Cost-Based Payment Methodology
The SBAP uses a cost-based payment methodology to reimburse LEAs for a portion of the costs for rendering health-related services to special education students throughout the fiscal year. This process uses a combination of LEA-specific information (such as interim claiming data and the LEA-specific IEP Ratio) and state-wide factors (such as RMTS percentages) to calculate the ultimate reimbursement to an LEA.
Costs are reported annually using an accrual-based accounting method for cost settlement, using the dates expenditures were incurred rather than the dates they were paid. After the Medicaid-allowable portion of the costs reported is determined, the costs are reconciled against the total amount of interim payments the LEA received throughout the year.
The LEA will be required to certify the LEA’s total actual incurred allowable costs and expenditures, including federal and non-federal share, and the availability of necessary public matching funds. The certification statement, or CPE form, will be included as part of the annual cost report and with each quarterly MAC claim.
Annual cost settlement reimbursements are deposited into a restricted account for each LEA, managed by the Pennsylvania Department of Education. In the event that the interim payments received exceed the allowable costs, a recoupment will be made from the LEA’s restricted account.
Participation and reimbursement for SBAP services is dependent upon the submission of compensable direct services claims throughout the fiscal year. For the costs associated with a specific service type to be considered during cost settlement, the LEA must have received and retained interim payments for that service type.
Sivic Solutions Group (SSG), the current Commonwealth Contractor for SBAP services, provides the annual cost reporting system, e-SivicMACS, here: https://pasbap.ssghosting.com/MAIN/Home.aspx?m=0