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Connecticut Medicaid School Based Child Health Program Training Instruction for completion of

Connecticut Medicaid School Based Child Health Program Training Instruction for completion of a SBCH Cost Report. Training Instruction _ SBCH Cost Report Definitions and Acronyms. Centers for Medicare and Medicaid Services (CMS)

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Connecticut Medicaid School Based Child Health Program Training Instruction for completion of

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  1. Connecticut MedicaidSchool Based Child Health Program Training Instruction for completion of a SBCH Cost Report

  2. Training Instruction _ SBCH Cost ReportDefinitions and Acronyms Centers for Medicare and Medicaid Services (CMS) means Centers for Medicare and Medicaid Services (HCFA prior to July 1, 2001) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency which administers Medicare, Medicaid, and the Children's Health Insurance Program. Provides information for health professionals, regional governments, and consumers.  Additional information regarding CMS and it’s programs is available at http://www.cms.hhs.gov/. Local Educational Agencies (LEA) or Board of Education (BOE) means local or regional boards of education as defined in Subsection (b) of Section 10-76a-1 of the Regulations of Connecticut State Agencies and in Part B of IDEA, as amended from time to time. State Department of Education (SDE) means school district’s cognizant agency.

  3. Training Instruction _ SBCH Cost ReportDefinitions and Acronyms (cont.) Individualized Education Program (IEP) means the ongoing plan of treatment services. An IEP shall be based upon the diagnostic findings of the evaluation study. School Based Child Health Services (SBCH) are services that are listed in child’s IEP that are coverable under one or more of the service categories described in Section 1905(a) of the Social Security Act and included in the State of Connecticut State Plan. Provider means school district or the local educational agencies or boards of education that participate in the Medicaid program as providers of School Based Child Health ("SBCH'') services. Department means the State of Connecticut Department of Social Services (DSS) or its designated agent.

  4. Training Instruction _ SBCH Cost ReportDefinitions and Acronyms (cont.) Qualified SBCH Service Providers include, but are not limited to: licensed physicians, licensed psychiatrists, licensed podiatrists, licensed osteopaths, licensed chiropractors, licensed naturopaths, licensed audiologists, audiologist’s assistant employed or supervised by licensed audiologist, licensed hearing instrument specialist, speech therapy assistants working under the direction of licensed speech pathologists, licensed speech pathologists, licensed advanced practice registered nurses (APRN), licensed registered nurses (RN), licensed physician assistants, licensed practical nurses (LPN), licensed psychologists, SDE certified school psychologists, SDE certified school social workers, DPH licensed independent social workers, DPH licensed substance abuse counselors, DPH licensed marital and family therapists, SDE certified school counselors, SDE certified guidance counselors, licensed occupational therapists, licensed occupational therapy assistants, licensed physical therapists, physical therapy assistants meeting requirements of Section 20-66 of the CGS, licensed respiratory care practitioners and licensed optometrists.

  5. Training Instruction _ SBCH Cost ReportDefinitions and Acronyms (cont.) Certified Public Expenditure (CPE) The use of CPEs requires states to annually collect reconciled and certified cost reports from units of government (school districts) providing direct Medicaid services. CPEs involve the transfer of recorded and reconciled costs from one unit of government (school district) to the State Medicaid agency (Department of Social Services). For school-based services, a CMS-approved time study is necessary to isolate and capture the cost of Medicaid-covered services provided by school personnel.

  6. Training Instruction _ SBCH Cost ReportIntroduction Starting on October 1, 2010 and going forward the SBCH Program services reimbursement rate methodology approved by CMS reflects certified public expenditure model and requires the department to annually reconcile and settle any differences between the interim payments issued to an LEA for the SBCH services and the actual costs incurred by an LEA to provide SBCH services to the Medicaid covered students enrolled in an LEA pursuant to students’ IEPs. An LEA specific fee-for-services (FFS) rates for SBCH services shall be calculated for each school year including the partial school year of October 1, 2010 through June 30, 2011. The initial interim FFS rates are statewide and will be replaced for each LEA after the cost reconciliation and settlement is finalized.

  7. Training Instruction _ SBCH Cost Report Introduction (cont.) An annual cost reconciliation and settlements shall be based on costs incurred by an LEA and reported to the department utilizing a universal School Based Child Health Cost Report. A SBCH Cost Report was developed by the department in excel and consists of the following sections: Certification– a summary of MEDICAID ALLOWABLE costs incurred by an LEA to provide SBCH services to the LEA enrolled Medicaid covered children pursuant to their IEPs. The costs incurred by an LEA has to reflect the same date of services period for which LEA received interim payments for Medicaid SBCH services.

  8. Training Instruction _ SBCH Cost Report Introduction (cont.) SBCH Cost Report - page1 through 21 are utilized to record Medicaid reimbursable costs incurred by a school district for delivery of the Medicaid covered SBCH services and to record Medicaid reimbursable administrative costs. The SBCH Cost Report shall be completed by providers who submitted Medicaid claims for SBCH services with dates of service falling within the cost reporting period. Cost reporting period for the purpose of the SBCH Cost Report is July 1 through June 30.

  9. Training Instruction _ SBCH Cost Report COST POOL COMPONENTS AND COST ALLOCATION BASES Direct Services Costs Componets Direct Services costs reported in the SBCH Cost Report should reconcile to the expenditures reported by district to the State Department of Education in the ED001Report. 1. Salaries and Wages and Fringe Benefits costs claimed should only be for the Direct Services Providers billing Medicaid and Medicaid billing personnel included in the quarterly listings submitted to the department. 2. Cost of Personal Service contracts to deliver direct services or to provide Medicaid billing services. 3. Cost of Supplies and Materials used by the direct services providers and Medicaid billing personnel is a reimbursable cost. 4. Cost of Purchased Property Services essential for delivery of services and essential for Medicaid billing is a reimbursable cost. 5. All Other Allowable Costs identified with a direct services provider billing Medicaid or Medicaid billing personnel are a reimbursable cost.

  10. Training Instruction _ SBCH Cost Report COST POOL COMPONENTS AND COST ALLOCATION BASES Direct Services Cost Components(cont): Indirect Costs Indirect costs (IDC) are calculated by applying approved unrestricted IDC rate to the adjusted direct costs. If a district did not submit to the State Department of Education a request for an Authorized Indirect Cost Rate, the indirect cost is calculated by applying the OIG (Office of Inspector General) allowed IDC rate of 10% to the cost of direct salaries and wages. The cost of fringe benefit and other costs are exempt from calculation of Indirect Cost when the OIG allowed IDC rate of 10% is used to calculate theIDC.

  11. Training Instruction _ SBCH Cost Report COST POOL COMPONENTS AND COST ALLOCATION BASES Administrative Claiming Costs Components: Selected expenses related to administration of Medicaid are claimable allowed Administrative Costs. 1. Salaries and Wages and Fringe Benefits of administrative support staff. 2. Purchased Services of administrative support staff, if any. 3. Transportation of special education students when transportation services are prescribed in students’ IEP. 4. Equipment depreciation or use allowance of 6 and 1/3% per year. 5. Buildings and improvements depreciation or use allowance of 2% per year.

  12. Training Instruction _ SBCH Cost Report Cost Allocation Bases: Cost Allocation Bases are either an average of the quarterly employee Time Studies or an average of the quarterly student enrollment statistics. Two types of cost allocation bases are utilized to calculate the Medicaid allowable cost applicable to the SBCH program, 1) a Statewide Allocation Base 2) a District-specific Allocation Base.. • Statewide Cost Allocation Bases are derived from completed time studies and are used to allocate the following costs: • Salaries and wages and fringe benefits of the direct services providers, Medicaid billing personnel and Medicaid administrative support staff • Other Expenses of the direct services providers, Medicaid billing personnel and Medicaid administrative support staff

  13. Training Instruction _ SBCH Cost Report Cost Allocation Bases (cont.) • District Specific Cost Allocation Bases based on "snap-shots" of student enrollment statistics are used to allocated the following costs: • Transportation Cost (subject to cost allocation plan TBD) • Depreciation Cost or Use Allowance Cost • Allowable Medicaid Cost 3. Snap-shot statistics are obtained quarterly at the start of each of the three quarters of the school year. • For school year 2012 Statistics and Penetration Data (snap shots) collection dates were: 9/12/2011 12/7/2011 3/7/2012

  14. Step-By-Step Instructions to Complete a SBCH Cost Report

  15. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost ReportYour district will receive an e-mail with attached blank copy of a SBCHcost report file in an excel format named2012-xxx-SBCH-Cost Report.xlsPlease open the attached file, then save it using the save as option. Step-By-Step Instructions to Complete a SBCH Cost Report Your district will receive an e-mail with attached blank copy of a SBCH cost report file in an excel format named2012-xxx-SBCH-Cost Report.xls Please open the attached file, then save it using the save as option. Choose Save As

  16. Replace xxx with school district’s number; for example Hartford school district’s number is 64,

  17. cost report name will read as follows 2012-064-SBCH-Cost Report

  18. Choose Continue

  19. Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost Report Provider Demographic and other Data Page 1, 1 Provider Data is used to record demographic and other information about a district and to record information related to the Indirect Cost Rate. Retrieve Page 1(worksheet with tab tilted 1 Provider Data ), then fill-in data in cells that are highlighted in yellow as follows: • Provider Name: enter school district’s name, for example Hartford School District or Hartford. Both are acceptable. For regional school districts, please spell out Regional School District and write districts number next to the description; for example for the Regional School District # 1 enter Regional School District # 1 • LEA Code: enter state town code or regional school district code. Listing of LEA town numbers can be found on page 1a, worksheet with tab titled1a List of State Town Codes

  20. Contact Information:

  21. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)LEA Code: enter state town code or regional school district code. Listing of LEA town numbers can be found on page 1a, worksheet with tab titled1a List of State Town Codes

  22. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) enter on line 35 in column B the Unrestricted Indirect Cost Rate approved by the State Department of Education. enter 10% on line 37 column B if district did not request from the State Department of Education an approval for an Authorized Indirect Cost Rate. If using an Unrestricted IDC Rate: - enter on line 39 in column B dates of the period the approved rate can be used and -enter on line 40 in column B the date rate was approved by SDE

  23. Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost Report ED001, Schedule 4 Special Education Expenditure Page 3,3 ED001, Sch #4 expenses is used to transfer to the cost report the gross Special Education Expenditures recorded on specific lines in Schedule 4 of the ED001 Report filed with the Department of Education. To Record Special Education Expenditures Retrieve page 3, worksheet tab titled 3 ED001, Sch #4 expenses and copy expenses from Schedule 4: Special Education Expenditure Data, column titled SPECIAL ED. Per C.G.S 10-76f (or from part 2 of the electronic version of Schedule 4) to cells highlighted in yellow in column #5 for each line and code identified on page 3. For example, to record Special Education Expenditures for school year 2012, obtain the 2011-2012 school year expenditure ED001Report with filing due date of September 1, 2012. Please make sure all edits and corrections are finalized prior to obtaining the ED001 Report

  24. A blank sample of a Schedule 4: Special Education Expenditures Data

  25. Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost ReportExample of an electronic version of part 2 of the Schedule 4: Special Education Expenditure Data

  26. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Page 3 on line 7 in column D: enter the school year of the ED001 report used

  27. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) Column #5: enter an amount on line/code identified with the same line/code in Column# 2 (or Part 2) on Schedule 4 of the ED001 Report.

  28. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Summary of Cost Allocation Bases can be found on Page 2 of a cost report, page titled2 Medicaid allocation % , it contains allocation bases derived from the quarterly“snap shots” and time study samples submitted to the department by School districts. Medicaid allowed specialized transportation cost shall be calculated using guidance applicable to calculating an Administrative Cost Claim. The State has not finalized its negotiations with the Federal Center for Medicaid and Medicare Services (CMS). The Specialized Transportation Cost Allocation Plan proposed by the State is still under review with CMS and the data used to develop cost allocation base used to calculate Specialized Transportation Medicaid allowable cost may change from the data currently collected

  29. Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost Report (continue)District specific allocation bases details are recorded on Page 2a, 2a Medicaid Alloc % detail. To record statistics retrieve page 2a (worksheet with tab titled 2a Medicaid Alloc % detail),then fill-in data in cells that are highlighted in yellow.

  30. Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost Report (continue)Statewide cost allocation bases are provided on Page 6, worksheet titled6 DSP Time Study Summaryand on Page 7,worksheet titled 7 Admin Time StudyNo input of data from districts is required.Example of Page 6, 6 DSP Time Study Summary Direct Services Providers and Medicaid billing personnel summary of the quarterly time studies can be found on Page 6, tab titled 6 DSP Time Study Summary

  31. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Example of Page 7, worksheet titled 7 Admin Time Study Statewide Cost Allocation Bases used to calculate administrative claim cost can be found on Page 7, worksheet titled 7 Admin Time Study

  32. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) SBCH CHART OF EXPENDITURE CODESCosts reported on a SBCH Cost Report should be identified using the SBCH Chart of Expenditure Codes. The SBCH Chart of Expenditure Codes is included with the SBCH Cost Report on page 4, worksheet tab titled 4 SBCH Chart of Exp Codes. The SBCH Chart of Expenditure Codes is segregated by an alpha code to identify an expense type followed by a numeric code to identify a position type. For example expenses for Social Workers’ salaries and wages will be coded to SW-010. Where SW=Salary and Wages and 010=position code for social workers

  33. For example expenses for Social Workers’ salaries and wages will be coded to SW-010. Where SW=Salary and Wages and 010=position code for social workers 4 SBCH Chart of Exp Codes

  34. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) Record salary & wages and fringe benefits Use Register pages 19 and 20 to record salary & wages and fringe benefit expenses of district employees who billed Medicaid, provided Medicaid billing functions or provided administrative support to the Medicaid program. The department shall provide districts with a summary list of all names of district's employees based on the quarterly lists that were submitted to the department during the cost reporting period. The summary lists of names provided to the districts by the department shall be sorted by a position type code. Registers identification by position type code. Each register form is identified in its title with a Position Title Code. A table listing all positions title codes is included with the SBCH Cost Report on Page 5, worksheet tab titled 5 Position Codes &Titles

  35. 5 Position Codes &Titles

  36. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (cont) Follow listed below instructions to record salary & wages and fringe benefits of district’s employed direct services providers, Medicaid billing personnel and administrative staff. • Retrieve page 19 with a tab titled 19-Register followed by a position title code and a description of the position’s title,. For example salaries and wages and fringe benefits for social workers should be recorded on page 19 titled 19-REGISTER(10)Social Worker . • Column #2 and Column #3: enter names of employees. Use the summary listings of employees sent to your district by the department. • Column #5: enter a number(s) of a schedule(s) where employee’s salary was reported in the ED001 report • Column #6: enter total salary paid to the employee during the cost reporting period.

  37. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) Steps to complete pages 19 and page 20(cont) • Column #7: enter a number(s) of a schedule(s) where employee’s fringe benefits cost was reported in the ED001 report • Column #8: enter total fringe benefit cost paid by the district for the employee during the cost reporting period • Column #9: enter the amount of paid salary cost that was reimbursed thorough Federal Funds • Column #10: enter the amount of paid fringe benefits cost that was reimbursed thorough Federal Funds

  38. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Example of page 19, 19-REGISTER(10)Social Worker

  39. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Example of page 20, 20-REGISER-Admin S&W, FB

  40. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) District employed Specialized Transportation Drivers and Monitors Page 21 - Register is used to record salaries and wages costs and fringe benefits costs of district employed Drivers of Specialized Transportation vehicles and district employed Monitors assisting children "one-on-one" during their transport on the specialized transportation vehicles. Use district's transportation and district's payroll records to obtain information necessary to completer Page 21-Register for specialized transportation drivers and for monitors assisting children "one-on-one".

  41. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Use 21-REGISTER-Transport S&W, FB To record salary & wages and fringe benefits for Special Education Transportation Drivers and Monitors employed by school district Drivers section

  42. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Use 21-REGISTER-Transport S&W, FB To record salary & wages and fringe benefits for Special Education Transportation Drivers and Monitors employed by school district Monitors section

  43. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) District employed Specialized Transportation Drivers and Monitors Page 21-Register should be completed using the following information: Column #2 and Column #3:enter names of district employed Drivers and Monitors providing one-on-one student assistance Column #5: enter a number(s) of a schedule(s) where employee’s salary was reported in the ED001 report Column #6: enter total salary paid to the employee during the cost reporting period Column #7: enter a number(s) of a schedule(s) where employee’s fringe benefits cost was reported in the ED001 report Column #8: enter total fringe benefit cost paid by the district for the employee during the cost reporting period.

  44. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) District employed Specialized Transportation Drivers and Monitors Page 21-Register (cont.) For Transportation Monitors employed by district please provide the following additional information: Column #10: enter Yes or No to the following question: Does Transportation Monitor provide other duties besides riding on the bus with student. Column #11: enter number of hours a day a Transportation Monitor spends on the bus with a student Column #12: enter the total number of hours the Transportation Monitor is paid during the week Column #13: enter the total number of paid days that are captured under the salary recorded in column #6 (enter actual days or 181 if days paid are equal to school year days)

  45. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) Summary Schedules of Personal Services Costs are included on Page 9 and Page 10. Page 9 is utilized to summarize Personal Services Costs of the Direct Services Providers and of Medicaid Billing personnel. Page 10 is utilized to summarize Personal Services Costs of the Medicaid Administrative support staff. Page 9 and Page 10 self populate. No input from the districts is required.

  46. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)Example ofPage 9, Wkst #2 Direct S&W

  47. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) Example of Page 10, Wkst #2a Admin S&W

  48. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (cont) Page 11, Wkst #3-404(Purch Prof Serv) is used to record costs of contracts for Purchased Professional and Technical Services necessary to the delivery of direct services and Medicaid billing that were included in expense reported on line 404, Code 300, 590 in Schedule 4 of the ED001 Report To record cost of contracts for Purchased Professional and Technical Services retrieve page 11 (worksheet with tab titled Wkst #3-404(Purch Prof Serv)), then fill-in data in cells that are highlighted in yellow as follows: Blank lines are included for the districts’ use to record direct service expense for which description is not provided on the form. Please write a description of the expense on a blank line in Column #4 and follow instructions to complete column #5, #6 and #10 provided below. Column #5:enter amount paid for a professional service contract for services of a direct service provider with position title described in column #4. Additionally, the total cost of contractsnot related to Medicaidshould be entered at the bottom of the schedule inColumn #5next to line titledPurchased Services not related to the Medicaid SBCH

  49. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report Record Purchased Professional and Technical Services Cost (cont.) Page 11, Wkst #3-404(Purch Prof Serv) Column #6:Enter "1" for when delivered services are 100% IEP Prescribed services Column #6: Enter "0" for when IEP and non-IEP prescribed services are delivered For example, a school district contracted with an outside provider for occupational therapy services to be provided only to students with occupational therapy prescribed in their IEP; then the district will enter “1” in column #6. Column #10 : enter the amount of paid contract cost that is reimbursed thorough Federal Funds

  50. Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue) Retrieve Page 11, tab titled Wkst #3-404(Purch Prof Serv)

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