maa News

KCSOS Webteam

March 2, 2010

Region 8 LEC

LEA Medi-Cal Billing and Free Care Regulations

Although we are not the oversight agency for the LEA Medi-Cal billing program, we often do field questions from districts and offer assistance when we can. As a courtesy to you, we would like to address a regulation titled "free care", which was set forth by Centers for Medicaid and Medicare Services (CMS), the federal oversight agency. We understand that some districts may be incorrectly billing for unallowable (non-IEP) medical services.

The free care and other health coverage regulations virtually eliminate the ability of districts to bill for medical services for non-IEP students. As we understand it, districts are very unlikely to meet the guidelines put forth by CMS as the stipulations make it almost impossible to comply. Please contact DHCS at lea@dhcs.ca.gov if you have any questions or concerns surrounding billing of medical services for non-IEP students.

Too Good to be True???

We understand that districts have been contacted regarding the LEA and MAA programs and some lofty projections have been made about how much revenue that districts are supposedly leaving on the table. Please keep in mind, if it sounds too good to be true, it likely is too good to be true. If you have any concerns regarding this issue, please feel free to contact us.

MAA Site Reviews

Another round of site reviews have been completed. Most were without problems! We have only one comment-please include in your audit binder a copy of any medical and/or Medi-Cal related materials that are specific to your district or area. The materials can pertain to any period during the school year. Examples are: agendas for meetings that include medical topics, listing of medical providers who accept Medi-Cal in your area, district specific medical referral forms and/or a listing of what medical services your district provides.

Samples and Web-Based Time Survey Forms

As a reminder, all of the samples should be written or typed by the participant only. If your district uses a web-based time survey form, there should be no auto-fill feature or anything that offers the participant wording suggestions.

ARRA (Stimulus) Funds

Remember that MAA participants cannot be paid with federal funds. Take precaution to ensure that the ARRA funds are not used to pay for your participants, as it will disqualify them from inclusion in the invoice.

Overall

Thank you very much for your cooperation and participation in the MAA program. Should you have any questions, please do not hesitate contact myself or Ken Gragg at kegragg@kern.org.

February 16, 2010

Medi-Cal Administrative Activities Program (MAA)

Notification of the 09/10, 4th Quarter Time Survey Period

The time survey week for the fourth quarter of FY 2009-2010 begins on Tuesday, May 4, 2010, and requires staff to time survey for five consecutive days when students are in session, in accordance with the 2009-2010 California School Based MAA Manual.

August 11, 2009

Agenda Items for MAA Coordinators Meeting

(Please note that 4 separate meetings were conducted and not all items were discussed at each location)

·        Rescission of CMS 2287 P-2-

·        At this time there are no pending regulations to eliminate the program. However, there is still pending a mandated report to Congress (contract no: HHSM-500-2005-00024). There is still an ongoing effort to "fix" the program.

·        The rule (2287 P-2) does state that CMS has tools at its disposal to address inappropriate claiming.

·        Audit findings-

·        LEC site reviews-Reviews were done in March. Most issues were clerical in nature and easily resolved. Please be sure time surveys are signed prior to submission of the invoice.

·        DHCS site reviews-Performed in April-DHCS stated that we would receive the official results in 60-90 days. We have yet to receive official results. DHCS did conduct exit interviews with the LEC and districts that were reviewed. Some of the items discussed were:

Code 15 and 16 were excessive

Identical handwriting found on multiple surveys

Participants signatures were not found on training roster

Erasures and corrections were not initialed

Samples were not coded correctly

Samples for services not Medi-Cal reimbursable

Samples were not Medi-Cal specific

Other Items-

·        It is not a DHCS mandated requirement to use specific dates in samples. Region 8 strongly recommends against this practice.

·        Coordinators should not have access to change a participant's time log or samples.

·        Identical samples (verbiage) and like handwriting has been observed. Please have participants write/type things in their own words. Only the participant should be writing (or entering) samples and time on their survey.

·        District responsibility versus vendor responsibility was discussed. Any disallowance, error or omission is the responsibility of the district. The LEC does not contract with vendors, nor can we hold them responsible.

·        Little MAA time-Those participants who consistently have less than 1 hour of MAA reimbursable time quarter after quarter should not be included in the invoice. The MAA Coordinator should make the determination and watch patterns regarding too little MAA reimbursable time.

·        Samples for PTO-should not be specific to type of leave, should only read "XX hours of paid time off."

·        Code 15 should reflect the amount of time the MAA participant devotes to completing the time survey form. We understand that there are days when it may take more than a quarter hour to properly account for his or her time; however, there are also days when little time is spent on time accounting activities. All time survey participants must be reasonable in their approach when recording time. Activities should not be performed during MAA week to enhance time in any particular code.

·        KCSOS' time frames for submission of invoices and time survey results:

·        Time survey results should be finalized within 3-4 months of the end of the time survey period. This helps pinpoint and correct any issues before 3 or 4 quarters have passed.

o The invoices are due as follows (due 13 months after the end of the time survey quarter):

1st quarter: October 31st

2nd quarter: January 30th

3rd quarter: April 30th

4th quarter: July 31^st

·        Upcoming site reviews- If your district has not been reviewed in the past 3 years, it is likely that a review will be scheduled sometime this fiscal year. 30-45 days notice will be given to the district and vendor.

·        Ways to maximize reimbursement was discussed:

·        Watch vendor fees as a percentage of the overall reimbursement

·        Increase # of eligible/legitimate participants

·        Get support from administration

·        Provide incentives

·        Hold participants accountable and give plenty of program support

·        Be sure to work with the business department regarding funding; specifically the stimulus funds as they are federal dollars.

·        The MAA website has been updated with the status of each MAA invoice and the LEC minutes are current. The website address is: http://kcsos.kern.org/maa/

August 8, 2009

The 09/10, second quarter time survey period begins on Saturday, October 17, 2009. Since I am not aware of any K-12 school in the United States that is in session on a Saturday, you will begin your survey on the following Monday.