Medicaid Policy and Resources


Medical Necessity


DHB Contacts 

  • Roseann Sparano, LEA Policy 10-C
  • Jim Flowers, Annual Cost Report
  • John Mathewson, Random Moment Time Study

Post Payment Review Pending

Cost Report

Beginning with cost reporting periods ending on or after June 30, 2008, the DHB will begin using a cost-based methodology for all Local Educational Agencies (LEAs).

  • Cost-based methodology will consist of a cost report, time study and reconciliation.
  • If payments exceed Medicaid-allowable costs, the provider will remit the federal share of the overpayment at the time the cost report is submitted; and
  • If the actual, certified costs of an LEA provider exceed the interim payments, the DHB will pay the federal share of the difference to the provider in accordance with the final actual certification agreement and submit claims to the Centers for Medicare and Medicaid Services (CMS) for reimbursement of that payment in the federal fiscal quarter following payment to the provider

Cost Report Documents

Medicaid Administrative Claiming (MAC) and Random Moment Time Study (RMTS)

  • The Centers for Medicare and Medicaid Services (CMS) have approved North Carolina’s School-Based Random Moment Time Study (RMTS) methodology, which was implemented October 1, 2007.
  • Participation in the School-Based Random Moment Time Study is required for LEAs to be reimbursed for both the Medicaid Administrative Claiming and Direct Service/Fee for Service Programs.
  • LEAs are required to reach an 85% return response rate per district per quarter.
  • If an individual district has non-returns greater than 15% and greater than five moments for a quarter, the LEA is in default and will receive a warning letter.
  • If the same LEA is in default (as previously defined) the next quarter, after being warned, the LEA will not be able to participate in the time study for a one-year period of time.
  • Based on approval of the time study, the State agrees to monitor the time study to assure proper use of the time study codes and proper application of the methodology.
  • The State agrees to provide summary reports to the CMS Regional Office detailing the results, issues and concerns identified in the monitoring process on a quarterly basis.
  • The State agrees to provide oversight of outside entity contracted to operate or monitor the time study process.
  • Time StudyMAC document
  • LEA Audit File Checklist MAC



Psychological and Counseling Services