______________ County Board of Education
Annual Medicaid Projection
FYE 6/30/2013
Direct Services
1
2
3
4
5
6
7
8
9
Total Salary, Benefits, and Other Direct Costs Net of Federal Funds
Average RMTS % (From Attachment 1)
Subtotal
Contractor Costs
Subtotal
Indirect Costs
Subtotal
IEP Ratio (From Attachment 3)
Total Eligible Costs
Personal Care
1
2
3
4
5
6
7
8
9
Total Salary, Benefits, and Other Direct Costs Net of Federal Funds
Average RMTS % (From Attachment 1)
Subtotal
Contractor Costs
Subtotal
Indirect Costs
Subtotal
IEP Ratio (From Attachment 3)
Total Eligible Costs
Case Management (Care Coordination)
1
2
3
4
5
6
7
8
9
Total Salary, Benefits, and Other Direct Costs Net of Federal Funds
Average RMTS % (From Attachment 1)
Subtotal
Contractor Costs
Subtotal
Indirect Costs
Subtotal
IEP Ratio (From Attachment 3)
Total Eligible Costs
Actual Q1
(7/1-9/30)
Actual Q2
(10/1-12/31)
Actual Q3
(1/1-3/31)
Actual Q4
(4/1-6/30)
Total
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
Actual Q1
(7/1-9/30)
Actual Q2
(10/1-12/31)
Actual Q3
(1/1-3/31)
Actual Q4
(4/1-6/30)
-
Total
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
Actual Q1
Actual Q2
Actual Q3
Actual Q4
(7/1-9/30)
(10/1-12/31)
(1/1-3/31)
(4/1-6/30)
-
Total
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
0.00%
-
-
______________ County Board of Education
Annual Medicaid Projection
FYE 6/30/2013
Transportation
Annual Estimate
Estimated Non-Federal Transportation Costs for the FY:
Salaries for Bus Drivers, Transportation Aides, Mechanics, etc.
Fringe Benefits for Bus Drivers, Transportation Aides, Mechanics, etc.
Lease/Rental
Insurance
Maintenance and Repairs
Fuel and Oil
Major Purchases under $5000
Contract - Transportation Services
Contract - Transportation Equipment
Depreciation Expense on School Buses
Total Estimated Transportation Costs
Indirect Costs
Subtotal
Application of Vehicle Ratio
Application of Trip Ratio
Total Eligible Costs
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Total Amount Received from DHHR
Amount Due From (Due To) DHHR
#DIV/0!
______________ County Board of Education
Annual Medicaid Projection
FYE 6/30/2013
Required Data Entry:
Unrestricted Indirect Cost Rate (See Attachment 2)
Total Number of Special Education Buses
Total Number of Buses
Vehicle Ratio
**Information to be obtained from county transportation director
Total Number of Medicaid Eligible Special Education Billable Trips
Total Number of Special Education Billable Trips
Trip Ratio
**Information to be obtained from county special education director
Average RMTS % ( See Attachment 1)
Direct Services
Personal Care
Case Management (Care Coordination)
IEP Ratio (See Attachment 3)
Direct Services
Personal Care
Case Management (Care Coordination)
#DIV/0!
#DIV/0!
SAMPLE County Board of Education
Annual Medicaid Projection
FYE 6/30/2013
Direct Services
1
2
3
4
5
6
7
8
9
Total Salary, Benefits, and Other Direct Costs Net of Federal Funds
Average RMTS % (From Attachment 1)
Subtotal
Contractor Costs
Subtotal
Indirect Costs
Subtotal
IEP Ratio (From Attachment 3)
Total Eligible Costs
Personal Care
1
2
3
4
5
6
7
8
9
Total Salary, Benefits, and Other Direct Costs Net of Federal Funds
Average RMTS % (From Attachment 1)
Subtotal
Contractor Costs
Subtotal
Indirect Costs
Subtotal
IEP Ratio (From Attachment 3)
Total Eligible Costs
Case Management (Care Coordination)
1
2
3
4
5
6
7
8
9
Total Salary, Benefits, and Other Direct Costs Net of Federal Funds
Average RMTS % (From Attachment 1)
Subtotal
Contractor Costs
Subtotal
Indirect Costs
Subtotal
IEP Ratio (From Attachment 3)
Total Eligible Costs
Actual Q1
(7/1-9/30)
100,000.00
49.80%
49,800.00
10,000.00
59,800.00
8,970.00
68,770.00
67.00%
46,075.90
Actual Q2
(10/1-12/31)
100,000.00
49.80%
49,800.00
10,000.00
59,800.00
8,970.00
68,770.00
67.00%
46,075.90
Actual Q3
(1/1-3/31)
100,000.00
49.80%
49,800.00
10,000.00
59,800.00
8,970.00
68,770.00
67.00%
46,075.90
Actual Q4
(4/1-6/30)
100,000.00
49.80%
49,800.00
10,000.00
59,800.00
8,970.00
68,770.00
67.00%
46,075.90
Actual Q1
Actual Q2
Actual Q3
Actual Q4
(7/1-9/30)
(10/1-12/31)
(1/1-3/31)
(4/1-6/30)
20,000.00
14.98%
2,996.00
2,996.00
449.40
3,445.40
100.00%
3,445.40
Actual Q1
(7/1-9/30)
300,000.00
2.87%
8,610.00
8,610.00
1,291.50
9,901.50
58.00%
5,742.87
20,000.00
14.98%
2,996.00
2,996.00
449.40
3,445.40
100.00%
3,445.40
Actual Q2
(10/1-12/31)
300,000.00
2.87%
8,610.00
8,610.00
1,291.50
9,901.50
58.00%
5,742.87
20,000.00
14.98%
2,996.00
2,996.00
449.40
3,445.40
100.00%
3,445.40
Actual Q3
(1/1-3/31)
300,000.00
2.87%
8,610.00
8,610.00
1,291.50
9,901.50
58.00%
5,742.87
20,000.00
14.98%
2,996.00
2,996.00
449.40
3,445.40
100.00%
3,445.40
Actual Q4
(4/1-6/30)
300,000.00
2.87%
8,610.00
8,610.00
1,291.50
9,901.50
58.00%
5,742.87
Total
400,000.00
199,200.00
40,000.00
239,200.00
35,880.00
275,080.00
184,303.60
Total
80,000.00
11,984.00
11,984.00
1,797.60
13,781.60
13,781.60
Total
1,200,000.00
34,440.00
34,440.00
5,166.00
39,606.00
22,971.48
SAMPLE County Board of Education
Annual Medicaid Projection
FYE 6/30/2013
Transportation
Annual
Estimate
Estimated Non-Federal Transportation Costs for the FY:
Salaries for Bus Drivers, Transportation Aides, Mechanics, etc.
Fringe Benefits for Bus Drivers, Transportation Aides, Mechanics, etc.
Lease/Rental
Insurance
Maintenance and Repairs
Fuel and Oil
Major Purchases under $5000
Contract - Transportation Services
Contract - Transportation Equipment
Depreciation Expense on School Buses
Total Estimated Transportation Costs
1,000,000.00
300,000.00
100,000.00
50,000.00
500,000.00
10,000.00
15,000.00
1,975,000.00
Indirect Costs
Subtotal
Application of Vehicle Ratio
Application of Trip Ratio
Total Eligible Costs
296,250.00
2,271,250.00
26.67%
50.00%
302,871.19
302,871.19
Total Amount Received from DHHR
500,000.00
Amount Due From (Due To) DHHR
23,927.87
SAMPLE County Board of Education
Annual Medicaid Projection
FYE 6/30/2013
Required Data Entry:
Unrestricted Indirect Cost Rate (See Attachment 2)
15.00%
Total Number of Special Education Buses
Total Number of Buses
Vehicle Ratio
**Information to be obtained from county transportation director
4
15
26.67%
Total Number of Medicaid Eligible Special Education Billable Trips
Total Number of Special Education Billable Trips
Trip Ratio
**Information to be obtained from county special education director
200
400
50.00%
Average RMTS % ( See Attachment 1)
Direct Services
Personal Care
Case Management (Care Coordination)
49.80%
14.98%
2.87%
IEP Ratio (See Attachment 3)
Direct Services
Personal Care
Case Management (Care Coordination)
67.00%
100.00%
58.00%
COUNTY BOARDS OF EDUCATION
MEDICAID RANDOM MOMENT TIME STUDY
FY13 ACTUAL RESULTS
RESPONSE RATE
Cost Pool
Direct Service
Personal Care
Case Management
Administrative
Pilot Q1
(2/15 to 3/31)
92.13%
78.60%
83.20%
89.47%
Pilot Q2
(4/1 to 6/30)
91.00%
78.05%
82.40%
89.25%
Actual Q2
(10/1-12/31)
96.60%
82.49%
81.24%
92.53%
Actual Q3
(1/1-3/31)
96.87%
90.10%
88.83%
96.13%
Actual Q4
(4/1-6/30)
TBD
TBD
TBD
TBD
FY13
Average
96.74%
86.30%
85.04%
94.33%
Actual Q3
(1/1-3/31)
50.39%
15.86%
3.22%
15.14%
Actual Q4
(4/1-6/30)
TBD
TBD
TBD
TBD
FY13
Average
49.80%
14.98%
2.87%
14.85%
ALLOWABLE PERCENTAGES
Cost Pool
Direct Service
Personal Care
Case Management
Administrative
Pilot Q1
(2/15 to 3/31)
49.16%
20.21%
4.24%
8.64%
Pilot Q2
(4/1 to 6/30)
44.83%
16.37%
4.94%
5.14%
Actual Q2
(10/1-12/31)
49.20%
14.09%
2.52%
14.56%
Notes: In any cost pool where the response rate is less than the required 85%, unallowable moments are added to
bring the response rate to 85%. This reduces the allowable percentage used in the cost settlement.
OSF
4/15/13
RMTS Results
ATTACHMENT #1
APPROVED INDIRECT COST RATES FOR
COUNTY BOARDS OF EDUCATION
FOR THE 2012-13 YEAR
County
Restricted
Rate
Nonrestricted
Rate
Barbour
Berkeley
Boone
Braxton
Brooke
1.78%
2.08%
3.16%
3.41%
0.00%
12.07%
8.71%
13.65%
12.10%
14.33%
Cabell
Calhoun
Clay
Doddridge
Fayette
3.01%
1.51%
1.53%
5.24%
2.54%
14.21%
1.78%
12.33%
17.78%
13.34%
Gilmer
Grant
Greenbrier
Hampshire
Hancock
4.29%
2.54%
2.38%
4.60%
7.40%
5.86%
11.29%
11.73%
14.31%
21.35%
Hardy
Harrison
Jackson
Jefferson
Kanawha
0.66%
3.23%
1.54%
2.92%
3.08%
3.33%
12.03%
12.81%
15.15%
12.50%
Lewis
Lincoln
Logan
Marion
Marshall
Mason
McDowell
Mercer
Mineral
Mingo
1.88%
0.00%
2.94%
1.62%
5.30%
1.31%
2.87%
4.63%
0.67%
0.15%
12.35%
8.98%
14.99%
13.58%
16.66%
10.34%
4.42%
15.38%
12.37%
11.34%
Monongalia
Monroe
Morgan
Nicholas
Ohio
2.17%
0.52%
3.52%
2.89%
2.39%
12.20%
12.77%
14.71%
7.45%
12.36%
Pendleton
Pleasants
Pocahontas
Preston
Putnam
5.19%
3.64%
1.49%
3.34%
3.00%
12.49%
24.86%
14.76%
13.96%
12.62%
Raleigh
Randolph
Ritchie
Roane
Summers
2.81%
2.54%
8.38%
1.68%
0.42%
10.97%
15.01%
16.63%
10.14%
7.97%
Taylor
Tucker
Tyler
Upshur
Wayne
5.12%
2.51%
4.70%
1.36%
1.17%
17.85%
18.52%
16.17%
13.75%
14.64%
Webster
Wetzel
Wirt
Wood
Wyoming
0.00%
0.00%
3.71%
2.00%
3.34%
1.92%
11.46%
17.21%
7.83%
17.72%
State Average
2.66%
12.67%
OSF
07/02/12
Approved Indirect Cost Rates 13
-1-
ATTACHMENT #2
MEDICAID ELIGIBILITY RATIOS
FOR THE 2012-13 SCHOOL YEAR
BASED ON THE RATIO OF MEDICAID ELIGIBLE STUDENTS TO TOTAL STUDENTS RECEIVING SERVICES
AS OF MAY 2013
# of
Students
Receiving
Direct
Services
247
1,837
502
232
614
1,252
67
146
115
645
121
186
495
313
635
205
1,123
590
884
2,426
210
475
493
777
487
535
275
902
427
492
675
164
224
347
724
81
160
79
470
849
1,311
3,019
147
244
125
265
101
146
340
806
88
344
101
1,942
341
2
31
30,834
# of
Medicaid
Eligible
Students
Receiving
Direct
Services
149
1,007
281
159
315
605
55
101
71
545
82
105
470
213
340
137
569
352
324
1,294
132
302
303
419
279
359
204
609
210
296
383
92
134
295
367
57
93
73
243
336
826
1,840
97
137
86
154
67
94
218
510
81
209
65
1,095
197
2
25
18,063
Direct
Services
Ratio
60.32%
54.82%
55.98%
68.53%
51.30%
48.32%
82.09%
69.18%
61.74%
84.50%
67.77%
56.45%
94.95%
68.05%
53.54%
66.83%
50.67%
59.66%
36.65%
53.34%
62.86%
63.58%
61.46%
53.93%
57.29%
67.10%
74.18%
67.52%
49.18%
60.16%
56.74%
56.10%
59.82%
85.01%
50.69%
70.37%
58.13%
92.41%
51.70%
39.58%
63.01%
60.95%
65.99%
56.15%
68.80%
58.11%
66.34%
64.38%
64.12%
63.28%
92.05%
60.76%
64.36%
56.39%
57.77%
100.00%
80.65%
58.58%
# of Students
Receiving
Care
Coordination
Services
444
2816
819
433
779
1881
142
269
206
933
177
320
921
599
894
320
2003
833
1290
3855
416
782
776
1093
691
677
667
1373
747
661
1545
294
329
740
859
146
249
168
898
1764
1552
716
257
400
225
395
159
251
691
1438
185
514
147
1936
791
258
116
44,840
AF
T
Personal
Care Ratio
100.00%
69.23%
91.67%
0.00%
57.14%
64.00%
0.00%
100.00%
100.00%
92.31%
85.71%
69.23%
86.96%
79.31%
90.00%
100.00%
100.00%
50.00%
60.00%
77.78%
100.00%
86.96%
100.00%
58.33%
76.19%
100.00%
0.00%
100.00%
82.35%
75.00%
0.00%
100.00%
91.67%
100.00%
62.50%
100.00%
0.00%
100.00%
45.45%
0.00%
85.71%
100.00%
100.00%
100.00%
0.00%
100.00%
100.00%
100.00%
100.00%
87.50%
90.00%
88.89%
100.00%
83.33%
100.00%
66.67%
0.00%
83.18%
D
R
County
Barbour
Berkeley
Boone
Braxton
Brooke
Cabell
Calhoun
Clay
Doddridge
Fayette
Gilmer
Grant
Greenbrier
Hampshire
Hancock
Hardy
Harrison
Jackson
Jefferson
Kanawha
Lewis
Lincoln
Logan
Marion
Marshall
Mason
McDowell
Mercer
Mineral
Mingo
Monongalia
Monroe
Morgan
Nicholas
Ohio
Pendleton
Pleasants
Pocahontas
Preston
Putnam
Raleigh
Randolph
Ritchie
Roane
Summers
Taylor
Tucker
Tyler
Upshur
Wayne
Webster
Wetzel
Wirt
Wood
Wyoming
Institutional Ed. Programs
WV School Deaf & Blind
State:
# of
Students
Receiving
Personal
Care
Services
3
39
24
7
25
5
3
13
7
13
46
29
10
5
13
4
10
18
3
23
2
12
21
16
4
17
12
5
12
12
8
9
2
11
14
5
2
6
7
2
7
10
16
10
9
2
6
5
3
547
# of
Medicaid
Eligible
Students
Receiving
Personal
Care
Services
3
27
22
4
16
5
3
12
6
9
40
23
9
5
13
2
6
14
3
20
2
7
16
16
4
14
9
5
11
12
5
9
2
5
12
5
2
6
7
2
7
10
14
9
8
2
5
5
2
455
# of Medicaid
Eligible
Students
Receiving
Care
Coordination
Services
255
1484
473
278
386
960
107
184
123
805
118
155
876
356
438
174
1006
478
474
2183
273
497
480
596
365
439
520
879
355
398
777
177
188
668
427
85
126
151
462
696
953
413
152
248
156
222
85
159
432
971
160
290
97
1126
558
228
98
26,220
Care
Coordination
Ratio
57.43%
52.70%
57.75%
64.20%
49.55%
51.04%
75.35%
68.40%
59.71%
86.28%
66.67%
48.44%
95.11%
59.43%
48.99%
54.38%
50.22%
57.38%
36.74%
56.63%
65.63%
63.55%
61.86%
54.53%
52.82%
64.84%
77.96%
64.02%
47.52%
60.21%
50.29%
60.20%
57.14%
90.27%
49.71%
58.22%
50.60%
89.88%
51.45%
39.46%
61.40%
57.68%
59.14%
62.00%
69.33%
56.20%
53.46%
63.35%
62.52%
67.52%
86.49%
56.42%
65.99%
58.16%
70.54%
88.37%
84.48%
58.47%
OSF
5/10/2013
Medicaid Ratios May 13
ATTACHMENT #3