District Administration - June 2008 - (Page AT7)

Medicaid Outlook Districts face Medicaid funding cuts, increased compliance requirements LIN LESLIE IS VICE PRESIDENT OF MARKETING, BUSINESS RESEARCH AND DEVELOPMENT for CARE Resources Inc., a stafﬁng and special education solutions ﬁrm located in Maryland and Arizona. This is the ﬁrst of a two-part series about Medicaid issues facing school districts. eral that commonly trigger audit ﬁndings: • Billing for services that are not covered or not adequately documented • Billing for services that are instructional rather than health related • Billing for services from providers who fail to meet licensure requirements • Inadequate capacity to examine or resolve overpayments • Lack of integrity in computer systems • Failure to maintain conﬁdentiality of information/records • Duplicate billing, or improper use of procedure codes • Failure to institute standard internal audit reviews What are some of the challenges for school districts? What’s ahead for school districts in terms of their ability to continue to access Medicaid? Schools may lose $635 million for the 2008-2009 school year. In addition, proposed rule changes will in many cases stop payments for services rendered in schools that Medicaid long has covered. At risk are monies collected by schools for specialized transportation to and from school, as well as the elimination of Medicaid recovery for service coordination and case management. Districts will face more restrictions for payment for services such as speech, occupational, physical therapy and in some cases, nursing services for particularly fragile children. Also, they will continue to be paid at rates far below the cost of services due to the manner by which rates are set. What is triggering the reduction of this funding stream for schools? The reductions are stemming from Medicaid funding cuts in general, but also from a tightening of conditions under which schools can recover costs for direct and administrative services. Over the course of the past 10 years, federal and state enforcement agencies have brought actions against various states for inappropriate and duplicate payments that impact school districts. Moreover, the institutional risks of noncompliance have grown from relatively non-adversarial audits and occasional return of payments to formal investigations resulting in sanctions and sizable returns of monies. “The manner by which districts must seek payment was designed for hospitals and medical providers.” The biggest challenge for school districts is to distinguish between a medically necessary service that meets criteria for reimbursement under Medicaid and services that are instructional in nature, which do not qualify for reimbursement. For instance, a district may determine that speech and language therapy may be necessary for a child who is struggling in reading and language arts. Medicaid auditors will argue that such therapies fail to meet criteria as a health service when they appear to support learning and instructional goals. Do districts have difﬁculty navigating the Medicaid billing procedure? Are the rules for reimbursable expenses changing? Some services rendered by schools may no longer qualify for reimbursement even though some of those services were approved by the respective state and federal Medicaid agencies. At issue is the degree to which services rendered in support of education qualify for reimbursement under Medicaid. Ironically, this is the same issue that was debated at the onset of the entry of school districts into the Medicaid arena during the late 1980s. Where are districts vulnerable in terms of compliance with Medicaid rules? Billing Medicaid for services is not a business solution common to school districts. In fact, the manner by which districts must seek payment was designed for hospitals and medical providers. Service claims for therapies and assessments is so challenging for districts that many turn to vendors for tasks such as tracking the delivery of services. In addition, districts struggle to secure and track provider credentials. This is particularly challenging in large school districts that may staﬀ hundreds of therapists, nurses and other personnel, both directly and through vendors. Part 2 of our Medicaid series will address ways that school districts can overcome some of the regulatory challenges. Achievement Today 7 There is a long list of trip-points for districts, but here are sevSummer 2008

Table of Contents for the Digital Edition of District Administration - June 2008

District Administration - June 2008
Contents
Editor’s Letter
Letters
News Update
Technology Update
Inside the Law
Conversations
Online Edge
Speaking Out
Professional Opinion
Crisis Response
Administrator Profile
District Profile
Cutting Costs from the Inside Out
New Literacies: Entering the Future
Online Videoconferencing
Achievement Today
Transporting Special Needs Students
How Well Does This Web Site Work?
New Products
Problem/Solution
Calendar of Events
Understanding the Times

District Administration - June 2008