2.3 Expenditure Narratives Guidance

Expenditure Narratives Overview

Crafting a comprehensive and clear narrative for the Reimbursement Spending Report (RSR) is crucial for transparency, accountability, and ensuring that Medicaid reimbursement dollars are used effectively. A mnemonic has been developed to help with this process: S.I.P. To remember the mnemonic, keep the following phrase in mind when writing RSR narratives: 

"Before you submit, take a S.I.P.!"

S.I.P. stands for...

Scope: Is the item/service being described covered by Medicaid reimbursement dollars?

• The RSR is solely reporting on Medicaid reimbursement spending by LEAs, therefore narratives in the report should report on only expenditures covered by these dollars.

Identify: Is the item/service identifiable? Is it uniquely searchable?

• Ensure to provide enough details so the item or service is easily identifiable in future reviews. This might involve mentioning the name of a specific program, a unique curriculum, or a specialized position, particularly if these are not universally known. A good check is to provide enough information so that the item or service can be found in a general internet search.

Purpose: Does the item/service satisfy a student health or program administration need?

• Expenditures are permissible if they satisfy a health-related service for students or support program administration. Consequently, report narratives should contain sufficient information to identify the purpose of the item/service.

The next five subcategory sections will provide additional guidance on narratives with examples of narratives that meet the criteria (sufficient) and those that fall short (insufficient).

Subcategory-specific guidance

• Name of Position/Contracted organization
• Be sure to include the position name or classification. If contracting hours with another organization, be sure to include the name of the organization in your narrative. If the position’s credentialed
• Purpose of position or contract
• Be sure to include what administrative or health-related service the contracting personnel is satisfying, if not easily identifiable in the narrative.

Example Narratives with Sufficient Information:

"XYZ school district contracts with Colorado 1st Hospital to have a Licensed Practical Nurse (LPN) at 3 middle schools."

• Narrative: Part-time Nurse (LPN) contracted with Colorado 1st Hospital providing health services at 3 middle schools.
• Reasoning: Sufficient Information. As the reader, we know what type of health service provider was contracted and with whom the LPN is contracted.

"XYZ school district hired 3 school counselors. The 1 school counselor is part-time (.5 FTE), the other two are full-time (2.0 FTE). They provide Mental health services for students in their districts."

• Narrative: Hired 1 part-time (.5 FTE) and 2 full time (2.0 FTE) school counselors, they provide student mental health counseling.
• Reasoning: Sufficient Information. Since they are listed [listed under appendix 2, typically provide health services, this is enough information for this expenditure]. It helps to add what they are primarily doing, since school counselors can also provide academic counseling, which is not an allowable expense.

Example Narratives with Insufficient Information:

"XYZ school district contracts with Jimmy Dean, MD, a local physician who comes into the middle school every Thursday and provides check-ups for the student."

• Narrative: Contract with local health office to provide check-ups for students
• Reasoning: This is insufficient information. The reader is not able to identify what kind of health office or the health service provider that they contract with. 

"XYZ School district contracts with a local mental health organization to supplement their school psychologists FTE."

• Narrative: 1.0 FTE school psychologist contracted with a local organization to provide additional mental health support for students.
• Reasoning: This is insufficient information. When contracting additional FTE from organizations, the organization name should be provided.

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