GCSD wants to max Medicaid
The Enterprise — Melissa Hale-Spencer
Serious business: Shannon Clegg, at the microphone, and her students speak to the Guilderland School Board about ideas for recycling. The students kept journals to analyze what they threw away and what was recycled, and then came up with solutions, presented to the board in a PowerPoint format.
GUILDERLAND — Education for students with disabilities is costly, and the school board wants to recoup as much as possible through the federal Medicaid program.
The board on Tuesday accepted audits on special programs and Medicaid compliance performed by Questar III, which is the Board of Cooperative Educational Service for Rensselaer, Columbia, and Greene counties, and presented by Kenneth R. Ziobrowski.
Assistant Superintendent for Business Neil Sanders told The Enterprise that Guilderland gets about $150,000 annually from Medicaid.
Stephen Hadden, Guilderland’s special education administrator, estimates that the district has roughly 120 students who are eligible for Medicaid, a federal health-care program for those with low incomes. A little more than half of those students were signed up last year for the school district to get Medicaid benefits for services.
When board members reviewed the audits at their April 29 meeting, President Barbara Fraterrigo asked if the district pursued them “aggressively.”
“I do three mailings a year with postage-paid envelopes,” said Hadden.
Board member Rose Levy asked why parents wouldn’t sign.
Hadden said it might take some of their insurance benefits away, and termed it “a trust factor.”
Fraterrigo wrote letters to Ziobrowski in response to his proposed plans for corrective action — one on special programs and the other on Medicaid compliance — in which she said the district agreed with the auditor’s recommendations — two recommendations on special programs and eight on Medicaid compliance.
Only once did her wording deviate: In response to a ninth recommendation for Medicaid compliance, Fraterrigo wrote, “The District, in concept, agrees with the auditor’s recommendations.
That recommendation was based on the auditor’s observation that Guilderland has a social worker and a speech therapist who are not licensed and so, according to Medicaid regulations, their services cannot be billed by the district. The auditor estimated $14,783 was lost based on 36 weeks of service, and also notes that nothing has changed since the same observation was made in the last audit.
“The district feels that it must consider the quality of service in meeting student needs when assigning providers,” wrote Fraterrigo in her letter to Ziobrowski. “However, it will endeavor to assign licensed personnel whenever possible to maximize Medicaid revenue.”
Board member Colleen O’Connell said she found it “disturbing” that an already identified problem hadn’t been dealt with. “Why do we have unlicensed staff?” she asked.
Hadden noted that the social worker and speech therapist are still certified; they are just not licensed to practice privately, which would be an added expense for them.
Fraterrigo asked if the two staffers couldn’t be required to get licensed.
Hadden said they had long tenure and that a new posting would say a licensed applicant is preferred.
The posting should say “required,” responded O’Connell.
“These little things are important,” agreed Fraterrigo.
Levy said it doesn’t make sense to lose out on $14,000 for the $300 annual cost of licensing.
O’Connell said she would not vote for an unlicensed professional. “You’re losing flexibility with staff,” she said.
When a provider isn’t licensed, he or she has to be supervised in order for the district to collect from Medicaid.
“We tested four service providers that were ‘under the direction of’ a qualified practitioner of which provided services to 27 Medicaid eligible students,” says the audit. “We noted only one qualified practitioner completed the UDO responsibilities in accordance with requirements….”
The report recommends, “The district should provide training to the individuals that are assigned to performing ‘under the direction of’ responsibilities.”
The district responded that new procedures will have the special-education administrator distribute forms to each licensed provider who supervises unlicensed providers.
At the same time, the audit noted that many session notes were missing from IEP Direct or not signed, as required. IEP Direct is the computer program the district uses to keep track of individualized education programs, which are mapped out for each student who is identified as having disabilities.
“The provider session notes are an integral part of Medicaid reimbursement where the district must be diligent with obtaining the required information and maintaining records,” says the report.
“The district should consider reviewing the records of those students that were not selected for the audit to ensure the district has the correct documentation and the district is maximizing Medicaid reimbursement opportunities,” the audit concludes.
The district responded by outlining its review system.
The audit also noted that some session notes “did not specifically state the student’s progress,” as required for Medicaid reimbursement, and advised service providers be trained to do so.
In response, the district held a training session on March 26 to outline a model session note, and providers were urged to move away from hand-written notes to use the software instead.
Similarly, the audit recommended each prescription and referral be reviewed for Medicaid requirements. The district responded with a workshop to help district staff use appropriate software and improved its review process.
The audit also noted instances where SpecEd Solutions did not submit for Medicaid reimbursement and it recommended the district improve communication with the company. The audit also said someone from the district should get monthly Medicaid eligibility lists from IEP Direct instead of waiting for SpecEd Solutions to provide them. Finally, the audit noted that claims were submitted only four months ahead of the deadline service date and recommended claims should be submitted no later than three months from the service date.
The district responded it will “spell out” for SpecEd Solutions the type of reports it wants regarding rejected and insufficiently documented claims and that it will communicate the other audit findings. SpecEd Solutions represents about 26 school districts in the Capital Region.
In March, Guilderland sent out requests for proposals for a third-party claims Medicaid administrator.
Sanders said that John Rizzo, Guilderland’s Medicaid compliance officer, has been looking around the state for other companies that do the work.
“Not many folks are willing to jump into this game,” said Sanders.
In the special-programs audit, Ziobrowski looked at a sample of eight students and identified incorrect calculations for four of them. The district over-claimed costs by $11,591 or $5,367 in excess cost aid.
The auditor recommended that the person making the calculations should be trained on reviewing individualized education programs, known as IEPs, and what information is needed for the calculation.
The district responded that the account clerk in the business office would be given access to IEP Direct, the software program used by the district, and that the business office would independently validate the related services identified on the IEP from information provided by the special-education department.
The second and final recommendation in the special-programs audit was based on an instance where the district included a special-education teacher’s salary for the calculation of a student’s in-district high cost that was also paid by a federal grant.
The audit recommended the district use a process so that, when amendments are made to the grants, reporting be changed accordingly; the district put such a process in place.
“When economic times are tough,” said Board Vice President Allan Simpson, summing up the views of the board’s audit committee, “we can’t keep taking the knife to our programs.”
In other business at recent board meetings, the board:
— Reviewed an audit, also presented by Ziobrowski, on 2013-14 risk assessment, which found no high-risk areas for Guilderland;
— Heard a proposal from Spanish students and their teacher, Shannon Clegg, that the district reduce waste by replacing lunch trays with biodegradable cornstarch trays or by buying trays that can be washed and re-used. The students became interested in recycling when they were keeping journals with vocabulary words centered on the environment. “It took on a life of its own,” said their teacher.
“Everyone on the board is very impressed with your leadership,” said Fraterrigo. “Stay tuned”;
— Heard from Sanders there is “no change” with the semi-annual asbestos inspection. The report is available at the district office. “As long as asbestos is contained, it’s not hazardous,” said Sanders;
— Heard an update on the $17.3 million capital project, passed by voters last November. The design phase is 70 percent complete, said Sanders. Cost estimates are expected in late May, before projects can be put out to bid.
By mid- to late July, the architect’s plan is to be submitted to the State Education Department, which may take six to eight months to review the proposal. Work is to start next spring and “most certainly” will continue for two summers, said Sanders;
— Heard from Superintendent Marie Wiles that the deputy secretary for education, Ian Rosenblum, toured Guilderland Elementary School and Farnsworth Middle School on April 23.
“We had a candid conversation,” said Wiles on the gap elimination adjustment; Rosenblum “attempted to make the point we received more in aid” than before the GEA when actually, Wiles said, the district will get $1.2 million less next year than in 2008-09. She is sending a fact sheet to the governor on the GEA.
Wiles concluded of the visit, “It was a very proud day for us in Guilderland”;
— Supported Fraterrigo’s initiative to establish a financial-literacy course as an elective at the high school, combining pieces of current business courses into one class. Fraterrigo, who has pushed for such a course for years, said, “My whole thing is life-long learning, things you need to survive in the world”;
— Heard Wiles praise Ed Frank’s Choices 301 program, which Farnsworth Middle School eighth-graders are attending as part of their health classes. The field trips to the Beacon of Hope Center on the outskirts of Altamont enhance student “understanding about the dangers associated with the use of alcohol and other drugs,” said Wiles.
She also said, “The consequences are talked about in very frank and poignant ways”;
— Learned that Paul Seversky, a consultant hired by the district, will present the findings of his Building Capacity Study on June 16 in two sessions: for staff, at 3:45 p.m. at Farnsworth Middle School, and for the community at 7 p.m. at the high school;
— Learned that it will evaluate the superintendent through electronic, rather than handwritten, surveys this year;
— Heard that two Guilderland High School seniors placed third at the Capital Region Juried Media Arts Competition: Jasmin Eustache in Digital Illustration for her piece, “Morality,” and Darina Relyea in Photography and Special Processes for her piece, “Myron”;
— Learned that Zoe Bousbouras was named 2013-14 Outstanding Business Education Student by the Business and Marketing Educators Association of the Capital District. Bousbouaras, who will attend Hudson Valley Community College in the fall, was recognized for her academic achievements as well as her leadership, motivation, and positive attitude;
— Heard congratulations for Colleen Ryan, a special-education teacher at Farnsworth Middle School, who was selected as Teacher of the Week by News Channel 10;
— Learned that research on bullying conducted at Guilderland, “Perceptions of School Climate as a Function of Bullying Prevention,” has been selected for publication by the Journal of Applied School Psychology;
— Agreed to pay $32 per hour for instruction of Guilderland students being tutored at Four Winds, a psychiatric health center in Saratoga;
— Approved a new high school Ping-Pong Club, advised by physical-education teacher Barbara Newton;
— Heard a description from Wiles of a National Junior Honor Society induction ceremony for 226 students on April 24, which she said was “a good kickoff to award season”;
— Heard, from Assistant Superintendent for Instruction Demian Singleton, congratulations for Jenna Robinson, who was selected YNN Scholar-Athlete of the Week. A Guilderland High School senior and a member of the track, cross-country, and lacrosse teams, Robinson has a 95.4 average and is active in the community. “She represents us very well,” said Singleton;
— Heard congratulations for Fionna Hayden, another Guilderland senior, who is president of the Best Buddies program and was recognized by WNYT’s “13 Kids Who Care” program;
— Heard congratulations for Sagar Kumar, a freshman, who won the Air Force award at the 24th Annual Greater Capital Region Science and Engineering Fair for his project, “Silent Flight — Can We Learn From Nature.” Kumar was mentored by his science teacher, William Gray;
— Heard congratulations for the Westmere Elementary fifth-graders in Cheri Hart’s class who entered the Schenectady Gazette writing competition, producing the Student Gazette. Gary Lvov won first place for Editorial, Nina Tuxbury won second place for Comics, and William Van Epps won third place for Comics; and
— Met in executive session on April 29 to discuss potential litigation strategy, and met in executive session on May 13 to discuss the superintendent’s evaluation, the board’s strategy for negotiating with the Guilderland Teachers’ Association, and an employee’s history and potential discipline or dismissal.