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.

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
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 services cost report, including:

  • Submitting a methodology
  • Submitting Fee for Service claims for direct services to the Medicaid Management Information System (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 IEP Direct Service Cost Settlement Program?

A school district representative may request the Cooperative Agreement by calling the MO HealthNet Division at (573) 751-9290, by email at MHDSchoolPrograms@dss.mo.govor in writing to:

Department of Social Services
MO HealthNet Division
Program Operations Unit
P.O. Box 6500
Jefferson City, MO 65102-6500

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.

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. Refer to Section 5 of the School-Based IEP Direct Services Cost Settlement Provider Manual for more information on the Cost Report Adjustment.

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 cost report year (July 1 – June 30) in which the service was delivered and billed to the MHD and must furnish or make records available to representatives of the MHD, Missouri State Auditor, Missouri Medicaid Audit and Compliance or CMS upon request.

Revised October 2024