School Based Access
Program (SBAP)
Medicaid Cost Reporting
and Cost Settlement
Training for FY
2014-2015
Commonwealth of Pennsylvania
Department of Human Services
Department of Education
• FY 2014-2015 Cost Settlement
Overview and Deadlines
• System Demonstration
Annual Financials in the PCG Claiming System
• Contact Information
FY 2014-2015 Cost Settlement
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.
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 https://claimingsystem.pcgus.com/pa/
•
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.
Cost Settlement Overview
Summary of SBAP Reimbursement Streams
SBAP Direct Services Reimbursement SBAP MAC Reimbursement Direct Services Reimbursement Logging Direct Services Logging Evaluation Services Ensuring Current Compliance Data Medicaid Allowable Costs (from Cost
Report) Annual Cost Report
Random Moment Time Study
Staff Pool List
Medicaid Administrative Claiming Quarterly Financials Random Moment Time Study
Staff Pool List
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
LEA submits Annual Medicaid Cost Report PCG performs LEA Desk Reviews PCG finalizes LEA Cost Settlements LEA signs Certification of Public Expenditure (CPE) Form
SBAP Training – Annual Cost Settlement 7
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. 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.
Cost Settlement Overview
Process
for FY 2014-2015
Annual Medicaid Cost Report
The Annual Medicaid Cost Report for the reporting
period July 1, 2014 to June 30, 2015 is due on
Annual Medicaid Cost Report
• 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!
Annual Medicaid Cost Report
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 2015.
• This expense occurred in July 2015, but pertained to services provided in June 2015.
• This expense should be recorded on the July 2014 - June 2015 annual cost report when the transaction occurred, not when it was paid.
Annual Medicaid Cost Report
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.
Annual Medicaid Cost Report
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.
System Demonstration
Annual Medicaid Cost Report
Getting Started – Annual Financials
Make sure FY15 is
selected
(default is current
fiscal year)
Annual Medicaid Cost Report
Getting Started – Annual Financials
SBAP Training – Annual Cost Settlement 15
Click on the Annual
field for the list of
pages to complete.
Annual Medicaid Cost Report
Page Name Crosswalk
MCRCS – (old)
CLAIMING SYSTEM – (new)
Annual Payroll Information Salaried Staff
Annual Payroll Information Contracted Staff
Transportation Payroll Information Transportation Salaried Staff
Direct Medical Services Materials and Supplies Direct Medical Services Other Costs
Transportation Other Costs Transportation Other Costs
Annual Tuition Costs Tuition
Direct Medical Services Equipment Depreciation Direct Medical Equipment Depreciation
Transportation Equipment Depreciation Transportation Equipment Depreciation
General and Statistical Information General and Statistical Information
Salaried Staff
SBAP Training – Annual Cost Settlement 17
MCRCS – (old)
Contracted Staff
MCRCS – (old)
Transportation Salaried Staff
SBAP Training – Annual Cost Settlement 19
MCRCS – (old)
Direct Medical Services Other Costs
MCRCS – (old)
Transportation Other Costs
SBAP Training – Annual Cost Settlement 21
MCRCS – (old)
Tuition
MCRCS – (old)
Direct Medical Equipment Depreciation
SBAP Training – Annual Cost Settlement 23
MCRCS – (old)
Claiming
Transportation Equipment Depreciation
MCRCS – (old)
Claiming
General and Statistical Information
SBAP Training – Annual Cost Settlement 25
MCRCS – (old)
Cost Report
MCRCS – (old)
System Demonstration
Annual Financials in the PCG Claiming System
Filling Out the Cost Report
Annual Medicaid Cost Report
Salaried Staff and Contracted Staff
There are two options to
enter data into the system:
• Export/Import
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
Annual Medicaid Cost Report
Entering Employee Costs
SBAP Training – Annual Cost Settlement 29
Enter data into each of the fields.
Include only numbers
Annual Medicaid Cost Report
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,
employer-paid 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.
Annual Medicaid Cost Report
Entering Employee Costs – Job Span Toolbar
SBAP Training – Annual Cost Settlement 31
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
Annual Medicaid Cost Report
Exporting/Importing Cost Data
The Annual Salaried
Staff page can also be
exported for completion
Annual Medicaid Cost Report
Exporting/Importing Cost Data
SBAP Training – Annual Cost Settlement 33
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.
Annual Medicaid Cost Report
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.
Annual Medicaid Cost Report
Direct Medical Services Other Costs
SBAP Training – Annual Cost Settlement 35
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).
These costs should only
include materials and
supplies listed on the
CMS approved list.
Click on the service
type to input costs for
materials and supplies.
Annual Medicaid Cost Report
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 astechnology 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.
Annual Medicaid Cost Report
Annual Tuition
SBAP Training – Annual Cost Settlement 37
Select Add New
Line Item to add
schools
All approved
providers are
listed in the
dropdown field.
Annual Medicaid Cost Report
Direct Medical Equipment Depreciation
Select Add Asset to include
Medical Equipment with a cost
Annual Medicaid Cost Report
Direct Medical Equipment Depreciation
SBAP Training – Annual Cost Settlement 39
XDo 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
Annual Medicaid Cost Report
Transportation
Answer the following
questions to determine
whether you are able
to record
• 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).
SBAP Training – Annual Cost Settlement 41
Annual Medicaid Cost Report
Transportation
LEA CAN report Specialized Transportation Specially adapted vehicle Same day student receives SBAP service and service paid Written in IEP (retain copies) Keep bus logs
of one-way trips Bill Medicaid &
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?
2. Did LEA bill Medicaid for transportation paid for (by LEA) during the school year AND log services in EasyTrac/IEP?
3. Did LEA keep bus logs detailing one way trips AND necessary IEP documentation?
LEA CAN report Specialized Transportation!
LEA CANNOT report Specialized Transportation
No Yes
Yes No
No Yes
Annual Medicaid Cost Report
Transportation
Annual Medicaid Cost Report
Transportation Salaried Staff
SBAP Training – Annual Cost Settlement 43
If including
transportation costs,
remember to complete
the transportation
ratios on the General
and Statistical page
Select Add New Line
Annual Medicaid Cost Report
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.
Annual Medicaid Cost Report
Transportation Other Costs
SBAP Training – Annual Cost Settlement 45
If including
transportation costs,
remember to complete
the transportation
ratios on the General
and Statistical page
Report costs as Specialized
Transportation, or
Not Only Specialized
Annual Medicaid Cost Report
Transportation Equipment Depreciation
Select Add Asset to include
Transportation Equipment with
Annual Medicaid Cost Report
Transportation Equipment Depreciation
SBAP Training – Annual Cost Settlement 47
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
Annual Medicaid Cost Report
SBAP Training – Annual Cost Settlement 49
Hover over fields for an
explanation of required
input.
Annual Medicaid Cost Report
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, 2014.
Annual Medicaid Cost Report
Individualized Education Program (IEP) Ratio
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
• 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, 2014.
2. 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
Annual Medicaid Cost Report
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.
Annual Medicaid Cost Report
Specialized Transportation Ratio
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)
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.
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.
Annual Medicaid Cost Report
One Way Trip Ratio
53 SBAP Training – Annual Cost Settlement
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
Annual Medicaid Cost Report
Transportation Ratios
Did LEA report Specialized Transportation costs?
Specialized Only Not Only Specialized Both
Which Transportation Ratios Should I Report?
Fill in the One Way Trip Ratio denominator.
Fill in the One Way Trip Ratio denominator
&
The Specialized Transportation
Fill in the One Way Trip Ratio denominator
&
Annual Medicaid Cost Report
Cost Report
SBAP Training – Annual Cost Settlement 55
After entering all applicable data
into the cost report, review the
summarized information on the
Annual Medicaid Cost Report
Cost Report
Annual Medicaid Cost Report
Cost Report
SBAP Training – Annual Cost Settlement 57
Annual Medicaid Cost Report
Cost Report
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.
You may be required to provide explanations for Required Edits before being able to CertifyThe 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
Annual Medicaid Cost Report
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:
Annual Medicaid Cost Report
LEA Indirect Cost Rate
Net Direct Service Costs (less federal funds) $800,000 Indirect Cost Rate (10%) .10
Indirect Costs $80,000
