School Health Services Program News | |
Our newsletter is a Department of Health Care Policy & Financing (HCPF) publication that provides information on the School Health Services (SHS) Program. The Colorado SHS Program is administered by HCPF in collaboration with the Colorado Department of Education (CDE). Providers participating in the program may receive federal matching funds for amounts spent in providing health services through the public schools to students who are receiving Health First Colorado (Colorado's Medicaid program) benefits. | |
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2024 Mid-Year Training Locations and Registration
Registration for the 2024 School Health Services Program (SHS) Mid-Year Refresher Training is now open. We will be hosting three (3) in-person sessions in different areas of the state as well as a virtual option. Training will be conducted by the Department of Health Care Policy and Financing (HCPF), Colorado Department of Education (CDE) and Public Consulting Group, Inc. (PCG). Topics to be covered may include updates about Free Care, Random Moment Time Study (RMTS), Cost Reports, Medicaid Administrative Claiming (MAC), interim payments, and updates from HCPF and CDE.
Register for 2024 in-person training sessions
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2024 Virtual Training Sessions | |
| Program Component | Date and Time | Registration Links | | Random Moment Time Study | Feb. 13, 2024
10 to 11 a.m. | Register | | Comprehensive Review | Feb. 13, 2024
1 to 2 p.m. | Register | | HCPF/CDE Updates | Feb. 14, 2024
10 a.m. to 1 p.m. | Register | | Financials | Feb. 14, 2024
1 to 2 p.m. | Register | | |
Registration links and information are on the SHS Training Website. | |
FY 2023-24 Annual Cost Reporting Frequently Asked Questions (FAQs)
Q: What does it mean when costs are flagged with warnings such as ‘High Salary’ or ‘Very High Salary’? Does it mean my costs are incorrect?
A: Throughout the completion of the annual cost report, districts will be flagged to provide additional information for costs and/or ratios that exceed thresholds. If a system edit or warning is triggered, districts will be required to provide a detailed explanation to address the potential issues raised by the warnings. It is important when entering explanations to provide enough detail to prevent further follow-up and confirm costs were accurately reported along with supporting documentation. Your responses will be carried over to the desk review, which helps PCG to close out edits prior to releasing the desk review.
Q: How should our district report costs for providers on the annual cost report?
A: Costs on the annual cost report are reported based on the accrual accounting method, based on date of service. Costs on the annual cost report for direct service Staff Pool List (SPL) participants can only be reported based on the time listed on the SPL. Hovering over the green job span bar in the PCG Claiming System can help with identifying when to report eligible costs based on the staff member’s exact dates listed on the SPL.
Q: Can mileage and staff training be included on the annual cost report under Direct Medical Other Costs?
A: Mileage reimbursement for travel between district buildings to perform direct medical services can be claimed on the annual cost report as long as the direct services are being performed within your district. Reimbursement for staff training is only allowable on the MAC quarterly reports as long as the training pertains to the provider’s main job function as it relates to the SHS program. Please keep in mind that Direct Medical Other Costs are costs for materials, supplies and equipment used for the provision of direct medical services.
Q: Can you report stipends as a part of a provider’s salary?
A: If the district paid a stipend that is related to the provider’s primary job function, it can be claimed on the annual cost report. Any residual pay, retirement, and sick leave payouts can be claimed on the annual cost report as well.
Q: How are thresholds for payroll costs determined?
A: Thresholds are calculated by taking payroll reported on the quarterly reports and taking the average based on the provider’s specific job category. This is a district-specific threshold unless the district did not have enough providers in a certain job category to calculate a standard deviation. If the district does not have enough providers to calculate a threshold, the statewide thresholds are used.
Q: Is reimbursement from the SHS program considered federal funds?
A: Reimbursement from the SHS program (quarterly/annual cost report and monthly interim payments) are considered state/local funds and should not be reported in the federal funds field of the cost reports.
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Centers for Medicare and Medicaid Services (CMS) Guidance on School Based Services Reminder
On May 18, 2023, the highly anticipated Comprehensive Guide to Medicaid Services and Administrative Claiming was released. The goal of the guide is to help states address the growing need for expanding access to critical services for students such as physical health, mental and behavioral health for children enrolled in Medicaid and CHP+. In accordance with the new guide, HCPF will be evaluating the current State Plan Amendment (SPA) to include any mandatory changes as a part of the guidance. If you haven’t already read the guide, please visit Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.
It is important that districts read and understand some of the implications that may arise as a part of the new guidance. For any questions regarding the guide, please feel free to reach out to HCPF.
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Utilization of the Locations Feature in the PCG Claiming System
After discussion about the use of ‘locations’ within the PCG Claiming System for staff pool list participants during the October Stakeholder meeting, PCG plans to remove this feature within the next year. In an effort to prepare for this change, coordinators should begin to transition from using multiple locations to one primary location on the SPL starting with the April – June 2024 quarter.
A Different Way to Track Locations
In lieu of the locations feature, coordinators can transition to using the ‘Description’ free form text box for the position. This text box can be updated at any point in the quarter when an individual leaves and there is a direct replacement. Coordinators can update the note indicating the location where the individual works.
Benefits to Tracking Locations in the Description Field
There will be no more improper locations or a mass list of individuals to remember to update with actual locations when the SPL opens for editing. This description feature will populate when the SPL is exported and will include updates made to the import file upon a successful imported SPL. This reduces the administrative burden on districts when updating their staff’s locations.
Below is a screenshot of what the description feature looks like and where it appears when updating a participant's SPL:
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National Provider Identifier (NPI) Ordering, Prescribing, and Referring (OPR)
At the October stakeholder forum, a discussion was held on the progress of districts fulfilling the next phase of the NPI OPR requirement that’s due June 30, 2024. HCPF addressed questions related to insurance requirements and steps to take when districts/Boards of Cooperative Educational Services (BOCES) encounter provider enrollment issues. Stakeholder questions were added to the updated NPI OPR guide that was sent to program coordinators on Oct. 20, 2023, and published on the SHS website. Gainwell Technologies, HCPF’s fiscal agent, should be contacted for troubleshooting provider enrollment issues. They can be contacted by calling 1-844-235-2387. If your inquiry is not resolved by Gainwell please contact Olga Gintchin directly with the Application Tracking Number (ATN). Reach out to Olga with any overall questions related to the requirement, best practices for completing the process, or with any other general concerns.
In mid-November 2023, claims with services requiring an NPI OPR started posting the following Explanation of Benefits (EOB) 1997 if the OPR provider is not enrolled with Health First Colorado:
"The referring, ordering provider, and attending type is invalid for the service. The service is not within the scope of the provider type."
Claims with this EOB have not been denied but should be reviewed by the district/BOCES to determine why the NPI is invalid. Please begin using provider NPIs in your billing as soon as they have completed the steps in the NPI OPR guide so that potential claiming issues may be addressed. Claims with an invalid NPI OPR will eventually be set to deny so it is important to troubleshoot issues early in the process.
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SHS Program Stakeholder Forum
The first stakeholder meeting of the new fiscal year yielded great stakeholder input and discussion. Now that everyone has had a few months to digest the information in the updated CMS guide, the discussion centered around potential implications to the Colorado SHS program. Keeping an open conversation with SHS program contacts is imperative as progress is made towards implementing program changes. The new CMS guide and how it impacts the SHS program will be a standing agenda item for stakeholder meetings and be incorporated into training for several years to come. Please email olga.gintchin@state.co.us, call Olga Gintchin directly at 303-866-4234, or submit questions anonymously via this google survey so that accurate information and expectations are being communicated. An estimated timeline for program changes will be shared during mid-year training in February including any changes to the estimated timeline that was shared during annual training.
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Senate Bill 23-174 (SB23-174)
On May 20, 2023, SB23-174: “Access to Certain Behavioral Health Services” was signed into law. The bill requires HCPF to provide certain behavioral health services to members under the age of 21 and has changes related to the SHS program.
Certain behavioral health services procedure codes will become available to be billed in addition to the codes that can already be billed through the SHS program. SHS program and billing manuals will be updated so that the newly available procedure codes are available for use on July 1, 2024. As a reminder, fee for service claims are required but continue to be paid at zero.
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Medicaid Eligibility Redeterminations Begin Again
Colorado has resumed regular eligibility reviews for people with Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) after a pause during the COVID-19 Public Health Emergency (PHE).
Not all members have the same annual renewal date. When it is time to renew, some members may be renewed automatically based on information on file for them. Everyone else is sent a renewal packet that must be completed, signed and returned right away. Members who fail to return necessary information may lose their benefits.
How can you help?
Please help us spread the word to Health First Colorado and CHP+ members to get ready for renewals by using our partner toolkits: Update Your Address and Take Action on Your Renewal. A new joint webpage, KeepCOCovered.com, also includes partner resources and information for those who may need to transition to other coverage.
Member facing materials are available in English and Spanish and have been transcreated into the top 11 languages spoken by members: Amharic, Arabic, Burmese, Chinese, Dari, Pashto, Russian, Somali, Swahili, Ukrainian, and Vietnamese.
A few specific ways you can help:
Where to Find More Information
Partners can find more Frequently Asked Questions (FAQs) about the end of the continuous coverage requirement and return to regular renewal processes are available in the PHE Planning Resource Center.
Members with questions about the renewal process can be referred to the Health First Colorado’s renewal webpage available in English and Spanish.
How to Stay Informed
The Public Health Emergency (PHE) Planning Resource Center will be updated as new information about the end of COVID-19 public health emergency and other COVID-19 policy evolves. To stay informed about the latest updates, please sign up for the COVID-19 public health emergency updates monthly newsletter.
HCPF hosts quarterly webinars on the PHE Unwinding. These webinars are geared toward community partners such as advocacy organizations, providers, and community organizations who may provide other assistance to Health First Colorado or CHP+ members (housing, social services, etc). The presentation and recording from the Oct. 25, 2023, PHE Unwinding webinar are posted in the PHE Resource Center.
Next Webinar Information
When: Jan. 24, 2024, 1 - 2 p.m. Mountain Time
Register in advance for this webinar.
Thank you for your collaboration to Keep Coloradans Covered!
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National Alliance for Medicaid in Education (NAME) | |
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The 21st Annual NAME Conference in Dallas, TX was a fantastic success, thanks to all the phenomenal members, presenters, and sponsors who came out to network, collaborate, and learn together to improve school-based Medicaid. Missed out on attending the conference? Don't despair! All conference materials from Dallas, as well as many of our past conferences, are available to NAME members year-round through the Members Only website - all you need to do is log in and start browsing. If you joined us in Texas last month, be sure to give a big "Thank you!" to our home-state hero, Marie LeBlanc (Englewood Schools), for chairing the Program Committee for our most successful conference to date. Colorado knows how to represent!
Speaking of representing, the Colorado-hosted "Not Our First Rodeo: Assessing the Impact of Free Care Expansion Three Years Later in Colorado” was an extremely popular breakout session this year, following on the heels of a similarly well-attended presentation in Baltimore, 2022! Kudos to Olga Gintchin, Omar Estrada, Michael McCoy, Hattie Pinkston, and Michelle Camille for putting together a great session for NAME members! Is there a topic that you want to see in a breakout session at NAME next year? Have you ever thought about presenting? Presentation teams need at least one Local Education Agency (LEA), State Medicaid, or State Education person presenting, but can include a variety of additional speakers. NAME will be sending out our "Call for Proposals" in the spring of 2024, and we'd love to have you apply.
In case you haven't heard, NAME is coming to Colorado for 2024! Additional details will be released over the coming months, so keep an eye out for emails, Facebook/Twitter announcements, and website updates.
NAME has a new president-elect! Shawna Dippman (MI) was elected as the first LEA presidential candidate in NAME's history. Thank you to all the members who voted online and during the conference!
Do you know of a student success story in your district that's a result of Medicaid reimbursement? NAME would love to share your story with our members to inspire and remind everyone of why we all try to be Medicaid champions for our students. Email your story to info@medicaidforeducation.org.
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Colorado Department of Education Updates | |
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2023 CDE Fall Conference
The Colorado School Health Services team delivered a compelling presentation at the 2023 CDE Fall Conference: “Exploring Well-Being and Belonging in Colorado,” held in Colorado Springs from Sept. 12-13. Our session, “School Health Services Program: An Overview of Using School-Based Medicaid Reimbursement Dollars to Improve Student Health,” provided a high-level explanation of the objectives of the program, along with how these funds are enhancing student health outcomes. Our presentation was intended to provide a basic understanding to educational professionals who may not know how the SHS Program works, particularly districts/BOCES not currently participating. Attendees gained valuable insights from in-depth analysis and engaging discussions. It fostered a collaborative environment where educators and health professionals exchanged ideas and experiences, further strengthening our commitment to student health and well-being.
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Reimbursement Spending Report (RSR) Update
We have implemented a minor update to the RSR form that impacts the narrative sections related to health services. As previously communicated and reiterated during our annual training, narrative submissions are mandatory this year. To facilitate this requirement, we have introduced conditional text boxes within the report. These boxes will clearly indicate which narratives are necessary for each specific section. For your convenience, they are located above the narrative fields of each health service category. Additionally, you can copy and paste the text from these boxes into your narratives to serve as labels, thereby enhancing the organization of your report. Below is an example of how this new feature will appear. For this example, the district selected FTE/Contracted Personnel & Equipment/Material/Supplies:
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This will populate the request for narratives similar to the expenditure items. This text block will be directly under the subtotal feature in each Health Service category section, as shown in this screenshot: | |
For a more in-depth walkthrough, review the step-by-step guide for this update.
If you already started on your report, your narrative drafts won't be affected, but you will see the new labels like in the example provided. If you have questions, feel free to reach out.
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Parental Consents Reviews
Part of the comprehensive review process includes a review of parental consents for the sample of students that districts/BOCES receive. If your organization is under a comprehensive review, here is a quick reminder of the process to review parental consents:
- Districts/BOCES under comprehensive review will receive two emails on Jan. 1. One email will be from Omar (Estrada_O@cde.state.co.us) with instructions. The second email will come from CDE’s secure file transfer system (Notify@transfer.cde.state.co.us).
- Districts/BOCES can then collect and submit parental consent forms for the sample of students they received and submit them via the secure file transfer system.
- Districts/BOCES have until Thursday, Feb. 29, 2024, to submit their parental consent forms.
Secure emails are automatically deleted every 30 days. Districts/BOCES who have not submitted the requested documents by Feb. 1 may need to be resend a new secure email. Reach out to Omar for any questions or comments.
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Upcoming Deadlines
Thursday, Feb. 29, 2024
- FY 2022-23 Reimbursement Spending Report to CDE due
- Parental consent files due for districts/BOCES under comprehensive review
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Need to meet?
If you would like 1:1 support on reimbursement spending, the Local Services Plan (LSP) or the reimbursement spending report, feel free to schedule a help session or email Omar Estrada.
All CDE School Health Services Program support documents, as well as links to LSP documents and reimbursement spending report, are on the CDE School Health Services website.
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FY 2023-2024 Stakeholder Dates | |
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Oct. 12, 2023
Jan. 11, 2024
April 11, 2024
All meetings will be via Zoom & In-Person
In person location:
303 E. 17th Ave, 11AB
Denver, CO 80203
9 a.m. – 12 p.m.
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Random Moment Time Study
Feb. 1, 2024
Apr. – June 2024 (AJ24) SPL and calendars open
Feb. 29, 2024
AJ24 certification is due
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Quarterly Cost Report
Jan. 2, 2024
Oct– Dec. 2023 (OD23) cost report opens for district reporting.
Jan. 26, 2024
OD23 cost report certification is due.
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The School Health Services Program is a joint effort between the Colorado Department of Education and the Department of Health Care Policy & Financing.
If you have any suggestions for the newsletter, please email the School Health Services Administrator Olga Gintchin, SHS Program Assistant Tracy Gonzales or Public Consulting Group (PCG).
Additional SHS Program Contacts:
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