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MEDICAID COST CALCULATION INSTRUCTIONS

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MEDICAID COST CALCULATION INSTRUCTIONS

     INSTRUCTIONS FOR 2004-05 SCHOOL YEAR

    SBHS 2006 MEDICAID COST CALCULATION INSTRUCTIONS

    The Department of Human Services (DHS) Excel worksheet for developing your annual Medicaid cost calculations includes a tab for each of the following disciplines:

    ; Nursing

    ; Occupational Therapist/Certified Occupational Therapist Assistant

    ; Physical Therapist/Licensed Physical Therapist Assistant

    ; Speech Language Pathologist/Speech Language Therapist Assistant

    ; Audiologist

    ; Psychiatrist

    ; Psychologist

    ; Delegated Health Care/Attendant

    ; Licensed Clinical Social Worker/Clinical Social Work Associate

    ; Transportation

Summary Tab

The Worksheet contains a “SUMMARY” tab that automatically populates when costs

    are entered for each of the disciplines. At the top of the “SUMMARY” tab, please list

    your Local Education Agency (LEA, either School District or ESD), ODE Institutional Identification number, OMAP provider number and a name and contact number for a person who can respond to questions about information submitted on the worksheet.

Instructions for Completion of the Individual Disciplines

    For each of the disciplines (with the exception of transportation reimbursements), the instructions are the same. All costs are based on actual, audited costs from the

    2004-05 School Year. If no actual, audited costs are available for the 2004-05 School Year, see Appendix B, “Frequently Asked Questions” for instructions on how to complete these sections or contact Lasa Baxter, DHS Policy Analyst.

Box 1A - Costs Attributable to the Discipline

Column A

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     INSTRUCTIONS FOR 2004-05 SCHOOL YEAR

    Line

    1. Enter the actual salaries and benefits (S&B) for the licensed billable staff in

    the discipline. Only staff licensed to bill Medicaid can have their salaries and

    benefits included in this line. *This line includes all assistants (COTA with OT;

    LPTA with PT; SLPA with SLP; and CSWA with LCSW). Do not include

    licensed staff that do not bill Medicaid.

    *DHC: An exception to above is in calculating costs for DHC; do include their

    costs. Do not include the costs of a teacher who may be qualified as a DHC

    unless performing DHC duties is a primary function of the teacher. Only

    individuals whose primary function is a DHC/Attendant are included here.

    2-10. Enter the actual costs for the categories related to the delivery of Medicaid

    services by the Medicaid billable staff. See Appendix A for a list of allowable

    direct costs (from OMB Circular A-87). NO COSTS INCLUDED IN YOUR ODE APPROVED

    RESTRICTED INDIRECT RATE ARE ALLOWABLE AND CAN BE CLAIMED AS A DIRECT EXPENSE.

    Box 1A (Continued)

Column B and Column C

    In column B insert the percentage of the total costs used by the discipline.

    Generally, most districts are able to track all wholly attributed direct costs of a

    discipline; thus the percentage to be listed for each expense in Column B should

    be 100%. However, if the costs for a discipline cannot be uniquely identified,

    specify the percentage of the direct cost that is applicable to the discipline. Line

    1. Because you are calculating the hourly costs of the discipline, 100% of the

    salaries and benefits of the discipline staff is automatically included in the

    calculation.

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     INSTRUCTIONS FOR 2004-05 SCHOOL YEAR

    2-10. Enter the percentage of the costs directly attributable to the discipline. If all

    costs are related to the discipline, enter 100%. If less than 100%, attach the

    documentation used to determine the applicable percentage

    Column C will automatically calculate the adjusted cost.

Box 1B - Prorated Costs of Management and Support Staff

Column A

    In this section, please enter the total actual audited salaries, benefits, and direct

    costs (not included in your ODE indirect rate) of the respective staff that perform

    work related to the activities of the licensed billable staff. Use Line 11 for

    Management (those individuals that provide direct non-clinical supervision to the

    discipline staff on line 1); Line 12 for Operations and Program staff (those

    individuals that support the institutionalization of the Medicaid claiming program,

    including training, procedure development, and implementation of cost claiming

    mechanisms); and Line 13 for Clerical staff (the individuals who provide clerical

    and administrative support for the staff listed in lines 1, 11 and 12). Line 11 for

    Management has two separate line entries because it is likely that more than one

    layer of Management may have duties associated with the discipline for which

    you are determining the hourly cost.

    Please note that you are allowed to include the direct costs in each of the lines

    that are associated with supporting the activities of the discipline. The only

    allowable direct costs are listed in Appendix A, Allowable Costs.

Column B and Column C

    The allocation of prorated costs may require calculating the supporting time for

    the staff attributable to an individual discipline. A LEA may use either a

    proportionate share of costs (percentages allocated equally between disciplines)

    or a per-billable-FTE rate (percentages based on the amount of billable FTE in a

    discipline divided by the total billable FTE for the LEA). All disciplines, when

    totaled together, must not exceed 100% of the costs for a given line item. For

    example, the costs on line 12 (Operations and Program staff) need to be

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     INSTRUCTIONS FOR 2004-05 SCHOOL YEAR

    allocated amongst disciplines to not exceed the total amount expended during

    the previous year.

    Line

    11/11a. If the manager supervises only billable staff for the discipline for which

    you are establishing rates, allocate 100% of the manager’s salary to Line 11.

    However, if the manager supervises more than one discipline, only allocate on

    Line 11 the percent of the manager’s salary and benefits applicable to the

    discipline for which you are establishing costs. For example, assume a manager

    supervises a total of 15 FTE, of which five are licensed billable FTE. Since the

    licensed billable staff makes up one-third (or 33%) of the total staff, then you

    would enter 33% on line 11. Attach a copy of documentation used to determine

    the percentage.

    12. Follow the same instructions provided for Line 11 above. Any non-licensed

    staff that does not bill Medicaid may be included in this line. Staff that cannot

    be included in this line would be any licensed staff that you may have but who

    do not bill Medicaid.

    13. Follow the same instructions provided for Line 11 above.

    Column C will automatically calculate the adjusted cost.

Box 1C - Calculation of Hourly Rate

Line

    14. Enter the number of licensed billable FTE in the discipline, calculated using

    the standard ratio of the number of hours worked per year divided by 173.34.

    15. This line automatically computes the cost per licensed billable FTE.

    16. This line automatically computes the cost per hour based upon 900

    instructional hours per year.

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    17. Enter the LEA’s current school year ODE approved restricted indirect rate.

    This rate should be shown as a decimal representation of the percentage.

    For example, if the approved indirect rate is 4.84% then the number entered

    should be .0484. Please remember that any of the costs included in the

    calculation of your restricted indirect rate cannot be claimed as direct costs in

    either Box 1A or Box 1B.

    18. This line computes the calculated hourly rate, including the indirect costs.

    19. This line calculates the 15-minute billing amount.

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Transportation Costs

    Reimbursement for IEP/IFSP transportation services shall be based on a per trip rate (a trip equals one way transport) for transporting IEP/IFSP students. Reimbursement rates are calculated based on your district’s previous fiscal years

    audited costs for IEP/IFSP transportation services. If a local education agency contracts for the transportation service, the total cost of the contract for that service would be reflected on Line 1.

    Line

    1. Total IDEA special education direct transportation costs are computed

    following OMB Circular A-87 guidelines for allowable costs. These direct

    costs may include the salaries and benefits of attendants and drivers

    (including costs attributable to the individual transportation aide when

    medically necessary on a regular education bus), vehicle maintenance and

    repairs, garage expenditures, vehicle expenditures including depreciation,

    interest and insurance and vehicle supply expenditures including fuel. Costs

    associated with delegated health care aides may not be included in this

    calculation. No costs used to determine an indirect cost rate may be claimed

    as a direct cost for transportation reimbursement.

    2. Actual data from the previous school year is used to determine the number of

    special education students requiring medically needy transportation who are

    Medicaid eligible. This percentage is derived from dividing the total number

    of Medicaid-recipient students requiring transportation by the total number of

    special education students requiring transportation, as per their IEP/IFSP.

    3. This line automatically computes the annual Medicaid transportation costs by

    multiplying the total amount of transportation costs (Line 1) by the percentage

    of eligible Medicaid special education students transported (Line 2).

    4. Actual data from the previous school year indicating the total number of actual

    trips for Medicaid-recipient students (this includes all transportation trips

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     INSTRUCTIONS FOR 2004-05 SCHOOL YEAR

    whether to a Medicaid covered service or not (billable and non-billable) as

    derived from the LEA’s transportation logs.

    5. The direct Medicaid Cost per trip is automatically calculated by dividing line 3

    by line 4.

    6. Approved Oregon Department of Education (ODE) indirect rate for the current

    year is entered.

    7. The total Medicaid cost per trip is automatically calculated based on the result

    of line 5 plus the approved ODE indirect rate.

    The LEA will bill per trip cost for Medicaid recipient students only on those days when medically necessary transportation is provided and a Medicaid-covered service, pursuant to their ISP/IFSP, is provided. For example, a child may be transported for 10 trips per week, yet the LEA may only bill transportation for 6 days per week when the child receives a Medicaid-covered service as specified on his/her IEP/IFSP.

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    Appendix A: Allowable Costs

EMPLOYEE TRAVEL EXPENSES ARE allowable for expenses for transportation,

    lodging, subsistence, and related items incurred by employees traveling on official business. Such costs may be charged on an actual cost basis, on a per diem or mileage basis in lieu of actual costs incurred, or on a combination of the two, provided the method used is applied to an entire trip, and results in charges consistent with those normally allowed in like circumstances in non-federally-sponsored activities.

    COMMUNICATION COSTS of telephone, mail, messenger, and similar communication services are allowable.

PUBLICATIONS AND PRINTING COSTS, including the costs of printing (including the

    processes of composition, plate-making, press work, and binding, and the end products produced by such processes), distribution, promotion, mailing, and general handling are allowable.

MATERIALS AND SUPPLIES are allowable. Purchases should be charged at their

    actual prices after deducting all cash discounts, trade discounts, rebates, and allowances received. Withdrawals from general stores or stockrooms should be charged at cost under any recognized method of pricing, consistently applied. Incoming transportation charges are a proper part of materials and supply costs. Also included here would be software used to operate your SBHS services.

PROFESSIONAL SERVICE COSTS for professional and consultant services rendered

    by persons or organizations that are members of a particular profession or possess a special skill, whether or not officers or employees of the governmental unit, are allowable.

    MEMBERSHIPS AND SUBSCRIPTIONS

    a. Costs of the governmental unit’s memberships in business, technical, and

    professional organizations are allowable.

    b. Costs of the governmental unit’s subscriptions to business, professional, and

    technical periodicals are allowable.

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    c. Costs of meetings and conferences where the primary purpose is the

    dissemination of technical information, including meals, transportation, rental

    of meeting facilities, and other incidental costs are allowable.

    d. Costs of membership in civic and community, social organizations are

    allowable as a direct cost with the approval of the Federal-awarding agency.

    e. Costs of membership in organizations substantially engaged in lobbying are

    unallowable.

    REPAIR OF EQUIPMENT USED BY DISCIPLINE. The cost of repairs of equipment used

    by discipline may be included in a district’s cost calculations.

    TRAINING provided for employee development is allowable to the extent which it

    benefits the Federal award.

    ADVERTISING expenses for vacant positions within the discipline may be included

    in a district’s cost calculations.

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    Appendix B: Frequently Asked Questions

    1. What if there are no actual audited costs for the discipline or function from the

    previous school year?

    If the LEA does not have audited costs for the discipline/function from the prior year, an estimate can be made based on budgeted amounts. However, cost reconciliation will need to be completed after audited costs are confirmed for the current year. Upon submitting the cost calculation worksheets, it should be noted on the worksheet for that discipline that the costs are estimates so that a notation can be made to ensure cost reconciliation is completed at the end of the year. If the individual discipline cost decreased, then once the 05-06 costs are finalized, DHS will exercise a cost recovery on the LEA for the overpayment. If the individual discipline costs increased, then the LEA has the option of submitting an adjustment request to receive the additional payment. Whether this is a financial advantage will depend on the amount of the increase and the total number of claims submitted to date.

3. What if the services are provided through contract?

    The intent of the cost calculations is to provide the best known hourly pricing for a service. The total paid amount of the contract can be entered in the top cost section and then an FTE assessed in the final section that will assist in the determination of an hourly rate. Probably easier, however, would be to enter the amount-per-hour compensation rate from the contract on line 16 (over-riding the formula), if the contract was negotiated and paid on a per-hour basis. Whichever methodology is selected, the LEA must document that the cost calculation is based on a contracted service, rather than paid FTE.

    4. What recent changes have occurred that will impact a local education

    agency’s billing for 2006?

    1. Licensed Clinical Social Workers

    Services provided by Licensed Clinical Social Workers (LCSW) and

    Clinical Social Work Associates (CSWA) will be billable for as of the 2004-

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    Medicaid Cost Calculation Instructions (updated Mar 2005)

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