CMS Guidance for Billing Medicaid During COVID-19
We just received an official
bulletin from CMS that contains some very important information for
districts that are billing Medicaid during the pandemic. Specifically, the
bulletin answers questions about RMTS, which I have excerpted below.
Overall, we understand that States are getting considerable
flexibility from CMS with regards to the delivery and reimbursement for
school-based Medicaid services. For example, States are getting permission to
use RMTS data averaged over two quarters for this quarter or are being allowed
to use last quarter’s RMTS data for this quarter. Some are still requiring time
studies, but doing so on a much more limited basis.
Beyond waivers, several states have passed emergency rules
that clarify that the provision of Medicaid reimbursable special education
services can be done via any modality for reimbursement except text or email.
This is also very helpful and allows districts to continue maximizing their
reimbursement.
On the whole, it appears CMS is granting whatever
flexibility States are asking for, so if districts in your state require
additional flexibility for Medicaid reimbursement they should be talking with
their SEAs and State Medicaid offices and asking for it.
Third
Party Questions and CMS Responses:
If
school is in session but being conducted remotely, for the purposes of the
Random Moment Time Study (RMTS) used in allocating Medicaid administrative
cost, please confirm that eligible RMTS school staff may continue to respond to
their sampled RMTS moment indicating their activity for their sampled date and
time (even if they were working remotely).
Yes,
even though the participant is working remotely, he or she may respond to the
sampled RMTS moment.
For those individuals sampled for the
RMTS who are not working, please confirm that the state or school district can
report the time as paid or unpaid time not working.
For
those individuals who are sampled, but are not working, the sample moment
should be coded to paid time not working if they are salaried, or unpaid time
if they are furloughed without pay or in some other unpaid status at the time
of the sample moment. The moments that are coded to paid time not working
should be reallocated across the other activity codes and a portion of the
costs recognized.
The current Medicaid Administrative
Claiming (MAC) Plan provides guidance for a situation when 85% percent RMTS
compliance isn’t reached, by allowing moments to be coded as non-Medicaid until
compliance is reached. However, the plan also requires individual
districts to reach 85 percent RMTS participation or potentially incur penalties
and/or non-participation in claiming. Would CMS be willing to NOT impose
individual district penalties while the school districts are working remotely
during the pandemic?
We recognize that RMTS overall staff
participation may be affected by the COVID-19 pandemic. During the
timeframe of the declared Public Health Emergency, CMS would not ask states to
impose any individual district penalties for districts that do not reach 85
percent RMTS participation. States could modify the MAC Plan to
temporarily suspend this requirement during the public health emergency.