Cost Report Training Presentation

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Cost Report Training Presentation

  1. 1. 2009 SHARS Cost Report Training SCHOOL HEALTH AND RELATED SERVICES (SHARS)
  2. 2. Housekeeping
  3. 3. Today’s Training Goals <ul><li>Review of the SHARS Program </li></ul><ul><li>Review elements of an acceptable SHARS cost report </li></ul><ul><li>Gain an understanding of ways to maximize SHARS reimbursement </li></ul>
  4. 4. Provide Services per IEP Time Study Document Claim School Health And Related Services (SHARS) Participation Cost Report Collection Reconciliation & Settlement Interim Payment Summary Actual Costs Count Students Count One-Way trips Submit Cost Report Document Review Document Reconcile Cost to Paid Amt Appeal/Adjust Recoupment Settle to Cost with Payouts
  5. 5. <ul><ul><li>SHARS allows local school districts to obtain Medicaid reimbursement for certain health-related services provided to students in special education who meet all three of the following requirements: </li></ul></ul><ul><ul><ul><li>Medicaid eligible, </li></ul></ul></ul><ul><ul><ul><li>meet eligibility requirements for Special Education described in the Individuals with Disabilities Education Act (IDEA), and </li></ul></ul></ul><ul><ul><ul><li>have Individual Educational Plans (IEPs) that prescribe the needed services. </li></ul></ul></ul><ul><ul><li>Federal and state matching plan—federal (60%) state (40%) </li></ul></ul><ul><ul><ul><li>Districts receive the federal share of total allowable costs after all approved allocation methodologies have been applied. </li></ul></ul></ul><ul><ul><li>SHARS Claiming process allows interim draw down of federal funds using district specific rates. </li></ul></ul><ul><ul><li>Nine (9) billable direct medical services in Texas; plus specialized transportation. </li></ul></ul>School Health And Related Services (SHARS)
  6. 6. <ul><li>Allowable School Health ( direct medical ) and Related Services include: </li></ul><ul><ul><ul><li>Audiology and Hearing, including evaluations and therapy sessions; </li></ul></ul></ul><ul><ul><ul><li>Physician Services; </li></ul></ul></ul><ul><ul><ul><li>Occupational Therapy, including evaluations and therapy sessions; </li></ul></ul></ul><ul><ul><ul><li>Physical Therapy, including evaluations and therapy sessions; </li></ul></ul></ul><ul><ul><ul><li>Psychological Services, including assessments and therapy sessions; </li></ul></ul></ul><ul><ul><ul><li>Speech and Language Services, including evaluations and therapy sessions; </li></ul></ul></ul><ul><ul><ul><li>Nursing Services, including routine medication administration services; </li></ul></ul></ul><ul><ul><ul><li>Counseling Services; </li></ul></ul></ul><ul><ul><ul><li>Personal Care Services; and </li></ul></ul></ul><ul><ul><ul><li>Specialized Transportation. </li></ul></ul></ul>Review of the SHARS Program
  7. 7. <ul><li>To be eligible to receive and retain federal reimbursement for Texas Medicaid reimbursement, as a provider of medical services for SHARS an ISD must: </li></ul><ul><ul><li>Be enrolled and approved for participation in the Texas Medical Assistance Program (TMAP); </li></ul></ul><ul><ul><li>Obtain a National Provider Identifier (NPI); </li></ul></ul><ul><ul><li>Ensure that SHARS services are provided by approved/qualified providers; </li></ul></ul><ul><ul><li>Meet Texas Education Agency (TEA) standards for delivery of SHARS; </li></ul></ul><ul><ul><li>Abide by rules and regulations of TEA; </li></ul></ul><ul><ul><li>Meet all eligibility requirements and participate in the Random Moment Time Study (RMTS); </li></ul></ul><ul><ul><li>Bill for SHARS allowable services covered by the TMAP; and </li></ul></ul><ul><ul><li>Submit a SHARS Cost Report . </li></ul></ul><ul><li>For assistance with SHARS Enrollment, Program and Policy, Billing and Payment, and Certification of Funds questions please contact: TMHP Customer Services at 1-800-925-9126 or Clarice Cefai, Senior Policy Analyst, HHSC (512) 249-3736; E-mail : [email_address] </li></ul><ul><li>For assistance with Random Moment Time Study (RMTS) please contact: </li></ul><ul><li>(512) 491-1715; E-mail: TimeStudy@hhsc.state.tx.us </li></ul>Review of the SHARS Program
  8. 8. <ul><ul><li>A school district must file claims to remain eligible to submit a cost report. </li></ul></ul><ul><ul><li>All initial claims should be filed within 365 days of the date of service or 95 days after September 30 (January 3), whichever comes first. </li></ul></ul><ul><ul><ul><li>NOTE: TMHP system still enforces original December 4 deadline. In order to avoid having claims denied, please submit October through August claims prior to December 4 until further notice. </li></ul></ul></ul><ul><ul><li>Costs not submitted via the claims process will be reconciled during the cost report settlement process. </li></ul></ul><ul><ul><li>Remember to keep track of interim payments during the year for settlement purposes. </li></ul></ul>Review of the SHARS Program
  9. 9. <ul><ul><li>In accordance with Title 1 of the Texas Administrative Code (TAC), §355.8443(e), each SHARS provider that received SHARS reimbursement is required to complete an annual cost report for SHARS services delivered or return the federal funds. </li></ul></ul><ul><ul><li>SHARS providers who are members of a cooperative or shared services arrangement must each submit a separate SHARS cost report. </li></ul></ul><ul><ul><li>The SHARS cost report period covers the federal fiscal year. </li></ul></ul><ul><ul><ul><li>October 1 through September 30 </li></ul></ul></ul><ul><ul><li>SHARS Cost Report is due on or before April 1 of the year following the close of the cost report period. </li></ul></ul>Review of the SHARS Program
  10. 10. <ul><ul><li>The purpose of the SHARS cost report is to ensure that School Districts, as governmental entities, are not paid more than their Medicaid-allowable costs to provide SHARS. </li></ul></ul><ul><ul><li>The cost report data will also be used to calculate and/or adjust future district-specific interim rates. </li></ul></ul><ul><ul><li>District-specific interim rates can be found on the SHARS website at: </li></ul></ul><ul><ul><li>www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Shars/Shars.html . </li></ul></ul>Review of the SHARS Program
  11. 11. <ul><li>SHARS Participation, Training, Rates, Billing, and Cost Report information can be found on the following websites: </li></ul><ul><ul><li>HHSC Rate Analysis SHARS website: </li></ul></ul><ul><ul><li>www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Shars/Shars.html </li></ul></ul><ul><ul><li>Fairbanks website: www.fairbanksllc.com </li></ul></ul><ul><ul><li>TEA website: www.tea.state.tx.us/index2.aspx?id=2814 </li></ul></ul><ul><ul><li>TMHP website at www.tmhp.com </li></ul></ul><ul><ul><ul><li>Texas Medicaid Provider Procedures Manual (TMPPM) </li></ul></ul></ul><ul><ul><ul><li>Chapter 42 www.tmhp.com </li></ul></ul></ul>TMPPM Chapter 42 Review of the SHARS Program
  12. 12. <ul><li>There are four allocation methods mandated by CMS to be used in the SHARS cost report that facilitate the identification of cost associated with Medicaid: </li></ul><ul><ul><li>RMTS direct services time study percentage </li></ul></ul><ul><ul><li>IEP Ratio </li></ul></ul><ul><ul><li>specialized transportation ratio </li></ul></ul><ul><ul><li>one-way trip ratio </li></ul></ul>Cost Allocation Methodology
  13. 13. Polling Question
  14. 14. RMTS Overview <ul><li>Public schools may be reimbursed with Federal Medicaid funds for both the provision of allowable direct medical services and for administrative activities which support the Medicaid program </li></ul><ul><li>To be eligible to obtain Medicaid reimbursements for either MAC or SHARS, each school district must also participate in the Random Moment Time Study (RMTS) </li></ul>
  15. 15. What is RMTS? <ul><li>R andom M oment T ime S tudy </li></ul><ul><ul><li>A federally accepted statistically valid random sampling technique that determines what portion of the selected group of participant’s workload is spent performing Medicaid reimbursable activities </li></ul></ul><ul><li>Statewide time study sample </li></ul><ul><li>Significantly reduces staff time needed to record participant activities </li></ul>
  16. 16. Time Study Periods <ul><li>Federal Fiscal Quarters </li></ul><ul><ul><li>1 st Quarter - October, November, December </li></ul></ul><ul><ul><li>2 nd Quarter - January, February, March </li></ul></ul><ul><ul><li>3 rd Quarter - April, May, June </li></ul></ul><ul><ul><li>4 th Quarter - July, August, September </li></ul></ul><ul><ul><li> ( No Time Study for the 4th quarter) </li></ul></ul>
  17. 17. ISD Contacts Roles RMTS Program Contact Primary & Secondary MAC Financial Contact Primary & Secondary SHARS Financial Contact Primary & Secondary Superintendent ISD
  18. 18. RMTS PROCESS Program Contact identifies pool of time study participants HHSC Contractor randomly selects moments and participants Program Contact ensures selected participants are trained Participant responds to selected moment by answering moment online HHSC contractor codes moment HHSC Contractor identifies pool of available time study moments 1 2 3 4 5 6
  19. 19. RMTS Program Contacts & Participant List <ul><li>RMTS Program Contacts’ ability to access, update and certify the Participant List (PL) is contingent on completing the annual HHSC mandatory training. </li></ul><ul><li>If an ISD's Participant List (PL) is not updated/certified each quarter by a RMTS Program Contact that was trained by HHSC for the current Federal Fiscal Year (FFY), the ISD is not in compliance with RMTS requirements </li></ul><ul><ul><li>ISDs not in compliance will be excluded from receiving payments for SHARS services for the entire FFY   </li></ul></ul><ul><ul><li>ISDs not in compliance will be excluded from submitting a MAC claim for any quarter in which compliance is not achieved   </li></ul></ul>
  20. 20. Annual Mandatory Training <ul><li>Annual RMTS training is mandatory for all districts that wish to participate in SHARS. This is required for RMTS Program Contacts. </li></ul><ul><li>Annual Medicaid Administrative Claiming (MAC) training is mandatory for all districts that wish to participate in MAC. This training is required for MAC Financial Contacts. </li></ul><ul><li>Annual SHARS Cost Report training is mandatory for all districts who are required to submit a SHARS cost report. This training is required for SHARS Financial Contacts. </li></ul><ul><li>Annual RMTS and MAC training is a combined training and can be accomplished by attending either “initial” or “refresher” training provided by HHSC </li></ul><ul><li>It is the responsibility of each ISD to ensure two or more of their designated RMTS  Program Contacts, MAC Financial Contacts and SHARS Financial Contacts attend the mandatory training. </li></ul>
  21. 21. Important Dates for RMTS <ul><li> Event Opens/Begins Closes/Ends </li></ul><ul><li>1 st Quarter - October, November, December </li></ul><ul><li>1st Quarter Participant List 08/06/2009 09/15/2009 </li></ul><ul><li>1st Quarter Time Study 10/01/2009 12/18/2009 </li></ul><ul><li>2 nd Quarter - January, February, March </li></ul><ul><li>2nd Quarter Participant List 09/16/2009 12/04/2009 </li></ul><ul><li>2nd Quarter Time Study 01/04/2010 03/31/2010 </li></ul><ul><li>3 rd Quarter - April, May, June </li></ul><ul><li>3rd Quarter Participant List 12/05/2009 03/15/2010 </li></ul><ul><li>3rd Quarter Time Study 04/01/2010 06/04/2010 </li></ul><ul><li>4 th Quarter - July, August, September </li></ul><ul><li>(No Time Study for the 4th quarter) </li></ul>
  22. 22. Time Study Team <ul><li>Ray Wilson Manager </li></ul><ul><li>Beverly Tackett Team Lead </li></ul><ul><li>Alexandra Young Rate Analyst </li></ul><ul><li>The HHSC Time Study Unit assists with questions pertaining to: </li></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>Participant List </li></ul></ul><ul><ul><li>RMTS </li></ul></ul><ul><ul><li>On-line RMTS Operating System </li></ul></ul><ul><li>If you have questions or need further assistance please contact: </li></ul><ul><li>[email_address] or call 512-491-1715 </li></ul>
  23. 23. <ul><ul><li>Failure to participate in or maintain eligibility requirements for RMTS will impact the ISD’s ability to receive federal Medicaid reimbursement for SHARS for the entire FFY(s) in which the default occurs. </li></ul></ul><ul><ul><li>Staff on the RMTS Participant List are the only staff for which costs may be reported on the SHARS cost report. </li></ul></ul><ul><ul><li>The results of the timestudy are the basis for the calculation of the direct medical services timestudy percentage that is used during the cost reporting process to allocate costs to the Medicaid program. </li></ul></ul>Relationship of RMTS to Cost Report Participant List = Allowable Costs
  24. 24. Relationship of RMTS to Cost Report Participant List = Allowable Costs <ul><li>Registered Nurses (RN) </li></ul><ul><li>Licensed Vocational Nurses (LVN) </li></ul><ul><li>Advanced Practice Nurses (APNs), </li></ul><ul><li>Delegated Nursing Services </li></ul><ul><li>Physicians (MDs) </li></ul><ul><li>Licensed Audiologist </li></ul><ul><li>Licensed Assistant in Audiology </li></ul><ul><li>Licensed Occupational Therapist (OT) </li></ul><ul><li>Certified Occupational Therapy Assistant (COTA) </li></ul><ul><li>Licensed Physical Therapist (PT) </li></ul><ul><li>Licensed Physical Therapy Assistant (LPTA) </li></ul><ul><li>Licensed Psychologist </li></ul><ul><li>Licensed Specialist in School Psychology (LSSP) </li></ul><ul><li>Licensed Psychiatrist </li></ul><ul><li>ASHA-Equivalent Speech Language Pathologist (SLP) with Texas license and master's degree </li></ul><ul><li>ASHA SLPs with Texas Licenses </li></ul><ul><li>Grandfathered SLP with Texas License and no master's degree </li></ul><ul><li>TEA- or SBEC-Certified Speech Therapists </li></ul><ul><li>Licensed Assistant in SLP </li></ul><ul><li>Licensed SLP Intern </li></ul><ul><li>Licensed Professional Counselor (LPC) </li></ul><ul><li>Licensed Marriage and Family Therapist (LMFT) </li></ul><ul><li>Licensed Clinical Social Worker (LCSW) </li></ul><ul><li>Personal Care Service Providers </li></ul>TEA = Texas Education Agency SBEC = State Board of Educator Certification ASHA = American Speech-Language-Hearing Association
  25. 25. <ul><li>Physician Assistant </li></ul><ul><li>Licensed Bachelor of Social Work </li></ul><ul><li>Licensed Master of Social Work </li></ul><ul><li>Service Coordinator/Case Managers </li></ul><ul><li>Interpreter/Translator/ Bilingual Specialist </li></ul><ul><li>Pregnancy, Education & Parenting Program Personnel </li></ul><ul><li>Orientation & Mobility Specialist </li></ul><ul><li>Outreach Workers </li></ul><ul><li>Psychology Intern </li></ul><ul><li>Behavioral Counselor </li></ul>Relationship of RMTS to Cost Report Participant List = Allowable Costs
  26. 26. Personal Care Service <ul><li>Personal care services are provided to help a child with a disability or chronic condition </li></ul><ul><li>to benefit from educational services. </li></ul><ul><li>Personal care services MUST be documented on the students IEP and may be </li></ul><ul><li>provided by a variety of school personnel including but not limited to: </li></ul><ul><ul><li>Teacher Aides; </li></ul></ul><ul><ul><li>Health Care Aides; </li></ul></ul><ul><ul><li>Instructional Aides; </li></ul></ul><ul><ul><li>Bilingual Aides; </li></ul></ul><ul><ul><li>Program Assistants; </li></ul></ul><ul><ul><li>Bus Aides/Monitors; and </li></ul></ul><ul><ul><li>Orientation/Mobility Specialists. </li></ul></ul>Relationship of RMTS to Cost Report Participant List = Allowable Costs
  27. 27. Educational/Direct Medical <ul><li>Educational services include: activities that are associated with traditional courses such as reading/English/language arts, writing, mathematics, science, social studies, physical education, and electives and do not require human intervention such as hands on assistance, supervision, or cueing of persons with disabilities and chronic conditions, to accomplish tasks that they would normally do for themselves if they did not have a disability or chronic medical condition. </li></ul><ul><li>Direct medical services include: activities that require human intervention such as hands on assistance, supervision, or cueing of persons with disabilities and chronic conditions, to accomplish tasks that they would normally do for themselves if they did not have a disability or chronic medical condition; personal care services; specialized transportation services; psychological services; counseling services; occupational therapy and evaluation; physical therapy and evaluation; audiology and evaluation; speech therapy and evaluation; nursing services; and physician services. </li></ul>Relationship of RMTS to Cost Report Participant List = Allowable Costs
  28. 28. <ul><li>The RMTS Direct Service Cost Pool/Participant List should include: </li></ul><ul><ul><ul><ul><li>All direct service staff, including those that are Federally-Funded Employees </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Contractors (list all positions that will perform services but are not employed by the school district, including shared services employees) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vacant Positions that will be filled during the quarter </li></ul></ul></ul></ul>Relationship of RMTS to Cost Report Participant List = Allowable Costs
  29. 29. <ul><li>The RMTS Direct Service Participant List should not include: </li></ul><ul><ul><li>Bus Drivers (unless they also provide a direct service) </li></ul></ul><ul><ul><li>SBEC-or TEA-Certified School Counselors </li></ul></ul><ul><ul><li>Educational Diagnosticians </li></ul></ul><ul><ul><li>Vacant Positions that will not be filled during the quarter </li></ul></ul><ul><li>Note: SBEC or TEA Certified School Counselors and Educational Diagnosticians may qualify under one of the Administrative Categories or as Personal Care Service Providers </li></ul>Relationship of RMTS to Cost Report Participant List = Allowable Costs
  30. 30. What if my ISD is in an SSA/Co-op? <ul><li>SHARS providers who are members of a cooperative or shared services arrangement MUST submit separate SHARS cost reports, which means each ISD must have a district specific RMTS participant list that includes “contracted staff” employed by the fiscal agent and district employees for which costs will be claimed. </li></ul>
  31. 31. Polling Question
  32. 32. <ul><ul><li>Direct Service Employee Salaries </li></ul></ul><ul><ul><ul><ul><li>position must be included on the applicable RMTS Participant List </li></ul></ul></ul></ul><ul><ul><li>Payroll Taxes & Benefits </li></ul></ul><ul><ul><ul><ul><li>“ actual” costs only </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>set aside/reserved funds are not actual cost </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>TRS on behalf of payments are not actual cost </li></ul></ul></ul></ul></ul><ul><ul><li>Contracted Direct Service Staff </li></ul></ul><ul><ul><ul><ul><li>position must be included on the applicable RMTS Participant List </li></ul></ul></ul></ul><ul><ul><li>Other </li></ul></ul><ul><ul><ul><ul><li>staff travel costs to provide direct medical services </li></ul></ul></ul></ul><ul><ul><ul><ul><li>continuing education costs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>direct medical services materials and supplies (from Appendix A) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>depreciation from other direct medical services equipment of $5,000 or more per item </li></ul></ul></ul></ul><ul><ul><li>Specialized Transportation </li></ul></ul><ul><ul><li>IMPORTANT: Report ACTUAL costs on the cost report NOT BILLED amounts </li></ul></ul>Medicaid Allowable Costs
  33. 33. Medicaid Allowable Costs <ul><ul><li>Specialized Transportation Services </li></ul></ul><ul><ul><li>School districts may claim SHARS reimbursement for specialized transportation for students whose IEP includes a documented need for transportation on a specially adapted vehicle </li></ul></ul><ul><ul><li>The average is a total of four one-way trips per day </li></ul></ul><ul><ul><li>Supporting documentation is required to be maintained </li></ul></ul><ul><ul><ul><li>Examples include but are not limited to: IEPs, transportation logs, attendance records, and session notes </li></ul></ul></ul><ul><ul><li>There can be other student transportation vehicles, e.g., minivans and vans that can be counted. The vehicle may be district owned, contracted, etc. and must meet the definition of a specially adapted vehicle </li></ul></ul><ul><ul><li>A specially adapted vehicle is one that has been physically modified (e.g. addition of a wheelchair lift, addition of seatbelts or harnesses, addition of child protective seating, or addition of air conditioning) </li></ul></ul>
  34. 34. <ul><li>Specialized Transportation Services (Cont’d) </li></ul><ul><ul><li>Reimbursement for covered transportation services is calculated on a student one-way trip basis, as long as the student receives at least one direct medical service on the same day. </li></ul></ul><ul><ul><li>Important: If the student receives a billable SHARS service (including personal care services on the bus) and is transported on a specially adapted vehicle, the following one-way trips may be claimed: </li></ul></ul><ul><ul><ul><li>From the student's residence to school </li></ul></ul></ul><ul><ul><ul><li>From the school to the student's residence </li></ul></ul></ul><ul><ul><ul><li>From the student's residence to a provider's office that is contracted with the district </li></ul></ul></ul><ul><ul><ul><li>From a provider's office that is contracted with the district to the student's residence </li></ul></ul></ul><ul><ul><ul><li>From the school to a provider's office that is contracted with the district </li></ul></ul></ul><ul><ul><ul><li>From a provider's office that is contracted with the district to the student's school </li></ul></ul></ul><ul><ul><ul><li>From the school to another campus to receive a billable SHARS service </li></ul></ul></ul><ul><ul><ul><li>From the campus where the student received a billable SHARS service back to the student's school </li></ul></ul></ul>Medicaid Allowable Costs
  35. 35. <ul><li>Allocation of Shared Transportation Costs </li></ul><ul><li>Transportation costs that cannot be applied directly to specialized transportation services (e.g., fuel, insurance, and/or vehicle mechanic costs) can be allocated based on the number of specialized transportation vehicles divided by the total number of transportation vehicles. </li></ul><ul><li>NOTE: ‘Other’ vehicles, not only buses, count as long as the vehicle in question meets the definition of “specially adapted.” </li></ul>Medicaid Allowable Costs
  36. 36. <ul><ul><li>Examples of Appendix A include but are not limited to: </li></ul></ul><ul><ul><li>Auditory, speech-reading, speech-language, and communication instructional materials </li></ul></ul><ul><ul><li>Mobility equipment (e.g., walkers, wheelchairs, scooters) </li></ul></ul><ul><ul><li>Portable crisis kit and first-aid kit </li></ul></ul><ul><ul><li>Positioning equipment (e.g., wedges, bolsters, standers, adapted seating, exercise mats) </li></ul></ul><ul><ul><li>Record forms (e.g., emergency cards, logs, medical sheets, accident reports, state forms) </li></ul></ul><ul><ul><li>Refrigerator for medicine … </li></ul></ul><ul><ul><li>Refer to the SHARS Cost Report training materials for a complete list of Appendix A items: </li></ul></ul><ul><ul><li>http://www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Shars/Shars.html </li></ul></ul>Medicaid Allowable Costs
  37. 37. <ul><ul><li>Appendix A (Cont’d) </li></ul></ul><ul><ul><li>Shared items such as computers, defibrillators, etc (from Appendix A) for all (including special education) students can be reported on the SHARS Cost Report </li></ul></ul><ul><ul><li>Costs applicable only to students other than Special Education students, should not be reported on the cost report </li></ul></ul><ul><ul><li>All costs, including shared costs, will be allocated to the Texas Medicaid Program by using the direct medical services percentage and the district's IEP ratio by the Fairbanks system. </li></ul></ul><ul><ul><li>Invoices must be maintained </li></ul></ul><ul><ul><li>Items costing $5,000 or more may be depreciated </li></ul></ul><ul><ul><li>NOTE: Report entire cost of items unless district is a member of a SSA/Co-op. </li></ul></ul>Medicaid Allowable Costs
  38. 38. <ul><ul><li>To maximize federal revenue sources it is recommended that staff that deliver SHARS be funded with state/local funds.   </li></ul></ul><ul><ul><li>Federal Funds include but are not limited to: </li></ul></ul><ul><ul><ul><li>IDEA </li></ul></ul></ul><ul><ul><ul><li>ARRA/Stimulus </li></ul></ul></ul>Medicaid Allowable Costs NOTE: MAC funds are considered “reimbursement” funds and are not required to be backed out of the SHARS cost report.
  39. 39. What if my ISD is in an SSA/Co-op? <ul><li>The fiscal agent can only report costs for the students enrolled in the district serving as the fiscal agent. All ‘shared’ costs must be allocated to each of the member districts. </li></ul><ul><li>For example, if a member district contributed 15.75% of the budget, that district would be allocated 15.75% of the paid hours and payroll costs for each staff person, as well as 15.75% of any other allowable direct costs. </li></ul><ul><li>Allocation of costs based on budget contribution is only one way in which a fiscal agent may choose to allocate costs. </li></ul><ul><li>IMPORTANT: Allocation methodologies used to distribute shared costs to member districts of an SSA/Co-Op must be documented and presented to HHSC upon request. </li></ul>
  40. 40. Polling Question
  41. 41. IEP Ratio <ul><li>Individualized Education Program (IEP) ratio for </li></ul><ul><li>direct medical services: </li></ul><ul><li>Total Medicaid students with IEPs requiring direct medical service(s) </li></ul><ul><li>divided by </li></ul><ul><li>Total students with IEPs requiring direct medical service(s) </li></ul>
  42. 42. IEP Ratio <ul><li>To calculate the IEP ratio, first compile an unduplicated list of all Special Education students for the entire reporting period. </li></ul><ul><li>From that list, compile a list of the students whose IEPs document the need for one or more direct medical services. That number is the denominator. </li></ul><ul><li>From the second list, compile a list of the students that were Medicaid at any time during the cost-reporting period. That number will be the numerator. </li></ul>
  43. 43. IEP Ratio IMPORTANT: Count ALL students with IEP/SHARS regardless of BILLED status ALL Students ALL Students with IEP/SHARS Students with IEP/SHARS that are also Medicaid eligible
  44. 44. <ul><li>From the list that was used to determine the denominator for the IEP ratio, compile a list of the students whose IEPs also document the need for specialized transportation services. </li></ul><ul><li>From the list that was used to determine the numerator for the IEP ratio, compile a list of the Medicaid students whose IEPs also document the need for specialized transportation services. </li></ul>Specialized Transportation Student Count
  45. 45. Specialized Transportation Student Count IMPORTANT: Count ALL students with IEP/SHARS/Specialized Transportation regardless of BILLED status ALL Students with IEP/SHARS ALL Students with IEP/SHARS/Special Transportation Students with IEP/SHARS/Special Transportation that are also Medicaid eligible
  46. 46. One-Way Trip Ratio <ul><li>One-way trip ratio for specialized transportation services: </li></ul><ul><li>Total number of one-way trips for Medicaid Students with IEPs requiring specialized transportation services </li></ul><ul><li>divided by </li></ul><ul><li>Total number of one-way trips for all students with IEPs requiring specialized transportation services </li></ul>
  47. 47. <ul><li>From the list that was used to determine the denominator for the IEP ratio, compile a list of the students whose IEPs also document the need for specialized transportation services. Those are the students for which you need to count all the one-way trips. That number of one-way trips will be the denominator. </li></ul><ul><li>From the list that was used to determine the numerator for the IEP ratio, compile a list of the Medicaid students whose IEPs also document the need for specialized transportation services. Those are the students for which you need to count all the one-way trips. That number will be the numerator. </li></ul>One-Way Trip Ratio
  48. 48. What if my ISD is in an SSA/Co-op? <ul><li>The fiscal agent can only report costs for the students ‘ enrolled ’ in the district serving as the fiscal agent. All ‘shared’ costs must be allocated to each of the member districts. </li></ul><ul><li>For example , if a member district contributed 15.75% of the budget, that district would be allocated 15.75% of the paid hours and payroll costs for each staff person, as well as 15.75% of any other allowable direct costs. </li></ul>
  49. 49. What if my ISD is in an SSA/Co-op? <ul><li>Determination of ‘enrolled’ per TEA … </li></ul><ul><li>“ While it is true that multiple districts may be involved in the provision of special education and related services to a student with disabilities, only one district can report Public Education Information Management System (PEIMS) data on a student, so it is our position that the SHARS-related billing should be through the district that is reporting PEIMS data.” </li></ul><ul><li>Additional information may be found in the Student Attendance Accounting </li></ul><ul><li>Handbook (SAAH) at: http://ritter.tea.state.tx.us/school.finance/handbook/index.html . </li></ul>
  50. 50. Fairbanks Demonstration
  51. 51. <ul><li>Important Reminder </li></ul><ul><li>If the district's Medicaid-allowable costs are less than its total Medicaid payments (federal and state shares), the district should consider one of the following: </li></ul><ul><ul><li>Spend more time to identify and report additional Medicaid-allowable costs on the cost report prior to submission. </li></ul></ul><ul><ul><li>Pay back the federal share of the difference after the reconciliation and settlement processes are completed. </li></ul></ul>Cost Report Information ($14,230 ) E. Difference $75,000 D. Less Federal Portion of Medicaid Payment made by TMHP during cost report period $60,770 C. Federal Portion of Medicaid Costs 60.77% B. FMAP Rate $100,000 A. Total Medicaid Allowable Costs From Cost Report Reconciliation
  52. 52. Cost Report Information <ul><li>To avoid common SHARS Cost Report processing issues please remember to: </li></ul><ul><ul><li>Have the proper employee of the district sign the certification forms. The person signing the cost report certification forms (2) for the SHARS Cost Report should be the district's Chief Financial Officer (CFO), Business Officer, Superintendent, or other official that has signatory authority for the district. </li></ul></ul><ul><ul><li>Sign and notarize both SHARS Cost Report certification forms. There are two forms: </li></ul></ul><ul><ul><ul><li>Cost Report Certification </li></ul></ul></ul><ul><ul><ul><li>Claimed Expenditures </li></ul></ul></ul><ul><ul><li>Signer and Notary dates must be no earlier than the electronic cost report submission date. </li></ul></ul><ul><ul><li>Ensure that the Signer and Notary dates are the same. The notary language on the Certification page reads “Subscribed and sworn before me.” This means that the date signed by the Signer and the Notary must be the same. </li></ul></ul><ul><ul><li>NO COPIES will be accepted. </li></ul></ul><ul><ul><li>Please print on one side only due to processing/scanning issues. </li></ul></ul><ul><ul><li>Printing on letterhead is not necessary. </li></ul></ul>
  53. 53. Cost Report Information <ul><li>Send HHSC the form (s) that contains original signatures for both the Signer and the Notary. </li></ul><ul><li>Mail original notarized certification forms (2) to: </li></ul><ul><li>REGULAR MAIL </li></ul><ul><li>HHSC Rate Analysis </li></ul><ul><li>Mail Code H-400 </li></ul><ul><li>PO Box 85200 </li></ul><ul><li>Austin, TX 78708-5200 </li></ul><ul><li>SPECIAL DELIVERY </li></ul><ul><li>HHSC Rate Analysis </li></ul><ul><li>Braker Center, Building H </li></ul><ul><li>Mail Code H-400 </li></ul><ul><li>11209 Metric Blvd. </li></ul><ul><li>Austin, TX 78758-4021 </li></ul><ul><li>HHSC recommends the Cost Report Certification pages be sent via courier, overnight, </li></ul><ul><li>or certified mail so you will have a tracking that shows it has been delivered successfully. </li></ul>
  54. 54. <ul><li>What if my cost report is not completed by APRIL 1 ? </li></ul><ul><ul><li>Failure to file a completed and acceptable cost report by the cost report due date in accordance with applicable instructions and guidelines may result in the placement of a vendor hold on the provider's SHARS payments until an acceptable cost report is received by HHSC. </li></ul></ul><ul><ul><li>If a vendor hold is placed on a district’s SHARS payments, it will be released once an acceptable cost report is received by HHSC. </li></ul></ul>Cost Report Information
  55. 55. <ul><li>Corrections may be made during the desk review process: </li></ul><ul><ul><ul><ul><li>Send written district initiated correction requests to: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>The request should include: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>District Name </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>District NPI and TPI </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Year of cost report that you need to re-open </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Brief description of issue/correction </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Length of time you will need to complete the revisions </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Please be advised that the district will also need to re-submit all original signed and notarized certification pages for the respective cost report year to HHSC. Official signature and notary dates must be no earlier than the electronic cost report re-submission date. </li></ul></ul></ul></ul>Cost Report Information
  56. 56. <ul><li>Effective January 1, 2009 an HHSC contact that is an employee of the District or a contractor/designee of the District may be entered as the districts SHARS Financial Contact. </li></ul><ul><li>A contractor/designee may be District staff, SSA, Co-op/Fiscal Agents, and/or a Vendor. </li></ul><ul><li>Each District is responsible for the designee’s actions and/or non-action. </li></ul><ul><li>District’s must document the authorization and provide documentation if requested. </li></ul><ul><li>HHSC recommends that the authorization to certify the quarterly participant list may be incorporated into the contract with the authorized entity. </li></ul>Cost Report Information
  57. 57. Polling Question
  58. 58. Reconciliation and Settlement Desk Review <ul><ul><li>Claims </li></ul></ul><ul><ul><li>RMTS </li></ul></ul><ul><ul><li>IEP Ratio </li></ul></ul><ul><ul><li>One-way trip ratio </li></ul></ul><ul><ul><li>Specially-adapted vehicle ratio </li></ul></ul><ul><ul><li>Staff costs and paid hours </li></ul></ul><ul><ul><ul><li>Staff must match RMTS Participant List </li></ul></ul></ul><ul><ul><li>Payroll costs </li></ul></ul><ul><ul><ul><li>salaries/compensation, payroll taxes, and employee benefits must be maintained at individual staff level and may be requested </li></ul></ul></ul><ul><ul><li>Other direct costs </li></ul></ul><ul><ul><li>Invoices must be maintained </li></ul></ul><ul><ul><li>Items costing $5,000 or more </li></ul></ul><ul><ul><ul><li>Proof of purchase date may be requested for depreciated items </li></ul></ul></ul>
  59. 59. Reconciliation and Settlement Desk Review <ul><li>Student-specific records that are required for SHARS become part of the student’s educational records </li></ul><ul><li>and must be maintained for seven years . </li></ul><ul><li>All records that are pertinent to SHARS billings must be maintained by the school district until all audit </li></ul><ul><li>questions, appeal hearings, investigations, or court cases are resolved. </li></ul><ul><li>Records should be stored in a readily accessible location and format and must be available for state or federal </li></ul><ul><li>audits. </li></ul><ul><li>The following is a checklist of the minimum documents to collect and maintain: </li></ul><ul><ul><li>IEP </li></ul></ul><ul><ul><li>Current provider qualifications (licenses, etc.) </li></ul></ul><ul><ul><li>Attendance records </li></ul></ul><ul><ul><li>Prescriptions and referrals </li></ul></ul><ul><ul><li>Medical necessity documentation (e.g., diagnoses and history of chronic conditions or disability) </li></ul></ul><ul><ul><li>Session notes or service logs, including provider signatures </li></ul></ul><ul><ul><li>Supervision logs </li></ul></ul><ul><ul><li>Special transportation logs </li></ul></ul><ul><ul><li>Claims submittal and payment histories </li></ul></ul><ul><ul><li>If applicable, non-school SHARS provider’s affiliation letter and signed agreement with the district </li></ul></ul>
  60. 60. Reconciliation and Settlement <ul><li>The 2009 SHARS Cost Reports must be cost reconciled and settled by August 31, 2011 (i.e., 24 months after the end of the reporting period).   </li></ul><ul><li>District will be sent a notice showing the results of the cost reconciliation and cost settlement processes, including the amount reported, any amounts adjusted and why, and the resulting amounts due to the state or due to the district.  </li></ul><ul><li>The notice gives the district 30 days to agree or request an informal review to dispute the adjustments.  </li></ul><ul><li>If the district agrees with the settlement and the district is owed money, the district should receive the additional payment in 4-6 weeks from the time HHSC receives the district's agreement. </li></ul><ul><li>If the district owes money, recoupment will be required. </li></ul>
  61. 61. Uses of SHARS Reimbursement <ul><li>The Medicaid funding that schools receive for delivering SHARS services to special education students is not considered federal money at the school district level and is not subject to the Single Audit Act under OMB A-133.  </li></ul>
  62. 62. Important Dates <ul><ul><li>Federal Fiscal Year </li></ul></ul><ul><ul><ul><ul><li>October 1 – September 30 </li></ul></ul></ul></ul><ul><ul><li>Cost Report Due Date </li></ul></ul><ul><ul><ul><ul><li>April 1 </li></ul></ul></ul></ul><ul><ul><li>Cost Report Training </li></ul></ul><ul><ul><ul><ul><li>January, February, and March </li></ul></ul></ul></ul><ul><ul><li>Cost Report Settlement Notice </li></ul></ul><ul><ul><ul><ul><li>August 31 </li></ul></ul></ul></ul>
  63. 63. Access <ul><ul><li>Access to the online 2009 SHARS Cost Report will not be available until 2009 SHARS Cost Report Training has been completed. </li></ul></ul><ul><ul><li>Please allow three (3) business days after training for access to be granted. </li></ul></ul><ul><ul><li>This training is also available and recommended for staff: signing the cost report and funds certification forms; compiling the Individual Education Plan (IEP) and one-way trip ratios; and, the Random Moment Time Study (RMTS) Program Contact (for direct services). </li></ul></ul>
  64. 64. Communication <ul><ul><li>Provider notifications for SHARS Cost Report Information are distributed by Fairbanks </li></ul></ul><ul><ul><li>Provider notifications for general SHARS information are distributed by TEA SHARS ListServ, TMHP Banner Notices, and Fairbanks </li></ul></ul><ul><ul><li>Sign up for TEA ListServ at: http://miller.tea.state.tx.us/list/ </li></ul></ul><ul><ul><li>For help with TPI/NPI numbers, resolution of payment issues, or Certification of Funds issues, call TMHP Customer Services or your TMHP Provider Relations Representative: </li></ul></ul><ul><ul><li>1-800-925-9126 </li></ul></ul><ul><ul><li>PLEASE make certain your district contact information is accurate on the </li></ul></ul><ul><ul><li>TEA, TMHP, and Fairbanks websites … </li></ul></ul><ul><li>THANK YOU!!! </li></ul>
  65. 65. <ul><li>SHARS Cost Reports– (512) 491-1361 – [email_address] </li></ul><ul><li>Yvonne Moorad - Team Lead </li></ul><ul><li>Amanda Hudson </li></ul><ul><li>Cathy Rutherford </li></ul><ul><li>SHARS District Specific Interim Rates – (512) 491-1361 – [email_address] </li></ul><ul><li>Yvonne Moorad - Team Lead </li></ul><ul><li>Cathy Rutherford </li></ul><ul><li>SHARS Program/Policy/Certification of Funds/Billing/Payment Questions </li></ul><ul><li>(512) 249-3736 -- [email_address] </li></ul><ul><li>SHARS Cost Report System Questions – [email_address] </li></ul><ul><li>Fairbanks Hotline: (888) 321-1225 </li></ul><ul><li>SHARS Website </li></ul>www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Shars/Shars.html Contacts
  66. 66. Other Related Information <ul><li>IEP and Other IDEA/Educational Questions can be answered by the </li></ul><ul><li>TEA Special Education Department : [email_address] </li></ul><ul><li>The Texas Medicaid Provider Procedures Manual (TMPPM) Chapter 42 is located at the TMHP website at: www.tmhp.com </li></ul><ul><ul><li>For help with TPI/NPI numbers, resolution of payment issues, or Certification of </li></ul></ul><ul><ul><li>Funds issues, call TMHP Customer Services: 1-800-925-9126 or your </li></ul></ul><ul><ul><li>TMHP Provider Relations Representative </li></ul></ul><ul><ul><li>The TMHP Provider Information Change (PIC) Form is located at: www.tmhp.com </li></ul></ul><ul><ul><li>(use to change district name, address to send Certification of Funds letters, etc.) </li></ul></ul><ul><li>Random Moment Time Study (RMTS) can be answered by the HHSC RMTS staff at: </li></ul><ul><li>(512) 491-1715 or E-mail [email_address] </li></ul>
  67. 67. We learned … <ul><li>What Medicaid-allowable costs may be submitted for the SHARS Cost Report </li></ul><ul><li>The elements of an acceptable SHARS cost report </li></ul><ul><li>How to identify opportunities to maximize federal reimbursement </li></ul>
  68. 68. Medicaid Administrative Claiming Independent School Districts
  69. 69. MAC vs. SHARS Similarities <ul><li>MAC </li></ul><ul><ul><li>Participant List </li></ul></ul><ul><ul><li>RMTS </li></ul></ul><ul><ul><li>Annual Training </li></ul></ul><ul><ul><ul><li>MAC Financial </li></ul></ul></ul><ul><ul><ul><li>RMTS </li></ul></ul></ul><ul><ul><li>Medicaid Federal Reimbursement </li></ul></ul><ul><li>SHARS </li></ul><ul><ul><li>Participant List </li></ul></ul><ul><ul><li>RMTS </li></ul></ul><ul><ul><li>Annual Training </li></ul></ul><ul><ul><ul><li>SHARS Cost Report </li></ul></ul></ul><ul><ul><ul><li>RMTS </li></ul></ul></ul><ul><ul><li>Medicaid Federal Reimbursement </li></ul></ul>
  70. 70. MAC vs. SHARS Differences <ul><li>MAC </li></ul><ul><ul><li>Administrative Activities </li></ul></ul><ul><ul><ul><li>Federal Medicaid reimbursement for administrative activities associated with linking students to appropriate Medicaid/health-related services </li></ul></ul></ul><ul><ul><li>Quarterly reporting </li></ul></ul><ul><ul><li>Claim only salaries/benefits </li></ul></ul><ul><ul><li>Different contracting requirements </li></ul></ul><ul><li>SHARS </li></ul><ul><ul><li>Direct Medical Services </li></ul></ul><ul><ul><ul><li>Federal Medicaid reimbursement for direct medical services </li></ul></ul></ul><ul><ul><li>Annual reporting </li></ul></ul><ul><ul><li>Claim more than salaries/benefits </li></ul></ul><ul><ul><li>Different contracting requirements </li></ul></ul>
  71. 71. Contacts <ul><li>Medicaid Administrative Claiming – (512) 491-1802 – [email_address] </li></ul><ul><li>Yvonne Moorad - Team Lead </li></ul><ul><li>Serena Lee </li></ul><ul><li>Jessica Makdsi </li></ul>http://www.hhsc.state.tx.us/medicaid/programs/rad/AcuteCare/MAC/SharsMac.html
  72. 72. Polling Question
  73. 73. QUESTIONS
  74. 74. Survey <ul><li>Your feed back is important to us. To launch a training survey, please log off in the following manner: </li></ul><ul><ul><li>File </li></ul></ul><ul><ul><li>Exit Webinar Thank You! </li></ul></ul>

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