IDEA was enacted in 1975, and by the late 1980s schools were so overwhelmed by the task of managing special education programs that whatever revenue they were bringing in from FFS Medicaid reimbursements was more than offset by the associated administrative costs.

In 1988, the federal government implemented School District Administrative Claiming (SDAC), also known as Medicaid Administrative Claiming (MAC). The purpose of this program was to reimburse districts for a percentage of the costs associated with administering and coordinating school-based Medicaid services and outreach activities. The SDAC program now provides more than $1 billion annually to school districts across the country.

Like the FFS program, SDAC claiming is quite complicated. How does one calculate the costs of administering this program across a district with 10 employees? What about 100 employees? 10,000 employees? The federal government has approved two sophisticated time study methodologies for SDAC. In most states, these two methodologies are referred to as either a time survey or random moment time study (RMTS). Each of these methodologies has its own intricacies, nuances, and potentially costly pitfalls.

Time survey

A time survey is created each quarter (four times a year) and covers a five to ten day period. The development of a time survey for SDAC requires the creation of a log into which all eligible participants in a school district enter their activities for each day in 15-minute increments.

To run a successful SDAC program using time survey methodology, the district must ensure that

• All relevant staff members participate
• All time surveys meet state Medicaid standards
• Each provider is properly trained to complete the time survey
• All employees understand the codes used for each 15-minute period, so they can accurately record their activities
• Surveys are disseminated within the state-approved time period prior to the time study
• Each participant completes the time survey and returns it within the approved time frame
• A randomly chosen representative sample of surveys is pulled for validation

Furthermore, district administrators have the following responsibilities:

• Amassing and calculating all 15-minute intervals properly, sometimes for thousands of employees
• Error checking and correcting
• Proper documentation and calculation of all financial expenses concerning the special education program
• Using the proper algorithms to generate the claim

Random moment time sample (RMTS)

Rather than a comprehensive account of all employees’ time for a five-day period, RMTS methodology selects a percentage of employees to account for their activities at a randomly selected moment in time. District administrators then can extrapolate how much employee time is spent on reimbursable activities. Medicaid reimburses districts based upon valid, statistically correct claims filed under this process.

The creation of a valid RMTS requires the following steps:

• Compilation of employee data from all participating school districts in the sample universe
• Creation of a sample pool
• Random selection of employees from the sample pool
• Pairing of the randomly selected employee with a randomly selected date and minute in time
• Recording by selected employees of the activities they were engaged in at the selected time
• Statistical analysis by a district administrator of all submitted responses
• Calculation of an average percentage of time spent on reimbursable activities by service providers
• Proper documentation and calculation of all financial expenses concerning the special education program

All school staff members that provide SDAC-related activities may be selected for an RMTS, such as therapists, counselors, nurses, and administrators. Some types of employees, such as 100% federally funded employees, employees who do not perform SDAC activities, bus drivers, custodians, and cafeteria workers may not participate in the program.

If performed incorrectly, any one step of either a time survey or an RMTS could invalidate some or all of the time study, costing your district dearly in rejected claims or, even worse, leading to audit findings that necessitate the repayment of Medicaid funds received.

Accelify understands the SDAC program, and we have the technology to manage RMTS and time survey methodologies. More importantly, we work with our client districts to manage the SDAC process from start to finish every quarter. We provide training and management services to simplify the SDAC process and maximize participation, we stay up to date on SDAC regulations at the state and federal level, and we make sure that your district isn’t missing any reimbursements.