Post on 15-Dec-2015
Carlisle Recently Jump Started their SBAP Billing Program
May 2010
Added 1 FTE – Dedicated Access Billing CoordinatorUpdated Leader Services Software Setup
Billing Form/File Management
June 2011
Revenues increased > $100,000Year 1
3/8/2012 4PASBO
14 Buildings4,800 Students
General Fund Budget: $64m
3/8/2012 5PASBO
Carlisle Area School District
Special Ed – 15.5% populationof that: 32.2 % MA Eligible30% Free & Reduced Lunch
Spec Ed Budget $7m + Pupil Health $5m
3/8/2012 6PASBO
How did we do it?
Billed by Service Category:• IEP’s and Transportation• Speech, OT, PT, and Psych Svc• And various smaller categories
Year 2-3: need to add:• PCA Services• Social Work Services
YEAR 3 GOAL: $300,000
SBAP-Direct Services overview
SBAP affords schools the opportunity to receive federal Medicaid funds for providing certain health-related services to special education students who are enrolled in the MA Program.The program began in 1992 and is jointly operated by the PA Department of Education (PDE) and Department of Public Welfare (DPW).
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Eligible schools
School Districts Intermediate Units MAWAs Charter Schools Approved Private Schools
Currently, over 600 schools participate.
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Covered services
Assistive Devices Audiology IEP Development Nursing (RN) Nursing (LPN) Occupational Therapy Orientation and
Mobility Personal Care
Assistant Physical Therapy
Physician Psychiatry Psychology Social Work Speech/Language Teacher of Hearing
Impaired Special Transportation
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PCA
$44,794,541 Speech, Language
$28,274,559 OT
$15,252,994 Transportation
$12,362,406 IEP Development
$15,132,210 Physical Therapy
$8,596,718 Psychology
$7,539,680 RN Nursing
$5,191,279
Teacher of HI
$2,925,027 Social Work
$1,870,712 LPN Nursing
$1,533,872 O&M
$676,106 Physician
$774,464 Asst. Devices
$151,314 Psychiatry
$56,713 Audiology
$100,985
Reimbursements by specialtyFor the 2010-2011 school year:
Total = $145,233,580
Considerations for participationDo you have:
• Sufficient staff and resources?
• Accessibility of records?
• Ability to maintain internal compliance programs?
• Commitment to keep current on program regulations?
• Commitment to training and conducting self-audits?
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Reimbursement factors
Special education population MA population Health-related services provided by school
staff and/or contracted services Number of MA-qualified service providers Number of parents providing consent Level of management
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Student must:
• Be entitled to services under IDEA.
• Be three years of age and under 21.
• Be enrolled in MA.
• Have an IEP that defines the MA-covered service.
Eligible students
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Student must:
• Have written Parental Consent.
• Have Medical Authorization.
• Receive the MA-covered service by a school employee or contractor who meets MA Provider qualifications.
Eligible students
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Documentation
Must be maintained for six years. Must fully disclose the nature and extent of
the service rendered. Must be legible. Must be readily available for an audit.
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Reimbursements
Reimbursements are made to PDE’s Comptroller’s Office and deposited into an LEA-restricted account.
Leader provides monthly Financial Reports. LEAs must ensure the availability of funds
prior to making a withdrawal request. Funds must be used for special education
programs and services.
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In meeting students’ educational needs, LEA staff members often find themselves delivering services that help ensure students are healthy and ready and able to learn.
The school setting provides an opportunity to enroll potentially eligible children in the MA Program or to assist children and their families who are already enrolled to access the MA services that are available to them.
ACP overview
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ACP allows LEAs to receive federal Medicaid funds in addition to the School-Based ACCESS Program (direct services revenue).Federal matching funds are available for certain administrative activities that are in support of the state’s Medicaid program.
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ACP overview
• School districts
• IUs
• Charter schools
• Approved Private Schools
Participating LEAs must also participate in the Direct Services Program.
Currently, over 150 schools participate.
Eligible schools
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One-week quarterly time studies held three times per year capture staff time.The time study must:
• represent tasks as they relate to the participants’ job descriptions.
• capture 100 percent of participants’ time.
ACP time studies
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Examples of administrative claimable activities:
• Informing individuals about the MA Program.
• Assisting individuals with the MA-application process.
• Monitoring, referring, or coordinating MA-covered services.
ACP claimable activities
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Reimbursements by quarter
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For the 2010-2011 fiscal year:
• July-Sept. 2010
$3,979,820
• Oct.-Dec. 2010
$3,753,608
• Jan.-March 2011$4,016,334
• April-June 2011
$4,104,988
Total = $15,854,750