IEP Direct Service Cost Settlement Program FAQs

What is the responsibility of the school who wants to enroll in the IEP Direct Services Cost Settlement Program?

School districts are responsible for the following functions:

  • The school district must be enrolled in the SDAC program.
  • Sign a IEP Direct Service Cooperative Agreement with the Department of Social Services.
  • Submit an approved Direct Service (IEP) methodology.
  • Submit direct service claims to MMIS for the cost settlement plan year to be eligible to cost settle.
  • Submit total number of IEP students as of December 1 for calculation of the IEP Ratio.
  • Submit annual cost report/reconciliation and certification of costs.
  • Maintain program compliance and participate in desk reviews.
  • Participate in the Random Moment Sampling (RMS)
Can a school district still bill Fee-for-Service (FFS) claims to MO HealthNet Division (MHD) and not enroll in the IEP Direct Services Cost Settlement Program?

No, a school district must be enrolled in the IEP Direct Services Cost Settlement Program to bill direct service claims to MHD.

Participation is voluntary. If a school district does not bill MHD for direct service claims, they are not required to participate in the IEP Direct Service Cost Settlement program.

Who is responsible for providing training material and training SDAC Coordinators/Financial Contacts?

Fairbanks LLC is responsible for the development of all IEP Direct Service Cost Settlement Program training materials and training SDAC Coordinators/Financial Contacts.

Can a school district utilize a third-party contractor for school district responsibilities?

Yes, school districts may contract with a third-party biller to assist with the annual IEP direct service cost report, including:

  • Submitting a methodology
  • Submitting fee-for-service claims for direct services to MMIS
  • Assisting with the annual IEP process
  • Submitting cost data for allowable costs and assistance with desk reviews
When will the school district be able to cost settle?

The annual IEP Direct Service Cost Report will open for submission 1 year after the plan year (July 1– June 30) ends.

Who does a school district contact if they are interested in participating in the SDAC program?

A school district representative may request the Cooperative Agreement by calling the MO HealthNet Division at (573) 751-9290 or by email at MHDSchoolPrograms@dss.mo.gov.

Can districts report costs for a provider that was not listed on the Personnel Roster for all 4 quarters within the plan year?

Districts should only report costs for quarters in which the provider was listed on the Personnel Roster within the plan year.

Does the district have to pay back FFS claim reimbursement the district received for a provider that was not listed on Personnel Roster for the specific quarter?

No, the final costs are settled against ALL billing for the entire plan year. However, the district would only be eligible to report costs for the quarters in which the provider was listed on the Personnel Roster within the plan year.

What are the main cost allocation components of a direct service cost settlement?
  • Direct Medical Percentage
  • Cost Data for Cost Pool 1 Direct Medical Service Providers
  • Medicaid IEP Ratio
  • Unrestricted Indirect Cost Rate (IDCR)
  • Federal Medicaid Assistance Percentage (FMAP)
  • Medicaid Fee-for-Service Paid Direct Services Claims
How long does a district have to request a cost report adjustment?

The request must be made within 12 months of the annual cost report cost settlement date.

Request for cost report adjustments must contain documentation necessary to support the request and must be sent to MHD or its designee in writing at least 90 days in advance of the expiration date.

What if a financial adjustment to a cost report indicates an overpayment of funds to the school district?

The school district may request repayment be deducted from the school district’s succeeding interim payments or the school district may return the overpayment to MHD within 60 days.

How long must a school district maintain related records?

School districts must maintain related records for six years after the year in which the service was delivered and billed to the MHD and make such available to representatives of the MHD, Missouri State Auditor, Missouri Medicaid Audit and Compliance or CMS upon request.