Medicaid I Curriculum – Raleigh, North Carolina
March 17-19, 2008
Training Overview
Topics discussed in this training session will include Title XIX policy and regulations; state plans;
Medicaid Services; Institutional and non-Institutional programs; Medicaid administration; Administrative
and Targeted Case Management; and an Overview of Rate Setting. We will pay specific attention to
federal Medicaid regulations and “hot topics” that are related to the above areas. We have arranged for
participants to receive CPE credits. Please see an instruction if you have any questions.
Training Program Level
This course is intended to be “entry level” for individuals with little or no experience with
Medicaid, or whose experience is limited to one area of Medicaid.
Training Prerequisites
The only prerequisite is a desire to expand your knowledge of Medicaid, and the willingness to
participate. Any and all questions are welcome!
Training Materials
Each participant has been given a training binder, including the following:
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Training Curriculum;
Copies of all PowerPoint presentations;
Trainer “bios”;
Medicaid 101 Guide; and
Training Evaluation.
The binder contains all materials for the session, except for group exercises and quizzes and their answers
that will be handed out as we move through the session.
Training Dates and Hours
Trainings days will be March 17-19, 2008 from 9am - 4pm, with two 15-minute breaks and a 1 hour and
15 minute lunch break each day.
Sign-In
We have sign-in sheets for each morning and afternoon session (a total of 6 in all). If you are not
requiring credit, we will require that you sign in on the first day, in the morning only. If you do require
credit, you must sign in for each session, a total of 6 times. We cannot grant credit without confirming
that you were present for all sessions.
Training Instructors
The sessions will be conducted by Amy Ferraro, Thomas Aldridge, and [TBD] from Public Consulting
Group, Inc. Please see the Attachments Section of your Training Binder for information on our
presenters’ expertise in working with the Medicaid program.
1
Training Outline – Day 1 (Monday, March 17th)
Topic
Time
Welcome and Introductions
Presenter(s)
9:00 – 10:00
Amy Ferraro
10:00 – 12:00
Amy Ferraro
** Conversation: What Do You Want to Get Out
of This Training?**
Overview of the Medicaid Program
 History of Medicaid
 Structure of Medicaid Program
 Single State Agency
 Overview of Who Provides Services
 Basic Tenets
 Medicaid Regulations 101
 FFP and FMAP Rates
 Mandatory versus Optional Programs and
Coverage Groups
 Medicaid Eligibility and Enrollment
 Coverage Types
 EPSDT
 The CMS 64 and 37
 Certified Public Expenditures (CPE)
 MMIS
 Departmental Appeals Board (DAB)
Rulings
(15 Minute Break
Incorporated)
1 Hour and 15 Minute Lunch Break
Medicaid State Plans
 Medicaid State Plans
 Organization of State Plans
 State Plan Amendments
 Drafting State Plan Amendments That Will
Be Granted CMS Approval
1:15 – 2:30
**State Plan Quiz**
15 Minute Break
2
Thomas Aldridge
Training Outline – Day 1 (Monday, March 17th) (Continued)
Topic
Time
2:45 – 4:00
Medicaid Services
 What is a Service?
 Eligibility
 Coverage
 Reimbursement
 Waivers
3
Presenter(s)
TBD
Training Outline – Day 2 (Tuesday, March 18th)
Topic
Time
Presenter(s)
Medicaid Administration
 What is Medicaid Administration?
 How Do You Determine Administrative
Costs?
 How Do You Recover Administrative
Costs?
 When Do You Need a Cost Allocation Plan
Amendment?
 Pros/Cons of Administrative Claiming
Mechanisms
 Mini-Quiz
9:00 – 10:45
Amy Ferraro
15 Minute Break
Current Issues With Programs
 Types of Services Provided in Facilities
11:00 – 12:00
Thomas Aldridge
1 Hour and 15 Minute Lunch Break
Current Issues With Institutional Programs
(Continued)
 Disproportionate Share Hospitals (DSH)
 Upper Payment Limits (UPL)
1:15 – 2:00
Thomas Aldridge
15 Minute Break
2:15 – 4:00
Current Issues With Institutional & NonInstitutional Programs (Continued)
 Types of Services Provided in the
“Community”
 Pharmacy & the Medicare Drug Bill
 School-Based Billing
 Rehab Option
4
Amy Ferraro
Training Outline – Day 3 (Wednesday, March 19th)
Topic
Time
Administrative Case Management (ACM) vs.
Targeted Case Management (TCM)
 Overview of TCM and how it is claimed
(illustrative example of service claiming)
 Overview of ACM and how it is claimed
(illustrative example of admin claiming)
 ACM vs. TCM
 The current federal landscape
9:00 – 10:00
Presenter(s)
Amy Ferraro
15 Minute Break
10:15 – 12:00
Overview of Rate Setting
 Introduction to Rate Setting
 Component of a Rate
 Rate Setting Examples
1 Hour and 15 Minute Lunch Break
**Rate Setting Exercise**
1:15 – 3:15
Final Quiz/Discussion
3:15 – 3:45
Evaluations
3:45 – 4:00
5
Thomas Aldridge