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HomeMy WebLinkAboutISB (Compliance Services Asssoc) 14-15GUARANTEED SCHOOL-BASED COMPLIANCE MEDICAID ADMINISTRATION AGREEMENT This Agreement is made by and betlveen Compliance Services Association, lnc., an ldaho General NON-Profit corporation, located at 6003 W Overland Road Ste. 201 Boise, lD 83709, hereinafier referred to as CSA, and Bonneville School District #93, ldaho Falls lD. hereinafter refened to as the SCHOOL OISTRICT. WHEREAS, CSA is an ldaho NON-Profit corporation organized to provlle COMPLIANT MEDICAID administration to ldaho schools, and has developed a complete COMPLIANT MEDICAID administration program which provides ldaho school distric{s with training, administrative, consultative, statistical, audit services, and a guarantee of compliance; WHEREAS, the SCHOOL DISTRICT wishes to obtain, and CSA wishes to fumish these COMPLIANT MEDICAID administration services; NOW THEREFORE, in consideration of the premises and the mutual promises and undertakings of the parties hereinafter set forth, the parties hereby agree as follows: The term of the Agreement shall be from August 20,2011ro. August 20, 2015. CSA will provide COMPLIANT MEDICAID administration servi@s as outlined in the SUMMARY OF MEDICAID ADMINISTRATION SERVICES (AttachmentA) document aftached. The SCHOOL DISTRICT agrees to perform the COMPLIANT MEDICAID administration services as outlined in the SUMMARY OF MEDICAID ADMI Nl STMTION SERVI C ES (Attachment B) document attached. As consideration for the provision of said services, the SCHOOL DISTRICT shall pay CSA an administration fee for all MEDICAID reimbursements received either by direci deposit, checks, or when payment is made available to the SCHOOL DISTRICT by the ldaho Department of Heafth & Welfare pending match payment. 3. 4. Pogc 1 of 8 GUARANTEED SCH00L…BASED COMPLIANCE MEDICAID ADMINISTRATION AGREEMENT a) The administrative fee is payable upon receipt of each invoice which will accompany the fully reconciled remittance report. b) The guarantee is reflected in a service level agreement and will include (Attachment A - Attachment B): . ldaho DHW School-Based Services Medicaid Program compliance. . IEP monitoring for guaranteed NO Audit fees or penalties paid from School District funds for SBS Medicaid billing audils. No guarantee for IDEA compliance. . itracklEP softrvare and itrackLOGS. NO OWRBILLT TG (Must "Opt tN") . Physician rcfenal. (Must'Opt IN') GUARANTEE WILL NOT INCLUDE: . Monitoring of IDEA qualiffing documentation, seruices provided, or documentation of services provided in schools. . Monitoring of "no school' days or student absent days. . Monitoring of hiring and/or qualifications of provirlers of services in schools. Added Value (No Charoe) Services orovided in this aoreement: (Check one box, each line) "Opt lN" "Opt OUT" Assisting with obtaining Signed Physician referrals E tr Use of itracklEP (Attachment D-REBATE) - fuackLOGS [ tr c) The Administrative Fee Table is as follorivs: (Fe€ tabte exctusivety for Bonnovile School Distric{ due to the long term relalionship and this being the first year otfering of CSA) - See Att chment E Prge 2 of E 9. GUARANTEED SCHOOL-BASED COMPLIANCE MEDICAID ADMINISTRATION AGREEMENT any such information to CSA at the termination of this agreement. SCHOOL DISTRICT agrees that in the case of any attempt to terminate this agreement before the end of the term, or any submission of any Medicaid billing(s) performed by SCHOOL DISTRICT or any other person or entity on its behalf, SCHOOL DISTRICT shall account for all such submissions and shall owe CSA the above-stated (Section 4(c)) adminisfative fee for all such submissions. SCHOOL DISTRICT also acknowledges and agrees not to disclose specialized information and knowledge learned through CSA, to other school districts or their agenb, or any other person or entity, via written or verbal communications. Sucfr disclosure is a material breach of this agreement. SCHOOL DISTRICT, by executing this agreement, wananE that the person signing this agreement has the authority to do so, so as to bind SCHOOL DISTRICT to its terms, and that all necessary meetings, approvals, authorizations, votes and other matters necessary to make this a valid and enforceable agreement binding SCHOOL DISTRICT have been completed, finalized and performed. This agreement represenb the entire agreement of the parties and can be modifred only by a writing signed by both parties. No prior verbal promises or agreements not contained herein are valid. This agreenrent shall be interpreted and enforced under the laws of the State of ldaho. ln the event of litigation arising out of an alleged breach of this agreemenl, the prevailing party shall be entilled to costs and attomey fees incuned. lN WITNESS THEREOF, the parties have signed this Agreement. CSA: Compliance Services Association, lnc. SCH00L D:STRICT:Bonneville Schoo:Distnct lЮ GUARANTEED SCHOOL-BASED COMPLIANCE MEDICAID ADMINISTRATION AGREEMENT Attachment A Summary of Guaranteed schoot{ased compliance tedicaid AdminasEatiyo Services As the guaranteeing consulting and billing agent csA agrees to adhere to all rules and regulations that govem the submitting of claims under the Rules and Regulations tratgovem the school-based Rehabilitative and Health Re/afed Serybes erognm. Below ie a list of services and recponaibllitiec that csA agnBes to deliver: . Guaranteed schoor-based services Medicaid compriance, administrative, consulting, audit seMces, to the school District. Guarantee based on infomation documented on the rEP and physician refenal. csA wiil pay ail fees and fines resufting in sBS Medicaid biiling audits. No guarantee for IDEA compliance. . State and federal Medicaid information, liaisons, and updates: Tirnely and accurate information regarding the rules and regulations associated with the Rehabilitative and Health Related SeNicris progrcm . Assistance with research and eventual identification of the school District Medicaid eligible population . Reasonable efforts in securing physician,s referrals (Attachn€nt C) . Upon request, on-site and web baining and instruction for Administrators, heahh- related professionals, paraprofessionals, and aides . Guaranteed, Accurate, dependable, and confidential Billing process. Traddng and Reconciliation of all submitted claims . Ac@ss to online service delivery soft:ware and Administrative reporting tools . Customized reports showing the status of all Medicaid transac{ions and reimbursements . Data warehousing and digital archival of School District billing information, submitted claims, service records, adjustment details, and audit information . Assistance in Audit Readiness preparation and facilitation to ensure proper prccedure and compliance; lnterface with the Deparfnent of Heatth and Wefiare as appropriate for audit findings Prgc 5 of t GUARANTEED SCHOOL.BASED COMPLIANCE MEDICAID ADMIMSTRATION AGREEMENT Attachment B School Dbtrict Reaponsibilities As the Provider of Record, the SCHOOL DISTRICT agrees to provide information to CSA that adheres to all Rules and Regulations that govem the Schoo!-based Rehablliffiive and Health Relafed seruic* Prognm. Below is a list of services and responsibilities that the SCHOOL DISTRICT agrees to perform: The SCHOOL DISTRICT is rceponsible for the fotlowing: . Ensure that; One time @nsents are signed, students qualiff for services listed on the lEP, all services listed on the IEP and Physician referrals are performed and documented by qualifred personnel, that all services and documentation is in accordance with IDEA, and that the compliant billing documentation is accurate with the documented services listed on the IEP and physician refenals. . Submit timely and accurate; IEP cover page and service page, amendmenE, service delivery logs (records) that meet Medicaid requirements for documenting service delivery and for which the SCHOOL DISTRICT is seeking reimbumement and to submit sucfi records to CSA via paper claims or weFbased soflrrare provided by csA, so that csA may provirje timely and accurate Medicaid claims and reporting for the district. . lnsure that certifications and licensures of all prac{itioners are accurate and up- to{ate. lnsure that all practitioners submitting claims are not disqualffied to do so by the Department of Health & welfare or the center for Medicare and Medicaid Services (CMS). Maintain necessary papenrork related to cerlifications, licensures, etc. of all qualified staff including conbac{ed services for whose services the School District is seeking reimbursement . Maintain all lndividual Education Programs (lEps) accordingto Rehabititative and Health Related Serybcs program guirJelines for all services for which the SCHOOL DISTRICT is seeking Medicaid reimbursemer . provide CSA with the IEP cover page and service page and amendments. . Maintain on file and provide cSA with copies of all recommendations or refenals from a physician or other practitioner of the healing arts for services for which the SCHOOL DISTRICT is seeking reimbursement. Pegc 6 of 8 GUARANTEED SCH00L―BASED COMPLIANCE MEDICAID ADMINISTRAT10N AGREEMENT ALchmentC Physicians Refertal ln the event that the SCHOOL DISTRICT does "Opt lN'to have CSA provide assistance in obtaining physician referrals as part of the contractual anangement the following applies: . CSA will monitor physician referrals for all students for which the district is submitting Medicaid claims. No claims will be submitted without insuring that a timely referral has been obtained by the district for the services identified in the student's lEP. CSA will coordinate the refenal process with the District and make reasonable efforts to obtain a refenal on behalf of the School District. . When CSA has exhausted reasonable means, CSA will notify the District of the names of the students for whom a refenal was not obtained along with the reason why. . CSA will maintain and archive refenals from a physician or other practilioner of the healing arts for services for which the School Distric{ seeks reimbursement ALchment D ib・ackIEP Sdb′att Solu●on o CSA w∥lrebate 1 00%ofthe invoice amount ofthe state of!daho:EP funding amount o CSA,inc.ul∥zes“propnetary SOttware"and its accompanying database system for processingi stOnng,and retreving a∥Medicaid B∥∥ng Re∞rds.This system has been optimized forthe idaho Medicald schoo卜 based services program, induding data co!:edion and eledronic transmission requirements,and provldes accurate b∥:ing services to pa∥ビcipating!daho School Dist"cts Prge 7 of 8 GUARANTEED SCHOOLBASED COMPLIANCE MEDICAID ADMINISTRATION AGREEMENT Attachment E Administsation Fee Table Combined Percentage (Aggregab) Not Shown lf the Federal reimbursement share is; Arsumption: s0 - t200,000 $200,mr - $400,(n0 ${00,mr -$6m,m0 $600,00r -$m0,m0 s800,001 - $r,m0,m0 $1,m0,00r -sl,200,000 El,Zn,ml &Above I Ycrr 1