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School Health and Related Services (SHARS) 2011 Cost Report Training

School Health and Related Services (SHARS) 2011 Cost Report Training October 1, 2010 – September 30, 2011. 1. Housekeeping. SHARS Cost Report Training is mandatory Attending the RMTS and MAC ISD Training does not fulfill this requirement

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School Health and Related Services (SHARS) 2011 Cost Report Training

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  1. School Health and Related Services (SHARS) 2011 Cost Report Training October 1, 2010 – September 30, 2011 1

  2. Housekeeping • SHARS Cost Report Training is mandatory • Attending the RMTS and MAC ISD Training does not fulfill this requirement • Only a trained contact will have access to edit the cost report • Having more than one trained contact is highly recommended • In order to get credit for today’s training you must be attentive for the entire training • SHARS screen must be active screen • Answer polling questions • Register/log in under the your name • Ask questions • If you dial in using your phone, enter the access code and audio pin found on the right side of your computer screen • Or you must have speakers and a microphone enabled computer 2

  3. Today’s Training Goals SHARS Cost Report Purpose and Requirements Review elements of an acceptable SHARS Cost Report Gain an understanding of ways to maximize SHARS reimbursement opportunities

  4. Purpose and Requirements Medicaid services provided by school districts in Texas to Medicaid-eligible students are known as School Health and Related Services (SHARS). Allowable School Health (direct medical) and Related Services (SHARS) include: • Audiology and Hearing, including evaluations and therapy sessions; • Physician Services; • Occupational Therapy, including evaluations and therapy sessions; • Physical Therapy, including evaluations and therapy sessions; • Psychological Services, including assessments and therapy sessions; • Speech and Language Services, including evaluations and therapy sessions; • Nursing Services, including routine medication administration services; • Counseling Services; • Personal Care Services; and • Specialized Transportation. 4

  5. Purpose and Requirements The purpose of the SHARS cost report is to ensure that School Districts, as governmental entities, are not paid more than their federal share (*FMAP 60/40) Medicaid-allowable costs to provide SHARS to students in special education who meet the requirements: • Medicaid eligible, • meet eligibility requirements for Special Education described in the Individuals with Disabilities Education Act (IDEA), and • have Individual Educational Plans (IEPs) that prescribe the needed services. * Note: Federal Medicaid Assistance Percentage (FMAP) is subject to change. 5

  6. Purpose and Requirements There are four allocation methods mandated by CMS to be used in the SHARS cost report that facilitate the identification of cost associated with Medicaid: • RMTS direct services time study percentage(state wide) • IEP ratio(district specific – self reported) • Specialized transportation ratio(district specific – self reported) • One-way trip ratio(district specific – self reported) SHARS Reimbursement Methodology rules are located in Title 1 of the Texas Administrative Code, Part 15, Chapter 354, Subchapter J, Division 23, Rule 355.8443. 6

  7. New Rules Effective October 1, 2011 The School Health and Related Services program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 25, Rules §1341-1342. Reimbursement rules applicable to School Health and Related Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 23, Rule §8443. In addition to the requirements of Rule §8443, the cost report is also governed by the Cost Determination Process Rules contained in Subchapter A: §355.101 Introduction; §355.102 General Principles of Allowable and Unallowable Costs; §355.103 Specifications for Allowable and Unallowable Costs; §355.104 Revenues; §355.105 General Reporting and Documentation Requirements, Methods, and Procedures; §355.106 Basic Objectives and Criteria for Audit and Desk Review of Cost Reports; §355.107 Notification of Exclusions and Adjustments; §355.108 Determination of Inflation Indices; §355.109 Adjusting Reimbursement When New Legislation, Regulations, or Economic Factors Affect Costs; and §355.110 Informal Reviews and Formal Appeals). Purpose and Requirements 7

  8. Additional detailed SHARS Participation, Training, Rates, Billing, and other Published Guidance Documentation can be found on the following websites: HHSC Rate Analysis SHARS website: http://www.hhsc.state.tx.us/rad/acute-care/shars/index.shtml Fairbanks website: www.fairbanksllc.com TEA website: http://www.tea.state.tx.us/index2.aspx?id=4456 TMHP website at www.tmhp.com Texas Medicaid Provider Procedures Manual (TMPPM) CHILDREN’S SERVICES HANDBOOK, Volume 2, Section 3 http://www.tmhp.com/TMPPM/2011/Vol2_Children's_Services_Handbook.pdf Purpose and Requirements 8

  9. Purpose and Requirements • The SHARS cost report period covers the dates of service in the federal fiscal year (October 1 through September 30). • SHARS Cost Report is due on or before April 1. • In accordance with Title 1 of the Texas Administrative Code (TAC), §355.8443(e), each SHARS provider that received SHARS reimbursement is required to participate in the time study and to complete an annual cost report for SHARS services delivered or return the federal funds. • Failure to complete a cost report will result inrecoupment of interim payments for applicable cost report period. • Failure to participate in the time study will result inrecoupment of interim payments for applicable cost report period. • Over billing during the cost report period will result inrecoupment. 9

  10. Effective January 1, 2009 an HHSC contact that is an employee of the District or a contractor/designee of the District may be entered as the districts SHARS Contact. A contractor/designee may be District staff, SSA, Co-op/Fiscal Agents, and/or a Vendor. Each District is responsible for the designee’s actions and/or non-action. District’s must document the authorization and provide documentation if requested. HHSC recommends that the authorization to certify the quarterly participant list may be incorporated into the contract with the authorized entity. Purpose and Requirements 10

  11. Purpose and Requirements A few more changes … • Financial Contact (must be district employee with legal authority to bind the district in financial and contractual matters) Coming Soon • SHARS Primary Contact (must be district employee) • Drop down list to identify and track Co-Ops/SSA relationships • Drop down list to identify and track Vendor/provider relationships • Agreement from provider (ISD) that information may be shared with all contacts listed (also tracked in system) 11

  12. Polling Question 12

  13. State of Texas Automated Information Reporting System(STAIRS) www.fairbanksllc.com (Formerly known as: Fairbanks System, SHARS Cost Report System, Time Study System, Medicaid Administrative System, …)

  14. STAIRSSHARS Cost Report Collection A few more changes … • Total population on Specially Adapted Vehicles • New and/or modified edits • EstimatedSettlement Amount (recoupment/payment) Coming Soon • Upload feature for Certification Forms Coming Soon Note: Dates reflected in the upcoming screen shots may not be for the current cost report year. 14

  15. STAIRSDashboard

  16. STAIRSManage Contacts Tab

  17. STAIRSManage Contacts Tab cont

  18. STAIRSManage Training Tab

  19. SHARS Cost Report Tab

  20. Cost Report Step 1

  21. Cost Report Step 1 cont

  22. Cost Report Step 2

  23. Cost Report Step 2 contReference slides 49-50

  24. Cost Report Step 2 contReference slide 51-59

  25. Cost Report Step 2 Edits

  26. Step 2 Edits • ± 15% variance on all ratios • ± 15% variance between Spec Trans Student Count and One-Way Trips • Number of Specially Adapted Vehicles depreciated (Step 4e) exceeds number reported as Specially Adapted Vehicles (G&S line16) • All ratios require numbers greater than zero (0) • Average Cost per One-Way Trip is higher than average

  27. Cost Report Step 3 Summary

  28. Cost Report Step 3aReference slide 60

  29. Cost Report Step 3bReference slide 60

  30. Cost Report Step 3b Edits

  31. Cost Report Step 3cReference slide 61-62

  32. Cost Report Step 3dReference slide 61-62

  33. Step 3 Edits • CR compared to PL • ± 15% variance in Total Benefits • Depreciated items less then $5,000

  34. Cost Report Step 4 Summary

  35. Cost Report Step 4aReference slide 64

  36. Cost Report Step 4b

  37. Cost Report Step 4b Edits

  38. Cost Report Step 4c

  39. Cost Report Step 4d

  40. Cost Report Step 4e

  41. Step 4e Edits • Gross Cost of Specially Adapted Vehicle is greater than average • Depreciated items less than $5,000

  42. Cost Report Submission - Summary

  43. Cost Report Step 5

  44. Cost Report Step 5 (continued)

  45. Cost Report Step 5 (continued)Reference slide 68-69

  46. Cost Report Step 7 – Upload FormsReference slides 71

  47. Polling Question 47

  48. General & Statistical • IEP Ratio • Students with IEP’s that receive direct medical services compared to Medicaid Students with IEP’s that receive direct medical services • Specialized Transportation Student Count • Students with IEP’s that require specialized transportation compared to Medicaid Students with IEP’s that require specialized transportation • One-Way Trip Ratio • Students with allowable One-Way trips compared to Medicaid Students with allowable One-Way trips • Total Population on Specially Adapted Vehicles(NEW) • Students that ride that Specially Adapted Vehicles, required by IEP and/or general population students. • Vehicle Ratio • Total number of vehicles compared to total number of specially adapted transportation vehicles 48

  49. IEP Ratio To calculate the IEP ratio, first compile an unduplicated list of all Special Education students for the entire reporting period. From that list, compile a list of the students whose IEPs document the need for one or more direct medical services. That number is the denominator. From the second list, compile a list of the students that were Medicaid at any time during the cost-reporting period. That number will be the numerator. 49

  50. IEP Ratio IMPORTANT: Count ALL students with IEP/SHARS regardless of BILLED status 50

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