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

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Connecticut MedicaidSchool Based Child Health

Program Training Instruction

for completion of

a SBCH Cost Report

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Training Instruction _ SBCH Cost Report

Definitions 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.

http://www.cms.hhs.gov/



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Training Instruction _ SBCH Cost Report Definitions 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.

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Training Instruction _ SBCH Cost Report Definitions 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.

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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.

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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.

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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.

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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.

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COST POOL COMPONENTS AND COST ALLOCATION BASESDirect Services Costs ComponetsDirect Services costs reported in the SBCH Cost Report should

reconcile to theexpenditures reported by district to the State Department of

Education in theED001Report.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.

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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 tothe 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.

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Training Instruction _ SBCH Cost ReportCOST 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 areprescribed 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.

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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..

1. 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

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Cost Allocation Bases (cont.)

2. 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:

9/12/201112/7/20113/7/2012

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Step-By-Step Instructions

to Complete

a SBCH Cost Report

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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report

Your district will receive an e-mail with attached blank copy of a SBCHcost report file in an excel format named 2012-xxx-SBCH-Cost Report.xls Please 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 named 2012-xxx-SBCH-Cost Report.xls

Please open the attached file, then save it using the save as option.

Choose Save As

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

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

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Choose Continue

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Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost ReportProvider Demographic and other Data

Page 1, 1 Provider Data is used to record demographicand other information about a district and to record information relatedto the Indirect Cost Rate.

Retrieve Page 1(worksheet with tab tilted 1 Provider Data ), then fill-indata 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

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Contact Information:

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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

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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report (continue)

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.

enter on line 35 in column B the Unrestricted Indirect Cost Rate approved by the State Department of Education.

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

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Training Instruction _ SBCH Cost Report Step-By-Step Instructions to Complete a SBCH Cost ReportED001, Schedule 4 Special Education Expenditure Page 3, 3 ED001, Sch #4 expenses is used to transfer to the cost report the grossSpecial Education Expenditures recorded on specific lines in Schedule 4 of the ED001Report filed with the Department of Education.

To Record Special Education ExpendituresRetrieve page 3, worksheet tab titled 3 ED001, Sch #4 expenses and copy expenses fromSchedule 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 the2011-2012 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

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

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

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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

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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.

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Summary of Cost Allocation Bases can be found on Page 2 of a cost report, page titled 2 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

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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.

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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 titled 6 DSP Time Study Summary and on Page 7, worksheet titled 7 Admin Time Study No 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

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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

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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

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4 SBCH Chart of Exp Codes

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

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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

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5 Position Codes &Titles

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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.

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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

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Example of page 19, 19-REGISTER(10)Social Worker

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Example of page 20, 20-REGISER-Admin S&W, FB

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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".

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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

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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

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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 periodColumn #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.

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District employed Specialized Transportation Drivers and MonitorsPage 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 studentColumn #12: enter the total number of hours the Transportation Monitor is paid during the weekColumn #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)

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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.

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

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Example of Page 10, Wkst #2a Admin S&W

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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 contracts not related to Medicaid should be entered at the bottom of the schedule in Column #5 next to line titled Purchased Services not related to the Medicaid SBCH

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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 servicesColumn #6: Enter "0" for when IEP and non-IEP prescribed services are deliveredFor 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

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Retrieve Page 11, tab titled Wkst #3-404(Purch Prof Serv)

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

Column #5: enter the total cost of contracts not related to Medicaid at the bottom of the worksheet next to line titled Purchased Services not related to the Medicaid SBCH

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Page 12, Wkst #4-407(Suppl & Material) is used to record cost of Other Supplies and Materials necessary to the delivery of direct services that were included in expense reported on line 407, Code 600 in Schedule 4 of the ED001 Report.

To record cost of Other Supplies and Materials expenses retrieve page 12 (worksheet with tab titled Wkst #4-407(Suppl & Material)), 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 and #10 as described below.


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Record Other Supplies and Materials Cost (cont)Page 12, Wkst #4-407(Suppl & Material)

Column #5: enter amount paid for Other Supplies and Materials necessary to the delivery of direct services of a direct service provider with position title described in column #4, or cost of supplies and materials necessary for processing of Medicaid billing For example a cost of supplies and materials, such as sponges, cotton pads, tong suppressors, pencils or pens used by Speech-Language should be recorded on an OSM-60, Speech-Language Therapist line.

Additionally, the total cost of supplies and materials not related to Medicaid should be entered at the bottom of the schedule in Column #5 next to line titled Supplies and materials not related to the Medicaid SBCH Column #10: enter the amount of paid supplies and materials costs that is reimbursed thorough Federal Funds.


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retrieve page 12 (worksheet with tab titled Wkst #4-407(Suppl & Material)

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Page 12, Wkst #4-407(Suppl & Material) Column #5: enter the total cost of supplies and materials not related to delivery of direct services at the bottom of the worksheet next to line titled Supplies and materials not related to the Medicaid SBCH

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Page 13, Wkst #5-408(Purch Prop Serv) is used to record cost of equipment service contracts necessary to the delivery of direct services that were included in expense reported on line 408, Code 400 in Schedule 4 of the ED001 Report.Record Property Services Cost.To record cost of a equipment service contracts retrieve page 13 (worksheet with tab titled Wkst #5-408(Purch Prop Serv)), then fill-in data in cells that are highlighted in yellow as follows: Column #5: enter amount paid for a equipment service contracts necessary to enable a delivery of a direct service by service provider with position title described in column #4 For example a cost of a service contract to calibrate equipment used to provide speech therapy should be recorded on a PPS-60, Speech-Language Therapist line.Additionally, the total cost of paid service contracts that is not related to Medicaid should be entered at the bottom of the schedule in Column #5 next to line titled Purchased Property Services-not related to the Medicaid SBCHColumn #10: enter the amount of a paid service contracts costs that is reimbursed thorough Federal FundsBlank 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 above instructions to complete column #5 and #10.


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Page 13, Wkst #5-408(Purch Prop Serv)

retrieve page 13 (worksheet with tab titled Wkst #5-408(Purch Prop Serv)

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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost ReportPage 13, Wkst #5-408(Purch Prop Serv) (cont.)

Column #5: enter the total cost of paid service contracts that is not related to delivery of direct services at the bottom of the worksheet next to line titled Purchased Property Services-not related to the Medicaid SBCH

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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. The following instructions applicable to cost reporting will be utilized for the 2012 SBCH Cost Report until further instructionsPage 16, Wks#7-Transportation is used to calculate cost of Specialized Transportation necessary to transport students who have specialized transportation and SBCH service prescribed in their IEP. The costs of specialized transportation were included in expense reported on line 409, Code 510 in Schedule 4 of the ED001 Report.Record Specialized Transportation Cost.To record Special Education Transportation expenses retrieve page 16 (worksheet with tab titled Wks#7-Transportation), then fill-in data in cells that are highlighted in yellow as follows:Column #7, lines 12 through 20: enter cost identified with the expense described in Column #4.For example an amount spent for vehicle maintenance that was included in the expense reported on Line 409, Code 510 in Schedule #4 of the ED001 report,; should be entered on line 16.


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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report Page 16, Wks#7-Transportation (cont.)

retrieve page 16 (worksheet with tab titled Wks#7-Transportation)

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Page 17, Wks #8- Depreciation allowance is used to record cost of Depreciation or Use Allowance cost for Equipment, Building and Improvements.

Depreciation costs or Use Allowance costs for Equipment, Building and Improvements

To record cost of capitalized equipment, buildings and improvements subject to depreciation retrieve page 17(worksheet with tab titled Wks #8- Depreciation allowance), then fill-in data in cells that are highlighted in yellow as follows: Column #1: enter a description of costs subject to depreciation. It may be a general description; for example, enter “School District Buildings”, then in

Column #6: enter depreciation expense in , if depreciation expense is not available then in

Column #2 and/or Column #3: enter acquisition costIf acquisition cost is not available the following options are allowed to be used in lieu of acquisition cost: 1) Fair market value is acceptable in lieu of an acquisition cost or 2) Replacement cost for insurance coverage may be sufficient in lieu of an acquisition cost.


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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report Page 17, Wks #8- Depreciation and Use Allowance

retrieve page 17(worksheet with tab titled Wks #8- Deprec or Use Allowance)

Follow the federal OMB A-87guidelines, inserted below, regarding how to classify and record cost subject to depreciation and use allowance.

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Federal OMB A-87 guidelines on Depreciation and use allowances. Depreciation and use allowances are means of allocating the cost of fixed assets to periods benefiting from asset use. Compensation for the use of fixed assets on hand may be made through depreciation or use allowances. A combination of the two methods may not be used in connection with a single class of fixed assets (e.g., buildings, office equipment, computer equipment, etc.) except as provided for in subsection g. Except for enterprise funds and internal service funds that are included as part of a State/local cost allocation plan, classes of assets shall be determined on the same basis used for the government-wide financial statements. The computation of depreciation or use allowances shall be based on the acquisition cost of the assets involved. Where actual cost records have not been maintained, a reasonable estimate of the original acquisition cost may be used. The value of an asset donated to the governmental unit by an unrelated third party shall be its fair market value at the time of donation. Governmental or quasi-governmental organizations located within the same State shall not be considered unrelated third parties for this purpose. The computation of depreciation or use allowances will exclude:

(1) The cost of land;

(2) Any portion of the cost of buildings and equipment borne by or donated by the Federal Government irrespective of where title was originally vested or where it presently resides; and

(3) Any portion of the cost of buildings and equipment contributed by or for the governmental unit, or a related donor organization, in satisfaction of a matching requirement. Where the depreciation method is followed, the period of useful service (useful life) established in each case for usable capital assets must take into consideration such factors as type of construction, nature of the equipment used, historical usage patterns, technological developments, and the renewal and replacement policies of the governmental unit followed for

Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report Page 17, Wks #8- Depreciation and Use Allowance (cont.)

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Federal OMB A-87 guidelines on Depreciation and use allowances. (cont.)the individual items or classes of assets involved. In the absence of clear evidence indicating that the expected consumption of the asset will be significantly greater in the early portions than in the later portions of its useful life, the straight line method of depreciation shall be used.Depreciation methods once used shall not be changed unless approved by the Federal cognizant or awarding agency. When the depreciation method is introduced for application to an asset previously subject to a use allowance, the annual depreciation charge thereon may not exceed the amount that would have resulted had the depreciation method been in effect from the date of acquisition of the asset. The combination of use allowances and depreciation applicable to the asset shall not exceed the total acquisition cost of the asset or fair market value at time of donation.

When the depreciation method is used for buildings, a building's shell may be segregated from the major component of the building (e.g., plumbing system, heating, and air conditioning system, etc.) and each major component depreciated over its estimated useful life, or the entire building (i.e., the shell and all components) may be treated as a single asset and depreciated over a single useful life.

Where the use allowance method is followed, the use allowance for buildings and improvements (including land improvements, such as paved parking areas, fences, and sidewalks) will be computed at an annual rate not exceeding two percent of acquisition costs. The use allowance for equipment will be computed at an annual rate not exceeding 6 2/3 percent of acquisition cost. When the use allowance method is used for buildings, the entire building must be treated as a single asset; the building's components (e.g., plumbing system, heating and air condition, etc.) cannot be segregated from the building's shell.

The two percent limitation, however, need not be applied to equipment which is merely attached or fastened to the building but not permanently fixed to it and which is used as furnishings or decorations or for specialized purposes (e.g., dentist chairs and dental treatment units, counters, laboratory benches bolted to the floor, dishwashers, modular furniture, carpeting, etc.). Such equipment will be considered as not being permanently fixed to the building if it can be removed without the destruction of, or need for costly or extensive alterations or repairs, to the building or the equipment. Equipment that meets these criteria will be subject to the 6 2/3 percent equipment use allowance limitation.


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Federal OMB A-87 guidelines on Depreciation and use allowances. (cont.)

A reasonable use allowance may be negotiated for any assets that are considered to be fully depreciated, after taking into consideration the amount of depreciation previously charged to the government, the estimated useful life remaining at the time of negotiation, the effect of any increased maintenance charges, decreased efficiency due to age, and any other factors pertinent to the utilization of the asset for the purpose contemplated. Charges for use allowances or depreciation must be supported by adequate property records. Physical inventories must be taken at least once every two years (a statistical sampling approach is acceptable) to ensure that assets exist, and are in use. Governmental units will manage equipment in accordance with State laws and procedures. When the depreciation method is followed, depreciation records indicating the amount of depreciation taken each period must also be maintained.


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Page 18, Wks#9-411(All Other Exp) is used to record cost of miscellaneous expenditures incurred by the district that were included in expense reported on line 411, Code 890 in Schedule 4 of the ED001 Report and that were necessary to the delivery of the direct services.Record All Other Expenditures Miscellaneous Cost.To record cost of a miscellaneous expenditures necessary to the delivery of direct services retrieve page 18 (worksheet with tab titled Wks#9-411(All Other Exp)), then fill-in data in cells that are highlighted in yellow as follows:Column #5: enter amount paid for a miscellaneous expense necessary to enable a delivery of a direct service by service provider with position title described in column #4 Additionally, the total miscellaneous cost not related to Medicaid should be entered at the bottom of the schedule in Column #5 next to line titled Miscellaneous Expenditures: not related to the Medicaid SBCH

Column #10: enter the amount of a paid miscellaneous expense costs that is reimbursed thorough Federal Funds 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 above instructions to complete column #5 and #10.


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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report Page 18, Wks#9-411(All Other Exp) (cont.)

retrieve page 18 (worksheet with tab titled Wks#9-411(All Other Exp))

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Training Instruction _ SBCH Cost ReportStep-By-Step Instructions to Complete a SBCH Cost Report Page 18, Wks#9-411(All Other Exp) (cont.)

Column #5: enter the total cost of paid miscellaneous expense that is not related to delivery of direct services at the bottom of the worksheet next to line titled Miscellaneous Expenditures: not related to the Medicaid SBCH

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Keep back-up

documentation for audit purposes.

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CERTIFICATIONAfter completion of the cost report print Certification page, enter only the requested information listed below, then sign the Certification and submit it to the Department of Social Services together with the completed SBCH Cost Report.

Certification page is included with the Cost Report and Certification page will self populate with information recorded on relevant pages of the Cost Report.

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CERTIFICATION

Line 20: write the name and e-mail address of the person the state may contact regarding any questions related to the expense data provided in the SBCH Cost Report.

Line 22: write a name of a Superintendent of a School District.Print completed Certification form. If an electronic signature go to line 21, otherwise print Certification page.

Line 21: should be dated and should be signed by a Superintendent of a School District or a Superintendent’s designee.

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To print Certification retrieve page with tab titled Certification.

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write the name and e-mail address of the person the state may contact regarding any questions related to the expense data provided in the SBCH Cost Report

write a name of a Superintendent of a School District

should be dated and should be signed by a Superintendent of a School District or a Superintendent’s designee.

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CERTIFICATIONLine 19, Certified Public Expenditure (CPE): The Total Certified Public Expenditure is an amount school district incurred to provide Medicaid SBCH services to the Medicaid covered students. Line 19 amount is inclusive of administrative costs incurred by the school district to administer and support delivery of SBCH services. Line 19 is subject to a desk review.The desk review will be conducted by the department or its designee. Specialized Transportation cost will be further allocated using a CMS approved Specialized Transportation Cost Allocation Plan. The final reconciliation and settlement shall be completed by the department within 24 months after the end of the cost reporting period.

Line 19 shall calculate automatically, no manual entry on any of the lines is required. Please do not override imbedded formulas.

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Submission Deadline Requirements

The Competed SBCH Cost Report with the signed CERTIFICATION must be submitted to the department via e-mail sent to [email protected] by January 31st or no later than seven months after the close of the School Year during which the costs included in the Cost Report were incurred.

As the CMS is still reviewing State’s proposed Cost Report and Specialized Transportation Cost Allocation Plan the 2011 and 2012 cost report filling was extended by six months. The 2012 cost report shall be submitted to the department by July 1, 2013.

mailto:[email protected]

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PowerPoint PresentationSummary of

Questions and Answers


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1. Q: is this a review, the cost report looks nearly identical as last year?A: This not a review of last year’s training materials, although it may seem as a

review to some who attended the training last year and prepared the 2011 SBCH Cost Report.

The following is a brief summary of changes between the 2011 report and 2012 report

Certification page :1.Added lines to identify separately cost of Salaries and Wages and cost of

fringe benefits2.Removed line reporting the cost of DME items3.Corrected formula calculating IDC to reflect use of the 10% OIG allowed rate

1 Provider Data page:Added line to record OIG allowed IDC Rate2 Medicaid allocation % page:Simplified layout of page 2a4 SBCH Chart of Exp Codes page:Simplified list of expenditure types and codes listed on page 46 DSP Time Study Summary page:Simplified layout of page 67 Admin Time Study pageSimplified layout of page 7

Training Instruction _ SBCH Cost Report Q&A

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2. Q: is this a review, the cost report looks nearly identical as last year?

A: Continue - answer to the above questionWkst #2 Direct S&W page 9 :1. Added columns to identify separately cost of Salaries and Wages

and cost of fringe benefits2. Added columns to identify Federal reimbursement for costs of

Salary and wages and fringe benefits3. Edited column descriptionsWkst #2a Admin S&W page 10 :1. Added columns to identify separately cost of Salaries and Wages

and cost of fringe benefits2. Added columns to identify Federal reimbursement for costs of

Salary and wages and fringe benefits3. Removed columns calculating IDC4. Edited column descriptionsWkst #3-404(Purch Prof Serv) page 11:1. Added columns to identify Federal reimbursement for costs

reported on page 112. Aligned line descriptions with chart of expenditure codes3. Edited column descriptions


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2. Q: is this a review, the cost report looks nearly identical as last year? A: Continue - answer to the above questionWkst #4-407(Suppl & Material) page 12:1. Added columns to identify Federal reimbursement for costs reported on

page 122. Aligned line descriptions with chart of expenditure codes3. Edited column descriptionsWkst #5-408(Purch Prop Serv) page 13 :1. Added columns to identify Federal reimbursement for costs reported on

page 132. Aligned line descriptions with chart of expenditure codes3. Edited column descriptionsWKS #7-Transportation page 16:Revised layout of page 16

Wkst #9-411(All Other Exp) page 18:1. Added columns to identify Federal reimbursement for costs reported on

page 132. Added lines for cost descriptions included in chart of expenditure codes3. Edited column descriptions


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2. Q: is this a review, the cost report looks nearly identical as last year? A: Continue - answer to the above question19-REGISTER(xx) xxxxxx pages19-xx:• Added columns to identify Federal reimbursement for costs of

Salary and wages and fringe benefits• Modified the description of the type of the direct services provider

as follows: Direct Service Employees Included in Quarterly Listings - who billed Medicaid during reporting period

19-REGISTER(800) Billing page 19:• Added columns to identify Federal reimbursement for costs of

Salary and wages and fringe benefits• Modified the description of the type of the direct services provider

as follows: Direct Cost - Medicaid Billing Employees Included in Quarterly Listings

20-REGISTER-Admin S&W, FB page 20:• Added columns to identify Federal reimbursement for costs of

Salary and wages and fringe benefits21-REGISTER-Transport S&W, FB page 21:Revised entire page 21


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3. Q: What does “Enter Schedule number only” mean? Is this the total that was entered in ED001 for that category?A:"Enter Schedule number only” , for example, as included in a description in column 5 of Register pages: means to enter the number of a schedule of the ED001 report where district included the amount of a salary that is going to be recorded in Column 6.

4. Q: How can district apply for an IDC rate? How can we validate whether the district has an approved IDC rate?A: For indirect rate cost proposal submittal or related questions, please forward requests to Dave St. Laurent at the following e-mail address: [email protected] learn how to prepare a proposal for IDC rate, please see below a Link to SDE site http://www.sde.ct.gov/sde/lib/sde/pdf/fiscal/lea.pdf

5. Q: . We are recording the salary & wages and fringe benefits for all Direct Service Providers that we submitted to you for the quarterly time studies, correct? We are not just recording only those Direct Service Providers that submitted MSI billings during the 2011-2012 school year? A: two conditions have to be met for the Salary and wages costs and fringe benefits cost of a Direct Service Provider to be included on Register page:1)the name of the direct service provider has to be included on the summary list, and2)the direct service provider had to bill Medicaid (submitted MSI billings) during the 2011-2012 school year.


mailto:[email protected]

http://www.sde.ct.gov/sde/lib/sde/pdf/fiscal/lea.pdf

http://www.sde.ct.gov/sde/lib/sde/pdf/fiscal/lea.pdf

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6. Q: Under direct service cost: cost of copier contract the direct service provider uses? We have a general copier contract for the whole district. Do we still claim for direct service providers? We bill electronically, however, we need hard copies of time studies, etc.A: Your district can include portion of the contract cost that is applicable to the direct service. Your district will have to allocate the total cost of copier contract using an allocation base. For example a number of boxes of copy paper; if your district can identify number of boxes used by direct service employees.

7. Q: Our district does not bill for contracted outside direct service contractors – we do not fill out Wks #3; correct?A: If district neither engage in any contracts to provide any of the medical services approved under SPA 10-018 nor contracted with a vendor to process Medicaid claiming, then answer to your question is Yes.

8. Q: I have a question regarding the direct service cost versus administrative claiming cost. For example (district name ) uses (name of a vendor) for billing. We claim under Administrative Claiming cost. Do we also list this under direct service cost? A follow-up call was placed to gain further information regarding this question and the following answer captures it allA: District can claim cost of a contract with a vendor for Medicaid Billing as a direct cost. Record this cost on page 11 of the SBCH CR. if contract cost was recorded on line 404 of Schedule 4 of ED001 report claim on Worksheet 4


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9. Q: Also, specialized transportation per the child’s IEP – does that include curb to curb?A follow-up call was placed to gain further information regarding this question.A: Yes.

10. Q: Do we report for school year of calendar year?A: Report for school year

11. Q: To bill for nursing services, can the nursing service be listed anywhere in the IEP or does it have to be under goals and objectives?A: I don’t know. Please contact your IEP contact at the State Department of Education.The SPA 10-018 requires that for the service to be SBCH billable has to be prescribed in the student’s IEP.

12. Q: How do we keep records to account for administrative time for IEP or 504 students?A: The SBCH time study instructions require that employees selected to participate in a time study keep source documentation of activities and for time recorded on the time study forms. Acceptable source documentation could be calendar notes for particular date, appointment records and records of schedules.


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13. Q: How do we account for use of materials for IEPed students when we purchase in bulk?A: It depends what cost of materials you are trying to allocate to the users. Please send us an e-mail with the type of purchase cost you are trying to allocate and we will work with you to develop an appropriate allocation base if feasible.

14.Q: Can we bill for Section 504 students who have billable services in their 504 plan?A: Districts can only bill Medicaid for SBCH service(s) prescribed in student’s IEP.


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END

Documents

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