|
Volume 13 Number 2 News: Medicaid The Congressional Research Service Dec. 20, 2007, released a summary of a Centers for Medicare & Medicaid Services final rule that eliminates Medicaid payments for administrative activities performed by school employees or contractors, and for transportation of students from home to school. In addition to physical, therapy, and other health related services for students covered under the Individuals with Disabilities Education Act (IDEA), the Medicaid program also historically has paid for administrative activities that school employees perform, such as Medicaid enrollment and medical care coordination, wrote report author Elicia J. Herz, a CRS specialist in social legislation. In late December CMS released a final rule, however, that the agency said would save $3.6 billion in federal funds over five years by eliminating payment for administrative services, such as outreach, service coordination, and referrals. The rule also eliminates reimbursement for transportation to and from school for students who previously received the transportation services under their individualized education plan (IEP) or individualized family service plan (IFSP) (No. 246 HCDR, 12/24/07 a0b5p2v2q1). CMS will continue to pay for medical services under the IDEA and to transport students to get medical services, according to the CRS report, Medicaid and Schools. Reimbursement Concerns President Bush voiced concern about transportation and administrative activities in his fiscal year 2007 budget request, Herz wrote. She added that Congress first requested Government Accountability Office reports on Medicaid billing for school-based administrative services in 1999. Among concerns the GAO identified in reports in 1999 and 2000 were the practice of schools hiring private contractors to help with Medicaid billing, who then were paid contingency fees "as high as 25 percent of federal payments," Herz wrote. In 2007, audits of 22 states by the Office of Inspector General at the Department of Health and Human Services found similar concerns, the author wrote. The OIG reported problems including Medicaid billing for transportation when another Medicaid-covered school service other than transportation was not provided on the same day, and billing when transportation services were not included in the student's IEP or IFSP. Examples of improper Medicaid billing for administrative services related to Medicaid functions included payment to employees who did not perform Medicaid administrative services and payment for nursing supplies, non-Medicaid outreach supplies, and education-related expenditures. Opposition to Rule The proposed rule was released Aug. 31, 2007 (No. 170 HCDR 9/4/07 a0b5b7b5d0). Herz wrote that education and groups that deal with Medicaid beneficiaries say the rule would limit access for needed health services for children. These groups also say the rule is inconsistent with decades of approved state Medicaid plans. Opponents further say that "additional federal funding for existing programs like IDEA or other appropriations to offset these Medicaid cuts are unlikely to be on the horizon," Herz wrote. The final rule was issued after the proposed rule underwent a 60-day public comment period ending Nov. 6, according to CMS. Congress approved a six-month moratorium delaying implementation of the rule until June 30. The moratorium was included in the Medicare, Medicaid, and SCHIP Extension Act of 2007 (S. 2499) that the President signed into law Dec. 29, 2007 (No. 1 HCDR 1/3/08 a0b5p7n8g9). To order the CRS report, "Medicaid and Schools," for a fee, call BNA PLUS at 800-372-1033, or e-mail bnaplus@bna.com.
|
