10/23/15: Ohio Medicaid School Program (MSP) Medicaid Eligibility Rate (MER)

Each school year, the Ohio Department of Medicaid (ODM) computes the Medicaid Eligibility Rate (MER) for each school district that is participating in the Medicaid School Program. This computation is made by submitting October Student Enrollment Data in a very specific file format to ODM. This data is usually obtained from your ITC or your EMIS Coordinator. ODM then computes two percentages that are used in the MSP Cost Report. The two percentages are “Total Percent of All Students that have Medicaid Insurance” and “Total Percent of IEP Students that have Medicaid Insurance”. The original due date for the 2014/15 data submission was 11/02/2015, but ODE has acknowledged that more time may be needed to collect the data and get it in the correct format. You will still want to get this data to your billing agent as soon as possible.

In prior years, the IEP MER was computed by taking your Total Number of IEP Students with Medicaid Insurance and divide it by Total Number of IEP Students.

Example: 55 IEP Medicaid Students divided by 100 IEP Students = 55% MER

Beginning with the 2014/15 school year, IEP MER will be computed by taking your Total Number of Students with a Paid Interim Claim divided by Total Number of Related Service IEP Students.

Example: 30 Paid Claim Students divided by 60 RS IEP Students = 50% MER

Since the new computation numerator is based on Paid Claims, we must remove from the denominator the students that do not receive MSP reimbursable services.

Initially, we are only asking districts to submit the normal “October Student Count Data”. Once all MER data has been collected, we will be sending each district a list of IEP students (based on the student count data submitted), and will be asking you to identify those students that have a Related Service listed in their IEP.

The MER for the IEP Student Enrollment is usually as much as 15% greater than the MER for All Student Enrollment. We expect that the MER for Related Service IEP Students will be as much as 15% greater than the MER of All IEP Students, but to fully maximize MER, all therapists must be documenting services and all MSP Parental Consent Forms must be obtained. Keep in mind, the larger the MER, the greater Medicaid reimbursement.