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: 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