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Medicaid Administrative Claiming (MAC)


Medicaid Administrative Claiming (MAC) Random Moment Time Study and Financial Reporting Training New York State Department of Health January 2013 – PowerPoint PPT presentation

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Title: Medicaid Administrative Claiming (MAC)

Medicaid Administrative Claiming (MAC)
Random Moment Time Study and Financial Reporting
  • New York State Department of Health
  • January 2013

  • Introduction to Medicaid Administrative Claiming
  • Random Moment Time Study (RMTS) for MAC
  • MAC Claim Calculation
  • Important Dates
  • Contacts and Questions

Introduction to Medicaid Administrative Claiming
  • Schools provide an array of health-related
    (medical) services in addition to traditional
    educational services to ensure that students
    are able to fully participate in the school
    environment. These direct medical services form
    the basis for the Medicaid School Supportive
    Health Services Program (SSHSP).
  • As school staff work with students on a daily
    basis, they are uniquely positioned to assist in
    enrollment of eligible students in Medicaid, to
    assist them in receiving the medical services and
    supporting administrative and outreach services
    they require, and to provide medically-necessary
    services. These administrative services form the
    basis for the Medicaid Administrative Claiming
    (MAC) Program.
  • Currently, school districts only receive Medicaid
    reimbursement for direct services based on a fee
    for service model with an annual cost settlement
  • School districts do not currently receive any
    reimbursement for the administrative functions
    associated with providing these services.

Medicaid Administrative Claiming (MAC) Overview
  • Through the MAC program, school districts can
    receive reimbursement for the costs of
    administrative and outreach activities that
    support the Medicaid program
  • Allowable MAC activities include
  • Facilitating Medicaid Outreach
  • Facilitating Medicaid Eligibility Enrollment
  • Translation Services Related to Medicaid Services
  • Medical Program Planning, Policy Development, and
    Interagency Coordination
  • Medicaid-Related Training and Professional
  • Referral, Coordination and Monitoring of Medicaid

MAC Participation Requirements
  • School districts can receive MAC reimbursement by
    meeting 3 main program requirements
  • Participate in SSHSP.
  • Participate in the quarterly Random Moment Time
    Study (RMTS) (a requirement to participate in
  • Submit quarterly financial data to be used in
    calculating the MAC claim.
  • Most school districts are already meeting the
    requirements of participation in SSHSP and in the
    quarterly RMTS.
  • School districts meeting the first two
    requirements need only to complete and submit
    quarterly financial data in order to access MAC

Participating in MAC
  • School districts that are currently participating
    in SSHSP and in the quarterly RMTS are eligible
    to receive MAC reimbursement for their direct
    service practitioners.
  • These school districts will need to complete a
    quarterly MAC financial submission in order to
    generate a MAC claim for their district.
  • MAC claims for the October December 2012 and
    January March 2013 will only include direct
    service practitioners included on the quarterly
    RMTS rosters.
  • School districts that are currently eligible to
    receive MAC reimbursement will have the
    opportunity to add new, Administrative Only staff
    to a new RMTS roster starting with the April 1,
    2013 quarter.
  • MAC claims starting with the April June 2013
    quarter may include both direct service
    practitioners and administrative staff included
    on that quarters RMTS roster.
  • School districts not currently participating in
    SSHSP and the quarterly RMTS are not eligible to
    receive MAC reimbursement at this time.
  • These school districts will need to begin
    participating in SSHSP and the quarterly RMTS
    prior to claiming for MAC reimbursement.

Random Moment Time Study (RMTS)for MAC
Random Moment Time Study for MAC
  • School Districts with employees that provide
    direct services to students are currently
    included in the Random Moment Time Study. They
    are included in two pools
  • Direct Services Therapy
  • Direct Services All Other
  • These cost pools measure the amount of time spent
    on providing direct services to students with an
    IEP as well as time spent performing MAC eligible
  • In the April-June 2012 quarter, a third pool will
    be added to the RMTS for employees that conduct
    Medicaid administrative activities to measure the
    amount of time that employees spend conducting
    Medicaid administrative and outreach activities.
  • Employees can only be included in one cost pool.
    Employees should be included in the cost pool
    that best represents the persons primary
    function and licensure/credentials.

Random Moment Time Study for MAC
  • The RMTS allows for capturing the percentage of
    time spent on administrative activities for the
    both the MAC pool and the direct services pools.

DS - All Other Cost Settlement MAC MAC
DS-Therapy Cost Settlement MAC - MAC Claim
Administrative Staff Pool
  • The following staff categories can be added to
    the Administrative Staff Pool List

Administrators Program Specialists
Counselors Non-licensed Psychologists
Nurses Non-licensed Social Workers
Interpreters Interpreter Assistants Non-licensed Orientation Mobility Specialist
Pupil Support Services Administrators Resource Specialist/Family Liaisons
Pupil Support Technicians Special Education Support Technicians
Psychologist Interns Special Education Teachers
Special Education Administrators Special Education Teachers Aide
School Bilingual Assistants
Non-Allowable Staff
  • The following staff categories are examples of
    staff that are Not Eligible to participate in MAC
    because they are included in the unrestricted
    indirect cost rate calculation

Board of Education Staff Physical Plant Staff
Legal Staff Security Staff
Office of the Superintendent Staff Communications Staff
Executive Administration Staff Information Technology Staff
Chief Business Office Staff Programming Staff
Budgeting/Finance Accounting Staff Telecommunications Staff
Non-Allowable Staff
  • Staff included in the calculation of the school
    districts unrestricted indirect cost rate cannot
    be included on the staff pool list.
  • The cost of these functions are not allowed
    because they unrestricted indirect cost rate is
    used in the calculation of the MAC claim and in
    the calculation of the direct services indirect
    costs for determining Medicaid-allowable costs
  • Staff paid entirely for these functions should
    not be included on the staff pool list
  • Staff paid partially for the functions can be
    included on the staff pool list, as long as their
    other functions are on the allowable list.
  • 100 Federally funded staff Should Not be
    included on any of the staff pool lists.

MAC Claim Calculation
MAC Claim Calculation
  • MAC claims are calculated for each participating
    district on a quarterly basis
  • The claim is based on the state-wide time study
    results for each cost pool.
  • The time study results are applied to district
    specific information such as costs (e.g. salary
    and benefits), Medicaid Eligibility Ratio (MER)
    ratio and the unrestricted indirect cost rate to
    calculate the MAC claim.
  • Each cost pool will be summarized into one total
    claim for each participating district.

MAC Claim Calculation Allowable Costs
  • Only Medicaid-allowable costs can be included in
    the MAC claim.
  • CMS has narrowly defined what costs can be
    reported as Medicaid-allowable costs eligible for
    MAC reimbursement
  • Personnel Services - Salaries
  • Include all costs paid to the participant
    including any additional compensation
  • Employee Benefits
  • Include all benefits paid to staff. Some examples
  • Dental Insurance
  • Health and Accident Insurance
  • Life Insurance
  • Long-term Disability Insurance
  • FICA
  • Medicare
  • Tuition Reimbursement
  • Workers Compensation
  • Teachers Retirement or Other Retirement Payments

MAC Claim Calculation Allowable Costs
  • Materials Supplies
  • Materials Supplies must be identified as used
    by the staff for which they are included
  • Materials Supplies can be identified using a
    reasonable allocation method
  • Some methods include headcount or FTE
  • Staff Travel
  • Costs for specific staff related travel
  • Examples include
  • Mileage
  • Conference related travel expenses
  • Staff Professional Dues and Fees
  • Report by service the total costs for
    professional dues and fees associated with the
    staff listed in the Quarterly Financial Report.

MAC Claim Calculation Non-allowable Costs
  • Non-allowable costs include
  • Federal funds
  • The web-based system requires that total costs be
    reported, with a separate column for reporting
    costs paid with federal funds. The system
    calculates the Medicaid-allowable costs.
  • State flow-through funds are funds received from
    the Federal government by the State of New York
    and then distributed to local districts.
  • Non-federal funds that have been committed as
    local match for other Federal or State funds or
  • Costs included in the calculation of the
    Unrestricted Indirect Cost Rate.
  • Staff who are paid entirely from these area
    should not be included in the staff pool list.
    Direct costs related to staff that are not
    identified as eligible time study participants

MAC Claim Calculation Additional Data Elements
  • In addition to the allowable costs, the MAC claim
    relies on three additional data elements to
    determine the claim amount
  • Administrative RMTS Percentage
  • Calculated based on the results of the quarterly
  • Statewide percentage for each cost pool applied
    to allowable costs to determine what portion of
    the allowable costs are for performing MAC
  • Indirect Cost Rate
  • Each school district has its own indirect cost
  • The indirect cost rate is applied to net direct
    costs (total costs less amount paid with federal
    funds) in order to allow for proper
    identification of indirect costs.
  • Medicaid Eligibility Ratio (MER)
  • School district specific ratio used to apportion
    costs to the Medicaid program.
  • MER is calculated based on the October student
    count data reported by the school districts.
  • MER Total Number of Medicaid Eligible Students
    / Total Number of Students

MAC Claim Calculation Example
Gross MAC costs 500,000
MAC (from RMTS) 15
Subtotal 75,000
Indirect Costs 1.15
Subtotal 86,250
MER Ratio 50
MAC Claim Gross FFP 43,125
FFP 50
MAC Claim Net FFP 21,563
Important Dates
Important Dates
February 28, 2013 MAC Quarterly is Due for the Period October-December 2012
March 1, 2013 Administrative employees are to be added to RMTS rosters
April 1, 2013 MAC pool will be included in the time study
Contacts and Questions
  • Public Consulting Group
  • 1-866-912-2974

Joe Weber Leslie Tremberth Ben Cormack Katie
Crowley Kirsys Cruz
Kyle Stanley Megan Shaughnessy Eric
Miller Sean Huse
Public Consulting Group, Inc. 148 State Street,
Tenth Floor, Boston, Massachusetts 02109 (617)