School Based Access Program (SBAP) Medicaid Cost Reporting and Cost Settlement Training for FY

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1 School Based Access Program (SBAP) Medicaid Cost Reporting and Cost Settlement Training for FY Commonwealth of Pennsylvania Department of Human Services Department of Education October - December 2015

2 Agenda FY Cost Settlement Overview and Deadlines System Demonstration Annual Financials in the PCG Claiming System Contact Information SBAP Training Annual Cost Settlement 2

3 FY Cost Settlement Overview and Deadlines

4 Cost Settlement Overview What is cost based reimbursement for SBAP? A cost based reimbursement methodology determines the actual cost of delivering direct medical services to special education students. Cost based reimbursement ensures that LEAs are reimbursed their total Medicaid allowable costs for the delivery of Medicaid allowable direct medical services. SBAP Training Annual Cost Settlement 4

5 Cost Settlement Overview How will cost based reimbursement impact LEAs? In accordance with Pennsylvania s State Plan, LEAs are required to participate in an annual cost reconciliation process. The cost reconciliation process will include the submission of an annual Medicaid cost report. LEAs will complete an annual Medicaid cost report online at The Medicaid cost report captures the actual costs of providing Medicaid covered health-related services as reported by the LEAs, which will be compared to Medicaid reimbursement received through SBAP interim payments for the fiscal year in order to determine the cost settlement. Interim payments are those payments received by the LEA for direct services throughout the fiscal year. These payments DO NOT include payments received for the quarterly MAC claims. SBAP Training Annual Cost Settlement 5

6 Cost Settlement Overview Summary of SBAP Reimbursement Streams LEAs receive reimbursement through 2 distinct streams for SBAP related activities: 1) SBAP Direct Services Reimbursement : LEAs receive payments based interim claims submitted for direct health-related and specialized transportation services LEAs complete an annual cost report which is used to calculate Medicaid Allowable Costs for comparison to the interim payments to determine the cost settlement 2) SBAP MAC Reimbursement: LEAs complete quarterly MAC claims for reimbursement of Medicaid Administrative activities SBAP Direct Services Reimbursement Direct Services Reimbursement Logging Direct Services Logging Evaluation Services Ensuring Current Compliance Data Cost Settlement Medicaid Allowable Costs (from Cost Report) Annual Cost Report Random Moment Time Study Staff Pool List SBAP MAC Reimbursement Medicaid Administrative Claiming Quarterly Financials Random Moment Time Study Staff Pool List SBAP Training Annual Cost Settlement 6

7 Cost Settlement Overview Process for FY Oct. Dec Feb. April 2016 April 2016 May June 2016 LEA signs LEA submits PCG performs PCG finalizes Certification of Annual LEA Desk LEA Cost Public Medicaid Cost Reviews Settlements Expenditure Report (CPE) Form LEAs input Direct Medical Service costs, Specialized Transportation costs, and General and Statistical (ratio) info. Salaried Staff Contracted Staff Materials/Supplies Depreciation LEAs certify Medicaid Cost Report in the PCG Claiming System. PCG reviews all cost report data for every LEA. Edit explanations Outliers As a result of any inconsistencies, LEAs give additional explanation or edit the data as needed & recertify cost reports. PCG notifies LEAs when settlement amounts are finalized. LEAs review and approve their final cost settlement information. Authorized Officer of the LEA (CEO, CFO, Superintendent) signs form and returns to PCG. SBAP Training Annual Cost Settlement 7

8 The Annual Medicaid Cost Report for the reporting period July 1, 2014 to June 30, 2015 is due on December 31, SBAP Training Annual Cost Settlement 8

9 This is the first year the annual cost report will be completed in the new PCG Claiming System (previously MCRCS) This is the same system used for Random Moment Time Study (RMTS) and Quarterly Financials Everything you need is now housed under one system for easy access! SBAP Training Annual Cost Settlement 9

10 Cost Reporting Requirements All costs captured on the SBAP Annual Medicaid Cost Report must be reported on an accrual basis. This is a requirement by the Centers for Medicare and Medicaid Services (CMS). Under an accrual based accounting methodology, expenses are recorded at the time in which the transaction occurs, rather than when the payment is made. Expenses are counted when the LEA receives the goods or services. The LEA does not have to wait until the expense is actually paid to record a transaction. Example of Accrual Based Reporting: In July 2015, the LEA pays salaries and benefits for the last two weeks of June This expense occurred in July 2015, but pertained to services provided in June This expense should be recorded on the July June 2015 annual cost report when the transaction occurred, not when it was paid. SBAP Training Annual Cost Settlement 10

11 Cost Reporting Elements Only allowable costs approved by CMS can be reported on the cost report. CMS approved a cost reimbursement methodology that includes a number of data elements Cost and data elements related to direct health-related services include: Salary costs for eligible direct service providers; Benefit costs for eligible direct service providers; Health-related purchased service costs for eligible direct service providers; Approved Direct Medical Service Materials and Supplies costs; Depreciation costs for Approved Direct Medical Service Equipment; Annual Tuition Costs; Pennsylvania Department of Education Unrestricted Indirect Cost Rate (UICR) (statewide factor); Random Moment Time Study (RMTS) Direct Medical Service Percentage Results (statewide factor); and Individualized Education Program (IEP) Ratio (LEA specific). Please ensure your LEA maintains all documentation to support allowable costs reported. This includes financial documentation & transportation logs. SBAP Training Annual Cost Settlement 11

12 Cost Reporting Requirements The CMS-approved cost elements related to transportation include: Salary costs for eligible transportation staff; Benefit costs for eligible transportation staff; Contract costs for eligible transportation staff; Other allowable transportation costs (such as fuel, insurance, repairs & maintenance, etc.); and Depreciation costs for approved transportation service equipment. Please ensure your LEA maintains all documentation to support allowable costs reported. This includes financial documentation & transportation logs. SBAP Training Annual Cost Settlement 12

13 System Demonstration Annual Financials in the PCG Claiming System

14 Getting Started Annual Financials Make sure FY15 is selected (default is current fiscal year) SBAP Training Annual Cost Settlement 14

15 Getting Started Annual Financials Click on the Annual field for the list of pages to complete. SBAP Training Annual Cost Settlement 15

16 Page Name Crosswalk MCRCS (old) Annual Payroll Information Annual Payroll Information Transportation Payroll Information Direct Medical Services Materials and Supplies Transportation Other Costs Annual Tuition Costs CLAIMING SYSTEM (new) Salaried Staff Contracted Staff Transportation Salaried Staff Direct Medical Services Other Costs Transportation Other Costs Tuition Direct Medical Services Equipment Depreciation Direct Medical Equipment Depreciation Transportation Equipment Depreciation General and Statistical Information Costs Summary Report Transportation Equipment Depreciation General and Statistical Information Cost Report SBAP Training Annual Cost Settlement 16

17 Salaried Staff MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 17

18 Contracted Staff MCRCS (old) Claiming System (new) v SBAP Training Annual Cost Settlement 18

19 Transportation Salaried Staff MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 19

20 Direct Medical Services Other Costs MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 20

21 Transportation Other Costs MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 21

22 Tuition MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 22

23 Direct Medical Equipment Depreciation MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 23

24 Transportation Equipment Depreciation MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 24

25 General and Statistical Information MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 25

26 Cost Report MCRCS (old) Claiming System (new) SBAP Training Annual Cost Settlement 26

27 System Demonstration Annual Financials in the PCG Claiming System Filling Out the Cost Report

28 Salaried Staff and Contracted Staff There are two options to enter data into the system: Export/Import Individually Selecting Staff SBAP Training Annual Cost Settlement 28

29 Entering Employee Costs Enter data into each of the fields. Include only numbers No commas or currency symbols Warnings will be triggered if data is outside expected thresholds. Examples: Benefit to salary ratio is high/low Salaries are high Explanations are required for any warnings SBAP Training Annual Cost Settlement 29

30 Salaried and Contracted Staff Salaries: Regular wages, extra pay, paid time off, overtime, bonuses/longevity, stipends, and cash incentives for full-time and part-time staff Total pre-tax earnings for the claimable period Benefits: Employer-paid health/medical, life, disability, or dental insurance, employerpaid child care for children of employees, retirement contributions, worker s compensations costs Report amount directly associated with each individual by benefits type Contracted Costs: Compensation paid by the district for a contracted individual who delivered any SBAP services to any special education students. Report gross Salaries, Benefits, and Contracted Costs for eligible SBAP direct service providers that were included on the appropriate Staff Pool Lists ONLY. Properly reduce these by any sources of federal funding. 18 SBAP Training Annual Cost Settlement 30

31 Entering Employee Costs Job Span Toolbar The system indicates the amount of time an employee was listed on the Staff Pool List by the Job Span toolbar. *Recall that you can only include employee costs for the period they were listed on the Staff Pool List. SBAP Training Annual Cost Settlement 31

32 Exporting/Importing Cost Data The Annual Salaried Staff page can also be exported for completion in Excel or csv. SBAP Training Annual Cost Settlement 32

33 Exporting/Importing Cost Data When importing the file back into the system, review the log which will outline any warnings or errors in the exported file. Once reviewed, check the box and select Commit. SBAP Training Annual Cost Settlement 33

34 Exporting/Importing Cost Data Exporting/Importing Tips: You may easily export your salaried or contracted staff into a spreadsheet, report costs in the spreadsheet and then import into the system. It s important to follow the following guidance when reporting costs this way. Don t change any information in the spreadsheet that exports out of the system except for adding numbers and decimals (your costs). Required fields to report costs are between salary and federal offset columns. Don t add commas, don t add dollar signs, etc. Only add numbers and decimal points. Please make sure ALL cells between salary and federal offset are filled with a number. If you have no costs to report you MUST put a zero in the cell between the salary and federal offset columns. Save your file as an EXCEL file. The exported spreadsheet is a.csv file, please save as an EXCEL file to import. Importing hours is NOT a required field. If you choose to import hours they must be whole numbers. Decimals in the hour s field will result in errors in the upload. SBAP Training Annual Cost Settlement 34

35 Direct Medical Services Other Costs Click on the service type to input costs for materials and supplies. These costs should only include materials and supplies listed on the CMS approved list. Service types appear only for those service categories for which a cost was reported on the Salaried or Contracted Staff pages (except for Assistive Technology Devices which will appear automatically). SBAP Training Annual Cost Settlement 35

36 Direct Medical Services Other Costs X Do NOT Include X Costs for materials and supplies applicable to ONLY general education students Costs for materials and supplies used in out-of-district (tuition-paid) institutions Direct Medical Equipment costing more than $5,000 Include these items in the Depreciation section of the cost report Federally funded costs (report any federal funds in the appropriate field) Helpful Hint: When determining whether or not a particular cost is eligible (such as technology equipment) think about how the item is used. Is the item used solely or predominantly for special education students and for providing health-related services? If so, the costs can be reported. Is the item used solely for educational (and not medical) purposes? If so, it should not be included. SBAP Training Annual Cost Settlement 36

37 Annual Tuition All approved providers are listed in the dropdown field. Select Add New Line Item to add schools SBAP Training Annual Cost Settlement 37

38 Direct Medical Equipment Depreciation Select Add Asset to include Medical Equipment with a cost over $5,000 SBAP Training Annual Cost Settlement 38

39 Direct Medical Equipment Depreciation X Do NOT Include X Costs for equipment applicable to ONLY general education students Costs for equipment used in out-of-district (tuition-paid) institutions Items costing $5,000 or less Federally funded costs SBAP Training Annual Cost Settlement 39

40 Transportation Answer the following questions to determine whether you are able to record transportation costs. SBAP Training Annual Cost Settlement 40

41 Transportation Specialized Transportation Services include: Travel to and from school and between schools or school buildings on a day when a Medicaid service is on the IEP to be rendered on school premises(must result in a paid claim) and special transportation is included on the IEP as a separate service. Travel to and from off-site premises on a day when a Medicaid service is on the IEP to be rendered off-site (must result in a paid claim) and special transportation is included on the IEP as a separate service; and Use of a specially adapted vehicle (such as a specially adapted bus or van). Bill Medicaid & log in EasyTrac Keep bus logs of one-way trips Specially adapted vehicle LEA CAN report Specialized Transportation Written in IEP (retain copies) Same day student receives SBAP service and service paid SBAP Training Annual Cost Settlement 41

42 Transportation Can I Report Specialized Transportation? 1. Did LEA use modified vehicles to transport special education students to or from school on a day they received another IEP health related service? No Yes 2. Did LEA bill Medicaid for transportation paid for (by LEA) during the school year AND log services in EasyTrac/IEP? No Yes 3. Did LEA keep bus logs detailing one way trips AND necessary IEP documentation? No Yes LEA CANNOT report Specialized Transportation LEA CAN report Specialized Transportation! 42 SBAP Training Annual Cost Settlement 42

43 Transportation Salaried Staff Select Add New Line Item to add staff If including transportation costs, remember to complete the transportation ratios on the General and Statistical page SBAP Training Annual Cost Settlement 43

44 Transportation Salaried Staff Indicate whether the employee works exclusively with Specialized Transportation, or Not Only Specialized Transportation (working with both general and specialized transportation). Complete all remaining required fields. SBAP Training Annual Cost Settlement 44

45 Transportation Other Costs Report costs as Specialized Transportation, or Not Only Specialized Transportation If including transportation costs, remember to complete the transportation ratios on the General and Statistical page SBAP Training Annual Cost Settlement 45

46 Transportation Equipment Depreciation Select Add Asset to include Transportation Equipment with a cost over $5,000 SBAP Training Annual Cost Settlement 46

47 Transportation Equipment Depreciation X Do NOT Include X Costs for equipment applicable to ONLY general education students Costs for equipment used in out-of-district (tuition-paid) institutions Items costing $5,000 or less Federally funded costs SBAP Training Annual Cost Settlement 47

48 General and Statistical Information SBAP Training Annual Cost Settlement 48

49 General and Statistical Information Hover over fields for an explanation of required input. SBAP Training Annual Cost Settlement 49

50 Individualized Education Program (IEP) Ratio The IEP Ratio is used to allocate a portion of the total direct medical services costs to the Medicaid program. LEA s are required to self report both the numerator and denominator of their IEP ratio. The IEP ratio will be LEA-specific and based on student count data. For the FY 2015 cost report, covering dates of service from July 1, 2014 through June 30, 2015, the appropriate date for the ratio data would be December 1, Total Number of Medicaid Eligible Special Education Students With a Prescribed Direct Health Related Service Total Number of ALL Special Education Students With a Prescribed Direct Health Related Service Students with only specialized transportation as the SBAP related service in their IEP should not be included in the IEP Ratio student count. SBAP Training Annual Cost Settlement 50

51 Individualized Education Program (IEP) Ratio In self reporting their IEP ratio, LEAs are acknowledging and agreeing to the following terms: 1. You used the PROMISe system to determine which of your students were Medicaid eligible on December 1, Your school accepts all fiscal liability for the accuracy of the data which you provide. PDE, DHS, or PCG will not have any liability for the accuracy of the data you submit. In certifying the cost report with the IEP ratio numerator and denominator entered, the LEA is certifying the cost data as well as the IEP ratio data, including the two terms above. SBAP Training Annual Cost Settlement 51

52 Specialized Transportation Ratio The Specialized Transportation Ratio is used when specialized transportation costs cannot be discreetly broken out from general transportation costs. Only applies to costs reported as Not Only Specialized. LEA must report the numerator and denominator. Total Number of Special Education Students with Specialized Transportation Services in their IEP Total Number of ALL Students Receiving Transportation Services (specialized or non-specialized) SBAP Training Annual Cost Settlement 52

53 One Way Trip Ratio The One Way Trip Ratio allocates a portion of specialized transportation costs to the Medicaid Program. PCG will input the numerator based on paid claims data, but if you report any specialized transportation, then you must input the denominator. Total Number of Paid Medicaid One Way Trips for Students with Specialized Transportation in their IEP Total Number of All One Way Trips for Special Education Students with Specialized Transportation in their IEP A One Way Trip is defined as a trip to or from school for a special education student with specialized transportation in their IEP on the same day the student received a SBAP direct health-related service. Transportation to AND from school would be considered two one way trips. SBAP Training Annual Cost Settlement 53

54 Transportation Ratios Which Transportation Ratios Should I Report? Did LEA report Specialized Transportation costs? Specialized Only Not Only Specialized Both Fill in the One Way Trip Ratio denominator. Fill in the One Way Trip Ratio denominator & The Specialized Transportation Ratio numerator and denominator Fill in the One Way Trip Ratio denominator & The Specialized Transportation Ratio numerator and denominator SBAP Training Annual Cost Settlement 54

55 Cost Report After entering all applicable data into the cost report, review the summarized information on the Cost Report page. SBAP Training Annual Cost Settlement 55

56 Cost Report Calculation of Medicaid Allowable Costs SBAP Training Annual Cost Settlement 56

57 Cost Report Calculation of Medicaid Allowable Costs SBAP Training Annual Cost Settlement 57

58 Cost Report You may be required to provide explanations for Required Edits before being able to Certify When you are satisfied this information is accurate and the cost report is complete, click Certify Annual Financials to submit and lock your cost report submission. SBAP Training Annual Cost Settlement 58

59 Direct Medical Service Percentage The Direct Medical Service Percentage is a state-wide rate identifying on average what portion of a direct service provider s time is spent performing direct health-related services. A rate of 25% means that on average, direct service providers spend 25% of their time providing direct medical services and 75% of their time performing other administrative duties, training tasks, etc. PCG will input this number from the RMTS results How is it calculated? Providers on the Direct Service Staff Pool List participate in the quarterly Random Moment Time Study and respond to moments PCG codes the RMTS results based on the providers responses The percentage used in the Medicaid Cost Report is the average of the results of the three quarterly time study periods (Oct-Dec, Jan-Mar, Apr-June) SBAP Training Annual Cost Settlement 59

60 LEA Indirect Cost Rate The Unrestricted Indirect Cost Rate (UICR) is used to include additional costs of doing business that cannot be easily identified within a particular grant, contract, or program, but are necessary for the general operation of the organization. Example: overhead costs, such as heating or electricity PCG will input this number PDE approved default UICR Example Calculation: Net Direct Service Costs (less federal funds) $800,000 Indirect Cost Rate (10%).10 Indirect Costs $80,000 Net Direct Service Costs + Indirect Costs $880,000 SBAP Training Annual Cost Settlement 60

61 DEADLINE REMINDER: The Annual Medicaid Cost Report is due on December 31, SBAP Training Annual Cost Settlement 61

62 Contact Information Phone: SBAP Training Annual Cost Settlement 62

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