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Questions & Answers pertaining to the Medicaid to Schools Documentation and Billing System dated 11-13-15

Questions & Answers pertaining to the Medicaid to Schools Documentation and Billing System dated 11-13-15

 

Question 1:  Page 4, Item J, the district refers to a “single category vs. discrete services,” what are state definitions of each? 

Answer 1:  The State of NH allows either method when claiming Preschool service. 

·         Single category, “bundled rate” methodology of $40.63, which includes all services provided to student on the date of service;       or  

          Discrete services (i.e. speech, OT, PT, aide, nursing) based on the actual units of covered service provided to student on the             date of service.

Question 2:  Understanding that MSD will respond to vendor questions regarding this RFP on the website, what is the expected                           date to have them posted?

Answer 2:  November 12, 2015 

Question 3:  Will MSD provide a RFP timeline to include evaluation dates, possible vendor demonstration dates, and award date?

Answer 3:  MSD will provide a timeline middle of December 2015-early January 2016.

Question 4:  Two copies of the proposal are required, is this to be 1 original and 1 copy?  Is an electronic copy on CD also                                    required?

Answer 4:  Required: 1 original and 1 copy, no electronic copy required

Question 5:  Does the District use an existing automated Medicaid Management System?  

Answer 5:  No

 If so: N/A

 Which one?

 When did the District install this system and begin using it in everyday use?

 What was the cost associated with the previous/current system?

 What are the reasons for seeking a new system?

 If not: 

How does the district staff currently document their services?  Paper logs?

   Yes, paper logs.

·         With the introduction of this new contract, would the district’s goal be to eliminate all paper logs or will some services still              utilize paper logs (such as transportation, attendant care, etc.)?  

Ultimate goal would be to eliminate all paper logs when and where possible.


Direct Service (IEP) Claims

School Year

Total # Submitted Claims

Total # of Paid Claims

Interim Payment Amount

Cost Reconciliation Payment Amount

Total Recovery

2011 - 2012

 N/A

N/A

N/A

N/A

 $1,489,852

2012 - 2013

 N/A

N/A

N/A

N/A

 $1,450,502

2013 - 2014

 N/A

N/A

N/A

N/A

 $1,559,217

2014 - 2015

 N/A

N/A

N/A

N/A

 $1,512, 500

  

Text Box: Direct Service (IEP) Claims School Year  Total # Submitted Claims  Total # of Paid Claims  Interim Payment Amount  Cost Reconciliation Payment Amount  Total Recovery  2011 - 2012   N/A N/A N/A N/A  $1,489,852 2012 - 2013   N/A N/A N/A N/A  $1,450,502 2013 - 2014   N/A N/A  N/A N/A  $1,559,217 2014 - 2015   N/A N/A  N/A N/A  $1,512, 500

Question 6:  Can you please complete the following table of Medicaid recovery? 

Answer 6:  See above information as requested.

Question 7:  Are there any associated audit findings within the district’s Medicaid program the awarded  vendor should be made                         aware of? 

                      a. Will the district need any assistance with audit preparation?

Answer 7:  Audit finding can be found on OIG website:  http://oig.hhs.gov/oas/reports/region1/11000014.asp

                    Yes, the district will need assistance with audit preparations.

Question 8:  Does the district currently submit claims for all services allowable under the state plan?

                   If not:

                  a. Which services are not currently billed?  

                  b. Would it be the District’s intention to begin submitting claims on all allowable                      

                     services?

Answer 8:  Yes

Question 9:  What services does the district currently seek reimbursement for from <state Medicaid agency>? 

                  a. Which services are not currently billed?  

                  b. Would it be the District’s intention to begin submitting claims on all allowable services? 

Answer 9:  Currently: Nursing services, Occupational therapy services, Physical therapy services, Speech, language and hearing                       services, Psychiatric services, Psychological services, Mental health services, Rehabilitative assistance, Preschool s                         services, vision services, Specialized transportation.

                      Limited Transportation is currently not billed.

                      Yes, it would be the District’s intention to begin submitting claims on all allowable services.

Question 10:  Can MSD please provide the following counts:

                  a. Total students 

                  b. Special education child count

                  c. Special education students with one or more related services 

                  d. How many (approximate) of the District’s special education students are Medicaid  eligible?   

Answer 10:  Total students: MSD: 14,633 students; Tuition students: 633 students

                     Special education child count: 2,783

               Special education students with one or more related service: approximately 1,000 in district;  50 out of district

               How many…are Medicaid eligible: 1,500

Question 11:  Which vendor / product does the district currently use for Special Education / IEP  Management?

                   a. Does the District plan to change vendor products in the foreseeable future?

                  b. Does the District want to set up a data interface between the awarded Medicaid system vendor and the current IEP                           product?

Answer 11:  District currently uses:  New Hampshire Special Education Information System (NHSEIS)                  

                       No, the District does not plan to change vendor products in the foreseeable future.

                       No, the District does not want to set u a date interface between the awarded Medicaid system vendor and the current                        IEP product.

Question 12:  Does the district’s special education management system have the ability to interface with a web-based Medicaid                            billing system to send student demographics and other information?

                           a. Is the IEP system capable of sending a list of the related services (including scope, frequency, duration) from a                               student’s IEP to a Medicaid system?

                          b. Does the IEP system house and manage treatment plans for student related services?

Answer 12:  No, the district’s special education management system does not have the ability to interface  with a web-based                               Medicaid billing system to send student demographics and other information.

                      No, the IEP system is not capable of sending a list of the related services (including scope, frequency, duration) from                       a student’s IEP to a Medicaid system?

                      No, the IEP system does not house and manage treatment plans for student related services.

Question 13:  How many staff members will be using the system and require training:

                  a. Speech language therapists:  28

                  b. Occupational therapists:  13 

                  c. Physical therapists:  6  

                  d. Mental Health related staff:  50

                  e. Nurses:  28 

                  f. Personal care aides:  300 

                  g. Transportation staff/contracted service:  *

                  h. Other/out of district facilities: * 

                  i. Medicaid coordinators: 1

                  j. Medicaid administrators: 2 

                 *Staff at Easter Seals NH/out of district facilities access to web-based system

Answer 13:  See answers above as indicated.

Question 14:  How would the District want to receive this training?

                 a. Vendor-led classes for all staff members?

                 b. Train-the-Trainer approach where vendor trains a cadre of MSD trainers who would then provide end-user training?

Answer 14:  District would consider both training methods depending on feasibility. District would also consider web-based                               training for subsequent use.

Question 15:  When does MSD wish to begin the implementation process of the awarded vendor/product?

Answer 15:  July 1, 2016

Question 16:  In Section 6, Selection, the second to last point discusses liability insurance as deemed necessary by the district,                                however there is no mention of the amount or form in the RFP. 

                         As this is an RFP for software use, does this point still apply, and if so, what are the district requirements?

Answer 16:  This section does not apply as this RFP pertains to software services.

Question 17:  When is the district looking to being use of the chosen system?

Answer 17:  July 1, 2016

Question 18:  Would you please complete the following table?

 

School Year

Direct Services Revenue

Administrative Claiming Revenue

2012-2013

$ 1,450,502

$ 0

2013-2014

$ 1,559,217

$ 0

2014-2015

$ 1,512,500

$ 0


Answer 18:  See above table for information as requested.

 Question 19:  Is the District currently billing Medicaid for services provided to non-special education students under the CMS                             “free care” policy?

Answer 19:  No

Question 20:  Does the District use a current Medicaid billing provider?  If so:

                 a. What is the name of the organization?

                 b. How long has the District contracted with the current vendor?

                 c. What are the reasons the District is looking for a new vendor?

                 d. What is the District currently paying for these services and the structure of those  payments (percentage, transaction                         fee, annual  amount)?

                 e. Upon contract award, will the current vendor be responsible for continuing to process claims (remittances, denials,                          etc.) for services documented in their system and/or submitted through them?

Answer 20:  No

Question 21:  How many staff members will require training on any new software application?

                  a. Administrators:  2

                  b. Clerical staff:  1

                  c. Service providers:  425

                  d. Transportation staff:  contracted service*

                  e. Other:  out of district facilities*

                  *most feasible method

 Answer 21:  See above for answer.

Question 22:  Does the District have a preference on how staff are trained (classroom, train-the-trainer,  online, etc.)?

Answer 22: District would consider all training methods depending on feasibility.

Question 23:  Do staff members have access to smart phones and/or tablets with which to document  services?

Answer 23:  Staff members have access to Chromebooks and computers.

Question 24:  Does the District currently use a software system to document/track services?  If so, do all  providers document                               their services using this system?

Answer 24:  No

Question 25:  Does the District document any services on paper?  If so:

                 a. Which services?

                 b. Does the District anticipate the continuation of paper documentation?

Answer 25:  Yes

                a. All

                b. Only when needed; ultimate goal is all electronic

Question 26:  Has the District had any previous audit findings regarding their School Medicaid program?  Please detail.

Answer 26:  Audit finding can be found on OIG website: http://oig.hhs.gov/oas/reports/region1/11000014.asp

Question 27:  Are there any services in the State School Medicaid plan for which the District chooses NOT to bill?  If so:

                 a. Which services and why does the District not bill for these services?

                 b. Would the District be interested in billing for all allowable services?

Answer 27:  No

Question 28:  What is the District’s parental consent percentage for the Medicaid billing program?

Answer 28:  Unknown

Question 29:  What is the target day for the contract award?

Answer 29:  July 1, 2016

Question 30:  What is the target “Live” day when the new vendor would begin managing claims for the District?

Answer 30:  September 1, 2016

Question 31:  Does the District’s SIS, Aspen, have the ability to interface via:

                 a. CSV-Yes

                 b. SIF-Yes

                 c. XML-Yes

                 d. Batch-No

                 e. Real-time transactions-No

Answer 31:  See answers as indicated above.

Question 32:  Does Aspen have a published API to retrieve attendance and student demographic information or will the awarded                          vendor be required to work with Follett?

Answer 32:  Awarded vendor will be required to work with Follett.

Question 33:  Does the District have a preference on the interface mechanism between the SIS and the  Medicaid system?

Answer 33:  SIF or XML

Question 34:  III. Term. B (pg. 3) – “The District shall have the option to renew the contract for two  successive 1 year periods                             under the same terms…..”.  What is the initial contract term? One year?

Answer 34:  One year

Question 35:  V. System Requirements. E (pg. 4) – Please detail the payroll information (data fields, volume, etc.) required to be                          uploaded.  In what format will the District’s Munis system provide the data?

Answer 35:  CSV format

Question 36:  V. System Requirements. F (pg. 4) – Does this requirement then require an interface and/or upload of student IEP                             data from the District’s special education management system?  If so:

                   a. Is the District’s special education management system capable of interfacing and providing this information?  

                   b. In what format(s) can the data be provided (SIF, CSV, XML, other)?

                   c. What data transport mechanisms are available?

Answer 36:  No; separate input of student IEP data

Question 37:  V. System Requirements. L (pg. 4) – How do transportation staff document students riding the bus today?  Are all                           students documented or only special education students?

Answer 37:  Transportation paper logs; only special education students are documented.

Question 38:  V. System Requirements. M (pg. 4) – Please describe the District’s meaning for processing transactions                                             “manually.”

Answer 38:  Availability to directly input paper claim into the State of NH-MMIS system.

Question 39:  V. System Requirements. O (pg. 4) – How does the District store these documents today?  Will that method be                                abandoned with the installation of this new system?

Answer 39:  Transaction logs and supporting documents required for program participation are retained in paper form. Ideally, as                        much information retained in one location, within the system is optimal.

Question 40:  Does the District currently file claims for Medicaid reimbursement of services? 

Answer 40:  Yes

Question 41:  Does District currently bill for fee for service? 

Answer 41:  Yes

Question 42:  How many providers does the district have for each type of billable service?

Answer 42:   Billable service providers

a.       Speech, Language & Hearing: 28

b.      OT: 13

c.       PT: 6

d.      Mental Health: 50

e.       Nurse: 28

f.       Paraprofessionals: 300

g.      Vision: 2

Question 43:  Does the District have a dedicated Medicaid staff? 

                 If so:

                 What are their responsibilities? 

Answer 43:   Two (2) dedicated staff

a.       Medicaid Coordinator – Administrative responsibilities, train staff, process claims

b.      Account technician – process claims

Question 44:  Are any physician orders (referrals) required?   

                 If so:

                 Which services require orders?

                 Does the district obtain the orders or will the contract recipient be responsible for orders?

Answer 44:  Yes; District obtains the recommendation/order for services listed below

a.       Speech, Language & Hearing services

b.      Occupational Therapy services

c.       Physical Therapy services

d.      Vision services

e.       Psychological services

f.       Psychiatric services

g.      Rehabilitative Assistance services (paraprofessionals)

h.      Preschool Services

Question 45:  Is there a credentialing process required either for State Medicaid, Department of Health, or any Managed Care                               Organizations for School District and School District Providers? 

                 If so:

                 What parts of the credentialing process will the contract recipient be responsible for? 

Answer 45:  Yes, each discipline has an “Enrolled Provider Qualifications” component.  Contract recipient will not be                                         responsible; the District will obtain all credentials required for billable service providers. 

Question 46:   Does the District use a computerized service documentation system? 

                 If so:

                  Which one?

                  When did the District begin using it in everyday use?

                  Does the district pay a percentage per claim fee, a per user fee, or a fixed amount and  what is this rate? 

                  Is it the intention of the District to continue using this documentation system?  

                  What issues with current vendor led to the RFP? 

Answer 46:  No

Question 47:  What student information systems, IEP management software or other software programs does the district                                        currently utilize and which ones will the recipient of this contract award be required to “interface” with? 

Answer 47:  SIS system:  Aspen, IEP management: New Hampshire Special Education Information System (NHSEIS), Financial                        software: Munis

a.       Interface with SIS system: Aspen

b.      No interface with NHSEIS for student IEP information

c.       Export from Munis to provide billable rate data Question 48:  Do service providers document all services delivered or only services provided to students with Medicaid                                          coverage? 

Answer 48:  Mixture of both at this time, ultimately would like to have a complete record of services provided by service                                    providers.

Question 49:  If the District has participated in filing direct service claims, what was the total amount of  reimbursements by year                        for each of the following years – gross receipts before billing fees?

                 2010-2011 :  $1,542,699

                 2011-2012 : $1,489,852

                 2012-2013 : $1,450,502

                 2013-2014 : $1,559,217

                 2014-2015 : $1,512,500

Answer 49:  See answers as indicated above.

Question 50:  Are there any associated audit findings within the district’s Medicaid program the awarded vendor should be made                           aware of? 

Answer 50:  Audit finding can be found on OIG website: http://oig.hhs.gov/oas/reports/region1/11000014.asp

Question 51:  Does the district participate in Medicaid Administrative Claiming?  

                If so:

                What vendor manages the Random Moment Time Studies? 

                What information will the contract recipient be expected to report, what is the frequency of reporting and to what                             entities? 

Answer 51:  No

Question 52: Does the district receive payments directly from the State Medicaid office for direct service claims? 

Answer 52: Yes

Question 53:  Does the district receive payments directly from any Managed Care Organizations for  direct service claims? 

Answer 53: No

Question 54:  Does the district receive any interim payments as a part of a cost settlement process? 

                 If so:

                 How often does the district pay their current vendor for the billing services? 

                 How often does the district pay their current vendor for the documentation services?

Answer 54:  No

 

 

 

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