Family Support Organizations

Becoming Medicaid Providers

Office Hours
June 10, 2014

TA Network Core Partners:

The Institute for Innovation & Implementation, University of
Maryland School of Social Work
Accountability Solutions, LLC.
The Center for Community Learning, Inc.
The Center for Health Care Strategies, Inc.
The Family-Run Executive Director Leadership Association
(FREDLA)
Human Service Collaborative
The National Federation of Families for Childrens Mental Health
Portland State University
The University of South Florida
The University of Washington
Youth M.O.V.E. (Motivating Others through Voices of
Experience) National

Ask the experts
Our experts today are:
Dayana Simons, MEd, LMHC, Senior Program Officer,
Center for Health Care Strategies, Inc. (CHCS)
dsimons@chcs.org
Deborah Harburger, MSW, The Institute for Innovation and
Implementation, University of Maryland School of Social
Work dharburger@ssw.umaryland.edu
Jane A. Walker, LCSW, Executive Director, Family Run
Executive Director Leadership Institute (FREDLA)
jwalker@fredla.org


OFFICE
HOURS
3 PM ET
3PM ET

BECOMING A MEDICAID PROVIDER!
Dayana
Si mons,
Center for
Heal th Care
Strategies
CONSIDERATIONS BEFORE
BECOMING A MEDICAID
PROVIDER
MISSION: Al i gnment wi th the fami ly- run organi zation s
mi ssi on (parent/youth support, education, and advocacy)
SERVICE DELIVERY: Experience and foundation for a
parent/youth peer support practice model and match to
Medicaid servi ce defi nitions, trai ni ng, and certi fi cation
I NFRASTRUCTURE: Busi ness admi nistration experience and
ski l ls for cl i ni cal supervision, pol i cies, el ectronic medi cal
records, bi l li ng, and qual i ty assurance processes
FINANCING: Cash fl ow, negoti ated payment rate, and cost
rei mbursement
STAFF TRAINING: Medicaid regulations, documentation

CONSIDERATIONS BEFORE BECOMING A
MEDICAID PROVIDER
State Plan
Arizona, Kentucky, Massachusetts, Oklahoma
Waiver(s)
Georgia, Indiana, Kansas, Maryland


FINANCING PARENT SUPPORT
PROVIDER
Medicaid Provi der
Direct payment through Medicaid
MCO Network Provi der
Payment through managed care organization (MCO)
Subcontractor
Payment through another provider who is paid either by Medicaid or
MCO
Medicaid Admini strative Dol l ars


MEDICAID PAYMENT
Debor ah
Har bur ger,
The I nst i t ute f or
I nnovat i on and
I mpl ement at i on,
Uni ver si t y of
Mar yl and School
of Soci al Wor k
SETTING A RATE FOR
FAMILY SUPPORT
The focus of your rate composition is the peer
support partner.
Assume 1 FTE peer support partner, unless you know
otherwise.
Ideally, use actual costs from your organization or
other similar organizations.
In the absence of actual costs, utilize living or
housing wages and profiles of average costs in your
geographic area.

CALCULATING PERSONNEL COSTS
Fri nge Benefi ts can i ncl ude:
FICA/Medicare
Retirement
Disability insurance
Life insurance
Unemployment insurance
Dental, prescription and health insurance
Worker' s compensation
Other costs that may be par t of your costs, dependi ng on the si ze of
your organi zati on, are separati on l eave payments, tui ti on remi ssi on,
empl oyee assi stance, wel l ness programs, and other empl oyee benefi ts.
Agai n, use actual costs i f you have them. I f not, you can use a number
l i ke 25% as a proxy cost. I f you of fer many benefi ts, you may want to
use a hi gher fi gure l i ke 30- 40%.
Fri nge benefi ts are cal cul ated as a percent of sal ar y costs
Most organi zati ons use standardi zed benefi t rates for al l empl oyees,
regardl ess of whi ch benefi ts they take

CALCULATING FRINGE COSTS
Rent/Offi ce Space Costs (per FTE per year)
Cel l ul ar Phone, Internet & Communi cati ons (per FTE per year)
Mi l eage
Total estimated miles x Privately Owned Vehicle Rate
Unless otherwise prescribed, use the U.S. General Services
Administration (GSA) rate for operation of a privately owned vehicle
(http://www.gsa.gov/portal/content/100715?utm_source=OGP&utm_me
dium=print-radio&utm_term=mileage&utm_campaign=shortcuts)
If you have agency cars available, factor in the cost of maintaining those
cars and the cost of gasoline and wear & tear on the vehicle instead of
using the GSA POV rate
Offi ce suppl i es and mai ntenance (i ncl ude any costs for pri nti ng,
photocopyi ng, fax machi ne, postage, IT software and equi pment,
and routi ne offi ce suppl i es; per FTE/year)
Management Informati on System User Fees (per FTE/year)
Insurance (general l i abi l i ty, professi onal l i abi l i ty) per FTE/year

CALCULATING OTHER COSTS
Personnel
Annual Amount
or Rate %FTE
Salary
Cost
Fringe
Benefits (25%)
Salary +
Fringe Cost
Family Support Partner 39,354 $ 1 39,354 $ 9,839 $ 49,192.50 $
Family Support Partner Supervisor 50,000 $ 0.10 5,000 $ 1,250 $ 6,250.00 $
Administrative Assistant 39,354 $ 0.15 5,903 $ 1,476 $ 7,378.88 $
Billing Support Specialist 39,354 $ 0.05 1,968 $ 492 $ 2,459.63 $
Administrator 55,000 $ 0.05 2,750 $ 688 $ 3,437.50 $
Total 1.35 54,975 $ 13,744 $ 68,718.50 $
Other Costs
Rent ($200/monthper FTEs) 3,240.00 $
Cellular Phone, Internet & Communications (@$110/month per FTE) 1,782.00 $
Mileage (10,500 miles per year @ $0.56/mile) 5,880.00 $
Office supplies and maintenance (incl printing, copier/fax) @ $750 per FTE 1,013 $
Management Information System User Fees (@$150/FTE) 203 $
Insurance (general liability, professional liability) @ $1,000 per FTE 1,350 $
Indirect Cost (7% of modified total direct costs) 5,526 $
Total Cost FTE 87,711.69 $
SAMPLE BUDGET FOR 1 PARENT
SUPPORT PROVIDER
The CMS gui dance regardi ng the use of peer supports for peer to
peer servi ces for parents, guardi ans and caregi vers can be found
at: ht t p: //www. medi cai d. gov/Medi cai d- CHI P- Program- I nformat i on/By -
Topi cs/Benefi t s/Downl oads/Cl ari f yi ng- Gui dance- Suppor t - Pol i cy. pdf
Becomi ng a Medi cai d Provi der of Fami l y and Youth Peer Support:
Consi derati ons for Fami l y Run Organi zati ons
http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261625
Joi nt CMCS and SAMHSA Informati onal Bul l eti n
http://www.medicaid.gov/federal -policy-gui dance/downloads/CIB-05-07-2013.pdf
Medi cai d Wai vers
http://www.medicaid.gov/Medicai d-CHIP-Program-Information/By-
Topics/Waivers/Waivers.html
Medi cai d Fi nanci ng for Fami l y and Youth Peer Support: A Scan of
State Programs: http: //www. chcs. org/resource/medi cai d- fi nanci ng- for-
fami l y- and- youth- peer - suppor t - a- scan- of - st ate- programs- 3/

RESOURCES
Your Turn to
ask
In Fredlas role with the TA Network, Fredla
has developed an Implementation Exchange
for family-run organizations who are moving to
become Medicaid providers.
Malisa Pearson is coordinating this project:
mpearson@fredla.org
IMPLEMENTATION EXCHANGE
Dayana Simons, dsimons@chcs.org
Center for Health Care Strategies

Deborah Harburger, dharburger@ssw.umaryland.edu
The Institute for Innovation and Implementation,
University of Maryland School of Social Work

Jane A. Walker, jwalker@fredla.org
Family Run Executive Director Leadership Institute
(FREDLA)
CONTACT US!