Medicaid Administrative Claiming for NWD/ADRCs Overview
Provide a detailed overview of Medicaid administrative claiming for the No Wrong Door/ADRCs system, emphasizing its benefits for state-level partners, the infrastructure development process, and the role of the Medicaid agency. Explore how administrative claiming can serve as a sustainable funding source for NWD activities and address questions and concerns effectively.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
Medicaid Administrative Claiming for NWD/ADRCs Presentation for State Level Partner Agencies About this Tool This PowerPoint presentation specifically targets engagement of state level partners, such as the Medicaid agency, State Unit on Aging, fiscal and policy staff, or other partners in the NWD System. The presentation template provides a basic outline of information the NWD lead agency could cover. States should adapt these presentations to reflect their own circumstances and desired content. Red text needs to change to reflect state-specific information. Refer to the Medicaid Claiming Workbook for further guidance
Objectives Provide an overview of Administrative Claiming for the NWD System and how it benefits the Medicaid Agency Review the draft approach for developing the infrastructure necessary for claiming Discuss the Medicaid agency s role in the process Address questions and concerns
Medicaid Administrative Claiming Overview Administrative Claiming provides federal financial participation (FFP), generally 50%, to cover activities that contribute to the efficient and effective administration of the Medicaid program Many local agency functions are potentially eligible for matching Medicaid administrative funds Administrative claiming can provide an ongoing, sustainable source of funding for NWD activities Slide 3
Medicaid Administrative Claiming for NWD/ADRCs Endorsed by ACL and CMS See: https://www.medicaid.gov/medicaid/financing-and- reimbursement/admin-claiming/no-wrong-door/index.html As of March 2017, in place in a number of states - for an updated list, please visit nwd.acl.gov/resources.html DC Florida Massachusetts Maryland Montana New Hampshire Ohio Oregon Washington Wisconsin Slide 4
How much do States Claim? Annual Reimbursements: Tier 1: $0 $999,999 Tier 2: $1,000,000 $3,999,999 Tier 3: $4,000,000 + Reimbursements are used to expand the capacity of the NWD System: Training/Staff Development Infrastructure Dispersed across agency staff Slide 5
Whats In It For Our NWD System Partners? Our NWD System integrates and coordinates access to Medicaid services Potentially reduces Medicaid costs by using functions at the ADRC/NWD to identify individuals with long term service needs and goals and divert them into non-Medicaid services Potentially delaying or preventing Medicaid eligibility or spenddown Streamlining enrollment and eligibility process for Medicaid LTSS services ADRC/NWD may reduce unnecessary assessments by screening and triaging Supports person-centered planning Supports sustainability of NWD System infrastructure Slide 6
Key Components of Administrative Claiming Infrastructure Phase II: Develop Agreements and Approvals Phase I: Assess Readiness and Document Medicaid Time Engage NWD System Lead Agency with a State Medicaid Agency Lead Establish Contractual Agreements Identify Permissible Sources of Non-Federal Funds for Match Secure CMS/DCA Review and Approval Identify Costs of Allowable and Allocable Activities Identify NWD System Activities Potentially Eligible for FFP Slide 7
Proposed Approach for Claiming Infrastructure Random Moment Time Study Standardized spreadsheet for establishing cost pool Agency will oversee the development of the infrastructure and ongoing operations
Approach for Developing the Claiming Infrastructure Show project plan [Agency Name] will develop and pilot draft codes Estimated timeframe is six months [Agency Name] will develop and work with the local agencies to populate cost pool spreadsheets [Agency Name] will develop a quality management approach for both the time study and cost pool
Partner Agencys Roles Identify the designated contact to assist with Medicaid claiming process Identify other existing agencies that are claiming Might provide good models or be willing to share infrastructure (e.g., can amend a contract or have joint procurement for potential time study vendors/contractors) Review of the draft codes and approach for the time study Review of approach for establishing the cost pool Review the quality management approach and determine the role of the Medicaid agency Assist in developing the MoU Submit the package to CMS
Questions and Concerns? Slide 11
