If an error (or edit) is identified, the user must make necessary revisions to resolve the issue or provide a written explanation as to why the reported cost data is accurate as stated. Here are a few tips to keep in mind when entering quarterly cost data: Additional staff cannot be added to the staff roster or cost report at the beginning of the quarter, unless it s a direct replacements Include ALL costs (including federal funds) in the salaries/benefits/pps sections. Use the Compensation Federal Revenues column to subtract any costs that should not be included for reimbursement 100% federal funded employees Remove participants from future staff rosters If not removed, report full cost data even if entire costs are fully federally funded Remove participants that are no longer with the LEA from the RMTS roster in a timely manner to avoid a large number of No Payroll Information edits When exporting and importing data, make sure to maintain all formatting of the original file, use ONLY the.csv file type, and do not forget to convert all functions into text values Provide sufficient details for the edit explanations. The more detail you provide when an explanation is prompted, the less likely you are to receive follow-up communication from PCG The system will not allow you to certify without resolving ALL system identified edits Annual Cost Reporting What makes the bus go? During this year s Spring RIS session, LEAs participated in an engaging activity on what is allowable to report under the Transportation Other Costs category of the DSC Annual Cost Report. As a reminder, before LEAs report any transportation, please meet with your Transportation Department and ask: Do these transportation costs pertain to a vehicle or driver associated with a physically adapted bus that has at least one route ridden entirely by students with specialized transportation in their IEPs? If the answer is NO, do not ever report! Pg 3

4 Annual Cost Reporting (continued) If the answer is yes, ask yourself: Are these costs exclusively (all of the time), 100% for routes that meet the criteria of always carrying students with specialized transportation in their IEPs, if so report these costs as specialized If the costs meet the criteria of at least one route, but the vehicle, driver has other capacities, report these costs as general Lastly, ask yourself, do these costs contribute to actually making the bus go to ensure a special education student with specialized transportation in their IEP can get to school to receive another DSC claimable direct medical service? If the answer is yes, and the cost is allowable, please report If this is a general cost that is required for the entire transportation department, and isn t necessarily discrete to make the bus go do not report Some examples of allowable costs: Maintenance and Repair costs, fuel & oil, insurance, air conditioning, and vehicle parts. Examples of non-allowable costs: CPR training for drivers, uniforms, drug testing, cameras and camera installation costs, general office supplies. Now is a great time to meet with your Transportation Department to discuss these requirements prior to the FY15 DSC Annual Cost Report opening in October! Compliance The PCG comprehensive compliance review includes a review of each of the Medicaid School Based Claiming (MSBC) major program components: Direct Service Claiming (DSC), annual cost reporting, and quarterly cost reporting. As part of the formal notification that will occur thirty (30) days prior to the start of the compliance review if selected, your Local Education Agency (LEA) will receive a list of required documentation to satisfy each portion of the review, a compliance review tool outlining the standards under review and the required documentation to satisfy those standards. In addition to the previously mentioned documents there will be two (2) Excel spreadsheets uploaded to your LEA s File Transfer Protocol (FTP) site outlining the claim samples under review for the DSC and for the annual portion of your compliance review. In an effort to better conserve resources, distribute and retain submitted documentation, PCG prefers that all documentation is submitted electronically via the LEA FTP site or by fax to our secure fax line at (602) Please arrange for all documentation to be received by PCG at least one business day prior to the start of the review if submitting documentation electronically OR five business days prior to the start of the review if submitting physical hard copy documentation. Pg 4

5 Compliance (Continued) Preparing for the DSC portion of the comprehensive compliance review 1. Read the engagement letter provided by PCG for details regarding the review 2. Reference the Compliance Review Tool final document included on the notification 3. Locate the LEA Selected Claims spreadsheet on your FTP site (note: this spreadsheet has multiple tabs) Start gathering the required documentation for each student and specific service included in the claim sample to cover the date of service on the claim. Use the Compliance Review Checklist found here on our program website as a guide: Please make sure that Individualized Education Plans (IEPs) are effective and cover the service date under review. Also, please make sure that copies of licensure for the prescribing Qualified Medical Provider, or QMP (please refer to the qualified medical provider table located on our program website at the same location listed above) to cover the date of their prescribing signature as well as licensure to cover the rendering provider on the day the service was provided. This may mean that the same provider must have two (2) different licenses submitted to cover one claim. Direct Service Claiming (DSC) Transportation services are reimbursable for students who have been determined by the LEA to be eligible for specialized transportation when all of the following criteria are met: Student is Medicaid eligible Student qualifies for special education and related services Specialized equipment or supervision must be required on transportation that is prescribed by a Qualified Medical Provider (QMP) and clearly indicated within the students IEP A DSC reimbursable related service must be provided and received on the same day (LEA must have documentation to prove other DSC billable service was provided on that same day) Signed and detailed transportation logs must be by the bus driver A maximum of two trips per day are allowed for traveling to and from school Pg 5

6 Spring Regional Information Session (RIS) Frequently Asked Questions (FAQs) 1. Can PCG provide a list of employee names alongside his or her corresponding area of expertise and direct telephone number? To allow for 24 hour response times, the utmost customer services, and documentation purposes, PCG has a telephone help desk and inbox system to best serve each LEA with their specific questions. Please see chart below and reference the appropriate department, either by telephone or , for the quickest service and response: 2. What is a System Hold? System holds occur when student is not eligible for AHCCCS at some point during the duration of the health aide preauthorization requested. System holds are not denials but rather conditional approvals meaning that the student has been approved for a portion of the requested duration. For additional information, please contact AHCCCS at (602) with questions on member eligibility or enrollment verifications. 3. How many times a year is the student roster due and how does it affect reimbursement? The student roster is due to PCG once each year and includes all students enrolled within the LEA on October 1 st of each Fiscal Year (FY). The student roster impacts both the quarterly Medicaid Administrative Claim (MAC) as well as annual cost settlement determination for Direct Service Claiming (DSC) because it is used to calculate the Medicaid Eligibility Rate (MER) and the Individualized Education Program (IEP) ratio. 4. What date should you use if October 1 st falls on a weekend day when populating the student roster? PCG recommends that the LEA populate all students enrolled on the following Monday of the fiscal year be reported to ensure all students who were enrolled on October 1 st are captured appropriately. 5. Who is qualified to sign Health Aide reviews? Health Aide services must be prescribed by a Qualified Medical Provider (QMP). For a comprehensive list of QMPs, please see the below link and click on the PDF document titled: Health Aide Prepayment Review Training under DSC: Volume 7, Issue 3 Pg 6

7 Spring Regional Information Session (RIS) Frequently Asked Questions (FAQs) 6. What are the most common differences when reporting between Quarterly and Annual costs? Please see the chart below that helps illustrate the commonalities and differences between quarterly and annual cost reporting: MAC Both Annual Cash-based reporting methodology Subject to the same allowable salaries, benefits, and PPS cost requirements Accrual-based reporting methodology Results in quarterly Claim reimbursement Impacted by Random Moment Time Study (RMTS) results Used to calculate cost for cost settlement determination Also includes administrative service provider cost pool MER applied to help calculate reimbursement Direct service cost pool Require the submission of a student roster 8. What is the purpose of completing a CPE form for Quarterly reimbursement? Also includes personal care provider cost pool IEP ratio applied to help determine cost Certified Public Expenditure (CPE) forms are required for each participating LEA who receives a Medicaid Administrative Claiming (MAC) reimbursement check for current or adjusted prior quarters. The CPE form must be completed by an authorized LEA representative responsible for indicating and certifying the LEA has expended (at minimum) as much non-federal funds as the Federal monies issued in the form for the applicable quarter. 9. Can PCG provide a list of the most commonly used acronyms within the Medicaid School Based Claiming (MSBC) program and their definitions? PCG has created and posted a New Coordinator Tips and Resources handout which includes FAQs, program terminology and definitions including a list of acronyms, as well as URL links to various resources for the Medicaid School Based Claiming (MSBC) program. Please go to the below link to access: If a licensed Speech-Language Pathologist (SLP) is terminated by AHCCCS due to an absence of billing and then must be placed in the administrative cost pool, can he or she still sign an IEP as a QMP for speech and/or health aide services? All covered services under the DSC Program must be determined by an AHCCCS registered provider. An SLP who is currently registered with AHCCCS and is fully licensed to meet the program requirements as a QMP may review and sign IEPs even if they are listed in the administrative service providers cost pool; however, if they have been terminated by AHCCCS and are not an active registered provider they may not review and sign IEPs as a QMP. Volume 7, Issue 3 Pg 7

8 Spring Regional Information Session (RIS) Frequently Asked Questions (FAQs) 11. Why are Personal Care Providers costs not reported Quarterly? Personal care provider cost pool costs are not reimbursable under the quarterly MAC claim as this particular provider type rarely provides administrative and outreach services associated with administrating the Medicaid School Based Claiming program. 12. How do you report direct replacement s payroll/pps costs during quarterly and annual cost reporting? If a full or part-time employee has terminated their employment during the reporting period and a new employee has directly replaced him or her in the same position, costs paid for that position during the reporting period can be reported for both employees. Total costs paid for that position (terminated employee s costs plus direct replacement costs) would be reported under the terminated employee s name within the cost report. To reduce edit explanation follow-up, it is a best practice to include the terminated employee s date of termination alongside the new employee s name and date of hire. Documentation to support and explain all reported costs must be maintained in the event of an audit. 13. Can new staff members be added to the Staff Pool List in the middle of a quarter?? New participant cannot be added to staff pool lists unless the new participant is a direct replacement for a terminated employee. LEAs must wait to add the new participant onto the next quarter s staff pool list 14. Should Superintendents and/or Principals be included on the staff pool list if he or she is only conducting minimal Medicaid reimbursable activities? LEAs should only include participants on the staff pool list if he or she is routinely performing Medicaid reimbursable activities throughout the quarter. 15. When completing the student roster, how should the Yes or No columns be completed? Please place a Y for Yes and an N for No in each of the applicable columns as appropriate. If you have specific questions on how to answer each question, please review the Student Roster Checklist here: If you have further questions, please contact PCG directly for further assistance. 16. How should undisclosed students be reported on the Student Roster? When reporting undisclosed students, the LEA should complete each field that requires text with undisclosed and each field that requires a date or numerical value with Volume 7, Issue 3 Pg 8

9 Spring Regional Information Session (RIS) Frequently Asked Questions (FAQs) (Continued) 17. If a parents signs both a Consent to Bill and a Non-disclosure Agreement, how should the LEA report the student on the roster? The LEA should abide by the most recently signed document in all instances as the newest documentation will supersede the previous. 18. If a specialized bus breaks down and must be towed to be repaired, is the towing of the specialized vehicle allowable? Yes. If the LEA maintains comprehensive documentation that the tow was for a specialized vehicle, and the invoice for the service reflects the costs and applicable date for the tow, the LEA may report this cost under the maintenance and repairs portion of transportation other costs. Volume 7, Issue 3 Pg 9