To view the entire newsletter, you may have to select “view entire message” at the bottom of your screen in some email platforms. You may also view the whole newsletter in the newsletter section of our SHS program website.

Fiscal Year (FY) 2024-25 Comprehesive Review Recap

Districts participating in the School Health Services (SHS) Program undergo a comprehensive review at least once every three years. This process examines all areas of the SHS Program. There are three categories that are reviewed:

• Annual and quarterly payroll information 
• Provider licensure
• Direct service claiming

Comprehensive reviews are now finalized for FY 2024-25. Thank you to the districts that underwent a comprehensive review and for your hard work in gathering all the required documentation during this process! Based on common findings, we would like to share important reminders to help maintain program integrity:

• Only report costs based on when the individual was listed on the Staff Pool List (SPL)
• Districts can hover over the green job span bar in the Public Consulting Group (PCG) Claiming System to view the exact dates an individual was on the SPL to report eligible costs
• Stipends are allowed to be reported as long as it relates to the individual’s primary job function within the SHS Program
• Please report federal funds and other non-allowable costs under the ‘Federal Funds/Non-Allowable Sources’ field in the PCG Claiming System

• In terms of the direct service claims portion of the comprehensive review, please ensure that all student medical plans of care include the following requirements:
• Scope = type of direct medical service prescribed
• Duration = start and end date of the prescription
• Frequency = how often the service is provided

• As a reminder, documentation for all costs and ratios must be retained at the district for at least 7 years from the last date of service

Certification for Public Expenditure (CPE) Reminder

Starting with the July – September 2024 (JS24) quarterly claim, the Certification for Public Expenditure (CPE) Form process will be completed electronically through the PCG Claiming System. To be prepared for this new process be sure to email PCG with the first name, last name, email, position, and phone number of the individual who should be added to the PCG Claiming System as your official CPE form signer. If these individuals are already in the system but will be signing the CPE form for your district be sure to let PCG know and the existing user’s permissions will be updated.

Mid-Year Frequently Asked Questions (FAQs)

Random Moment Time Study (RMTS) FAQs

Q: Is there recommended language for coordinators to send before an RMTS quarter starts to help staff pool list participants understand the purpose of the RMTS?

A: Yes. Within the PCG Claiming System, under the resources section, there is an email template that coordinators can use when reaching out to participants prior to the start of an RMTS quarter.

Q: As a coordinator, will I receive notifications when my participants have unanswered follow-ups?

A: Yes. If you are a coordinator who gets normal moment reminders you will also get reminders if a participant has an unanswered follow-up. Follow-up reminders only get sent to coordinators two days after the follow-up has been created if the follow-up is still unanswered. Coordinators who aren’t already signed up for moment reminders can email cormts@pcgus.com to request moment notifications.

Q: How long do participants have to respond to a follow-up?

A: Participants have three days to respond to moment follow-ups.

Q: Do moments assigned to vacant positions impact a district’s response rate?

A: No. Moments assigned to vacant positions that expire do not impact a district’s response rate. If a district fills a vacant position, any unexpired moments become the responsibility of the participant to answer.

Medicaid Administrative Claiming (MAC) FAQs

Q: How can I report costs related to licensure?

A: Professional dues and fees can be reported under quarterly other costs. These costs should be reported in the quarter in which the district pays for them. Make sure any other costs tie to an individual on the Staff Pool List.



Annual Cost Reporting FAQs

Q: What are the documentation requirements to support direct medical other costs?

A: Items reported under the direct medical other costs section in the annual cost report should be supported by documentation that includes the name of the item, purchase price, and date of purchase. 

Q: When will mandatory changes required by the new Centers for Medicare and Medicaid Services (CMS) guidance for specialized transportation take effect?

A: The new CMS guidance requires that a vehicle be modified and that modification be required in a student’s IEP for it to count as a specialized transportation trip. That change will first need to be approved by CMS after HCPF submits the State Plan Amendment (SPA) to CMS. Upon approval of the SPA, HCPF must be compliant with those mandatory changes by July 1, 2026.

Q: With the new CMS guidance on specialized transportation, will districts still need to maintain documentation and track one-way trips for students?

A: Yes, the minimum requirement is that districts/BOCES have documentation to support one-way trips for students. This must still be retained at the district with the implementation of the new guidance, dependent on approval of the SPA. This includes bus logs which should show which student took the trip on what day and how many per day. In addition, districts are still required to bill Health First Colorado for one-way trips that qualify under the new guidance.

SHS Program Stakeholder Forum

Our last stakeholder meeting was held on January 9, 2025. The Department of Health Care Policy and Financing (HCPF) informed stakeholders that analysis is still ongoing for upcoming mandatory changes required by the CMS Comprehensive Claiming Guide. Mandatory changes will be incorporated into SHS program training after CMS approval.  

An update was also provided for the vendor change for the provider call center from Gainwell Technologies to Optum. More information regarding this vendor change can be found on HCPF’s website.  

A project is also underway to develop a video sharing stories of how SHS reimbursement dollars were spent to support student health at participating districts/BOCES. We discussed the current status of that video project and next steps for stakeholders who have agreed to participate in the video.

Other program components discussed included: 

• HCPF’s process of verifying Medicaid provider IDs for required providers listed on the direct service staff pool list before the RMTS sample is generated. Resources and reminders for this requirement are listed later in this newsletter. 
• Mid-year training topics 
• Feedback for the prototype of a new PCG claiming system 
• Structure of the new coordinator monthly mentorship calls 
• Random Moment Time Study (RMTS) moment follow ups 

Starting in Fiscal Year (FY) 2025-26 there will be stakeholder vacancies in both the North Central and Pikes Peak Regions. These vacancies are for stakeholders whose terms will expire at the end of FY 2024-25. HCPF is also still searching for stakeholders located in the Southeast and Northwest Stakeholder Regions. The Southeast and Northwest Regions are currently supported by stakeholders that are not located in those regions.

The stakeholder program supports HCPF and The Colorado Department of Education (CDE) by representing member districts at stakeholder meetings and providing mentorship during monthly new coordinator meetings and training sessions. Program feedback from stakeholders and information dissemination to stakeholders’ member districts are essential for SHS program collaboration. Applications will be emailed in the coming weeks if you are interested in applying or reapplying to be a stakeholder in the following regions:



• North Central
• Pikes Peak
• Southeast
• Northwest

A detailed list of which districts/BOCES are included in each region can be found on The Colorado Department of Education's website.  

Stakeholder Spotlight

Name: Marlee Hart 

District/BOCES: San Juan Board Of Cooperative Education Services (BOCES), Durango School District (SD) 9R, Montezuma-Cortez SD RE-1, Dolores SD RE-4a, and Archuleta SD JT#50 

As a stakeholder, what region(s) and districts do you represent: I represent the Southwest Region, including Alamosa, Bayfield, and San Luis BOCES, as well as my own districts/BOCES! 

Years supporting SHS program: 10 years this July 

Biggest tip for new coordinators: Start building a contact-tree with names and emails for your Special Education department, Finance and Human Resources departments, and your health teams. Add in some fellow coordinators or stakeholders, your billing agent, and PCG, HCPF, and CDE. Laminate it. Love it. Start building relationships with these folks so when you need to schedule a training, pull payroll info, or ask a program question, the right folks are waiting at your fingertips. 

Success story at your district: Across my districts/BOCES, a huge success has been increasing nursing and mental health services for our students, whether it was moving a part-time nurse to full time, hiring additional nurses to ensure every school had one on site, adding social workers, or implementing a mental health/antibullying curriculum for middle school students. 

Anything else you'd like to share: When you feel overwhelmed, try to remember you have a community of support ready and willing to help in any way you need. We all want to see this program succeed, and we do our best in whatever role we have. 

Mid-Year Training

If you’d like to review any portion of mid-year training, recorded sessions are now available in the training portion of the SHS program website. Three in person mid-year training sessions were hosted across the state. Four virtual training sessions by topic were also held. In person sessions are the preferred method to attend training because they help form important program connections necessary to share best practices for program implementation. This was apparent during training again this year as there were many examples of networking and collaboration. Thanks to all stakeholders who assisted with the new coordinator portion of mid-year training.

National Provider Identifier (NPI) Ordering, Prescribing and Referring (OPR) Medicaid Provider ID Requirement Resources and Reminders

The CMS requirement for Physical Therapists (PTs), Occupational Therapists (OTs), and Speech Language Pathologists (SLPs) to have a valid individual Medicaid provider ID to be included on district/BOCES’ direct service staff pool list has now been in effect since October 1, 2024. It is the district/BOCES’ responsibility to ensure compliance with this requirement including that PTs, OTs, and SLPs included on direct service staff pool lists: 

• Are billing appropriately 
• Are not receiving RMTS moments without a valid Medicaid provider ID 
• Do not have salaries and benefits claimed without a valid Medicaid provider ID 

HCPF conducts SPL reviews for these providers as a courtesy while districts/BOCES are learning how to manage this new requirement. The following resources and tips are also available for districts/BOCES compliance: 



• Track Medicaid Provider ID expiration dates so providers are removed from SPL when IDs expire 
• Proactively review InterChange to resolve denied claims before the 120-day timely filing period has passed. This can be done by reviewing the Explanation of Benefits (EOB) codes included on the denial. Follow this guide for steps to review submitted claims 
• Utilize the provider enrollment page and the NPI OPR guide on the SHS program website for help troubleshooting provider enrollment. 
• Email hcpf_schoolhealthservices@state.co.us with the Application Tracking Number (ATN) and a summary of the issue for the fastest response time 
• Utilize the resources on the HCPF Revalidation website including the Provider Revalidation Dates Spreadsheet 
• Learn best practices from stakeholders listed on Stakeholder Areas of Knowledge tool under the blue bar of the SHS program website for NPI OPR requirement  

National Alliance for Medicaid in Education (NAME) Updates

NAME is pleased to announce the selection of our new Executive Director, Mark Smith, QIDP, CPM, MPA. Read more about Mark here.

NAME is committed to helping create and nurture networks of school-based Medicaid professionals and share best practices to improve school Medicaid programs across the country. Join us in Philadelphia, October 7-10, 2025 for the 23rd Annual NAME Conference where you'll meet fellow Medicaidians, learn from your colleagues, and maybe have some fun in the process! Registration will open later this spring, so keep an eye on NAME's socials and your inbox for more updates.

Are you rocking your blue NAME swag in the wild? We'd love to see it! Tag us on your socials and show your NAME spirit. Missed out on a hoodie or a t-shirt at the conference? Don't despair - NAME will begin selling our swag online later this spring so everyone has the opportunity to get into some stylish (and cozy!) merch.

Welcome Andria Thornhill

We are excited to announce that Andria Thornhill has accepted the position as the School Health Services Medicaid Coordinator for the Colorado Department of Education (CDE). In addition to her systems management and technical skills, Andria brings a wealth of knowledge and experience as the former School Health Services program coordinator for the Gunnison School District. She is looking forward to working with school district teams across the state. Andria's email is thornhill_a@cde.state.co.us. 

Parental Consent Forms



A proposed rule to modify the Individuals with Disabilities Education Act (IDEA) Part B regulation was posted on May 18, 2023. At that time, districts/BOCES were informed to conduct business as usual regarding parental consents, as this was only a proposed rule in the public comment period. On December 27, 2024 the United States Department of Education announced a withdrawal of the proposed rule change. This means that there is no change to the parental consent requirement and districts/BOCES should continue obtaining parental consents as they did before the proposed rule was posted. 

Parental consent forms were due from districts/BOCES undergoing a comprehensive review on February 28, 2025. For future comprehensive reviews, CDE is considering aligning the parental consent portion of the comprehensive review with the timing of the HCPF portion of the comprehensive review that is conducted by PCG. If implemented, this change would be based on positive stakeholder feedback to align the timing of all comprehensive review components. Although the timing would be aligned, districts/BOCES would still need to submit parental consents directly to CDE. 

Local Services Plan (LSP)

Districts/BOCES with LSPs due at the end of the fiscal year should allow ten months to complete a new LSP submission. For districts/BOCES in the cohort renewing (2020-25) or for districts/BOCES in their first year of program participation, initial drafts are due June 17, 2025. Final submissions are due July 1, 2025. If you don’t know when your LSP is due, you may check your cohort on the CDE website. CDE reviews LSP submissions as they are submitted and may provide the district/BOCES with notes. For districts/BOCES who aren’t in their year of renewal, a revision of the LSP on file may also be recommended. Please contact Andria if you have not received an email concerning your district/BOCES’ review. 

Reimbursement Spending Report to CDE

Reimbursement spending reports were due February 28, 2025. Data from reimbursement spending reports will be reviewed and used in FY 2023-24 district/BOCES data flyers after 2025 annual training.

FY 2024-2025 Stakeholder Dates

April 10, 2025

9 a.m. – 12 p.m.

All meetings will be hybrid, via Zoom & In-Person

In person location:

303 E. 17th Ave,

Denver, CO 80203

Quarterly Cost Report

April 1, 2025

January – March 2025 (JM25) quarterly cost report will open

April 30, 2025

JM25 quarterly cost report is due

The School Health Services Program is a joint effort between the Colorado Department of Education and the Department of Health Care Policy & Financing. For questions related to:

• Receiving SHS reimbursement, please email HCPF’s School Health Services general inbox.
• Quarterly Cost Reporting or the Random Moment Time Study, email the Quarterly/RMTS Help Desk.
• Annual Cost Reporting, Cost Settlement, or Transportation claiming, email the Annual Cost Report Help Desk.
• Reimbursement Spending Report, Local Services Plan, or Parental Consent, email Andria Thornhill at CDE.

If you have any suggestions for the newsletter, please email the School Health Services Email Box.

• Please notify all state program contacts of any SHS support staff changes at your district/BOCES. 

School Health Services

Public Consulting Group - Claiming System

Colorado Department of Education

Health First Colorado