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PA Bulletin, Doc. No. 13-827

NOTICES

Payment Methodology for Services in the School-Based Access Program

[43 Pa.B. 2524]
[Saturday, May 4, 2013]

 The Department of Public Welfare (Department) intends to revise the payment methodology in the School-Based Access Program (Program) in accordance with recommendations made by the Centers for Medicare and Medicaid Services.

Background

 The Medical Assistance (MA) Program covers a broad range of health-related services through the Program, including assistive technology devices, nursing, nurse practitioner, occupational therapy, orientation, mobility and vision, personal care, physical therapy, physician, psychology, counseling, social work, special transportation and speech, language and hearing services. Services provided in the Program must be health-related, not educational, in nature and must be provided by a qualified MA provider. To be eligible for MA payment, services must be medically necessary and must be listed on the child's Individualized Education Program (IEP).

Payment Methodology

 School-based services are paid on a cost-related basis. Beginning with the 2012-2013 academic year, a cost reconciliation and cost settlement specific to each local education agency (agency) will be processed annually, to assure that each agency does not receive more in interim payments than the costs incurred for delivering Program services during the school year.

 The direct and indirect costs of providing Program services, less any Federal payments for these costs, will be collected utilizing cost reports received from each agency that reflect the cost of providing services during the previous State fiscal year (July 1 through June 30). Allowable costs will be calculated using the data from the cost reports, the agency's Unrestricted Indirect Cost Rate (UICR) established by the United States Department of Education, the agency's Random Moment Time Study (RMTS) Activity and the agency's ratio of students who are MA beneficiaries to the entire school population. Allowable costs include direct health-related costs such as salaries, benefits and health-related purchased services, supplies and transportation costs, as well as indirect costs using the agency-specific UICR.

 The direct health-related RMTS is used to determine the percentage of time that personnel spend on direct health-related services, general and administrative time and all other activities to account for 100% of agency staff time to assure that there is no duplicate claiming. The product of allowable costs multiplied by the agency's direct health-related RMTS percentage is then multiplied by the Medicaid Eligibility Rate. The Medicaid Eligibility Rate is calculated for each agency by dividing the total number of students who are MA beneficiaries and have an IEP by the total number of students who have an IEP; this agency-specific IEP ratio reduces the direct health-related cost pool by the percentage of students who are MA beneficiaries and have an IEP.

 Each agency will be required to certify the accuracy of the total actual costs and expenditures incurred in delivering Program services. All annual cost reports will be subject to review by the Department or its designee.

 The cost reconciliation process will be completed after the close of the reporting period covered by the annual cost report. The total allowable costs will be compared to the agency's interim MA payments for Program services provided during the reporting period. If an agency's interim payments amounts exceed the actual certified costs incurred in delivering Program services, the agency will return an amount equal to the overpayment to the Department. If the actual certified costs incurred in delivering Program services exceed the interim MA payments, the agency will receive the Federal share of the difference from the Department. The Department will notify the agency of the amount due from or to the agency within 90 days of receiving the cost report.

Fiscal Impact

 It is anticipated that implementation of revised payment methodology used for services delivered under the Program will have no State fiscal impact for the Department because the non-Federal match is covered by the Agencies.

Public Comment

 Interested persons are invited to submit written comments regarding the revised payment methodology to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments will be reviewed and considered.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

BEVERLY D. MACKERETH, 
Acting Secretary

 Fiscal Note: 14-NOT-816. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 13-827. Filed for public inspection May 3, 2013, 9:00 a.m.]


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