- Cost Pool 1 is made up of direct service/therapy personnel and is the same listing of providers in the state plan.
- Cost Pool 2 is made up of staff involved in administrative activities rather than direct service activities.
A random sample is selected for each statewide cost pool. At the end of the quarter, the RMTS results are compiled by activity code. The results of Code 4b, “Direct Medical Services, Covered as IDEA/IEP Services," are used as one part of the quarterly cost report calculation, which will be the direct service payment to the school.
School districts will submit a quarterly cost report to report their provider costs for staff in Cost Pool 1, along with other costs related to the direct service personal and delivery of medical services. The cost report then calculates the amount each school district is eligible to receive as reimbursement.
On an annual basis, school districts must complete a cost settlement process. Each school district completes an annual cost report which compares their total Medicaid-allowable costs to each school district's Medicaid interim payments, to determine the school's final costs. If a provider received more in interim payments than the actual costs for Medicaid services provided in schools, the provider will pay back the federal share of the overpayment when the Annual Settlement cost report is submitted. If the actual costs of a provider exceed total interim payments, DHHS will pay the federal share of the difference to the provider.