Fall 2015 Presentation to School Business Officials New York State Department of Health

1. Preschool/School Supportive Health Services Program (SSHSP) – Medicaid Cost Report and Cost Settlement Training Fall 2015 Presentation to School Business Officials New York State Department of Health New York State Education Department

2. Agenda NY SSHSP • NY SSHSP Overview • NY SSHSP Cost Settlement Timeline • NY SSHSP Services • NY SSHSP Allowed Cost Cost Report Overview & Demonstration • General and Statistical • Annual Payroll Information • Direct Medical Service Materials, Supplies, and Equipment • Annual Contract Cost • Annual Tuition Cost • Intergovernmental Agreements • Supplemental Forms • Transportation • Summary and Certification • Desk Review Cost Settlement Calculation SSHSP Policy Updates www.pcghealth.com | 2015 NYSSHSP Cost Report Training

3. NY SSHSP Overview - Background • In New York State, Medicaid reimbursement is available for certain services provided to students with Individualized Education Programs (IEPs). This program is called the Preschool/School Supportive Health Services Program (SSHSP) and is administered by the New York State Department of Health in conjunction with the State Education Department. • Medicaid provides reimbursement for medically necessary services that are provided by SSHSP billing providers (public school districts and counties) to Medicaid-eligible students with IEPs as long as all Medicaid requirements are met. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

4. NY SSHSP Overview - Background • School districts and counties participating in SSHSP are responsible for submitting interim fee-for-service claims to Medicaid throughout the year as services are provided. SSHSP providers receive interim payments based on a fee schedule. • School districts which employ direct medical clinicians who provide Medicaid billable services are responsible for including those clinicians on the quarterly RMTS rosters. • Following the close of each school fiscal year (June 30th), all districts and counties participating in SSHSP are required to submit an Annual Medicaid Cost Report. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

5. IMPORTANT REMINDER – NY SSHSP Overview School districts and counties participating in SSHSP are responsible for submitting claims to Medicaid throughout the year as services are provided. SSHSP providers receive interim payments based on a fee schedule. See Medicaid Alert #15-01, posted January 20, 2015, announcing the approval of Medicaid State Plan amendments for certified public expenditures (CPEs). www.pcghealth.com | 2015 NYSSHSP Cost Report Training 5

6. NY SSHSP Overview – Cost Based Reimbursement What is cost based reimbursement? • Cost based reimbursement is a reimbursement methodology designed to ensure that reimbursement for the delivery of medical services reflects the actual cost of providing the service. • A cost based reimbursement methodology determines the actual cost of delivering SSHSP services to special education students. • School districts and counties are responsible for submitting an Annual Medicaid Cost Report in order to determine their allowable cost settlement. • The Annual Medicaid Cost Report determines the cost settlement amount. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

7. NY SSHSP Overview – Cost Based Reimbursement What are the possible results of cost settlement for SSHSP providers? 1. If Medicaid costs exceed reimbursement received, a settlement will be due. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

8. NY SSHSP Overview – Cost Based Reimbursement What are the possible results of cost settlement for SSHSP providers? 1. If Medicaid costs are less thanreimbursement received, school districts and counties may have to pay back the difference. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

9. NY SSHSP Overview – Cost Based Reimbursement How does the random moment time study (RMTS) relate to the cost reporting process? School Districts • The SSHSP cost settlement process directly links to the RMTS. • Only the salaries of those employees listed on a school district RMTS roster are eligible to be included in the cost settlement process. Counties • Contractors are not included in the RMTS and should not be included on rosters. • Districts or counties with 100% contracted clinicians do not need to participate in the RMTS. • If a county has employees providing direct services, those individuals complete 100 percent time tracking. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

10. NY SSHSP Overview – Cost Based Reimbursement How does the random moment time study (RMTS) relate to the cost reporting process? (continued) • The RMTS is used to capture the percentage of time direct medical staff spend on providing direct medical services. • This percentage is called the “direct medical percentage” and is used to calculate direct medical service costs. • The direct medical percentage is used in the final cost settlement calculations. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

11. NY SSHSP Timeline – Cost Settlement Cycle www.pcghealth.com | 2015 NYSSHSP Cost Report Training

12. NY SSHSP Timeline – Cost Settlement Cycle www.pcghealth.com | 2015 NYSSHSP Cost Report Training

13. NYSSHSP Services and Allowed Cost What are the Medicaid Allowable Costs? • Medicaid Allowable Service Costs included in the annual Medicaid Cost Report must relate to one of the following direct medical services which are included in the State Plan Amendment: www.pcghealth.com | 2015 NYSSHSP Cost Report Training

14. NYSSHSP Services and Allowed Cost Who can provide the Medicaid allowed direct medical services? Medicaid Allowed Direct Medical Services must be provided by a Medicaid qualified practitioner in order for the cost to be reported. Slides 15 and 16 include the list of Medicaid qualified practitioners for the SSHSP. Handout 1, posted on SED’s Medicaid-in-Education website, also includes this information: http://www.oms.nysed.gov/medicaid/training_materials/handout_1_prov_quals_and_doc_rqrmnts_may_2015.pdf www.pcghealth.com | 2015 NYSSHSP Cost Report Training

15. Medicaid Approved Practitioners www.pcghealth.com | 2015 NYSSHSP Cost Report Training

16. Medicaid Approved Practitioners www.pcghealth.com | 2015 NYSSHSP Cost Report Training

17. NYSSHSP Services and Allowed Cost How does a student’s IEP factor into the NY SSHSP Cost Settlement? • In order for a medical cost to be reported, the cost must be associated with a student who has an IEP for one of the Medicaid Allowable Services (see list on Slide 13) Should school districts and counties use cost or accrual accounting when reporting cost? • Districts and counties should use accrual accounting. Accrual based accounting is based on date of service. SSHSP providers should not use cash accounting or date of payment. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

18. IMPORTANT REMINDERS – NY SSHSP Services and Allowed Cost In order to report an allowed medical service cost, the service must be provided by a Medicaid qualified practitioner. The service must be included in the individual’s IEP The report must use Accrual Based Accounting www.pcghealth.com | 2015 NYSSHSP Cost Report Training 18

19. Cost Report Overview & Demonstration www.pcghealth.com | 2015 NYSSHSP Cost Report Training 19

20. NY SSHSP Timeline – Cost Settlement Cycle www.pcghealth.com | 2015 NYSSHSP Cost Report Training

21. General and Statistical Information • Some sections of the General and Statistical Information page are automatically populated by PCG, other sections require Districts and Counties to report data. Sections of the General and Statistical Information page that Districts and Counties report: • Medicaid One-Way Trip Ratio Denominator • Specialized Transportation Numerator and Denominator • Total Service Encounters www.pcghealth.com | 2015 NYSSHSP Cost Report Training

22. General and Statistical Information • Medicaid One-Way Trip Ratio • For Districts and Counties who billed Medicaid for specialized transportation, they should report the “total one way trips for Medicaid eligible students with special transportation in the IEP” • The numerator of the Medicaid One-Way Trip Ratio is populated by PCG and reflects the total Medicaid paid one way trips • Districts and Counties should use bus logs as a reference when reporting the denominator of the Medicaid One-Way Trip Ratio www.pcghealth.com | 2015 NYSSHSP Cost Report Training

23. General and Statistical Information Specialized Transportation Ratio • Districts and Counties who billed Medicaid for special transportation should report both, the numerator and denominator of the Specialized Transportation Ratio • Districts and Counties must report the number of Medicaid eligible special education students receiving special transportation services per their IEP • Districts and Counties should also report the total number of district-wide or county–wide students to which the district or county provides transportation services. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

24. General and Statistical Information Service Encounters • Districts and Counties will need to count the number of Individualized Educational Program (IEP) direct medical service encounters delivered per school year. NOTE: The reporting requirement for the Encounter data will begin with reporting periods beginning on or after July 1, 2014. LEAs will not be required to report this data for periods prior to July 1, 2014. • An encounter is defined as a documented face-to-face direct medical service visit that was provided pursuant to the recommendations of a student’s IEP by a qualified provider. Example: a student’s IEP contains a recommendation that Occupational Therapy services are to be provided for 20-30 minutes/3 times a week for 6 months. Each documented visit in which the student actually received at least 20 minutes of occupational therapy from a qualified provider would be counted as one encounter www.pcghealth.com | 2015 NYSSHSP Cost Report Training

25. IMPORTANT REMINDERs – General and Statistical Information Districts and Counties who billed Medicaid for special transportation, should report transportation cost and ratio data. Service Encounters is a mandatory cost report section, and should be completed based on district and county medical records. For Service Encounters: Consider only face-to-face contact time with the student and qualified provider; do not include pre-session planning or post-session write-up time when totaling up service encounters www.pcghealth.com | 2015 NYSSHSP Cost Report Training 25

26. Annual Payroll Information • School district staff are prepopulated from RMTS school district participants (or 100 percent time tracking if applicable for counties) • RMTS quarters are prepopulated based on participation within the school district Salary costs for eligible SSHSP direct service providers employed by school districts and counties include: • Regular wages or extra pay • Paid time off (e.g., sick or annual leave) • Overtime • Bonuses or longevity • Stipends • Cash Bonuses and/or cash incentives Note: Salaries are those payments from which payroll taxes are deducted. The reported salaries should be the total gross earnings for the individual during the reporting period. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

27. Annual Payroll Information Benefit costs for eligible SSHSP service providers employed by school districts (and counties where applicable) include: • Employer-paid health/medical, life, disability, or dental insurance premiums • Employer-paid payroll taxes such as Medicare, Social Security • Employer-paid child day care for children of employees • Retirement contributions • Worker’s compensation costs Note: Report the expended amounts paid by the school district or county which are directly associated with each staff member by type of employee benefit. Note: FICA payments may be reported under the category for Social Security. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

28. Annual Payroll Information • Salary and benefit costs for eligible SSHSP service providers • Only those salary and benefit costs for eligible SSHSP service providers that were included on the Quarterly RMTS roster are eligible for SSHSP CPE reimbursement • Quarters marked with a “1” denote the individual participated in the RMTS and the district/county should report costs related to that period. • Quarters marked with a “0” denote the individual did not participate in the RMTS and the district/county should exclude costs related to that period. • All individuals who participate in the RMTS during the October-December quarter will automatically be marked with a “1” for the July-September quarter. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

29. IMPORTANT REMINDERS – Annual Payroll Information 1. Salaries are those payments from which payroll taxes are deducted. The reported salaries should be the total gross earnings for the individual during the reporting period. 2. Salary and benefits should only reflect the compensation for the quarters worked in which the employee participated in the RMTS. Ex. If an employee participated in two (2) of the RMTS quarters, only the salary and benefits for the two quarters should be reported www.pcghealth.com | 2015 NYSSHSP Cost Report Training 29

30. Direct Medical Service Materials, Supplies, and Equipment What are the approved direct medical service material, supply and equipment costs? • CMS has approved a very limited list of direct medical service material, supply, and equipment costs (available on the MCRCS Dashboard). • Only those items included within the approved list can be reported on the Medicaid cost report. • Examples include: hearing aids, stethoscopes, wheelchairs, etc. • Districts and counties can report costs for materials, supplies, and equipment which are actively used for the provision of a direct medical service. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

31. Direct Medical Service Materials, Supplies, and Equipment Example: A student uses an IPad during the provision of Speech Therapy provided by a Licensed Speech-Language Pathologist. Can this cost be included? • Yes – The item was used for the provision of a direct medical service. Example: A student with a Speech Disability uses an IPad only during general education classes. Can this cost be included? • No – The item was not used for the provision of a direct medical service. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

32. IMPORTANT REMINDERS – Direct Medical Service Materials, Supplies, and Equipment When reporting Direct Medical Service Materials, Supplies, and Equipment, districts and counties should report all CMS approved costs less than $5,000 on the Direct Medical Service Materials, Supplies, and Equipment page. Direct Medical Service Materials, Supplies, and Equipment in excess of $5,000, should be reported on the Direct Medical Service Materials, Supplies, and Equipment Depreciation page. Districts and Counties should ONLY report Direct Medical Service Materials, Supplies, and Equipment cost if there is a CMS approved practitioner approved to provide the service in use of the medical service materials, supplies, and equipment. • www.pcghealth.com | 2015 NYSSHSP Cost Report Training 32

33. Direct Medical Service Materials, Supplies, and Equipment - Depreciation Costs for Approved Direct Medical Service Equipment What is Depreciation? • “Depreciation” is the systematic and rational allocation of the acquisition cost of an asset over its estimated useful life What type of depreciation needs to be used in order to report costs on the Medicaid Cost Report? • Allowable depreciation expenses for direct medical services will be determined using pure straight-line depreciation as defined in OMBA-87 Straight-line depreciation method is a method of calculating the depreciation of an asset which assumes the asset will lose an equal amount of value each year The annual depreciation is calculated by dividing the purchase price by the estimated useful life of the asset www.pcghealth.com | 2015 NYSSHSP Cost Report Training

34. Direct Medical Service Materials, Supplies, and Equipment - Depreciation Costs for Approved Direct Medical Service Equipment When is it required to report direct medical service materials and supplies as depreciated cost? • If a single direct medical service material and supply cost exceeds $5,000, then the item should be depreciated • Only those items included within the approved list can be reported on the Medicaid cost report When will depreciable costs need to be reported? • These costs are only collected and reported annually on the Medicaid cost report www.pcghealth.com | 2015 NYSSHSP Cost Report Training

35. IMPORTANT REMINDERS – Direct Medical Service Materials, Supplies, and EquipmentDepreciation Costs for Approved Direct Medical Service Equipment 1. Straight-line depreciation method is a method of calculating the depreciation of an asset which assumes the asset will lose an equal amount of value each year 2. The annual depreciation is calculated by dividing the purchase price by the estimated useful life of the asset www.pcghealth.com | 2015 NYSSHSP Cost Report Training 35

36. Annual Contractors Cost Contracted staff costs include compensation paid for services provided by any outside private agency (such as BOCES) or individual (such as an independent therapist) who delivered any SSHSP services to Medicaid and/or non Medicaid students Only costs incurred from agencies other than public schools or counties may be included under Annual Contractors Cost. School districts and counties must report the service type, contracted vendor or individual, total amount paid, and any amount paid using federal funds. All individuals whose cost are captured in this section must be included on the Supplemental Form for Contracted Practitioners. Contract Costs with other school districts or counties must be reported in Intergovernmental Contract Cost www.pcghealth.com | 2015 NYSSHSP Cost Report Training

37. IMPORTANT REMINDERS – Annual Contractors Cost 1. All individuals whose costs are captured in this section must be included on the Supplemental Form for Contracted Practitioners – this includes BOCES 2. Contract Costs with other school districts or counties must be reported in Intergovernmental Contract Cost 3. Contract costs should only be reported for students with an IEP for a related service • www.pcghealth.com | 2015 NYSSHSP Cost Report Training 37

38. Annual Tuition Cost This section identifies the reimbursable portion of tuition expenditures for approved private schools and other entities other than public schools and counties 1. Only tuition costs incurred for students with at least one direct medical service in their IEP can be reported 2. The cost report must include the following: • The specific school/agency to which tuition was paid • The total annual tuition paid to the specific school/program • The portion of tuition payments made using federal funds *Note: If the cost for the providers at a tuition school are reported in the Annual Contractors Cost section, the remaining tuition cost cannot be reported in this section. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

39. IMPORTANT REMINDERs – Annual Tuition Cost 1. Public School Tuition should NOT be reported in Annual Tuition Cost. Public School Tuition should be reported in Intergovernmental Tuition 2. Tuition cost should ONLY be reported for costs associated with a student who had an IEP for a related service 3. BOCES cost should not be reported under Annual Tuition, but the cost should be broken out by related service in Annual Contract Cost • www.pcghealth.com | 2015 NYSSHSP Cost Report Training 39

40. Intergovernmental Tuition and Contract Cost This section identifies expenses and revenues related to contract and tuition services between public school districts and counties Public school districts and counties are required to report contract and tuition expenses paid to other school districts or counties under the Annual Intergovernmental Agreements section Public school districts and counties are also required to validate revenues received from other districts and counties for the provision of contract or tuition services - This validation occurs during the Desk Review period www.pcghealth.com | 2015 NYSSHSP Cost Report Training

41. Intergovernmental Tuition and Contract Cost (continued) Intergovernmental Agreement (IA) contract expenses paid to a public school district or county are reported in the same manner as Annual Contract Costs The district/county must report the service type, contracted entity, total amount paid, and any amount paid using federal funds. IA tuition expenses paid to a public school district or county are reported in the same manner as Annual Tuition Costs The district/county must report the tuition school, total amount paid, and any amount paid using federal funds. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

42. Intergovernmental Tuition and Contract Cost (continued) IA revenues will be compiled by PCG. After the reports are certified, PCG will extract IA expenses and provide each public school district and county a summary of revenues based on reported expenses IA contract revenues received from a public school district or county are reported for services provided by the reporting entity to another entity’s students The district/county must validate the service type, entity from which revenue was received, total amount received, and the total amount from federal funds IA tuition revenues received from a school district or county are reported for services provided by the reporting entity to another entity’s students The district/county must validate the entity from which revenue was received, total amount received, and the total amount from federal funds www.pcghealth.com | 2015 NYSSHSP Cost Report Training

43. Intergovernmental Tuition and Contract Cost (continued) Example: A public school district contracts with a county for Speech Therapy. • The school district reports an expense to the county under IA Contract Expenses • Once all reports are certified, PCG extracts this information from the school district’s report and provides it to the county • The county will then validate that amount during the Desk Review as an IA Contract Revenue www.pcghealth.com | 2015 NYSSHSP Cost Report Training

44. IMPORTANT REMINDERS – Intergovernmental Tuition and Contract Cost 1. Public school districts and counties are required during the Desk Review period to validate revenues received from other districts and counties for the provision of contract or tuition service. 2. As with Annual Tuition and Contract Cost, Intergovernmental Tuition and Contract Cost must be associated with a service provided to a student with an IEP that includes the related service. 3. Costs related to dormitory or maintenance fees are not Medicaid reimbursable and therefore should not be included in this section. • www.pcghealth.com | 2015 NYSSHSP Cost Report Training 44

45. Transportation – Payroll Salary costs for eligible specialized transportation service providers include: • Regular wages or extra pay • Paid time off (e.g., sick or annual leave) • Overtime • Bonuses or longevity • Stipends • Cash Bonuses and/or cash incentives Note: Salaries are those payments from which payroll taxes are deducted. The reported salaries should be the total gross earnings for the individual as paid by the school district or county for the reporting period www.pcghealth.com | 2015 NYSSHSP Cost Report Training

46. Transportation – Annual Payroll Information Benefit costs for eligible SSHSP service providers employed by school districts (and counties where applicable) include: • Employer-paid health/medical, life, disability, or dental insurance premiums • Employer-paid payroll taxes such as Medicare, Social Security • Employer-paid child day care for children of employees • Retirement contributions • Worker’s compensation costs Note: Report the expended amounts paid by the school district or county which are directly associated with each staff member by type of employee benefit. Note: FICA payments may be reported under the category for Social Security. www.pcghealth.com | 2015 NYSSHSP Cost Report Training

47. Transportation – Payroll Salary and Benefit costs for eligible specialized transportation service providers Only those salary and benefit costs for eligible specialized transportation service providers are eligible for SSHSP cost reimbursement Eligible specialized transportation service providers include Bus Drivers, Mechanics, Substitute Drivers School districts and counties are required to report gross expenditures and then properly reduce expenditures for funds paid from federal funding sources Costs associated with both Specialized and non-Specialized transportation should be reported www.pcghealth.com | 2015 NYSSHSP Cost Report Training

48. Transportation – Other Cost CMS has approved a list of specialized transportation non-personnel costs, including: • Lease or Rental Costs • Insurance Costs • Maintenance and Repair Costs • Fuel and Oil Costs • Purchases under $5,000 • Contract Costs – for transportation services and transportation equipment • Only those items included within the above categories can be reported on the Medicaid cost report www.pcghealth.com | 2015 NYSSHSP Cost Report Training

49. Transportation – Equipment Depreciation Depreciation for specialized transportation assets follows a similar process as that for the depreciation of direct medical service materials and supplies. If a single specialized transportation non-personnel item cost exceeds $5,000, then the item should be depreciated www.pcghealth.com | 2015 NYSSHSP Cost Report Training

50. NY SSHSP Timeline – Cost Settlement Cycle www.pcghealth.com | 2015 NYSSHSP Cost Report Training