Medicaid I Training Curriculum
Baltimore, Maryland
November 17 – 19, 2014
Training Overview
Topics discussed in this training session will include a high level overview of the Medicaid program
including Title XIX policy and regulations; state plans; Medicaid Services; Medicaid administration; Rate
Setting; the Impact of Health Care Reform; and various aspects of the Medicaid program. 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.
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;
FFP/FMAP “cheat sheet”;
Trainer “bios”; 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 November 17 – 19, 2014 from 8:30 AM – 4:00 PM the first two days and 8:30 AM –
12:15 PM on the final day, with two 15-minute breaks and a lunch break. Breakfast will be provided
before 8:30 AM each morning. Please refer to the registration details regarding other meals. Please note
that we have incorporated time for questions and comments. If discussion results in a session going for
longer than the allotted time, we will adjust the schedule accordingly.
Sign-In
We have sign-in sheets for each morning and afternoon session (a total of 6 in all). If you are not
requiring CPE credit, we will require that you sign in on the first day, in the morning only. If you do
require CPE 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.
1
Training Outline – Day 1 (Monday, November 17th)
Topic
Time
Presenter(s)
Welcome and Introductions
** Conversation: Why are you here?**
Overview of the Medicaid Program
 History of Medicaid
 Structure of Medicaid Program
 Single State Agency
 Overview of Who Provides Services
 Basic Tenets and Waivers
 Service Claiming
 Admin Claiming
 FFP and FMAP Rates
 Mandatory versus Optional Programs and
Coverage Groups
 Medicaid Eligibility and Enrollment
 Coverage Types
 Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT)
 The CMS 64 and 37
 Certified Public Expenditures (CPE)
 Medicaid Management Information Systems
(MMIS)
 Waste, Fraud, and Abuse
 Third Party Liability (TPL)
 Departmental Appeals Board (DAB) Rulings
8:30 – 9:15
Amy Ferraro
9:15 – 12:00
Amy Ferraro
(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
**State Plan Quiz**
1:15 – 2:30
TBD
15 Minute Break
Medicaid Services
 Eligibility
 Coverage
 Reimbursement
 Provider Assessments
 Waivers
2:45 – 4:00
2
TBD
Training Outline – Day 2 (Tuesday, November 18th)
Topic
Time
Presenter(s)
Medicaid Administration
 What is Medicaid Administration?
 New OMB Uniform Guidance
 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
 Targeted Case Management
8:30 – 11:00
Amy Ferraro
Aspects of the Medicaid Program
 Disproportionate Share Hospitals (DSH)
 Uncompensated Care (UCC)
 Upper Payment Limits (UPL)
 Intergovernmental Transfers (IGT)
11:00 – 12:00
(15 Minute Break
Incorporated)
TBD
1 Hour and 15 Minute Lunch Break
Aspects of the Medicaid Program (Continued)
 Hospitals, including IMDs
 Nursing Homes
 ICFMRs/IRPTFs
 FQHCs/RHCs
 Rehabilitative Services Option
 School-Based Billing
 Pharmacy
1:15 – 4:00
(15 Minute Break
Incorporated)
3
TBD
Training Outline – Day 3 (Wednesday, November 19th)
Topic
Time
Presenter(s)
Rate Setting
 Introduction to Rate Setting
 Components of a Rate
 Rate Setting Example
 Rate Setting Definitions
8:30 – 10:30 AM
Amy Ferraro
**Rate Setting Exercise**
15 Minute Break
Health Care Reform Implementation and Issues and Hot
Topics
 Overview of Health Care Reform
 Medicaid Expansion
 Health Benefit Exchange Overview
 New HCR Grant Opportunities and Medicaid
Provisions
 Eligibility System Upgrades
 Eligibility Changes and Effects of Specific
Populations
 Essential Benefits Package
 Accountable Care Organizations
 ACO vs. HMO
 Notable Marketplaces/Snapshots
10:45 – 11:45
TBD
Final Quiz & Evaluations
11:45 – 12:15
All
4
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Medicaid I – Proposed Curriculum (Continued)*