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Wednesday, March 10, 2010

Medicaid Tutorials Introduction

Welcome to NESCSO’s Medicaid Tutorial collection and access* to the Medicaid Learning Center!
NESCSO is pleased to offer video tutorials from Medicaid subject matter experts on many of the major functions and administrative requirements of a Medicaid program. This area of our website provides links (below) to these video sessions. Our rich curriculum is divided into the following areas:
General Administration of the Medicaid Program

Policy Budget and Finance

MMIS and Related Systems and Processes

You may review the entire curriculum (below) with descriptions of each of the topics available as well as a short bio of our subject matter experts. NESCSO continues to add topics to our collection. Please check back often for new additions. We also encourage you to contact us with your suggestions for future tutorials.

Please take a moment to review the general introduction to this Medicaid tutorial program narrated by Stephanie Anthony JD., M.P.H. Stephanie is currently a Principal Associate at the Center for Health Law and Economics at the University of Massachusetts Medical School. This introduction contains a high level overview of a typical Medicaid Agency, its relationship to other state agencies, the role of a single state agency, the State Plan, benefit plans and people covered and the role of the federal government.

Other Sources of Medicaid Educational Materials

In addition to the Medicaid tutorials produced by NESCSO, the NESCSO library contains links to many other Medicaid educational tutorials produced by other organizations.

We are also pleased to offer full access to the Medicaid Learning Center to our NESCSO members only* . The Medicaid Learning Center is a leader in web-based, online Medicaid education. Their catalog of courses covers topics ranging from the basics of Medicaid to the intricacies of MITA. 

The modules include:

The Medicaid Basics Module (MBM)

The MITA Learning Module(MLM)

The Medicaid Knowledge Center (MKC)The Medicaid Dictionary

To take a tour of the Medicaid Learning Center visit http://www.medicaidlearning.com/take_a_tour . NESCSO members may contact Nancy Peterson to receive access information. Please contact Nancy at Nancy.Peterson@umassmed.edu or at 508.856.6425.

 

Medicaid Curriculum

General Administration of the Medicaid Program

 Title

Session Description / Presenter Biography

Introduction

 

Time - 10:30 min.

This session is a general introduction to this video tutorial series. It also contains a high level overview of a typical Medicaid agency organization, how it relates to other state agencies, the role of a single state agency, benefit plans and people covered, the state plan, and the federal role.

 

Narrated by Ms. Stephanie Anthony, JD., M.P.H. Ms. Anthony is currently a Principal Associate at the Center for Health Law and Economics at the University of Massachusetts Medical School. She was formerly the Deputy Director of the Massachusetts Medicaid program.

Legal Framework for the Medicaid Program

 

Time - 40:37 min.

This session provides an overview of the legal framework of the Medicaid program. It touches upon the different eligibility requirements and provides an explanation of mandatory vs. optional services.

 

Narrated by Ms. Jean Sullivan, JD., M.P.H. Ms. Sullivan is currently the Associate Vice Chancellor, Commonwealth Medicine and Director of the Center for Health Law and Economics at the University of Massachusetts Medical School.

Waivers and Health Reform Initiatives

 

Time - 19:42 min.

This session probes the Medicaid and CHIP state plan process and the development and approval of CMS waivers. The session includes a review of HCBS waivers and the financial and policy considerations under various waivers.

 

Narrated by Ms. Stephanie Anthony, JD., M.P.H. Ms. Anthony is currently a Principal Associate at the Center for Health Law and Economics at the University of Massachusetts Medical School. She was formerly the Deputy Director of the Massachusetts Medicaid program.

Member Relations

 

Availble in 2010

This session explores the outreach and enrollment process, the Board of Hearings (grievances/appeals), and constituent affairs.

 

Narrated by TBD.

External Relations

 

Time - 31:58 min.

This session takes an in-depth look at the myriad of key outside groups that interact with a Medicaid agency. Interagency, governor and legislative relations will be reviewed as well as Federal CMS and OMB agencies and a state's congressional delegation. Media and Advocates relations will also be reviewed.

 

Narrated by Ms. Brenda Harvey.Ms. Harvey is currently the Commissioner of Health and Human Services for the state of Maine.

Clinical Expertise and Oversight

 

Time - 31:58 min.

This session describes the role of the Medical Director within a Medicaid agency. It also includes an explanation of utilization management (Prior authorization and DUR), quality measures (HEDIS) and evidence based medicine.

 

Narrated by Ronald Steingard, MD.Dr. Steingard is currently the Professor of Psychiatry and Pediatrics and Chief Medical Officer, Center for Health Policy Research for Commonwealth Medicine.

Long-Term Care

 

Available in 2010

This session explains the long term care program within Medicaid. It reviews Institutional vs. home and community based services and the rebalancing effort. Chronic care and disease management are discussed and finally the dual eligible population is reviewed together with the services, financing and integrated programs related to this population.

 

Narrated by TBD

Disability Determination Process

 

Available in 2010

This session describes the disability determination process required for the eligibility category of individuals age 19 through 64 who must be disabled to qualify for Medicaid. It offers a more in-depth discussion of the major challenges that face a state Medicaid agency manager and offers solutions for administering a high quality program that also meets federal timeliness goals.

 

Narrated by Gus Adams, Ph.D. Dr. Adams is the Director of Disability Evaluation Services, a division of the UMass Medical School that performs disability determinations for MassHealth (Office of Medicaid) and the Massachusetts Department of Transitional Assistance.

Policy, Budget and Finance

 Title

Session Description / Presenter Biography

Medical Eligibility
(section 1)
Medical Law and Regulations

 

Time - 19:44 min.

This session outlines the federal statutes, Social Security act, waiver agreements, state Medicaid manual, state law state Medicaid plan, and the program operations manual system (POMS) that affect the Medicaid elegibility process.

 

Narrated by Ms. Marybeth McCaffrey and Mr. Allen Bryan. Marybeth McCaffrey has been an attorney for 20 years, the past decade spent in the area of Medicaid eligibility as a Health Care Policy Attorney Analyst. She has chaired the National Eligibility Technical Advisory Group (E-TAG) since 1995, helping CMS and States interpret and implement federal legislation and policy. Mr. Bryan is currently on the staff of the CMS Regional Office (Region 1).

Medical Eligibility
(section 2)
Requirements and Options

 

Time - 13:24 min.

This session outlines the eligibility process, categories of coverage, eligibility factors, key financial terms, financial factors and methodologies, standards, determination process and SCHIP.

 

Narrated by Ms. Bethany Hamm.Ms. Hamm is MaineCare's Program Manager for the Maine Department of Health and Human Services.

Medicaid Eligibility
(seciton 3)
Common Coverage Groups

 

Time - 16:18 min.

This session provides eligibility examples such as SSI, TANF, Medically Needy and Spenddown. Other topics include Optional Coverage Groups, Medicare savings plan, "QMB and Dual eligible's," uninsured, waiver group and Long Term Care.

 

Narrated by Ms. Marybeth McCaffrey.Marybeth McCaffrey has been an attorney for 20 years, the past decade spent in the area of Medicaid eligibility as a Health Care Policy Attorney Analyst. She has chaired the National Eligibility Technical Advisory Group (E-TAG) since 1995, helping CMS and States interpret and implement federal legislation and policy.

Financing/ Budgeting

 

Available in 2010

This session is devoted to a review of FFP, FMAP, non-federal share and federal claiming. It also includes a discussion of other revenue generation vehicles.

 

Narrated by Mr. John Robertson.Mr. Robertson is currently the Chief National Accounts Strategist for Public Sector Partners.

State Budget Preparation, Monitoring and the Legislative Approval Process

 

Available in 2010

This session explains how a Medicaid prepares its budget, its integration within other state agency budgets and the approval process through the governors office and legislature. It also discusses the monitoring process and reporting requirements.

 

Narrated by TBD.

Program Integrity

 

Available in 2010

This session provides an explanation of the Medicaid program integrity process. It includes a review of false claims, Third Party Liability (TPL), coordination of benefits, and recoveries. It includes and overview of the federal Payment Error Rate Measurement program (PERM), various audits and compliance measures.

 

Narrated by Ms. Jenifer Hartman.

Provider Relations

 

Available in 2010

This session will explain the various provider networks and delivery systems which include fee for service, primary care physician plans, and managed care organizations. Procurements and contracting will be discussed as well as provider payment rates, methodologies and negotiations. A final section will deal with the big three providers, managed care organizations, nursing homes and hospitals.

 

Narrated by TBD.

Payment Methodologies

 

Time - 39:04 min.

This session explains the various payment methodologies utilized by Medicaid within their role as purchaser. This video highlights the importance of value purchasing related to the enormous level of expenditures by Medicaid. Future themes and concerns regarding payments and suggestions for success are offered.

 

Narrated by Mr. Kevin Quinn.Mr. Quinn is currently the Director of Payment Method Development, ACS Government Healthcare Solutions.

MMIS and Related Systems/Processes

 Title

Session Description / Presenter Biography

Medicaid Management Information Systems (MMIS)

 

Available in 2010

This session explains the engine that runs a Medicaid program. It details what a MMIS system is, how it supports management, the high level features and the more detailed functions related to members, providers, benefit plans, edits/audits/rules, authorizations, third party liability, claims control, financial aspects, reporting, fraud detection, contacts and ancillary features. It briefly touches upon Health Information Technology (HIT) and the MMIS.

 

Narrated by TBD

PAPD, APD, IAPD and What it Means

 

Available in 2010

The who, what, when, where and why of Advanced Planning documents. This session provides an explanation of the need for these documents, federal and state roles and FMAP implications. All of the detailed components are reviewed and how they correspond to the life cycle of system development. The session ends with a listing of related references.

 

Narrated by TBD

The World of Claims, Codes and Payments

 

Time - 32:07 min.

This session provides an excellent overview and description on the claims process (CMS 1500, UB 04), the various code sets (i.e. ICD 10, CPT, HCPCS...) and payment methods (RUGS, DRG's...) utilized by Medicaid.

 

Narrated by Mr. Kevin Quinn.Mr. Quinn is currently the Director of Payment Method Development, ACS Government Healthcare Solutions.

MITA (Medicaid Information Technology Architecture) Overview

 

Time - 28:15 min.

This session provides an excellent overview of the MITA program

 

Narrated by Mr. Rick Friedman.Mr. Friedman is currently the Director for the Division of States Systems, CMS/Center for Medicaid State Operations.