The Ohio Department of Medicaid’s Provider Network Management (PNM) module serves as the single-entry point for secure portal functions and is designed to streamline processes for providers including enrollment, credentialing, and self-service. PNM aims to reduce administrative burdens for providers by offering a centralized system for managing their participation in Ohio Medicaid. Since October 1, 2022, OHID is required to access the PNM module.
The Ohio Department of Medicaid (ODM) is working on the Cost Reporting and Final Settlement process. Cost Reports should be filed within 18 months of the end of the school fiscal year (SFY), with Final Settlements paid within 24 months of the end of the SFY. The 22/23 Cost Report is the upcoming Cost Report filing that must be filed through The Ohio Department of Medicaid’s PNM system by the Treasurer.
ODM sends out adjudication orders for the Final Settlement of each SFY Cost Report. If you have no questions or concerns regarding the adjudication order, please sign and return the waiver as soon as possible to ensure timely reimbursement. If you have any questions or concerns regarding your adjudication order, please contact Shelly Jolley.
For tracking purposes, please send a copy of the adjudication order to Shelly Jolley.
Agreed Upon Procedure (AUP) Audit – This is the annual audit that each MSP participating district must have performed by a CPA. This audit verifies costs reported on the Cost Report and it also tests Paid Claims. Cost findings result in a cost adjustment, and claim errors result in a payback of only the individual claim amount received. The cost of this audit is a reimbursable expense on the Cost Report and is reimbursed at 50%.
The Ohio Department of Medicaid (ODM) is working on the Cost Reporting and Final Settlement process. Cost Reports should be filed within 18 months of the end of the school fiscal year (SFY), with Final Settlements paid within 24 months of the end of the SFY. The 21/22 Cost Report is the upcoming Cost Report filing that must be filed through The Ohio Department of Medicaid’s PNM system by the Treasurer.
ODM sends out adjudication orders for the Final Settlement of each SFY Cost Report. If you have no questions or concerns regarding the adjudication order, please sign and return the waiver as soon as possible to ensure timely reimbursement. If you have any questions or concerns regarding your adjudication order, please contact Shelly Jolley.
For tracking purposes, please send a copy of the adjudication order to Shelly Jolley.
Cost Report/Final Settlement School Fiscal Year (SFY)
2019/20
Year 11
Cost Settled June 2022
2020/21
Year 12
Cost Settled June-August 2023
2021/22
Year 13
Cost Settled June-August 2024
2022/23
Year 14
Cost Report in Process, due 12/31/2024
2023/24
Year 15
Last School Year, Cost Report Prep to Begin 1/1/24, due 12/31/2025
2024/25
Year 16
Current School Year, Cost Report due 12/31/2026
2025/26
Year 17
Next School Year, Cost Report due 12/31/2027
Your main Cost Reporting contact at HBS is Shelly Jolley – Sjolley@teamhbs.com
In order to include “Contracted Therapy Costs” on the MSP Cost Report, there are specific procurement requirements that must be followed. School Districts must obtain 3 contract price comparisons for all MSP related therapy contacts that exceed the lessor of $25,000, or your district’s formal procurement threshold.
The following is a summary of the procurement requirements.
When the total contract amount exceeds the lesser of $25,000, or your district’s threshold, please document the following:
Rationale – Document the rationale used in selecting the vendor. (lowest price, most qualified, etc.)
Full/Open Competition – Do not set unreasonable contract requirements, unnecessary experience, noncompetitive pricing between affiliated companies, or conflicts of interest.
Limited Competition – In cases where competition is limited, document the rationale used to support this claim.
Cost or Price Analysis – Document the cost/price for each vendor in your comparison.
Include the following 3 statements in all MSP related contracts:
Vendor will comply with the requirements of 45 CFR 164.504(e)(1) for safeguarding and limiting access to information concerning beneficiaries.
Vendor will allow the representative of the U.S. Department of Human Services, ODM, ODE or their respective designee access to the subcontractor’s books, documents and records.
Vendor acknowledges that they or their principles are not suspended or debarred.
All non-ESC contracts over $100,000 must be competitively bid or have ODE approval.
Contracts over $100,000:
All non-ESC contracts over $100,000 must be competitively bid or have ODE approval.
HBS has developed an optional “Contract Procurement Checklist” that can be helpful in documenting these MSP Contract Procurement Requirements. You can download it here.
