Meyer Center facing challenges after change to Medicaid reimbursement rules – Greenville News
A Greenville school for special needs children says it is losing money due to a change in how it receives Medicaid funds.
Chris Neeley, executive director of The Meyer Center in Greenville, said the center is losing $25,000 a month because the S.C. Department of Health and Human Services (SCDHHS) now requires schools to bill parents’ private insurance before seeking Medicaid reimbursement.
Josh Baker, SCDHHS director of operations, said the requirement is not a new one, but rather the enforcement of a rule that school districts had gotten away with not having to follow.
A statement from SCDHHS said traditionally, Medicaid agencies are the payer of last resort for most programs and services.
Recent federal guidance on the use of private insurance for Medicaid beneficiaries prompted SCDHHS in 2015 to update its policies, which includes enforcing the longstanding federal requirement that school districts participate in the third-party liability (TPL) process, the statement said.
The state Department of Education and SCDHHS allowed a year of planning and outreach to school districts before the updated policy went into effect in January, SCDHHS said.
The agency “didn’t just one day sort of say, ‘Hey schools, here’s a new rule you have to follow,’” Baker said. “There was a very long forward process that started with federal guidance to enforce this.”
Neeley said the federal government is not requiring the change. “South Carolina is doing this,” he said. “South Carolina made a choice. Other states are still billing Medicaid directly for school-based services.”
Matthew Flaminio, CEO of Michigan-based Go Solutions, the company that processes the Medicaid billing for The Meyer Center, said South Carolina is the only state he works with that requires schools to go through the administrative process of submitting claims to a private insurer before it will consider reimbursement for Medicaid.
Neeley said the change was made by former state Medicaid director Christian Soura, under the direction of former Gov. Nikki Haley.
He is asking the agency to revert the policy back to what it was.
“He’s saying we made this decision and we can just change it. I would see that change as us, in many respects, deciding not to comply with federal regulations. Those are generally not decisions we make. So I don’t know that that’s really an option that’s on the table,” Baker said.
Neeley said he met this week with SCDHHS and three Upstate Senate leaders to discuss a resolution.
“They are unable to attempt a legislative fix with so little time left in the session,” Neeley said in an email to The Greenville News.
He said the state is going to contact CMS in Washington “to see if a special provision can be made for us to circumvent the TPL process, but that will possibly take months for a decision. Meanwhile, we hope to receive a short term reprieve from billing our students’ private insurance so that we can bill Medicaid directly. We hope to have an answer from DHHS on that in the next week or two.”
Neeley said all children with disabilities qualify for school-based services (occupational, speech and physical therapies) under the Individuals with Disabilities Education Act (IDEA).
Schools across South Carolina had been able to bill Medicaid directly for payment for those services under the IDEA “because every student with disabilities has a civil right to a Free Appropriate Public Education (FAPE) at no cost to the parent, guardian or student,” he said.
Neeley said the change in Medicaid billing has “jeopardized critically needed treatment to South Carolina’s most vulnerable citizens – children with disabilities.”
Founded in 1954 by Dr. Leslie Meyer, the Meyer Center is a Greenville-based nonprofit public charter school that serves preschool children with special needs and their families through education and physical, occupational and speech therapy, into a regional or statewide model.
The school-based therapies for children with disabilities are required and they’re supposed to be at no cost to the parents or the family.
The Meyer Center is providing the services, Neeley said, but “our budget won’t allow me to continue to sustain this kind of loss much longer. It’s going to get to the point where I might have to lay off staff. Then the children are going to be hurt because they’re not going to get the services we’re required to (provide).”
Even more frustrating, Neeley said is 90 to 95 percent of the private insurance companies aren’t going to pay for the school-based services because Medicaid is supposed to cover the costs.
“They’re making us go through this whole rigmarole only to get a denial two, three or four months later. Then when you get a denial, they will allow you to bill Medicaid. From a cash flow standpoint, you might provide services in January and not get reimbursed until June,” he said.
And Neeley said, it now puts burdens on the families of children with disabilities because their insurance is “going to be taking a hit.”
“It’s a big disaster.”
Baker said Neeley is mischaracterizing this as a thing that Medicaid did to him and his students by extension.
For years, school districts and other public entities like social services have not complied with federal requirements.
“This was not something that was allowed. This wasn’t a specific waiver grant by the federal government,” Baker said. “We just didn’t enforce the rule.”
He said the Meyer Center is not losing money. The money is being delayed.
“What has happened is he has to now bill the insurance. The insurance has to either pay him or reject and if it rejects, he comes back and bills us,” Baker said.
But, “federal education law dictates that he still serves these students, so students are not going to lose services,” he said. And “the rules of free, appropriate public education still apply to The Meyer Center. They can’t charge parents for these services.”
Neeley said half of his students have Medicaid and private insurance.
“The only ones we can bill right now are the ones who have only Medicaid,” he said, so the center is “getting less money.”
Neeley said he met with McMaster and Soura in February about the impact the Medicaid reimbursement change is having on his school. Greenville attorney and Meyer Center board member Nick Nicholson was among those who sat in on the meeting.
Nicholson left the meeting with the understanding that “the change was an administrative one made at the state level and that it could be changed back administratively.”
“But I question how much money they’re saving relative to the overall state budget versus the impact it’s having on the Meyer Center,” Nicholson said.
The state has been trying to cut Medicaid services, which cuts Medicaid dollars, Neeley said.
“Haley did not take the Medicaid expansion under Obamacare so South Carolina lost out on about $12 million in Medicaid dollars. To make matters even worse is that 79 percent of those is federal dollars,” Neeley said. “The match between the federal government and South Carolina on Medicaid is 79 to 21, so it’s not really that big of a hit for the state to exempt schools from having to bill these parents’ private insurance.”
The Meyer Center, Baker said, is the only school in the state that is saying services could be compromised.
“Other districts may not love the rule but nobody is going so far as to say that this is going to compromise services,” he said. “My concern here is that that maybe some of the effects are being a bit overstated.”
The state mandated switch to TPL (Third Party Liability) requirement has been challenging for all districts, Greenville County Schools included, said spokesperson Beth Brotherton in an email to The News.
The requirement is the same for charter schools and traditional schools and, she said, it has made the process “more complicated and lengthy for all of us.”
Greenville County Schools currently has five charter schools, four of them, including the Meyer Center, have been accepted into the State Charter District.
Brotherton said initial communication about change in the process was sent to school districts in March 2016. Statewide training did not occur until November/December of 2016 for the mandate that began on began on January 1, 2017.
She said Greenville County Schools is not a billing agency. It uses a private contractor for Medicaid billing like the Meyer Center and other charter schools.
“All information about the mandate received by the district was disseminated to both billing companies at the same time. Go Solutions managers were given all of the information that the district received and were aware of all changes in Medicaid billing procedures,” Brotherton said.