NYS Medicaid in Education

Medicaid Administrative Claiming (MAC) (Presentation)
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.

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

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. DOH intends to utilize CPEs in an effort to increase federal funding of the SSHSP. The CPE methodology will allow 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.

The components of CPEs include a Random Moment Time Study (RMTS) and a Cost Based Settlement Process.

Random Moment Time Study (RMTS) Training (User Guide)
A user guide for RMTS coordinators and participants (direct service providers eligible to bill Medicaid) who may be selected to receive a random moment. This presentation provides a detailed explanation of the Random Moment Time Study process and illustrates how to respond in the system. This document is the training guide used in all RMTS related trainings for the State of New York School Supportive Health Services Program.

NY SSHSP Medicaid Cost Based Settlement Process (User Guide)
School districts and counties billing for Medicaid services under the SSHSP will be required to participate in an annual cost reporting process. The cost report will be used in conjunction with the RMTS in the SSHSP cost settlement process. A cost report is a web-based software application that demonstrates the school district’s and county's cost of providing IEP services to Medicaid-eligible students. The school district and county business office is responsible for completing the annual cost report.

Presentation cpe cost settlement presentation fall 2013 (3,094 KB) (posted 12/9/13)
This presentation explains the revised process by which Medicaid reimbursement to school districts and counties will be calculated, effective for dates of service beginning October 1, 2011 and going forward.

Recorded Cost Report WebEx recorded cost report webex external website(posted 12/9/13)

CMS Approved Direct Medical Services Materials (16 KB) (posted 9/11/12)

Additional Resources
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: March 11, 2014