DDES Memo Series
2003-12
December 3, 2003
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
To:
Area Administrators/Assistant Area Administrators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From:
Sinikka Santala,
Administrator
Re: Reimbursement for Health Insurance Portability and Accountability
Act Compliance
DOCUMENT SUMMARY
This memo informs counties of the reimbursement process the Division
has implemented to allow the claiming of HIPAA compliance expenditures.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
amends the 1986 IRS code to improve portability and continuity of health
insurance. The designation of the Act is to improve the Medicare program
of Title XVIII of the Social Security Act, the Medicaid program under
Title XIX of the same Act and increase the efficiency and effectiveness of
the entire health care system.
The Department of Health and Family Services (DHS
) has determined that
the county agencies that administer the Medicaid Home and Community Based
Waiver Services Programs (HCBW Programs) are performing health plan
functions for DHS
and are its business associates under HIPAA.
Consequently, counties have made extraordinary expenditures in their
pursuit to comply with the act for Medicaid and other insurers. The
counties, as business associates of DHS
, must comply with the
requirements of HIPAA dealing with: 1) the confidentiality of health or
health-related information, 2) the standards for the security of
individual health information that is electronically maintained or
transmitted, and 3) the standards for electronic transactions.
The complete compliance requirements can be found under sec. 12.04 of
each state/county contract.
County expenditures associated with the above activities may include,
but are not limited to, salary and fringe of a privacy officer, HIPAA-related
data processing costs, printing of HIPAA release forms, direct contractor
costs, etc. The expenditure must be 100% directly dedicated to HIPAA
activities.
The expenditures can not be part of, or be included in any, cost
allocation method including Agency Management Support and Overhead (AMSO).
All reported expenditures are subject to verification and review as part
of the counties' annual OMB A-133 audit.
On a monthly basis, the counties will identify their 100% HIPAA direct
dedicated expenditures and submit them to the State of Wisconsin's
Department of Health and Family Services (DHS
) via the appropriate
Community Aids Reporting System (CARS) profile. The Human Service
Department, Department of Social Services and 51 agencies assisting Family
Care counties in running the residual COP-Waiver program for children may
include their 100% HIPAA direct dedicated expenditures on CARS.
The DHS
, Division of Disability and Elder Services (DDES), Office of
Operations, will then apply the counties' Medicaid Eligibility Rate (MER)
to all eligible 100% direct dedicated HIPAA compliance expenditures. The
result will be claimed at 50% Federal Financial Participation (FFP). The
MER, for a county, is based on the ratio of the total number of
Medicaid-eligible persons served by the county in the target population,
to the total number of persons served by County Human Service Agencies,
County Social Service Departments and Chapter 51 Board Agencies (County
Agency) in the same Medicaid target groups.
For purposes of the MER calculation, a "person served" is
defined as an individual receiving services from the County Agency and for
whom the County Agency has recorded case information into the DHS
Human
Services Reporting System (HSRS).
The Division has developed a reporting mechanism that will allow
counties to report HIPAA expenditures to the Department with the
information necessary to draw down the federal reimbursement. Two CARS
profiles have been created for claiming HIPAA expenditures. The two
profiles are to allow counties to claim 2002 and current year costs, 2003
and beyond. Profile 520 will be used to report CY 2002 expenditures and
Profile 521 will be used to report current calendar year
expenditures.
After this year, there will only be one profile for current year HIPAA
expenditures, 521. These two profile lines will need to be inserted on the
CARS 600 report when a county is reporting HIPAA expenditures. The intent
is for the county to report all direct HIPAA charges/expenditures on a
separate profile for 2002 and another profile for 2003.
The Division will use the MER and apply that to the county charges to
arrive at the share of Medicaid expenditures that are eligible for
reimbursement at the federal administrative rate of 50%. This information
will be shared with the CARS unit, and after the federal claim has been
received, a cash adjustment will be made based upon each county’s costs
and MER results.
The State will calculate the county’s specific MER on an annual basis
using data reported in HSRS by the county agency. Each year, the data on
persons served from HSRS will be compared against Medicaid eligibility
information from the MEDS data warehouse. HSRS records that match the
Medicaid eligibility information are determined to be Medicaid
eligible.
In other words, if a HSRS "person served" is found on the
MEDS eligibility file, the "person served" is Medicaid eligible.
If no match is found, the "person served" is non-Medicaid
eligible. A match exists if the client name, date of birth, sex code, and
social security number are the same on both the HSRS file and the MEDS
eligibility file.
Each County’s MER is calculated using the following equation:
Where:
a = Medicaid Eligibility Rate
b = Medicaid-eligible persons served by the county in the target
population
c = Non-Medicaid-eligible persons served by the county in the target
population
Note: The numerator in the MER calculation includes the "total
number of Medicaid eligible persons served by the County in the target
population."
If you have any questions, please contact Dennis Dombrowicki, Office of
Operations, Division of Disability and Elder Services, (608) 266-3057, dombrdh@wisconsin.gov
.
Regional Office Contact:
Area Administrator
Central Office Contact:
Dennis Dombrowicki
Office of Operations
(608) 266-3057
Memo Web Site:
http://www.dhs.wisconsin.gov/partners/local.htm
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