Medicaid Administrative Claiming for NWD/ADRCs
Presentation for State Level Partner Agencies
About this ToolThisPowerPoint presentation specifically targets engagement of state level partners, such as the Medicaid agency, State Unit on Aging, fiscal and policy staff, or other partners in the NWD System. The presentation template provides a basic outline of information the NWD lead agency could cover. States should adapt these presentations to reflect their own circumstances and desired content.Red textneeds to change to reflect state-specific information.Refer to the Medicaid Claiming Workbook for further guidance
Objectives
Provide an overview of Administrative Claiming for the NWD System and how it benefits the Medicaid AgencyReview the draft approach for developing the infrastructure necessary for claimingDiscuss theMedicaid agency’srole in the processAddress questions and concerns
Medicaid Administrative Claiming Overview
Administrative Claiming provides federal financial participation (FFP), generally 50%, to cover activities that contribute to the efficient and effective administration of the Medicaid programMany local agency functions are potentially eligible for matching Medicaid administrative fundsAdministrative claiming can provide an ongoing, sustainable source of funding forNWDactivities
Medicaid Administrative Claiming for NWD/ADRCs
Endorsed by ACL and CMSSee:https://www.medicaid.gov/medicaid/financing-and-reimbursement/admin-claiming/no-wrong-door/index.htmlAs of March 2017, in place in a number of states - for an updated list, please visitnwd.acl.gov/resources.html
How much do States Claim?
Annual Reimbursements:Tier 1: $0 – $999,999Tier 2: $1,000,000 – $3,999,999Tier 3: $4,000,000 +Reimbursements areusedto expand the capacity ofthe NWDSystem:Training/Staff DevelopmentInfrastructureDispersed across agency staff
OurNWD Systemintegratesandcoordinatesaccess to Medicaid servicesPotentiallyreducesMedicaid costs byusing functions at theADRC/NWDtoidentifyindividuals with long term service needs and goals anddivertthem into non-MedicaidservicesPotentially delayingor preventing Medicaideligibility or spenddownStreamliningenrollment and eligibility process for Medicaid LTSSservicesADRC/NWDmay reduce unnecessary assessments by screening and triagingSupports person-centeredplanningSupports sustainability ofNWD Systeminfrastructure
What’s In It For Our NWD System Partners?
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Key Components of Administrative Claiming Infrastructure
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Phase I: Assess Readiness and Document Medicaid Time
Identify Costs of Allowable and Allocable Activities
Engage NWD System Lead Agency with a State Medicaid Agency Lead
Identify NWD System Activities Potentially Eligible for FFP
Phase II: Develop Agreements and Approvals
Establish Contractual Agreements
Secure CMS/DCA Review and Approval
Identify Permissible Sources of Non-Federal Funds for Match
Proposed Approach for Claiming Infrastructure
Random Moment Time StudyStandardized spreadsheet for establishing cost poolAgencywill oversee the development of the infrastructure and ongoing operations
Approach for Developing the Claiming Infrastructure
Show project plan[Agency Name]will develop and pilot draft codesEstimated timeframe issix months[Agency Name]will develop and work withthe local agenciesto populate cost pool spreadsheets[Agency Name]will develop a quality management approach for both the time study and cost pool
Partner Agency’sRoles
Identify the designated contactto assist with Medicaidclaiming processIdentify otherexisting agencies that areclaimingMightprovide good models or be willing to share infrastructure (e.g.,can amend a contractor have joint procurement for potential time study vendors/contractors)Review of the draft codes and approach for the time studyReview of approach for establishing the cost poolReviewthe quality management approach anddetermine therole ofthe Medicaid agencyAssist indeveloping the MoUSubmitthepackage to CMS
Questions and Concerns?
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