Provider Notice issued 05/15/13

Cost Calculation for Medicaid School-Based Health Services for FY12

Local education agencies (LEAs), enrolled with the Department of Healthcare and Family Services (HFS) to provide Medicaid covered medical services to children with an individualized education plan (IEP), are required to bill HFS the actual cost of providing a medical service. This notice describes how LEAs must submit their costs to HFS.

To assure that submittals are valid, and from authorized LEAs, LEAs will be required to use HFS' Medical Electronic Data Interchange (MEDI) system for certification of individuals authorized to submit data for the LEA through the digital signature process.

LEAs must submit their cost information by completing an electronic cost calculation form for each school-based health service it provided during the 2011-2012 school year (i.e., fiscal year 2012). Between May 16, 2013, and July 19, 2013, each LEA should complete, and submit, an electronic cost calculation form for each type of direct medical service provided by the LEA, and billed to HFS for Medicaid match. LEAs that do not complete the Web-based cost reporting process by July 19, 2013, will not receive adjustments to claims submitted previously for the 2011-2012 school year, nor will HFS be able to process any future claims.

After LEAs submit their electronic cost calculation forms for fiscal year 2012, HFS will review the information, and follow up with individual LEAs, as appropriate. HFS will process adjustments using the computed rates to re-price all claims with dates of service between July 1, 2011, and June 30, 2012. HFS will make these adjustments automatically; LEAs should not re-submit previously filed claims in order to receive their claim adjustments.

Please see the instructions for submitting electronic cost calculation forms following this notice. Questions concerning this notice should be directed to the School-Based Health Services at 217-558-1389 or by e-mailing School-Based Health Services.

Theresa A. Eagleson, Administrator

Division of Medical Programs

Instructions for Completing the Required Fee-for-Service Cost Calculation Form

The cost calculation form must be accessed through MEDI. In order for LEAs, or billing agents on behalf of an LEA, to log-in and access MEDI via the myHFS website, a State of Illinois digital identity is required. Instructions to obtain an Illinois digital identity and access MEDI may be found on the MEDI website.

In order to complete the cost calculation form:

1. Log-in to MEDI.

2. Select the "Local Education Agency" link. If a billing agent logs onto the MEDI System, a link to "Local Education Agency" will be displayed.

3. Select "FFS Cost Calculation."

4. Select the school district from the drop-down list.

5. Select service type.

6. Select fiscal year 2012.

7. Complete the cost calculation form.

In order to complete a cost calculation form, all requested information must be reported. This includes Lines A, B, C, G, I, and M.

 

Line A. Enter the total number of full-time equivalent staff providing this service.

 

For example, if the LEA had one full-time speech therapist providing services, and a contract to have an additional half-time speech therapist assistant, 1.5 is to be reported under "A."

 

Line B. Enter the total annual hours that the service providers worked during this fiscal year.

 

This amount must be calculated by multiplying the number of FTE service providers reported under "A," by the number of hours per day such employees are required to work. The result should then be multiplied by the number of days required per year. As an example, if the LEA reported 1.5 FTE speech therapists and those therapists worked 8 hours per day for 176 days for the year, the number reported under "B" would be 2,112 hours (1.5 x 8 x 176 = 2112).

 

Line C. Enter total annual hours service providers worked on the provision of this direct service.

 

This must include face-to-face time, as well as preparatory and follow-up time necessary for a direct service event, as defined in "H3a and H3b Direct Services" of the Illinois Guide for School-Based Health Services Administrative Claiming.

 

Line G. Enter the total amount of salaries and benefits paid to relevant service providers.

 

The amount under "G" must represent the total salary and benefit cost of relevant practitioners incurred by the LEA in the school year, less any federal funding. If the LEA is completing a cost sheet for speech therapy services, both speech therapists and speech therapy assistants providing services in the LEA are the relevant practitioners. Include only actual costs incurred by the LEA. They may include costs of personnel directly employed by the LEA and those with whom the LEA contracts for such services. They may not include any costs incurred by other LEAs.

 

Line I. Enter the cost of non-salary expenses attributable to the provision of this service.

 

The amount under "I" may include costs of supplies and materials used directly by the relevant practitioners and necessary for the delivery of services. Material and supply costs that cannot be isolated for, and directly associated with the provision of services, may not be included here.

 

Line M. Enter the LEA's unrestricted indirect cost rate.

 

This rate has been provided to the LEA by the Illinois State Board of Education and is available on their website.

 

Upon completion of the relevant cost forms, select the "Save Changes and Submit" button. By selecting this button, the reported costs will be electronically submitted to HFS.

The procedures above need to be repeated for each service type for which the LEA provided and billed medical services eligible for Medicaid match.

All costs reported in the FFS cost calculation form must be directly related to, and consistent with, data reported in the LEA's administrative claims for the previous year. After the submission closure date, HFS staff will review the submitted cost data and final calculated rates for validity and reasonableness. HFS will not process claims from LEAs with costs that appear unreasonable or unsupported. All reported costs are subject to documentation reviews by HFS. Any claims that include costs that are not adequately supported will be subject to recoupment by the federal government.

Final costs calculated by HFS will be used to determine total claimable amounts for Medicaid matchable services. Federal matching dollars will be claimed at these amounts, regardless of the amount billed on individual claims. After HFS completes its review of the submitted information and approves the final calculated rates, HFS will notify LEAs of their final computed service costs for each of the service types submitted. All claim adjustments will be performed retroactively by HFS.

Documentation of Transportation Costs

The web-based cost calculation form cannot be used to calculate transportation costs. LEAs must continue to determine their respective special education transportation costs as before and have documentation supporting the costs available for review.

Billable transportation services costs per round trip shall be based on the reported transportation costs for special education students, as reported to ISBE in the "Pupil Transportation Claim and Reimbursement System" (PTCRS, 2nd Quadrant). To determine a per round-trip cost, the reported Special Education costs (Expenditures & Deductions, Line 23C) must be divided by the number of special education students in the LEA for the year reported to ISBE (Pupil Headcount, Line 9), divided by the number of School Attendance Days (Pupil Headcount, Line 6).

A qualifying billable transportation trip is the provision of a transportation service where each of the following conditions is met:

A. Special transportation is necessary because of the child's medical condition and is documented in the child's IEP.

B. A medical service other than the transportation itself is provided on the day of the transportation.

C. The LEA provides special accommodations in providing the transportation service beyond what otherwise are routine transportation services provided to all students.

All three of these conditions must be met to bill for a transportation service. LEAs will need only to enter the actual round-trip cost of special transportation services in Row T of the electronic cost calculation form.