Medicaid in Education Alert
New York State Department of Health (DOH), Office of Health Insurance Programs (OHIP)
New York State Education Department (NYSED)
Preschool/School Supportive Health Services Program (SSHSP)
Medicaid in Education

Issue #18-04

To: All SSHSP Medicaid Providers
From: NYS DOH OHIP SSHSP &
NYSED Medicaid in Education Unit
Date: July 06, 2018
Subject: 2013-14, 2014-15, and 2015-16 Certified Public Expenditure (CPE)
Claims Submitted to the Centers for Medicare and Medicaid
Services (CMS)

Claims Submitted to the Centers for Medicare and Medicaid Services (CMS)
The New York State Department of Health (DOH) has submitted certified public expenditure (CPE) claims to the Centers for Medicare and Medicaid Services (CMS) for the Preschool/School Supportive Health Services Program (SSHSP). These settlements represent the Medicaid allowable costs incurred by school districts and counties providing SSHSP services during the 2013-14 (July 1, 2013 – June 30, 2014), 2014-15 (July 1, 2014 – June 30, 2015) and 2015-16 (July 1, 2015 – June 30, 2016) school years. The CPE settlement amount was $25.3 million for 2013-14, $24 million for 2014-15, and $31 million for 2015-16.

SSHSP Provider CPE Claim Submission
School districts and counties that participated in the 2013-14, 2014-15 and 2015-16 cost settlement processes will be required to submit completed Certification of Public Expenditure forms for each school year. The Certification forms will be available through the MCRCS cost reporting system on July 16, 2018. School districts and counties should review their Medicaid Allowable Costs on the Cost Summary Report page, their Medicaid Paid Claims data on the Medicaid Paid Claims Summary, and their cost settlement calculations on the Cost Settlement Summary page of MCRCS prior to completing the CPE form.

Once school districts and counties have reviewed the calculation of their cost settlements, they will need to print, sign, and return the completed CPE forms to PCG at nysshsp@pcgus.com. The completed CPE form must be signed by the Chief Executive Officer, Chief Fiscal Officer, or Superintendent of the school district or county. CPE forms are due to PCG no later than August 10, 2018. Failure to return the completed CPE forms may result in the withholding of future SSHSP interim payments. If a school district or county does not have the technology to submit the signed CPE form via email to nysshsp@pcgus.com, they should contact PCG to request the appropriate address to mail the form.

CPE Claim Distribution/Gainsharing
Sections 368-d (6) and 368-e (5) of the NY Social Services Law provide for distribution to SSHSP providers CPE cost settlement amounts in excess of $150 million for the 2013-14 (April 1, 2013 – March 31, 2014) and 2014-15 (April 1, 2014 – March 31, 2015) state fiscal years. This threshold was not met; therefore, no distributions will be made for CPE cost settlements during these periods, which include the entire 2013-14 school year CPE cost settlement and first three quarters of the 2014-15 school year CPE cost settlement.

The same sections of law further provide that starting with the 2015-16 (April 1, 2015 – March 31, 2016) state fiscal year, SSHSP providers will share 13.05% of the net CPE cost settlement. This period includes the final quarter of the 2014-15 school year CPE cost settlement and the entire 2015-16 school year CPE cost settlement  Thus, 13.05% of the net CPE settlement applicable to each period starting April 1, 2015 and forward will be distributed to school districts and counties in proportion to their positive settlement.

CPE cost settlement amounts will be distributed only after all CPE forms have been completed, signed and returned to PCG.

Negative Settlements
A portion of the final cost settlement calculations for participating school districts and counties resulted in a negative settlement. Negative settlements occur when interim payments to a provider exceed allowable reported costs for the SSHS Program. For the 2013-14, 2014-15 and 2015-16 school years, the Department will hold SSHSP providers with negative settlements harmless if the SSHSP provider completed all cost reporting requirements and responded to all necessary desk review queries. That is, school districts and counties with negative settlements that fulfilled all SSHS Program requirements will be permitted to retain their interim fee-for-service payments and will not be required to pay back any money to the State Department of Health.

Incomplete Cost Reports and/or Desk Reviews
Those school districts and counties that did not complete the required cost report process, and thus were not in compliance with all requirements of the SSHSP, will be required to return all Medicaid funds (payments for interim claims) received during the applicable school years.

CPE Provider Trainings
PCG will be conducting trainings the weeks of July 16th and July 23rd, 2018 on the cost settlement process and the CPE forms. Training information will be sent directly from PCG at nysshsp@pcgus.com. The schedule of trainings may be viewed on the "Training Calendar" link at https://www.oms.nysed.gov/medicaid/training_materials/

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or at SSHSP@health.ny.gov, or Public Consulting Group (PCG) at 1-866-912-2974 or at nysshsp@pcgus.com, or the NYS Education Department, Medicaid Unit at medined@nysed.gov.

Last Updated: July 30, 2018