| (a) Introduction. Medicaid Administrative Claiming
(MAC) is a joint federal-state funded health care program which provides
reimbursement for the costs of Medicaid administrative activities
that refer eligible or potentially eligible Medicaid recipients to
appropriate Medicaid and health-related services.
(b) Definitions. The following definitions apply when
the terms are used in this section.
(1) CMS--Centers for Medicare & Medicaid Services.
The federal agency within the United States Department of Health and
Human Services responsible for overseeing and directing Medicare and
Medicaid, or its successor.
(2) FFY--Federal fiscal year. Begins October 1 and
ends September 30 of the following calendar year.
(3) Governmental entity--A state agency or a political
subdivision of the state. A governmental entity includes a city, county,
school district, special district, community mental health center,
or other unit of government.
(4) HHSC--The Texas Health and Human Services Commission
or its designee.
(5) MAC Financial Claim--The claim for reimbursement
submitted to HHSC by a governmental entity each federal fiscal quarter.
(6) Participant--A governmental entity employee or
contractor position, including a federally funded position, responsible
for performing MAC activities in support of Medicaid or medical services
as a weekly part of the position's job duties. These activities must
directly support efforts to identify, enroll, and maintain Medicaid
eligibility for eligible and potentially-eligible children and adults.
(7) PL--Participant list. A comprehensive list of all
participants eligible for inclusion in the Random Moment Time Study,
as defined in paragraph (9) of this subsection.
(8) QSI--Quarterly Summary Invoice. An invoice of costs
reimbursable to a MAC participating governmental entity.
(9) RMTS--Random Moment Time Study. A federally-approved,
statistical sampling technique administered by HHSC to identify the
percentage of time that is reimbursable under the MAC program versus
the percentage of time that is directly or indirectly related to covered
services and other activities.
(10) STAIRS--State of Texas Automated Information Reporting
System. HHSC's online application for submitting cost reports and
accountability reports.
(c) Eligible providers. A governmental entity is eligible
to be reimbursed for MAC activities if it meets the following criteria.
(1) It has entered into a written provider agreement
with HHSC.
(2) It operates one of the following provider types
or programs:
(A) Early Childhood Intervention (ECI);
(B) local health department (LHD);
(C) local mental health authority or local intellectual
and developmental disability authority (MH/IDD authority);
(D) school district, public charter school, or state
school (school district); or
(E) Aging and Disability Resource Center (ADRC).
(3) The provider or program is enrolled in Medicaid.
(d) Eligible activities.
(1) To be claimed through the MAC program, administrative
activities must:
(A) directly support efforts to identify, enroll, and
maintain Medicaid eligibility for eligible and potentially-eligible
children and adults; and
(B) directly support the provision of services covered
under the Texas Medicaid State Plan.
(2) The following activities have been identified by
CMS as eligible for reimbursement:
(A) outreach;
(B) utilization review;
(C) eligibility determination;
(D) Medicaid referral, coordination, and monitoring;
(E) scheduling or arranging transportation to Medicaid
covered services;
(F) translation services;
(G) program planning;
(H) development and interagency coordination;
(I) training;
(J) provider relations; and
(K) activities that determine a consumer's need for
direct medical care.
(e) Governmental Entity's Responsibilities.
(1) Designated contacts. A governmental entity that
participates in MAC must:
(A) designate an employee to serve as an RMTS contact
who:
(i) ensures that the entity's PL is verified and updated
quarterly;
(ii) attends the RMTS training required in paragraph
(2) of this subsection;
(iii) provides RMTS training to sampled participants;
(iv) provides ongoing technical assistance to entity
participants;
(v) ensures entity compliance with 85 percent required
time study response rate; and
(vi) ensures all contact information recorded in STAIRS
is current and accurate; and
(B) designate an employee to serve as a MAC financial
contact who:
(i) serves as the main point of contact between the
entity and HHSC for all MAC financial-related issues;
(ii) maintains the accuracy of all contacts in STAIRS;
(iii) communicates with all key stakeholders to ensure
all participants claimed engaged in eligible activities during the
claiming period on a weekly basis;
(iv) attends the MAC financial training required in
paragraph (3) of this subsection;
(v) certifies the accuracy of the MAC Financial Claim
and the availability of matching funds;
(vi) ensures that the QSI is signed by an entity employee
with signature authority and is notarized; and
(vii) ensures that all supporting documentation described
in paragraph (4) of this subsection is maintained.
(2) RMTS training. Annual training conducted by HHSC
is mandatory for all RMTS contacts who certify a PL for an entity.
(3) MAC financial training. HHSC provides annual training
to participating governmental entities.
(A) Each primary MAC financial contact must attend
and receive credit for training for each FFY in which the governmental
entity chooses to participate.
(B) Training is provided for each FFY and is not retroactive.
(C) A governmental entity that does not have a trained
MAC financial contact who is an employee of the entity is prohibited
from submitting a MAC Financial Claim. Governmental entity-contracted
vendors are not permitted to enter an entity's data into STAIRS for
any entity that does not have a trained MAC financial contact who
is an employee of the entity.
(4) Documentation. A governmental entity that participates
in MAC must maintain documentation that supports the MAC activities
performed by the entity and all costs submitted for reimbursement.
(A) A governmental entity must collect and maintain
MAC participation documents in a readily-accessible location and format,
including:
(i) financial data used to develop the expenditures
and revenues for the claim calculations, including the state and local
match used for certification;
(ii) copies of computations used to calculate financial
costs;
(iii) all revenues offset from the claim, by source;
and
(iv) all signed and certified QSIs.
(B) Participation documents must be maintained for
a period of no less than three years. In the case of an audit during
the first three retention years, the records must be retained three
years after the close of the audit. A school district must retain
participation documents for a period of no less than five years, but
in the case of an audit during the first five retention years, the
records must be retained five years after the close of the audit.
(f) Claim calculation.
(1) Preparers of MAC Financial Claims must apply the
cost principles outlined in:
(A) 2 CFR Part 200; and
(B) §355.102 of this chapter (relating to General
Principles of Allowable and Unallowable Costs), §355.103 of this
chapter (relating to Specifications for Allowable and Unallowable
Costs), §355.104 of this chapter (relating to Revenues); and §355.105
of this chapter (relating to General Reporting and Documentation Requirements,
Methods, and Procedures).
(2) The costs allowable for submission through a MAC
Financial Claim are:
(A) for an ECI, LHD, MH/IDD authority, ADRC, or school
district:
(i) salary, payroll taxes, and benefits; and
(ii) contracted staff expenses; and
(B) for an ECI, LHD, MH/IDD authority, or ADRC:
(i) materials and supplies;
Cont'd... |
