“The mission of the Mental Health Division is to promote recovery and safety.”
Financial Consideration
In fiscal year 2004, the RSN will receive payments according to the Historical Payment Process, detailed below, multiplied by 33.33% and according to the New Payment Process, detailed below, multiplied by 66.67%. In fiscal year 2005 the RSN will receive payments according to the Historical Payment Process, detailed below, multiplied by 33.33% and according to the New Payment Process, detailed below, multiplied by 66.67%.
Historical Payment Process (33.33% for FY04 and 33.33 for FY05)
Rates of Payment are in the body of the contract.
Inpatient Payments
Inpatient Payments will be entered into the accounting payment system the first working day of the month based on data collected two months prior to payment. Three types of payments may be made each month (if applicable.) These are the initial estimate, 6-month reconciliation, and 18-month reconciliation. The following describes each of the three types of payments:
Initial Estimate:
The initial estimate payment uses Medicaid enrollee data from two months prior to payment and applies the corresponding rate to calculate a gross inpatient payment estimate. Two times a year, January and July, the MHD calculates estimated utilization amount based on a six-month average of actual utilization 12-18 months back. (This estimate is then used for 6 months until a new estimate is calculated.) The initial estimate payment is calculated as the gross inpatient payment estimate less estimated utilization.
6-Month Reconciliation:
The 6-Month Reconciliation payment is an adjustment for Medicaid enrollees. It has been determined that after six months Medicaid enrollee counts are final. If the final Medicaid enrollee counts increase, the RSN receives additional funds. No adjustment is made if Medicaid enrollees decrease until the 18-Month Reconciliation.
18-Month Reconciliation:
The 18-Month Reconciliation payment is the final payment for a particular month of service. The MHD has determined that after 18 months the process for measuring community hospital utilization to be charged to the RSNs is complete. This final calculation looks at the gross initial inpatient payment (using final Medicaid enrollees multiplied by corresponding rates) less actual utilization less all previous payments made. MHD pays for any increase or collects for any decrease.
Payments are made based on enrolled Medicaid enrollee information furnished by the Medical Assistance Administration generally between the 1st and the 10th of the previous month. The information is compiled to fit the Mental Health Division’s categories of enrollees, which are shown in the Rates of Payment section of the contract. Enrollees are assigned by the CSO at the time of eligibility, unless it is a statewide CSO, TANF reinstatement or other circumstances that prevent equitable distribution of enrollees. Under these circumstances they will be distributed by current zip code on file at the time of distribution.
The Medical Assistance Administration also furnishes the information on community hospital utilization in the Medicaid Management Information System (MMIS) between the 5th and the 20th of the previous month. This information indicates how many claims have been paid by the MMIS to providers and the cost of those claims.
Outpatient Payments
Outpatient payments will be processed at the same time Inpatient payments are processed (entered into the accounting payment system the first working day of the month based on data collected two months prior to payment.) Three types of payments are made each month on one payment document. These are the initial estimate, the remaining consolidated, and the 6-Month Reconciliation.
The following describes each of the three types of payments and possible reductions:
Initial Estimate:
The initial estimate payment uses the Medicaid enrollee data from two months prior to payment and applies the corresponding rate to calculate a gross PHP outpatient payment estimate for each type of enrollee. Next, the Federal Medicaid Assistance Percentage (FMAP) is applied to determine the amount of state match required per Medicaid rules (CHIP kids have a different FMAP rate than the rest of the categories). FMAP calculation yields both the federal piece of the payment and total state match required.
Monthly Consolidated:
Each RSN is paid a Monthly Consolidated amount. This is the total amount of state funds the RSN will receive even if their initial estimate payment requires more state match than the consolidated amount. If the state match requirement is higher than the consolidated amount the RSN is required to certify at the end of the state fiscal year that local funds have been used as match in order to keep all of the federal funds paid.
6-Month Reconciliation:
The 6-Month Reconciliation payment is an update of the Medicaid enrollees. It has been determined that after six months Medicaid enrollee counts are final. If the final Medicaid enrollee counts increase, the RSN receives additional funds; however, if Medicaid enrollees decrease the payment is reduced by the federal portion since state funds have already been distributed in full in the initial estimate payment process.
The same Medicaid enrollee data used for inpatient is used to calculate the outpatient Medicaid enrollees; however, it is compiled differently to fit the outpatient Medicaid enrollee categories which are shown in the Rates of Payment section of the contract. Enrollees are assigned by the CSO at the time of eligibility, unless it is a statewide CSO, TANF reinstatement or other circumstances that prevent equitable distribution of enrollees. Under these circumstances they will be distributed by current zip code on file at the time of distribution.
New Payment Process (66.67% for FY04 and 66.67% for FY05)
Rates of Payment are in the body of the contract.
Payments
Payments will be entered into the accounting payment system the first working day of the month based on data collected two months prior to payment. Three types of payments are made each month (if applicable). These are the initial estimate, 6-month reconciliation, and 18-month reconciliation. The following describes each of the three types of payments:
Initial Estimate:
The initial estimate payment uses Medicaid enrollee data from two months prior to payment and applies the corresponding rate to calculate a gross Medicaid payment estimate. Two times a year, January and July, the MHD calculates estimated utilization amounts based on a six-month average of actual utilization 12-18 months back. (This estimate is then used for 6 months until a new estimate is calculated.) The initial estimate payment is calculated as the gross Medicaid payment estimate less estimated utilization. In the initial payment there is also a calculation for state only clients based on the number of GA-U, medically indigent, ADATSA and state only children as provided by MAA. Then the remaining state funds are allocated for urban, border, ITA commitments and homeless factors.
6-Month Reconciliation:
The 6-Month Reconciliation payment is an adjustment for Medicaid enrollees. It has been determined that after six months Medicaid enrollee counts are final. If the final Medicaid enrollee counts increase, the RSN receives additional funds. No adjustment is made if Medicaid enrollees decrease until the 18-Month Reconciliation.
18-Month Reconciliation:
The 18-Month Reconciliation payment is the final payment for a particular month of service. The MHD has determined that after 18 months the process for measuring community hospital utilization to be charged to the RSNs is complete. This final calculation looks at the gross Medicaid payment (using final Medicaid enrollees multiplied by corresponding rates) less actual utilization less all previous payments made. MHD pays for any increase or collects for any decrease.
Payments are made based on counts furnished by the Medical Assistance Administration generally between the 1st and the 10th of the previous month for Medicaid enrollees. The information is compiled to fit the Mental Health Division’s categories of eligibles, which are shown in the Rates of Payment section of the contract. Enrollees are assigned by the CSO at the time of eligibility, unless it is a statewide CSO, TANF reinstatement or other circumstances that prevent equitable distribution of enrollees. Under these circumstances they will be distributed by current zip code on file at the time of distribution.
The Medical Assistance Administration also furnishes the information on community hospital utilization in the Medicaid Management Information System (MMIS) between the 5th and the 20th. This information tells us how many claims have been paid by the MMIS to community hospitals and the cost of those claims.
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For more ways to get in touch with the Department of Mental Health Services, go to the DSHS Contact Information Web page. Mental Health Related Questions Contact:
