Certified Public Expenditures (CPEs)

School Supportive Health Services Program
Preschool Supportive Health Services Program


Certified Public Expenditures (CPEs)
Federal Medicaid law and regulation authorize the use of Certified Public Expenditures (CPEs), an annual cost reconciled and settled reimbursement methodology. The CPE methodology allows NYS to request additional federal funding for SSHSP costs that are not completely covered by current Medicaid reimbursement. DOH has contracted with Public Consulting Group, Inc. (PCG) to implement and support the additional reimbursement methodology.

School districts and counties billing for Medicaid services under the SSHSP are required to participate in an annual cost reporting process. The components of CPEs include a Random Moment Time Study (RMTS) and a Cost Based Settlement Process.

State Plan Amendment (SPA) 11-39-A and 11-39-B have been approved by the Centers for Medicare and Medicaid Services (CMS). These SPA's are located under Resources, along with SPA 09-61 (encountered based billing).

Random Moment Time Study (RMTS)
Medicaid Alert 17-03
(HTML) (PDF) (posted 9/14/17)
Temporary Suspension of Random Moment Time Study (RMTS)

Manual RMTS Manual Fall 2014 (1 MB) (posted 9/2/14)
The RMTS Coordinator Manual details how to navigate the new RMTS system and certify the district staff pool list, as well as updating and certifying the district calendar.

NY SSHSP Medicaid Cost Based Settlement Process
Manual cost reporting guide (960 KB) (UPDATED-posted 11/20/17)
The Manual to Cost Reporting for the SSHS Direct Service Claiming Program guides you thru the web-based software application that demonstrates the school districts and counties cost of providing IEP services to Medicaid-eligible students. The school district and county business office is responsible for completing the annual cost report.

Medicaid Alert 17-04 (HTML) (18 KB) (posted 10/30/17) 
Certified Public Expenditure (CPE) Cost Report Training

CMS Approved Direct Medical Services Materials (16 KB) (posted 9/11/12)
Cost Reporting Update - Service Encounters CPE-update for cost reporting for service encounters final 5-21-15 (418 KB) (posted 5/21/15)

Medicaid Alert 16-07 medicaid alert 16-07 posted november 8 2016 iep ratio methodology and reporting updates (104 KB) (posted 11/8/16)
IEP Ratio Methodology and Reporting Updates

Medicaid Administrative Claiming (MAC)

Medicaid Alert 13-13 MA 13-13 MAC Suspended (18 KB) (posted 11/7/13)
Suspension of Medicaid Administrative Claiming (MAC) RMTS
Medicaid Alert 13-01 (184 KB) (posted 2/6/13)
Medicaid Administrative Claiming

Presentation medicaid administrative claiming powerpoint february 2013 (2.22 MB) (posted 2/5/13)
Currently, school districts and counties only receive Medicaid reimbursement for direct services based on a fee for service model with an annual cost settlement process. The MAC program is a reimbursement process for claiming the costs of administrative and outreach activities that support the Medicaid program.

Additional Resources
Presentation DOH and PCG presentation to NYS Association of School Business Officials on December 5 2014 (237 KB) (posted 12/5/14)
DOH/PCG Presentation to NYS Association of School Business Officials, December 5, 2014
Medicaid Alert 13-11 ma alert 13-11 iep ratio (68 KB) (posted 11/7/13)
SSHSP Cost Report - Establishment of the IEP Ratio
Attachment 1 - IEP Ratio Uploading Instructions

Public Consulting Group, Inc. Contact Information
Hotline: 866-912-2974
E-mail: NYSSHSP@pcgus.com

Last Updated: November 20, 2017