Specifications include, but are not limited to: The Contractor) shall assist the State in the following areas: 1. Define State objectives related to the redesign of SBS reimbursement and non-federal share financing in the State for both medical and administrative services. 2. Conduct an analysis documenting the current state of Medicaid SBS reimbursement in Vermont, including the following: a. Coverage i. Which services delivered in a school-based settings are eligible for Medicaid/CHIP reimbursement b. Service delivery approach (e.g., LEA employment of SBS providers, contracts with community-based providers for SBS delivery, etc.) c. Reimbursement methodology i. General SBS rate-setting approach; ii. How payment rates are set for specific services; iii. Medicaid Administrative Claiming approach for SBS; iv. How providers bill for and document delivery of services; v. Current per-service payment amounts d. Aggregate Medicaid and CHIP volume and reimbursement related to SBS, stratified by service type and geography (e.g., LEA, county, and / or other geographic units identified by the state) e. Non-federal share financing approach (e.g., state general funds, local property taxes, certified public expenditures, intergovernmental transfers, etc.) 3. Develop a national landscape scan of best practices related to Medicaid/CHIP reimbursement and non-federal share financing of SBS for both medical and administrative services. The landscape scan should focus on new flexibilities and best practices highlighted under the recently released CMS guidance, examples from leading states, and opportunities for additional federal Medicaid match. 4. Options Analysis and Recommendations Development: Based on the State’s objectives, current state analysis and best practice review, contractor will develop possible options related to SBS payment and non-federal share financing redesign for the State’s consideration. Contractor will work with State to evaluate options and develop a recommended SBS reimbursement and nonfederal share financing approach. Recommendations should prioritize expanding access to care, improving administrative efficiencies, and maximizing available federal Medicaid reimbursement under the program, within regulatory guardrails established by CMS. 5. Reimbursement Methodology Development: Based on the recommendation, contractor will develop a detailed description of the new Medicaid/CHIP SBS reimbursement methodology and non-federal share financing approach, which would be used to establish new SBS rates.
