Solutions Overview: Medicaid Entitlements for California

Copyright © 2018 Charter School Capital, Inc. All Rights Reserved.
Introduction to
Our Medicaid
Billing Program
February 11, 2020

2
AGENDA
 Background on CSC and PCG
 The Value of Medicaid Billing
 Our Platform and Process
 Wrap Up and Next Steps
TODAY WE’LL COVER:

3
TODAY’S PRESENTERS
Ryan Eldridge
Charter School Advisor
Charter School Capital
Rich Collins
Product Specialist
Rose Jenson
Manager Client Services
Public Consulting Group

4
4
•
WHO WE
ARE
 Charter School Capital helps schools access,
leverage, and sustain the resources charter schools
need to thrive, allowing them to focus on what
matters most – educating students.
 In the past 12 years, we have:
o Served more than 1,000,000 students and their
families
o Supported more than 700 charter schools
o Invested $2B in helping charter schools better
serve their communities
 Facilities financing arm supports charter leaders with
long-term leases
o Over 42 schools across the country
o Tenant improvements and energy services
 More than 60 employees headquartered in Portland,
OR
 Stellar track record with schools and investors
COMPANY OVERVIEW

5
PCG EDUCATION:
NATIONAL MEDICAID
BILLING EXPERTS
 Privately held with no venture funding,
headquartered in Boston, MA
 Diversified and serving many state and cities in
the areas of Human Services, Health,
Technology and Consulting
 Public Focus. Proven Results.
 Partnering with over 4,200 school districts in the
US in various capacities, including 18 of the 25
largest districts
 Largest Medicaid and IEP vendor in the US
 Over 25% of all IEPs nationwide are created in
our EDplan system
 Generated more than $6.2 billion in federal
school-based Medicaid reimbursement for our
clients
 $500M+ in Medicaid claims submitted in school
year 2017-2018
CT
ME
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PA
NY
VT
WV
OH
NC
SC
GA
FL
ALMS
AR
LA
TX
OK
KS MO
IL
WI
IA
MN
SD
MT
WY
CO
NM
AK
AZ
UT
ID
OR
WA
CA
NV NE
ND
TN
IN
MI
DE
RI
NJ
MA
NH
MD
KY
HI
BOSTON

The Value of Medicaid
Reimbursements

7
OUR PROGRAM
LET’S YOU
RECOUP COSTS
 Schools are required to deliver services to
students with disabilities through IDEA
 More students are requiring health-related
services than before:
o Speech Therapy
o Counseling Services
o Occupational Therapy
o Physical Therapy
o Nursing Services
 Schools reporting the intensity of services has
increased, requiring more highly-skilled staff,
which causes an increase in costs
Medicaid billing provides an opportunity to recoup
a portion of costs schools are required to expend
on these services

8
WHICH EXPENSES QUALIFY FOR MEDICAID
REIMBURSEMENT?
Qualifying
Students:
Students on
Medicaid
Qualifying
Services:
Speech Therapy
Counseling Services
Occupational
Therapy
Physical Therapy
Nursing Services
Medicaid Reimbursement Eligibility Framework
 Your school is eligible to receive
reimbursements (for services that
qualify) for students who are on
Medicaid
 On average, this may be 10-15%
of your total student population
 The average annual
reimbursement per qualifying
student receiving services in
CA is $400
Eligiblefor
Reimbursements

9
REIMBURSEMENTS WILL ADD UP …
120k 129k 138k 147k 158k 169k 181k 194k 208k 222k
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10
Annual Cumulative
Assumptions:
 300 qualifying students in year 1
 Annual student growth rate of 5%
 Annual expected Medicaid services reimbursement growth rate of 2%
 $400 average annual billing per student
Estimated Annual and Cumulative Gross Cost Recoup for California Charter School
Total estimated 10-year
cumulative gross billings
of $1.7 millionTotal estimated 5-year
cumulative gross billings
of $0.7 million

Our Platform and Process

11
OUR PLATFORM SIMPLIFIES THE BILLING PROCESS
Determine medical
necessity for student:
• Individualized Education
Program (IEP)
• Physician Authorization
Services delivered by
service providers
Charter
School
PCG
Platform
Provide support
documentation:
• IEP
• Physician Authorization /
Ordering, Rendering or
Prescribing (ORP) practitioner
• Provider licensure/credential
• Medicaid Parental Consent
State
Medicaid
Agency
State Medicaid agency reviews claims, approves or
denies payments
State sends reimbursement to Charter School for
services they are already provided
Additional Ongoing
Requirements:
• Schools provide related cost data
provide cost data annually
• Potentially participate in a
quarterly random moment time
survey (RMTS)
Document Support Provide / Participate
Package Information and Submit
PGC platform collects data along the way and identifies services that meet claiming
requirements and submits those services to state Medicaid agency
$$
Received

12
BILLING SERVICES PLATFORM: BACKED BY PROFESSIONALS
 Technology is at the core
o Track service documentation and reporting allowing
you to recoup costs without adding a new team
o Allows you to compare services provided to
students by individual health care contractors to
submitted invoices
 Dedicated, knowledgeable team
o Training, project management, legal, compliance,
policy, technology
o Identify program expansion opportunities
 National experience and local staff
o Submit claims for 1,400+ districts and charters
across 26 states
o Deep knowledge and understanding of charter
school market

13
KEY FEATURES
Key Features:
 Provide online service documentation tool to collect service data
o Use any device: Mobile logging; speech to text
 Get signatures electronically from parents, doctors using EdPlan Connect
 Multi-layer claiming quality control process to review completeness of claims data
 Reporting to let you know how you are doing and what gaps you may have
 Online training resources to support your staff
 Virtual help desk support

14
THANK YOU FOR
JOINING US!
NEXT STEPS… • Contact us!
• Fill out the readiness assessment
• Have a call or meeting to discuss your
potential, the program, and your needs
Ryan Eldridge
Charter School Advisor
reldridge@charterschoolcapital.org

Solutions Overview: Medicaid Entitlements for California

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