Independent School Districts

1
MAC Financial Training

• Independent School Districts

Federal Fiscal Year 2013
2
Agenda

• Program Overview
• School-based Medicaid programs
• Enrollment process
• Program contact responsibilities
• Random Moment Time Study (RMTS) Overview
• Medicaid Administrative Claiming (MAC) -
  Financial Reporting
• Allowable costs
• Claim submission
• Claim calculation
• State of Texas Automated Reporting System
  (STAIRS) Demonstration
• Desk Review Helpful Program Information
• School Health and Related Services (SHARS)
  Overview
• Wrap Up

3
Medicaid Overview

• Jointly-funded state and federal health-care
  program
• An entitlement program that provides health
  coverage to people with low-income, people 65 and
  older, and people with disabilities
• School setting
• Enroll eligible children in Medicaid program
• Assist children already enrolled in Medicaid to
  access the benefits available to them

4
Medicaid Administrative Claiming (MAC) Program

• Federal reimbursement for the costs of Medicaid
  administrative activities performed in the school
  setting
• Linking students to appropriate
  Medicaid/health-related services
• Separate from but complimentary to School Health
  and Related Services (SHARS) program
• Centers for Medicare Medicaid Services (CMS)
  administers the MAC program at the federal level
  and reimburses states for allowable outreach
  activity performed under the MAC program.
• The Health Human Services Commission (HHSC) is
  the Medicaid Single State Agency in Texas
  (responsible for the administration of the MAC
  program at the state level).

5
MAC Program

• Reimbursement for certain medical and
  health-related outreach, case management and
  administrative activities surrounding the health
  services that are delivered.
• Programs are reimbursed for these activities,
  regardless of whether the student is Medicaid
  eligible or not.
• These services may be to a student or family, and
  are for activities that include coordinating,
  referring, or assisting the student/family to
  access the health-related services.

6
MAC Activities

• Activities that improve the access to Medicaid
  coverage or improve the use of Medicaid covered
  services, include but are not limited to
• Informing Medicaid eligible and potential
  Medicaid eligible children and families about the
  benefits and availability of services provided by
  Medicaid (including preventive, treatment,
  screening) including services provided through
  the Early Periodic Screening, Diagnosis, and
  Treatment (EPDST) program.
• Assisting individuals or families to complete
  Medicaid eligibility application.
• Scheduling or arranging transportation to
  Medicaid covered services.
• Providing translation services for the purpose of
  accessing Medicaid services.
• Developing strategies to assess or increase the
  capacity of school medical/dental/mental health
  programs.
• Arranging for any Medicaid covered service that
  may be required as a result of a specifically
  identified medical/dental/mental health
  condition.
• Additional examples can be found on the HHSC MAC
  website

7
To Participate in MAC . . .

• Complete the following
• Intergovernmental Cooperation Agreement
• Business Associate Agreement
• Texas Identification Number Application
• Vendor Direct Deposit Form
• Vendor Information Form
• MAC Program Operating Plan
• Submit original documents.
• Documents are open-ended.
• Documents and instructions can be downloaded from
  the HHSC MAC website

8
Intergovernmental Cooperation Agreement
Business Associate Agreement

• ISD Agrees
• To account for activities of staff providing
  Medicaid administration
• To submit quarterly participation data through
  STAIRS
• To provide expenditure information on a quarterly
  basis
• To spend an amount equal to the federal match
  received on health related services for clients
• To designate a liaison to work with HHSC
• Comply with HIPAA regulations

• HHSC Agrees
• To pass on to the ISD 95 of Title XIX federal
  share for Medicaid Administration
• To reimburse allowable administrative costs at
  the appropriate Federal Financial Participation
  (FFP) rate (50 or 75)
• To include the ISD expenditures for Medicaid
  administration in the claim it submits to CMS
• To designate a liaison to work with the ISD
• Comply with HIPAA regulations

9
Texas Identification Number Application
Formerly known as the TPIN Texas Payee
Identification Number Assigned by the
Comptrollers office for the purpose of
identifying any party receiving a payment from
the State of Texas. The use of this number on
all claims will reduce the processing time
required by the State.
10
Vendor Direct Deposit Form

• Complete form to
• Set-up direct deposit for MAC,
• Change financial institutions, or
• Change account number or type
• Section 2 Leave the boxes blank if you do not
  have your 11 digit Texas Identification Number
• Select Texas Health Human Services Commission
  as the agency with which you are doing business
  or leave blank

11
VENDOR INFORMATION FORM

• The ISD is the vendor.
• Section 2 (Person Who Will Sign the Contract)
  must contain the information of the person that
  signed the Intergovernmental Cooperation
  Agreement.
• Send the original, signed form to HHSC.

12
MAC Program Operating Plan

• Cover page must be printed on district
  letterhead.
• All contacts must match in STAIRS.
• POP includes only
• District Contact Information
• Primary RMTS Coordinator (district employee)
• Primary MAC Financial Coordinator (district
  employee)
• Superintendent
• RMTS Coordinator Roles Responsibilities
• Contact will agree to terms by initialing section
• MAC Financial Coordinator Roles
  Responsibilities
• Contact will agree to terms by initialing section
• Authorized Signatures

13
Resubmit documents?

• Vendor Direct Deposit Form
• Depository bank, account number, etc changes
• Must complete form again submit to HHSC
• MAC Program Operating Plan
• Update only District Contact Information page
  submit to HHSC if one of the program coordinators
  changes
• Must update contacts in STAIRS
• Unnecessary to send entire POP again or any
  additional documents (organizational chart,
  description of coordinators job functions
  responsibilities, etc.)

14
System Contacts

• Communication is critical
• Superintendent
• Random Moment Time Study (RMTS) Coordinator
• Medicaid Administrative Claiming (MAC) Financial
  Coordinator
• School Health Related Services (SHARS)
  Financial Coordinator

15
Primary MAC Financial Contact Responsibilities

• Must be an employee of the district
• Serve as financial liaison to HHSC and STAIRS
• Communicate with all key stakeholders (RMTS
  contact, Special Education department, SSA/Co-op
  contacts, etc.)
• Attend MAC financial training for each Federal
  fiscal year
• Ensure that the MAC financial data is certified
  each quarter in STAIRS
• Ensure the Quarterly Summary Invoice is signed
  and notarized by the proper individuals
• Maintain financial documentation and supporting
  materials
• Must be listed as the primary MAC Financial
  Contact on the MAC Program Operating Plan and in
  STAIRS
• Ensure all contact information is current and
  accurate

16
Documentation Recordkeeping Requirements

• Participation documents (Contract, MAC POP, etc)
• The following is a checklist of the minimum
  documents to collect and maintain quarterly
• Financial data used to develop the expenditures
  and revenues for the claim calculations including
  state/local match used for certification
• Copies of computations used to calculate
  financial costs
• All revenues offset from the claim, by source
• Quarterly Summary Invoice (signed notarized)
• Roster of eligible individuals, by category,
  submitted for inclusion of RMTS (Participant
  List)

17
Documentation Recordkeeping Requirements (cont.)

• Information must be available upon request by
  federal or state entities.
• Documents must be stored in a readily accessible
  location format.
• Records should be maintained for a period of no
  less than five (5) years or if an audit has
  started, the records shall be retained until the
  audit is completed and all issues are resolved.

18
Training

• Primary and secondary contacts should be trained
  for every Federal fiscal year (FFY).
• Initial and Refresher training options
• Having more than one trained MAC financial
  contact is highly recommended.
• MAC Financial Contact Role
• Training is from FFY to FFY.
• Not retro-active
• Switching Districts
• Full Access vs. View Only

19
Random Moment Time Study (RMTS) Overview
20
MAC Quarterly Process
1
2
3
4
Todays Main Focus
21
Participant List Allowable Salary Costs

• The district identifies eligible participants at
  the beginning of each quarter via the
  Participant List (PL).
• Costs reported are position-specific not
  person-specific.
• Substitutes - Individual replacing a provider on
  leave
• Direct replacement - Individual hired to fill a
  vacant position
• These are the only positions for which financial
  data can be reported.
• Positions and categories left off the Participant
  List cannot report their costs for that quarter.

22
Participant List (cont.)

• The Participant List drives the number of
  eligible MAC participants and determines the MAC
  financial cost eligible.
• If a Participant List is not certified for a
  quarter by a district, that district will not be
  able to participate in RMTS and will not be able
  to report MAC costs for that quarter.
• The results of the time study are the basis for
  the calculation of the administrative time study
  percentage that is used during the MAC financial
  process to allocate costs to the Medicaid program.

23
Ineligible Participants MAC Only Category

• Overhead costs/indirect costs are captured in the
  Indirect Cost Rate (IDCR) on the claim
• Salaries for staff in accounting, budgeting,
  payroll, human resources, purchasing, and
  employee relations are generally indirect costs
• Ineligible participants include
• Function 41- General administration
• Function 53- Data processing services

24
MAC Participation Requirements

• MAC financial quarters will not be opened unless
  the following requirement are met
• Active contract with HHSC
• An Intergovernmental Cooperation Agreement must
  be filed and executed with HHSC in order to enter
  financial expenditure information.
• Approved MAC Program Operating Plan
• Received MAC / RMTS training for the FFY
• Certified Participant List for that quarter
• Required RMTS participation must be satisfied for
  the quarter in which the claim is filed.
• If you are unable to access the quarter, please
  contact the MAC team.

25
Important Dates for MAC

• Federal Fiscal Year 2013
• Federal Fiscal Quarter Financials
  Open Financials Close
• (6 p.m. CST)
• 1st Quarter (Oct Dec) February 18, 2013 April
  5, 2013
• 2nd Quarter (Jan Mar) May 27, 2013 July 12,
  2013
• 3rd Quarter (Apr Jun) August 19, 2013 October
  4, 2013
• 4th Quarter (July Sept) November 25,
  2013 January 10, 2014

Claim must be certified and must upload QSI in
the system by deadline.
26
MAC Financial Data Collection

• Interim billing is not a MAC requirement
• Where to enter financial data?
• Electronic Reporting
• MAC financial reporting will be completed
  entirely online via the State of Texas Automated
  Information Reporting System (STAIRS) located on
  the Fairbanks LLC website.
• Who can enter data?
• Trained MAC Financial Contacts

27
Financial Data

• District Employee Salaries/Wages
• Position must be included on the Participant List
  for that quarter
• Perform MAC activities
• Payroll Taxes Benefits
• actual costs only
• Set aside/reserved funds are not actual costs
• TRS on behalf of payments are not actual costs
• Contractor Payments
• Position must be included on the Participant List
  for that quarter
• Perform MAC activities
• Federal Revenues (Federal revenues offset
  expenditures)

28
District Employees

• Compensation of employees
• Wages and salaries
• Subject to federal withholdings
• Reconcile back to general ledger

29
District Employees (cont.)

• Quarterly salaries/wages for the individuals on
  the participant list
• Federal Fiscal Quarters October-December,
  January-March, April-June, July-September

30
Position Specific Example

• Example Position 85 had the following employee
  changes
• throughout the quarter
• Employee A works Jan 1st thru Jan 19th, earns
  800.
• Substitute A works Jan 20th thru Feb 28th, earns
  1,200.
• Employee B works March 1st thru March 31st, earns
  1,500.
• The Total MAC Reportable Expenditure for Position
  85 is 800 1,200 1,500 3,500.

31
Detailed ReportingPayroll Taxes Benefits

• Examples of Employer-Paid Benefits
• Health Insurance
• Life Insurance
• Medicare
• Employer 403(b) Contribution
• Liability Insurance
• Workers Compensation
• Unemployment Compensation
• Social Security

32
Payroll Taxes Benefits (cont.)

• Only Report True Expenditures
• If your district incurs an insurance cost
  (premium paid), the district is entitled to
  report the cost incurred during the quarter.
• If your district is self-insured and pays a third
  party administrator for claim administration,
  the district is entitled to report the cost
  incurred for administrative fees and claims paid
  during the quarter.
• The district should not report any assumed
  liability such as set-aside funds, the cost
  should reflect the true expenditures of the
  district.
• Teachers Retirement System (TRS)
• Only costs to the district are allowable
• On behalf of retirement payments cannot be
  claimed
• Please ensure that you maintain documentation
  that the costs were actually paid by the ISD.

33
Employee vs. Contracted Staff

• Employee Full-time and Part-time
• Providers hired by the district On payroll
• Listed on participant list as Full-time employee
  or Part-time employee
• Report costs under Employee Salaries and
  Payroll Taxes and Benefits columns and
  Federal Revenue column if appropriate
• Contracted Staff
• Not employees of the district on Accounts
  Payable
• Either outside vendor or through SSA/Co-op
  (fiscal agent)
• Listed on participant list as Contract
• Report costs under Contracted Staff Costs
  column and Federal Revenue column if
  appropriate

34
Contracted Staff (cont.)
35
Contracted Staff (cont.)

• Ensure participant list is up-to-date (employment
  type is correct)
• Request breakdown of costs on invoice from the
  contractor to ensure the number of positions you
  are claiming and to place the costs in the
  correct categories

36
Federal Revenues

• Identify ALL federal funded positions on the
  participant list.
• Report (state, local, federal) position costs
  in the Employee Salary, Payroll Taxes Benefits
  and Contracted Staff columns as appropriate.
• The Federal Revenue column is used to subtract
  the Federal portion of costs that were included
  in the Employee Salary, Payroll Taxes Benefits
  and Contracted Staff columns.
• Example

37
Federal Revenues (cont.)

• Federal funds include, but are not limited to
• Federal Grants
• Matching Funds
• ARRA/Stimulus Funds
• NOTE MAC and/or SHARS funds are considered
  reimbursement funds and are not required to be
  backed out of the MAC financial claim as revenue
  offset.

38
Federal Revenues (cont.)

• To maximize federal revenue sources, it is
  recommended that MAC providers are funded with
  state/local funds.
• The system will automatically calculate the
  Local/State Net Expenditures (Gross Salaries less
  Federal Revenue).

39
What if my ISD is in an SSA/Co-op?

• The fiscal agent can only report costs for the
  students enrolled in the district serving as
  the fiscal agent. All shared costs must be
  allocated to each of the member districts.
• For example, if a member district contributed
  15.75 of the budget, that district would be
  allocated 15.75 of the paid hours and payroll
  costs for each staff person.
• Allocation of costs based on budget contribution
  is only one way in which a fiscal agent may
  choose to allocate costs.
• IMPORTANT Allocation methodologies used to
  distribute shared costs to member districts of an
  SSA/Co-op must be documented and presented to
  HHSC upon request.
• Allocation methodologies should appropriately
  reflect the level of direct service costs
  associated with the students enrolled in each
  district.

39
40
What if my ISD is in an SSA/Co-op?

• Determination of enrolled per TEA
• While it is true that multiple districts may be
  involved in the provision of special education
  and related services to a student with
  disabilities, only one district can report Public
  Education Information Management System (PEIMS)
  data on a student, so it is our position that the
  SHARS-related billing should be through the
  district that is reporting PEIMS data.
• Additional information may be found in the
  Student Attendance Accounting
• Handbook (SAAH) at
• http//www.tea.state.tx.us/index4_wide.aspx?id77
  39menu_id645menu_id2789

40
41
Regional Day School Program for the Deaf (RDSPD)

• If host district reports all the students on
  their PEIMS data
• Host district will report 100 of the salary and
  benefits of the providers for the RDSPD.
• Allocation of costs not required
• Member districts will not report any costs
  associated with the RDSPD.
• Contact HHSC regarding district-specific
  questions.

42
Functional Reporting

• There are two options to enter financial data
• Participant Details
• Detailed basis by individual position
• Group Summary Schedule
• Summary of costs by category
• Refer to the participant list
• Financial detail by position/individual must be
  kept on file
• Enter Total Employees Total Contractors claimed
  that quarter

43
Financial Tips

• Refer back to the certified participant list for
  the quarter.
• The participant list is available in advance.
• Do NOT make adjustments from prior quarter with
  current quarter.
• Contact HHSC to correct a prior quarter.
• Not necessary to mail the MAC financial
  supporting documentation each quarter. However,
  the district is required to maintain the
  financial data and the records must be made
  available upon request from state or federal
  entities.

44
Detailed Explanations System Edits

• STAIRS is designed to perform various edits
  checks depending on the data entered.
• Explanation of variances are required.
• Provide a concise explanation as to why a costs
  increased or decreased, etc.
• Helps find possible errors and allows ISD to
  correct the current financial report before
  certifying the data.
• Contact HHSC if a data entry error occurred in a
  previous quarter.

45
Example Quarterly Summary Invoice(QSI)
46
Quarterly Summary Invoice (QSI)

• Signing the Quarterly Summary Invoice certifies
  that the following items are true and correct
• I am the officer authorized to submit this form
  I have examined this statement and to the best of
  my knowledge and belief, the expenditures
  included in this statement are based on the
  actual cost of recorded expenditures
• The required amount of State and/or local funds
  were available and used to pay for total
  computable allowable expenditures
• This statement is of expenditures that the
  undersigned certifies are allocable and allowable
  to the State Medicaid program
• I understand that this information will be used
  as a basis for claims for Federal funds and
  falsification and concealment of material fact
  may be prosecuted under Federal or State civil or
  criminal law.

47
Quarterly Summary Invoice (cont.)

• Have the proper employee of the district sign the
  Quarterly Summary Invoice (QSI).
• Per the RMTS/MAC Implementation Guide effective
  April 25, 2007 pg. 17 Certifier must have
  signature authority which includes the Chief
  Executive Officer (CEO), Chief Financial Officer
  (CFO) Executive Director (ED), Superintendent
  (SI) or other individual (district employee)
  designated as the financial contact for the ISD.
• Printing on letterhead is not necessary.
• Ensure that the Signer and Notary dates are the
  same. The notary language on the QSI reads This
  instrument was acknowledged before me. This
  means that the date signed by the Signer and the
  Notary must be the same.
• The Notary should not be writing his/her name in
  the field marked Printed Name of Officer of
  Provider.
• The district must keep the QSI onfile.

48
MAC Claim Calculations
Cost Pool Net Expenditures Claimable Percentage Claim Amount Total Federal Share 5 Retention Net Claim
Cost Pool 1
Cost Pool 2
Direct Service Admin
Administrative Only
49
Claimable Percentage

• RMTS Results
• State-wide, quarterly
• Ratio developed for Cost Pool 1 and Cost Pool 2
• Medicaid Eligibility Rate (MER)
• District-specific, quarterly
• Percent of students in district who are Medicaid
  eligible
• Unrestricted Indirect Cost Rate (IDCR)
• District-specific, annually
• Developed by TEA

50
Random Moment Time Study (RMTS) Results

• Identifies reimbursable and non- reimbursable
  time.
• Used to identify the percent of time providers
  are participating in MAC activities (as well as
  participating in direct medical services). Each
  cost pool has separate and different time study
  percentages. The MAC financial claim is
  calculated for Cost Pool 1 and Cost Pool 2
  using their relevant cost and time study
  percentages.

51
Medicaid Eligibility Rate (MER)

• The Public Education Information Management
  System (PEIMS) enrollment data for the current
  school year is submitted to TEA by each district.
• The Medicaid eligibility files for each quarterly
  period is gathered by HHSC.
• The Medicaid eligibility data is sent to TEA for
  use in the developing the MER.
• TEA develops an unduplicated Medicaid eligibility
  file from the quarterly files provided by HHSC.
• The unduplicated Medicaid eligibility file is
  matched against the PEIMS enrollment data. There
  are 2 matches performed 1) first is a match
  based on Social Security Number (SSN), 2) for
  those who do not match based on SSN, a second run
  is performed based on first name, last name and
  date of birth.
• The total number of matches divided by the total
  number of enrolled students (by district) becomes
  the districts quarterly MER.

52
Indirect Cost Rate (IDCR)

• Must have an approved IDCR from the Texas
  Education Agency (TEA)
• How can your district get an IDCR?
• Submit an Exhibit J-2, Schedule of Expenditures
  for Computation of Indirect Costs
• Located in districts official audited Annual
  Financial Report (AFR)
• A new indirect cost rate must be obtained every
  fiscal year.
• Helps ISD recover some of indirect costs
• CMS approved use of unrestricted IDCR
• Charter schools that need an IDCR should contact
  TEA Division of Federal Program Compliance

53
STAIRS (Fairbanks) System Demonstration
54
MAC Claim Desk Review

• Utilized to ensure integrity and accuracy of the
  claim data
• Discrepancies brought to the attention of primary
  MAC financial contact identified in the system
• HHSC will contact ISD requesting explanation,
  clarification, and/or correction of discrepancies

55
MAC Reimbursement

• Timeframe for reimbursement
• MAC reimbursements are Title XIX Medicaid
  administrative reimbursement funds
• Not considered ARRA funds
• Are subject to the Single Audit Act
• MAC reimbursement is recommended to be used to
  enhance the provision of health services and/or
  improve and/or expand the level and quality of
  health/medical services provided to all students
  within the district.

56
STAIRS Reminders

• Passwords will not change each school year.
• If you forget your password, you can reset it at
  the log-in screen.
• Fairbanks can consolidate username/passwords for
  contacts with multiple ISDs.
• You will be able to access historical data.
• Messages (Warnings) are highlighting areas where
  there may be an issue.
• All reference material is on the website.
• Contact Fairbanks regarding system issues.

57
Allowing E-mail Messages

• Communication is done predominantly via e-mail.
• Role in Fairbanks dictates what messages you
  receive.
• Critical that your district authorize your e-mail
  system to accept emails from Fairbanks.
• Confirm with your IT staff to make sure that
  e-mails with info_at_fairbanksllc.com,
  _at_hhsc.state.tx.us, and _at_tea.state.tx.us
  extensions pass through firewalls and spam
  filters.

58
Managing Contacts in STAIRS

• Primary contacts can
• Add and/or delete contacts
• Assign additional roles to contacts
• Restrict access of trained contacts
• Only one primary contact per role
• Unlimited number of secondary contacts
• Contact Fairbanks if you are having any issues

59

• School Health Related Services (SHARS) Overview

60
Wrap Up

• If you are not listed in STAIRS as a contact,
  then you cannot receive credit for completing
  this training.
• Primary contact at the district can add you to
  STAIRS
• There are no certificates for training.
• You will receive an email thanking you for
  attending todays training however, this does
  not mean that you received training credit.
• Training credit can be viewed in STAIRS.
• MUST filter appropriately
• Can print screen to keep for your records
• A maximum of 7 days processing time is required
  after attending training before the session
  attended will be listed next to the contacts
  name and the status column will then show full
  access.
• Once full access is indicated, you will be able
  to update/certify the MAC financial data.

61
MAC Website

• http//www.hhsc.state.tx.us/rad/
• Select
• Medicaid Administrative Claiming (MAC)
• Independent School Districts (ISD)
• MAC Guide
• Participation Documents
• Frequently Asked Questions
• Training Materials
• Important Notices

62
Additional Resources

• CMS Medicaid School-Based Administrative Claiming
  Guide
• Office of Management Budget (OMB) Circular A-87
• Title 45 Code of Federal Regulation (CFR) Part 74
  and 95
• Title 42 CFR 430.1 and 42 CFR 431.15
• Title 19 of the Social Security Act, section
  1903(a)(7)
• General information regarding Texas Medicaid
  Program
• http//www.hhsc.state.tx.us/medicaid/

63
Common Acronyms

• MAC Medicaid Administrative Claiming
• SHARS School Health Related Services
• CMS Centers for Medicare Medicaid Services
• HHSC Health Human Services Commission
• TEA Texas Education Agency
• HIPAA Health Insurance Portability and
  Accountability Act
• FFP Federal Financial Participation
• TIN Texas Identification Number (formerly known
  as TPIN Texas Payee Identification Number)
• POP Program Operating Plan
• RMTS Random Moment Time Study
• TS Time Study
• PL Participant List
• STAIRS State of Texas Automated Information
  Reporting System (formerly known as Fairbanks)
• FFY Federal Fiscal Year
• MER Medicaid Eligibility Rate
• IDCR Indirect Cost Rate
• PEIMS Public Education Information Management
  System
• RDSPD Regional Day School Program for the Deaf
• QSI Quarterly Summary Invoice

64
Contact Information

• Medicaid Administrative Claiming
• Ph [phone] Email
  MAC_at_hhsc.state.tx.us
• Yvonne Moorad (Team Lead)
• Jessica Makdsi
• Texas Education Agency Division of Federal
  Program Compliance
• Ph [phone] Email
  FPC_Compliance_at_tea.state.tx.us
• STAIRS (Fairbanks, LLC. )
• Ph [phone] Email
  info_at_fairbanksllc.com