Business Partner Understanding and Access to Qualification Data

Presentation Transcript

Business Associate Agreement and Access to Eligibility Information September 14, 2010 William Lessard Department of Medical Assistance Services

Purpose of BAA To defend ensured wellbeing data To protect it is utilized for assigned reason

Business Associate Agreement DMAS is outfitting qualification information to class division suppliers School division suppliers consent to utilize this information to Determine the qualification rates for the school cost reports Assist Medicaid, Medicaid Expansion and FAMIS understudies in getting to human services

Components of BAA Data Security Plan Chain of Trust Scope of Work

Data Security Plan Describes methodology for shielding the information May be a different arrangement or part of a current information security arrange If part of a current information security arrange, audit arrangements and consider correcting to allude to Medicaid qualification information

Personnel Costs Track gathered compensation and advantage costs No assessments are permitted Include all agreement costs

Personnel Costs Track finance and contract costs by reserve source Determine % subsidized by state/neighborhood stores, IDEA reserves, other government reserves or other subsidizing sources Only costs supported by state/nearby finances will be conveyed forward for repayment

Non-Personnel Costs Line things Travel Materials and Supplies Capital Costs Indirect Costs

Requirements for Non-Personnel Costs Line things dependent upon CMS endorsement At choice of school division Directly identified with school medicinal administrations (not general supplies) DMAS will give extra direction Documentation required, for example, a devaluation plan Indirect costs just repaid to the degree they are in the backhanded cost rate

Travel Costs Cost acquired by school Cost of therapeutic administrations staff going between schools to convey administrations Recommend that school divisions construct the cost in light of mileage utilizing logs

Material and Supply Costs Not the same as material and supply costs for authoritative claim Directly identified with the conveyance of restorative administrations (not general supplies) 100% allotted to therapeutic administrations DMAS is building up a non-selective rundown in view of DOE School Health and Therapy Guidelines CMS has not yet affirmed programming costs

Capital Costs Major moveables straightforwardly identified with the conveyance of medicinal administrations 100% dispensed to medicinal administrations Cost for the most part over $5,000 and a valuable existence of no less than two years DMAS is building up a non-restrictive rundown in view of DOE School Health and Therapy Guidelines Use straight-line technique Separate deterioration plan Does exclude devaluation for structures incorporated into the regulatory claim

Indirect Costs Use Unrestricted Indirect Cost Rate affirmed by DOE No other aberrant expenses

Tentative Cost Reporting and Settlement Schedule June 30 – End of financial year September 30 – DMAS disperses cost report shapes and different reports November 30 – Deadline to submit cost reports May 31 – Deadline for DMAS to settle cost reports (180 days from accommodation)

Tentative Cost Reporting and Settlement Schedule CMS has requested that DMAS indicate time spans Similar to time allotments for other cost reporting suppliers Open to talk about other time spans

DMAS Cost Settlement Contractor Clifton Gunderson 4461 Cox Road, Suite 210 Glen Allen, VA 23060

Certification CMS requires that open suppliers (school divisions) confirm costs School divisions as of now guarantee costs for the managerial claim Cost report accreditation replaces the Medicaid/FAMIS Program State/Local Match Quarterly Certification (Med-2A through Med 2-G) Final frame to be dictated by CMS

Cost Settlement If DMAS has made interval installments, then the cost report will figure out which party owes the other party

Cost Settlement If DMAS owes the school division, DMAS will pay the distinction in the following settlement If the school division owes DMAS, DMAS can recover the excessive charge either (1) by direct installment or (2) by gathering the excessive charge from future installments that generally would be made (adverse adjust) CMS has not yet endorsed the pessimistic adjust approach

Interim Payments Interim installments will be made for endorsed claims Important to class divisions for income If break installments are too vast, be that as it may, school divisions could owe DMAS extensive sums

Interim Payment Calculations DMAS has not yet decided fitting break rates for the coming monetary year DMAS will utilize managerial asserting data, accessible overview information and Medicaid assert data to suggest a between time rate DMAS will make proposal before the school year starts utilizing moderate suppositions DMAS will work with school divisions, especially little school divisions Large room for give and take until first cost report is settled Future interval rates can be founded on earlier year settled expenses

Interim Rate Calculation Estimated Reimbursement ÷ Estimated Claims = Interim Payment Rate

ProForma Cost Report A school division can set up a proforma cost report for FY2006 DMAS can give evaluations of qualification rates, coordinate administration time contemplate rates and claims paid

School Division Responsibility as far as possible will be the present charges The school division can decide the amount it is paid on an interval premise by the charges it presents A school division can submit charges equivalent to the present rate, the prescribed break rate or a more preservationist break rate Interim installments have no effect on definite repayment

Contact Information DMAS John Jurgens, Health Insurance Reimbursement Specialist, 804-371-2446 or john.jurgens @dmas.virginia.gov DOE Amy Edwards, Medicaid Specialist, 804-692-0150 or amy.edwards@doe.virginia.gov