Medicaid Personal Care (MAPC) is a funding source for individuals with developmental disabilities who have Medicaid and require hands on support to complete their personal cares. Following are some frequently asked questions regarding MAPC for people with developmental disabilities in Dane County.
- How do I know if someone I work with is eligible for MAPC?
- To receive MAPC, a person must have Medicaid and require assistance completing their personal cares. As the MAPC program requires a great deal of record keeping and administrative oversight, Dane County only seeks this funding source when a person has at least 1 hour of billable hands-on support needs per day. Use the “MAPC “indicators” worksheet to determine the likelihood of eligibility.
- How do I get someone enrolled in an MAPC program?
- If people live at home with their parents, they can access MAPC services through Community Living Alliance (CLA) or any home health organization that provides this service. A staff nurse at one of these agencies will complete an assessment and a Personal Care Screening Tool (PCST). The State uses this to determine eligibility. If a person receives DD residential support from any of our residential agencies or through Goodwill Co-Employment or Fiscal Assistance, refer the individual to CLA’s Supported Living MAPC program.
- What is the reimbursement rate for MAPC?
- The county receives $16.08/hr. for MAPC services. If a person is eligible for 20 hours of MAPC per week the county can receive up to $16,723/yr. ($16.08 × 20 hours × 52 weeks = $16,723).
- If a waiver participant has a current SDS budget of $50,000 and is newly eligible for 20 MAPC hours per week, would the county receive $16,723 in new revenue?
No. The county first bills MAPC for $16.08/hr. Assuming we receive $16,723/yr. in MAPC we subtract this from what we bill waiver ($50,000 - $16,723 = $33,277). $33,277 gets billed to the CIP waiver. The federal government pays approximately 60% of these support costs ($19,966). County tax dollars pay the remaining 40% ($13,311).
Without MAPC, the county would bill waiver for the entire $50,000 SDS rate. The federal government would pay approximately 60% of these costs ($30,000). County tax dollars would pay the remaining 40% ($20,000).
In this scenario, the SDS rate remains $50,000. Using MAPC decreases the amount of county tax dollars spent from approximately $20,000 to $13,311/yr. The county saves $6,689 in local tax dollars.
The county collects a maximum of $6.43 in new revenue for each billable hour of MAPC. ($6,689 new revenue divided by 20 hours per week in MAPC billing divided by 52 weeks per year.) In reality, the county collects between 60-70% of eligible MAPC revenue. This reduces new revenue to approximately $4/hr.
- If an individual is authorized for 20 hrs./week of MAPC, why is a supported living agency only billing for 13 hours?
- System-wide, Dane County collects between 60-70% of eligible MAPC dollars. Many factors impact the rate of collection such as:
- The amount of time a person spends outside of their home. Staff can only provide MAPC in an individual’s home.
- The longevity of an individual’s staff. Only “qualified” personal care workers can bill MAPC. “Qualified” staff must meet Medicaid-specified training requirements. Often staff are ineligible to bill MAPC when they first work in a home; this is true until CLA receives a Training Verification/Exemption form from the residential agency and/or in-home training has been completed.
- The staff must be checked off by the Registered Nurse for all nurse-delegated tasks and cannot bill that time until this has been completed.
- The accuracy of staff reporting. Staff do not always check each time a personal care is provided.
- I hear people complain about the administrative burden of MAPC. What do they mean?
- While all bureaucratic systems have rules that need to be followed, MAPC rules are very complex and specific. Two examples include:
- A face-to-face nursing visit must occur every 50-60 days. Nurses must observe a person in their home receiving a billable MAPC service from a “qualified” personal care worker. This provides a 10-day window of time when nurses can visit. If the nurse arrives to observe a care and the staff has not met MAPC training requirements the nurse must reschedule the visit.
- Every consumer has a Daily Record of Care (DROC). This “timesheet” must be completed and signed by every staff that completes a personal care. Each individual has at least 30 DROCs per month. If an agency supports 30 individuals who receive MAPC, they must process over 900 MAPC DROCs per month. Agencies must review these DROCs for accuracy and signatures. Agencies then forward the sheets to a nurse for signature. CLA oversees MAPC for approximately 370 individuals with developmental disabilities. This means CLA reviews and signs-off on over 10,200 DROCs per month or 122,400 per year.
- Why are MAPC billing statements several months behind?
- While reasons vary, they include billing delays at EDS as well as time spent:
- Tracking down missing signatures on DROCs.
- Identifying when and why a person’s LTC-FS does not match their Personal Care Screening Tool PCST.
- Missing DROCs during the month.
- Reviewing and processing DROCs
- Checking for any hospitalizations, nursing home placements, etc. so that no DROCs are submitted during those hours.
- Who monitors MAPC billing and collections?
- The county contracts with CLA to provide the MAPC nursing oversight for MAPC completed by supported living providers. CLA coordinates and oversees the billing for this MAPC. Mickey Roiland is the Dane County accountant who monitors MAPC billing; Doug Hunt is the Dane County program specialist assigned to MAPC. Each month, residential agencies receive a computer printout of their consumer’s MAPC eligibility and the revenue collected. Broker directors receive a similar report quarterly.
- What is a broker’s role in monitoring and helping maximize MAPC revenue?
- Work with an individual’s team to ensure that people with 1 or more hours per day of personal care needs are enrolled in the MAPC program.
- Work with your broker director to identify individuals whose MAPC billing consistently falls below 60% of eligible hours. Work with individuals’ teams on ways to increase MAPC billing.
- Avoid the temptation to call supported living directors every time there is a monthly anomaly in MAPC billing. Agency directors, a county accountant and county program specialist already review monthly billing statements. All wish to maximize MAPC revenue.
- Before seeking additional SDS funding for a person with increasing physical needs, determine if the person is eligible for MAPC. If so, start the assessment process. If a person already receives MAPC, see if they are eligible for more MAPC.
- Notify the nurse providing MAPC oversight when you make changes in a LTC-FS that may impact the PCST.
- Respond within 24 hours when a nurse notifies you about discrepancies between the LTC-FS and PCST.