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?