Massachusetts Resources

Welcome to the Massachusetts Resources page. Here you will find information, forms and guidance for Medicaid and how it relates to schools.

As a reminder, the School-Based Medicaid Program (SBMP) in Massachusetts is not a fee-for-service program. Reimbursement is greatly dependent on quarterly statewide time studies. SBMP requires participation in multiple processes:

• Random Moment Time Study (RMTS),
• Direct Services Claiming (DSC),
• Administrative Claiming Activities (AAC), and an
• End-of-fiscal-year Cost Report.

The annual cost report determines the cost settlement and encompasses all these areas of the program. Responses to statewide time studies are measured quarterly and determine the level of Medicaid-Claimable time within each quarter. Tuition, Transportation, staff expenses, etc. are reported in the quarterly Administrative Activity Claiming (AAC) submissions, and these numbers are factored into the cost report. The Medicaid Penetration factor, or the number of students for whom the district has paid claims throughout the year as compared to the full student enrollment for non-IEP claiming or Special Education enrollment for IEP students also holds weight in the cost report. Your active participation and timely submittal of required elements will ensure maximum return on efforts.

General Information

EDMS Guidance

• Vital Information – A list of key tasks and deadlines for SBMP.
• Who to contact – Your EDMS contact list
• Medicaid Program Responsible Parties – An overview of the various programs you may participate in and who to contact with questions on the items.
• Required Administrative Items – This targeted user guide will assist in the management of key claiming controls.  This guide is located in the Acuity Help Menu.
• District Information Management – This guide will help district administrators keep contact information updated.  This guide is located in the Acuity Help Menu.

SBMP Resources

• State SBMP Resource Center – this link will take you to the SBMP site, which should be your primary source of all bulletins, guides, and support material.

MA Guidance

From EDMS

• Medicaid Administration Calendar – A single page flowchart of key tasks to help you keep on track of management. 
• New Service Provider Flowchart – A single page flowchart to help you manage bringing on a new service provider.
• New Student Flowchart – A single page flowchart to help you managing adding a new student to your Acuity Sessions account.

SBMP Resources

SBMP 101 Trainings

• SBMP has created a number of topic-specific training videos available on their website at the link below. We encourage districts to review these annually for update to date information from SBMP.
• https://www.mass.gov/info-details/school-based-medicaid-program-sbmp-trainings

Nursing Guidance

• District Nurses looking for continuing education, support on SNAP, and other training resources, please visit the Northeastern University Online Program List at the link below. Many of these offerings are free and they cover a variety of topics related to School-based Medicaid Claiming for Nurses and the programs commonly used for this.
• https://neusha.org/index.php/online-program-list/

MA Forms

• One-time Consent Form – The current version for the DESE authored form (2018 version) can be found in Acuity Sessions for each student, and we would recommend that you print and access the form from there to ensure that all demographic information is correct. However, in the event you need a more genaric version, or need to provide the form to a family without a student in the system as yet, this version can be used.  As a reminder, all students should should have this consent version on file in order to pursue claiming.
• Out-of-District Service Log – As a reminder, as a requirment of participation, you must have evidence to support all cost report categories you claim. This includes tuition. The way SBMP varifies this via Out-of-District logs, and it is the obligation of all districts to complete the top part of each log for every student they outplace and then provide the log to the facility. It is the obligation of the facility to ensure the logs are completed by each provider working with the student and must be returned to the district in a timely manner for all student regardless of any eligibility information. We recommend that you collect and process these monthly. 

Random Moment Time Study (RMTS) – Participation in RMTS is a required component of the SBMP program and is the most critical part of the process. Districts must invest the time necessary to ensure that accurate calendars and work schedules are entered in the system for all participants. Accurate Work Schedules maximize the chance that if a moment is assigned to a participant, it should be for a time in which a participant is expected to be working. It is also important to remember that even if you are not pursuing Interim Claiming for nurses, all nurses, by definition, qualify as participants for RMTS and should at least be added to your Administrative Only pool. In contrast, it is important that we don’t “dilute” the RMTS pools by including people who don’t necessarily qualify as a participant. In addition to ensuring only those that need to be on the list are reviewed and placed in the correct pool each quarter, it is important that participants complete the MANDATORY RMTS training each year, as it is generally updated annually and those who take the training are more likely to complete moments with adequate detail for the RMTS coders to quantify their time. There is a two-school-day time limit to respond. If moments are unanswered, the moment is automatically coded as non-billable time. If an LEA has a response rate lower than 85 percent in any RMTS pool in any quarter, the superintendent receives a notification letter. If the statewide response rate for any RMTS pool does not reach 85 percent in a given quarter, LEAs will be unable to claim reimbursement for that quarter if: 1) that LEA failed to achieve an 85 percent response rate in the same RMTS pool within the last two years; and 2) that LEA’s response rate was lower than 85 percent in that quarter.

Direct Service (Interim) Claiming (DSC) – Direct Services Claiming (interim claiming for service areas in which the district has elected to participate) are billed throughout the year to demonstrate that reimbursable services were provided to an eligible member. Medicaid-covered medical services include speech-language pathology, occupational therapy, physical therapy; mental and behavioral health services; skilled nursing services; audiology services; personal care services; applied behavior analysis (ABA) services for students with autism spectrum disorder; medical nutritional counseling; certain physical and behavioral health screenings; and fluoride varnish treatment.Interim claiming for direct service encounters is another important component of the RMTS-based reimbursement program. Recording your service encounters for all students that you work with, regardless of Medicaid eligibility, will ensure ample evidence is available to support RMTS responses. Additionally, if a district fails to produce at least one paid claim in any quarter for a specific service, they will not be able to include the cost for that service for that quarter on their Cost Report. As a reminder, since Medicaid Expansion, services can either be IEP-ordered or non-IEP ordered. Service documentation should reflect the appropriate designation.

Administrative Activity Claiming (AAC) – AAC claiming is the venue for districts to collect reimbursement for tuition, transportation, and staffing expenses. AAC is reported by quarter and districts should strive to submit their AAC data as close to the close of the quarter as possible. SBMP has established a final firm deadline of October 15th of each year to submit all final quarter information; however to ensure that EDMS has time to submit the AAC files and respond to any inquiries from SBMP, we ask all districts to have their final ACC files submitted no later than September 15th each year. 

Cost Reports/Settlement – Throughout the year, LEAs submit interim claims for reimbursable services provided to eligible MassHealth-enrolled members through MassHealth’s Medicaid Management Information System (MMIS). Providers must submit per-unit claims for all services for which they seek reimbursement in the annual DSC cost report due on December 31 each year. Interim claims are required to demonstrate that reimbursable services were provided to an eligible member. Interim claims that are adjudicated in MMIS and determined to be “paid” (regardless of interim billing fee) are the basis for which costs can be included in the annual Cost Report and the basis for the number of students that can be counted in the Medicaid Percentage Rate calculations. The annual DSC cost report calculates total gross Medicaid allowable expenditures based on each LEA’s actual incurred and allowable costs. Interim claims are paid quarterly.

After the conclusion of the fiscal year, LEAs submit an annual DSC cost report that includes costs to provide Medicaid-covered services and LEA-specific Medicaid eligibility statistics used to calculate Medicaid penetration factors. These inputs, and the statewide Random Moment Time Study (RMTS) results, are used to determine the gross Medicaid reimbursable amount, also referred to as the Certified Public Expenditure amount.