Administrative Claiming Services

The Vendor is required to provide school-based Medicaid program administrative claiming to measure what a person is doing during a moment of time of the workday.
- Requirement:
•    Have first random moment time study (RMTS) prior to start of July 2026 – October 2026 semester. 
•    The semester begins October 1, 2026.
•    Establish a team of qualified staff specifically designated to the state Medicaid school based administrative claiming (SBAC) program.
•    Implement and maintain an online RMTS and cost data for leas to access the reimbursable federal contribution that includes a method for calculating claims consistent with the center for Medicare and Medicaid services (CMS) guidelines and preparing and filing claims with department.
•    Online system must allow leas to run individual reports.
•    Must calculate Medicaid eligibility rate (MER) for local education agencies (lea). Describe calculation process to obtain the mer.
•    Provide semester claim reports to all participating leas. 
•    Department shall agree upon the timeline for submission of the quarterly claim reports. 
•    The semester claim report should contain the following:
o    The staff pool lists;
o    Reported quarterly expenditures;
o    Medicaid eligibility rate (MER);
o    Indirect cost rate and staff pool list
o    Assist leas with semesters staff pool lists to ensure receiving appropriate reimbursement
•    Provide quarterly written progress reports to the department. 
•    The vendor and department shall agree upon the timeline for submission of the quarterly written process report.
•    The written semester progress report should include:
o    Time study results by administrative activity code; 
o    Description of problems such as failure of leas to participate in time study or failure to submit cost data by district name along with possible resolutions; 
o    85% compliance report (all districts must answer their random moments within the CMS approved timeline and not answer than 85% in a given semester) must be provided within two weeks after the quarter has ended; 
o    Other customized data reports as requested. 
o    Example: control listing of time study surveys 
o    District by district comparison by statewide averages.