IDAHO IS NOT AN ADMINISTRATIVE CLAIMING STATE
•The Idaho Department of Health and Welfare currently has
Divisions that conduct these Administrative activities, therefore it would be duplicative billing which is not allowed under Administrative Claiming.(Medicaid School-Based Administrative Claiming Guide, May 2003, CMS)
•Concerns brought forth by Sally Richardson, Director of Center for Medicaid and State Operations, Health Care Financing Administration. June 17, 1999
•Some school-based providers are not adequately documenting Medicaid administrative claims;
•Some school-based providers are including administrative activities related to services that Medicaid does not cover or for services to children who are not eligible for Medicaid; and
•Some school-based providers may have claimed the same administrative costs twice by including activities that have already been paid for as part of the Medicaid service itself or by the State or local school district under the Individuals with Disabilities Education Act.
•Administrative Claiming would increase current work for school personnel
•Administrative Claiming is managed by a time study submitted to Medicaid by schools on a quarterly basis, but must be documented on a monthly basis, this time study must be approved by CMS.(Medicaid School-Based Administrative Claiming Guide, May 2003, CMS)
•Administrative Claiming would increase Medicaid’s oversight of this provider(Medicaid School-Based Administrative Claiming Guide, May 2003, CMS)
Medicaid School-Based Administrative Guide, May 2003, CMS
Examples of allowable/unallowable activities for Administrative Claiming
Allowable Activities / Unallowable Activities- Medicaid outreach activities to inform students and their families about the availability of Medicaid
- Administrative activities must be necessary “for the proper and efficient administration of the Medicaid State Plan”
- Assist families in applying for these programs
- Facilitating Medicaid eligibility determinations
- Medical/Medicaid related training and general administration
- IE: Outreach explaining Medicaid requirements, offering, arranging AND furnishing of family planning services
- Medicaid intake processing
- Medicaid preadmission screening for inpatient care
- Prior authorization for Medicaid services
- Utilization review
- Coordination of medical/dental/mental services
- Patient follow-up, patient assessment, patient counseling, patient education, parent consultation, billing activities
- The school cannot provide activities that are already being offered or should be provided by other entities, or through other programs.
- Medical and other direct services
- Medicaid administrative activities must not duplicate payments that have been, or should have been, included as part of a direct medical service.
- Providing care, treatment, and/or counseling services to an individual
- Activities which are conducted for the purpose of fulfilling education-related mandates under the IDEA are not allowable as administrative costs under the Medicaid program.
- Child Find
- Initial evaluations and reevaluation
- Individualized Education Program (IEP)
- Explaining the eligibility process for non-Medicaid programs, including IDEA.