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)
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 (330 KB) (REVISED-posted 5/21/15)
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.

2015 SSHSP Random Moment Time Study and Cost Settlement Training 2015 fall sshsp combined rmts and cpe presentation updated oct 28 2015 (2,728 KB)  (REVISED-posted 10/28/15)
Curriculum for Fall 2015 training on SSHSP Random Moment Time Study and Cost Settlement.

  • The RMTS presentation provides a detailed explanation of the RMTS process and illustrates how to respond in the system.
  • The CPE presentation explains the revised process by which Medicaid reimbursement to school districts and counties will be calculated, effective for dates of service beginning 10/1/2011 and going forward.

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 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: September 26, 2016