MaineCare seed/match procedures for School Administrative Units

The Department of Health and Human Services (DHHS) Office of MaineCare continues to work with the Department of Education to find solutions to some fundamental issues regarding reimbursements for services provided to MaineCare-eligible students in Special Purpose Private Schools (SPPS) and public school administrative units (SAUs).

MaineCare seed/match procedures for services provided by SPPS

MaineCare will continue to pay 100 percent of the eligible claims submitted by SPPS to include both the federal portion and the State seed/match portion required for each claim. This procedure is a continuation of the process introduced in May 2012. The seed/match amount associated with each claim paid by MaineCare has been advanced to DHHS from subsidy allocations of the responsible SAUs. In the case of State Agency Clients (SAC), the seed/match amount has been advanced to DHHS directly from the DOE State appropriation for SAC. Adjustments were made to June 2012 subsidy checks for MaineCare payments made to SPPS in February 2012 for services provided by SPPS as far back as late 2010 but not previously paid by MaineCare.MaineCare has continued to make 100 percent payments to SPPS in March, April, May and June 2012 for services provided but not previously paid by MaineCare prior to those dates. The seed/match for those March, April, May and June 2012 payments have been advanced to DHHS by the DOE but the Department has not yet made subsidy adjustments to reflect those advancements to DHHS. The detail of those advancements and subsidy adjustments for each SAU will be released soon to each SAU. It is anticipated that the subsidy adjustment for those March, April, May, and June seed/match advances to DHHS will be made in September 2012 to the ED279 subsidy printouts. That adjustment will be prorated over the 10 remaining subsidy payments in FY2012-13. For example, a $10,000 adjustment would reduce each of the 10 remaining subsidy payments by $1,000. Each SAU will be provided the detail associated with those payments and be given 10 days to review and respond with any correction before subsidy adjustments are made. Beginning in September 2012, the subsidy adjustments for SPPS seed/match advancements to DHHS will be made quarterly in September, December, March and June.

New MaineCare seed/match procedures for services provided by public SAUs

New procedures are being implemented for public SAUs that are approved MaineCare providers and submit claims to MaineCare for reimbursement for services provided by the SAU to MaineCare eligible students.In order to be compliant with the Center for Medicaid and Medicare Services (CMMS) requirements, payments made by MaineCare to SAUs will be subject to a seed/match procedure much like the procedure for the SPPS. MaineCare will pay 100 percent of the eligible amount for each service provided by the SAU, and that amount will include both the federal portion and the State seed/match portion for services provided by the SAU beginning July 1, 2012. Please note: 100 percent payments will be for services provided to eligible students after July 1, 2012 and submitted to MaineCare after July 1, 2012.All claims for services provided prior to July 1, 2012 and submitted to MaineCare will pay only the federal portion regardless of when the claim is submitted.The DOE has advanced to DHHS the seed/match portion that will allow the 100 percent payment for eligible services provided by public SAUs beginning July 1, 2012. The DOE will make quarterly adjustments to subsidy to reflect those advancements to DHHS made on behalf of SAUs. The first quarterly adjustment to the ED279 subsidy printouts will be in October 2012, and the remaining subsidy checks will reflect seed/match portion payments made by MaineCare through September 30, 2012. As with the SPPS procedures, SAUs will be provided the detail of the MaineCare payments for each service and an opportunity to verify accuracy before subsidy adjustments are made.
This new Inter-Governmental Transfer (IGT) approach will eliminate the need for each SAU to submit Certified Public Expense (CPE) forms (required by MaineCare through FY2010-11) or so-called Budget Forms (required in FY2011-12). In addition, this IGT approach will not involve the time study and year-end cost reconciliation procedures previously required by CMMS rules.The following is a summary of the MaineCare payment process and accounting procedures detail for services provided to a MaineCare eligible resident student by either the resident public SAU or the Special Purpose Private School on behalf of the resident public SAU.

New MaineCare process for SAUs

Payment of eligible MaineCare services:

  • DHHS pays SPPS or SAU 100 percent of eligible costs (includes federal portion and SAU seed/match portion).
  • DOE transfers MaineCare Seed amount to DHHS on behalf of SAUs – as IGT.
  • DHHS provides MaineCare payment details to Maine DOE for the IGT. DOE reconciles this information with the IGT amount.
  • DOE will provide the payment detail to each SAU for review.
  • DOE adjusts each SAUs State subsidy to recapture amount transferred to DHHS. See ED79 Line 59E “private” – for payments to SPPS – and “public” – for payments to school administrative units.

MaineCare payments to SPPS

SAUs accounting of MaineCare revenue paid to special purpose private schools:

  • The MaineCare seed/match payment to SPPS that DOE has provided to DHHS on behalf of the SAU should be accounted for as revenue to the unit’s General Fund, replacing the subsidy recaptured for this purpose. (Fund Code 1000 and Revenue Code 3111)
  • The SAU should account for the portion of services (equal to MaineCare seed/match paid amount to SPPS) as a contracted service expenditure (for breakdown of costs see payment detail(s) provided by the DOE). The following are Accounting Handbook codes for these expenditures:
Type of Service Fund Program Function Object
Behavioral Health Day Treatment 1000 2500 2330 3440
Psychological 1000 2800 2140 3440
Speech/Hearing 1000 2800 2150 3440
Occupational Therapy 1000 2800 2160 3440
Audiology 1000 2800 2170 3440
Physical Therapy 1000 2800 2180 3440
Social Work 1000 2800 2110 3440
Counseling 1000 2800 2120 3440

Essential Programs & Service (EPS) special education allocation:

  • Expenditures equal to the MaineCare seed/match amount paid to SPPS that has been reported utilizing the appropriate Accounting Handbook codes will be included as related services expenditures for the maintenance of effort calculation in the determination of the SAU’s EPS special education allocation.

MaineCare payments to SAUs

SAU accounting of MaineCare revenue paid to a SAU for services provided by the resident SAU:

  • SAU deposits MaineCare payment from DHHS into General Fund (Fund Code 1000 and Revenue Code 4585). This payment from DHHS provides both the federal portion as well as the SAU seed/match amount to the General Fund. The SAU seed amount will replace the amount removed from subsidy to support current budget. (Recommended method.)
  • If SAU deposits MaineCare payment into Special Revenue (Fund Code 2460 and Revenue Code 4585), then the SAU must transfer the SAU seed/match portion to their General Fund. (Allowable method but not recommended.)
    • Transfer Out Special Revenue to General Fund (Fund Code 2460 and Object Code 9120).
    • Transfer In General Fund from Special Revenue (Fund Code 1000 and Revenue Code 5203).

EPS special education allocation:

  • No change in reporting of special education expenditures – all special education expenditures should be reported under the appropriate Accounting Handbook and Model Chart of Accounts. Note: It is important not to net revenues against expenditures as this may result in an error in the unit’s EPS special education allocation.
  • No change in reporting for amount used for Federal Revenues. This shall remain an amount equal to the actual special education expenditures reported as federal expenditures in special revenue accounts.
  • Change in how amount is determined for MaineCare revenue for EPS special education maintenance of effort calculation:
    • For those SAUs that deposit MaineCare payment into General Fund, the amount brought into General Fund (Fund Code 1000 and Revenue Code 4585) less the amount of subsidy reduction (ED279 Line 59E) for the same fiscal year – resulting in only the federal portion being applied. This amount can be verified against the federal portion indentified in the payment detail from DHHS.
    • For those SAU that deposit MaineCare into Special Revenue (Fund Code 2460 and Revenue Code 4585) and then transfer the SAU seed/match portion to their General Fund (Fund Code 2460 and Object Code 9120). The federal portion shall be determined by taking the amount deposited into Special Revenue less the transfer to the General Fund. This amount can be verified against the federal portion indentified in the payment detail from DHHS.

Note: We strongly recommend that MaineCare payments be deposited into a SAU’s General Fund account.

Resources

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