MSB is examining our business model for providing School-Based Medicaid billing, administration and consultation services in Maine. We continue to assess our budget, resources and services that we currently provide to LEAs across Maine and those services that we intend to provide in the future. MSB is making every effort to continue to provide additional support and service to Maine LEAs at an affordable, equitable cost to districts. We believe we can provide additional support that will both ease the administrative burden on LEAs while increasing the rate of reimbursement that LEAs are currently receiving.
Our intent is to provide additional resources and support to districts by altering our future agreements with respect to the fee structure that we are currently offering. In the near future, when we propose new or renewal agreements to be considered by LEAs, instead of offering a "per student" fee structure, we plan to offer a fee structure that is based on a percentage of the amounts that districts are actually receiving from MaineCare/Medicaid, GPA included. Remember, districts are now receiving both the federal portion they have always received for Medicaid reimbursement plus a state amount that is netted from GPA funding to districts. At this time, we are expecting to offer a 10% effective rate as our fee in year 1. Our goal is to reduce that percentage when and where feasible. Whether we utilize a simple percentage fee, include a hybrid where part of the 10% is a fixed, per student fee, or once again utilize a per student fee - any of these options will be negotiable when it comes time to negotiate a formal agreement with each LEA.
In exchange for the 10% effective rate, MSB will continue to provide the services we are providing now, plus proposed enhanced services which can be found in the attached exhibit.
In order for this fee structure to be sustainable for MSB, it will require a certain level of participation by Maine LEAs. We are therefore requesting that you respond to my attention, in writing by Friday, March 1st with your level of interest in once again entering into an agreement with MSB for Medicaid administration.
This letter and your response are not binding to either MSB or the LEA, and all terms and conditions would be negotiated at the time of the agreement.
If you would like to discuss this letter, the LEA's intentions or any other topic related to School-based Medicaid and how MSB can help your district, please feel free to give me a call or send me an email. We would enjoy the opportunity to come meet with you.
Director of Client and Business Services
Current Services Offered by MSB:
- Comprehensive Claiming Services
- HIPAA compliant, electronic claims submission process
- Claims adjustments when needed
- Re-submission of denied claims
- Quality assurance and testing of claiming process
- Web-based progress note/service documentation system
- Lumea™ collects service documentation data that satisfies MaineCare progress note requirements
- Lumea™ caseload reporting provides utilization information about service providers
- Lumea™ electronic signatures and data collection eliminates paper-based reporting
- Audit support and consultation
- In the event of state or federal audits, MSB assists the district in understanding and collection of necessary data
- Throughout the audit process, MSB consults and assists with providing information, rationale and support for billing
- When there are findings, MSB helps the district effectively respond by providing written responses to findings that are based on policy and technical guidance
- Regulatory Consultation and Training
- MSB provides both on-site and regional training and forums to educate LEAs as to program requirements
- Website with guidance, forms, templates, checklists, etc. to assist LEAs with MaineCare requirements
- Program Specialists and Claims Analysts available for all needs and requests by LEAs
- Liaison with MaineCare, Department of Education and other relevant agencies
- Administrative Support
- Available to assist with administrative needs with respect to "maintenance" of Lumea, MIHMS, APS, etc.
- Troubleshoot issues with MIHMS and work with State officials to ensure a smooth, compliant billing process
- Customer Care available to all administrators and service providers via chat, toll free phone and email
Proposed Enhanced Services Offered by MSB:
- List of Excluded Individuals and Entities (LEIE) checking: Medicaid providers of all types, including LEAs, are required by law to check the LEIE to ensure the LEA is not submitting claims for any staff that are excluded from participation in federal reimbursement programs. MSB is making plans to assist with the preliminary match process
- Enhanced Audit Support: Given the likelihood that MaineCare will continue to conduct unprecedented audits of school-based claiming, MSB is preparing to provide additional support to assist LEAs throughout the audit process
- Additional field staff to provide additional on-site support, training and administrative assistance to LEAs
- Additional office staff to expand and formalize our administrative support including:
- MIHMS maintenance
- Updating provider information and credentials
- Updating service locations
- Lumea maintenance
- Adding parent consent data
- Updating provider credential data
- Updating student data
- Updating user data
- Updating provider caseloads
- Updating diagnosis codes and APS registration information (section 28 & 65)
- Eligibility tracking to determine MaineCare eligible students
- Registering students with APS for sections 28 & 65
- Adori™ special education management system is offered as a free additional service under this model
- MSB's standard Section 504 forms module is offered as a free additional service under this model