1.2 Components

Navigating this LSP Component

The cover page identifies the school district, BOCES, or state education institution entering into the contract with the State of Colorado. In this section, the following LEA information is requested: residing county and district #, common name of LEA, and the start/end date of the LSP. The name, phone number, and email of the LEA’s contact for this program is also requested in this section. The person listed on this page will be considered primary contact for the program and will be responsible for submitting documents in a timely manner. 

The Cover Page also holds the due date for the LSP, a link to the CDE School Health Services Program Website, the LSP submission instructions, and the CDE contact information should additional support be needed.

Navigating this LSP Component

Before developing the Program Plan of the LSP, districts must assess the health needs of the local student population. This assessment should identify the health needs of children and youth in the local community. Use the assessment to determine if and how well current services are meeting those needs. Understanding the gaps in service provision allows the district to set priorities when determining which health services to offer with reimbursement dollars.

Although districts are allowed a small measure of flexibility in developing a program plan, the statute requires that the plan be developed with comprehensive input from the local community. To this end, districts must demonstrate the collection and use of input from community members when determining which health services to include in the LSP. The selection of services will not be made based on limitations in a district’s general fund but on the health needs identified and prioritized by the community members. A BOCES must demonstrate the collection and use of input from member district communities.

A. Community Health Needs Assessments

Use the results from the community health needs assessment to provide comprehensive answers for the following questions:

Additional Guidance: Consider detailing the methodology of the needs assessment. Mention the individuals or groups who spearheaded the assessment, the data sources consulted, and any significant contributors who offered insights on local health challenges.

Additional Guidance: Highlight the specific health challenges or requirements of students in your community that emerged from the assessment.

Additional Guidance: Specify the selection criteria for community participants and outline the methods employed to gather their feedback. This could include the number and type of meetings held, online surveys, telephonic conversations, and so on.

Additional Guidance: Enumerate the health needs that were prioritized during this process. Ensure that these needs align with the health services you plan to offer using the reimbursement funds.

Additional Guidance: Describe the approach taken to integrate community feedback into decisions about which health services to prioritize for funding.

Note: Every local community is unique, which means that answers to these questions will also be unique to the local community. For an example of what this could look like, view your current CDE reviewed LSP or contact another LEA participating in the School Health Services Program to view theirs.

B. Uninsured/Underinsured Health Needs Assessment

Additional Guidance: Underinsured is defined in the statute as “a person who has some health insurance, but whose insurance does not adequately cover the types of health services for which a school district may receive federal matching funds under this section” 26-4- 531 (1) (d), C.R.S. Elaborate on the characteristics of the uninsured and underinsured student populations in your district and the methods used to identify them.

Additional Guidance: Detail the approach and methodology used for the targeted needs assessment focusing on uninsured and underinsured students. Mention the main contributors, data sources, and any significant informants who shed light on the health needs of these populations.

Additional Guidance: Highlight the specific health requirements or challenges faced by uninsured and underinsured students as revealed by the assessment process.

C. Community Participation

In the planning process for the Local Services Plan (LSP), community involvement is not only required, it also plays a pivotal role in creating a great LSP. The "Community Participation" section, Part II-C, requests that LEAs document the community participants who contributed to the planning. It's essential to distinguish district employees from other participants, which can be done by marking "Y" under the designated "Dist Emp?" column. For comprehensive feedback, if districts have utilized surveys and amassed responses from numerous community members, they can opt to attach a consolidated list of these names to the LSP, rather than inputting each name individually. This approach underscores the value of community feedback and ensures transparency in the planning process.

Navigating this LSP Component

The Program Plan, outlined in Part III of the Local Services Plan (LSP), provides a comprehensive overview of how an LEA allocates the school Medicaid reimbursement between administrative costs and health services. This section is pivotal as it details the anticipated expenditures, both for program administration and for the health services intended to be offered. The Program Plan ensures that funds are used effectively, with a CDE recommended cap of 20% on administrative costs to ensure the majority of the reimbursement is directed towards health services for students. Within this section, LEAs will find subsections detailing estimated yearly reimbursements, an overview of program expenditures, and a breakdown of health services by category. By completing this section, LEAs can provide a clear roadmap of how they intend to utilize the reimbursement funds to meet the health needs of their students.

Explore each section in this module for more on what information is needed to complete each section of the Program Plan.

This section requires the LEA to enter the common name of the school district, which should match the name entered on the cover page.

Here, the LEA will provide the amount of reimbursement they expect to receive after the State withholds its 2.5% administrative costs. The reimbursements are for the federal share of the cost of IEP, IFSP, or other plans of care health services provided by Medicaid-qualified providers to students enrolled in Medicaid. These reimbursements are made for services delivered on dates within the contract year, which runs from July 1 through June 30.

This section provides a breakdown of how the reimbursement funds will be spent.

LEAs are required to enter the percentage of total expenditures allocated for administrative purposes. This includes anticipated payments to billing agents, costs incurred for administering the School Health Services Program, coordinator and program staff salary/benefits, office supplies, and indirect costs. It's recommended that administrative costs not exceed 20% of the total reimbursement received. Exceptions are made for LEAs new to the program with the approval of the CDE School Health Services Consultant.

LEAs are required to enter the percentage of total expenditures allocated for the purposes of providing health services to their students.

This subsection breaks down expenditures by six main categories and five sub-categories, detailing the health services that will be offered using the reimbursement funds. This is done using a matrix, with main categories as the rows and subcategories as the columns. See the example below, showing three category selections:

In the example above, an LEA has indicated that they intend on spending Medicaid reimbursement dollars on (A) FTEs & Contracted Personnel, (B) Equipment, Materials, & Supplies, and (C) Professional Development & Trainings, in the (1) Nursing category by using an “X” in the appropriate boxes. In the field, this may look like paying a Nurse Practitioner’s salary using Medicaid reimbursement dollars, and making sure they have the necessary equipment and training needed to provide exceptional health services to students. LEAs always have the option of contacting the CDE School Health Services Consultant for any questions concerning how to categorize health services on their LSP.

For definitions and examples of CDE Health Service categories, visit the Health Service Categories module.

Health Services Categories

Local Education Agencies (LEAs) have the option of selecting among six main categories, each with five subcategories, to indicate how reimbursement dollars will be spent. These categories are also present on the Reimbursement Spending Report to CDE, and will be how LEAs categorize how they spent their Medicaid reimbursement dollars in a given fiscal year. Use the table of contents to explore each main category, and the definitions for each subcategory under it. 

For reference, here is a screenshot of a blank Local Services Plan (LSP) Health Service category from a recent (October 2023) LSP template:

(1) Nursing

Expenditures in this category are those relating to the provision of nursing services including direct health services delivered by a licensed nurse or delegated nursing services delivered by a Health Assistant/Clinic Aide or Intensive Health Tech. It also includes assessment tools, training or other professional development, and equipment used to provide or enhance nursing services.

LEAs may hire or contract with a Registered Nurse (RN), Licensed Practical Nurse (LPN), or other nursing professional. FTE/contracted personnel providing delegated nursing services like a Health Assistant/Clinic Aide or Intensive Health Tech fit under this subcategory as well. Costs associated with contracting services for relevant FTE/contracted personnel in the Nursing category are included as well.

Expenditures in this subcategory include all health-related equipment, materials, and supplies directly related to the provision of nursing services to students. Purchases in this category can also be for use by FTE/contracted personnel under the Nursing category. Example purchases can include general office supplies, boxes of gloves or masks, otoscopes, stethoscope, thermometer, or cots for the nursing office.

This subcategory includes professional development and training for FTE/contracted personnel under the Nursing category, including materials or supplies required for that training such as books or computer software. Expenditures under this subcategory can also include travel and other related costs to attend health-related conferences and training related to the Nursing category.

Costs associated with screenings or assessments conducted by FTE/contracted personnel identified in the Nursing category are included in this subcategory. This includes costs related to routine health screenings, immunization assessments, or related software costs if conducted by FTE/contracted personnel under this category. 

Costs under this subcategory serve to help low-income students access basic health-related necessities on a limited basis. In the Nursing category, this can include vouchers or costs related to provision of health-related equipment, visits to external health providers, or urgent health interventions not predicted in advance, particularly if provided by a relevant FTE/contracted personnel under the Nursing category.

(2) Mental Health

Expenditures in this category are those associated with the provision of mental health services to students and can include psychology, social work, counseling, behavior therapy, suicide prevention, anti-bullying programs, or other mental health services. It can also include costs for assessment tools, curriculum, and mental health training for staff to provide tools used to deliver mental health services.

LEAs may hire or contract a psychologist, social worker, counselor, therapist, or other professional providing mental health services to students. This includes contracted hours for additional mental health services for students.

Expenditures in this subcategory include all health-related equipment, materials, and supplies directly related to providing mental health services to students. Purchases in this category can also be for use by FTE/contracted personnel under the Mental Health category. Example purchases include general office supplies, stability balls, sensory swings, weighted blankets, etc.

Expenditures in this subcategory include staff development and training for FTE/contracted personnel in the Mental Health category. It can also include health-oriented material such as books or computer software used for staff development. Costs relating to the travel and attendance of health-related conferences relating to the Mental Health category can also be included. Costs in this category also include purchase of curricula or training materials focused on mental health topics, such as bullying-prevention or suicide-prevention, for training provided to students, staff, or families.

Costs associated with screenings or assessments conducted by FTE/contracted personnel identified in the Mental Health category are included in this subcategory. This includes costs associated with evaluations to identify potential mental health concerns in the student population, including related software costs.  

Costs under this subcategory serve to help low-income students access basic health-related necessities on a limited basis. In the Mental Health category, this can include vouchers or costs related to urgent counseling or therapy services, crisis interventions, or emergency support for students experiencing a crisis.

(3) Student Health

Expenditures in this category are those associated with supporting and promoting the overall health and wellbeing of students that are not captured by the other health service categories. This includes health-related assistive technology, costs associated with health-related case management services, sub-contracted services for dental or physician services or related follow-ups, health education curriculum or instruction for students not categorized in the Mental Health category, or health-oriented feeding programs such as providing breakfast to low-socio economic status (SES) students.

LEAs can hire or contract with a licensed physician, vision specialist, care coordinator, or other professional providing general health services for students not listed in any other health service category. This includes contracted hours for additional health services for students.

Expenditures in this subcategory are those that do not fit under any other health service category and include all health-related equipment, materials, and supplies directly related to providing health services to students. Purchases in this category can also be for use by personnel under the Student Health category. Example purchases include printing costs for health-related educational pamphlets, health-related assistive technology, wheelchairs, and hearing aids. 

Expenditures in this category include purchases of health-related curricula for classroom or group settings. Other purchases may also include staff development and training to deliver curricula (Train the Trainer) for health-related topics directed at students and families. It could also include health-oriented material such as books or computer software used for staff development and training related to the Student Health category. Note: Mental health-related professional development/training, even those directed to students or families, should be placed under the “Mental Health” category.

Costs associated with screenings or assessments conducted by FTE/contracted personnel identified in the Student Health category are included in this subcategory. This can include evaluations conducted to identify or monitor various health conditions among students, including nutritional assessments, physical fitness tests, health surveys, etc.

Costs under this subcategory serve to help low-income students access basic health-related necessities on a limited basis. In the Student Health category, this can include vouchers or costs related to unexpected medical costs, sudden needs for health-related support or materials, or other interventions not predicted in advance.

Special Services Provider

Expenditures in this category include specialized services delivered by an Audiologist, Physical Therapist (PT), Occupational Therapist (OT) or Certified Occupational Therapist Assistant (COTA), Speech-Language Pathologist(SLP), Orientation and Mobility Specialist (OM), or other Special Services Provider not covered in the Nursing or Mental Health Categories. Costs for assessment tools, curriculum, and training for SSP staff to provide specialized services to students are also included in this category.

LEAs can hire or contract with a Speech Language Pathologists (SLPs) or SLP Assistants (SLPAs), Physical Therapists (PTs) or PT Assistants (PTAs), Occupational Therapists (OTs) or Certified OT Assistants (COTAs), Orientation & Mobility Specialists, or Audiologist. This includes contracted hours for services typically provided by FTE in the Special Services Provider category for students.

Expenditures in this subcategory include all health-related equipment, materials, and supplies directly related to providing specialized health services to students. Purchases in this category can also be for use by FTE/contracted personnel under the Special Service Providers category. Some examples may include general office supplies, hand exercisers, adaptive tricycles, walkers, adaptive devices, gait belts, exercise bands, etc.

Expenditures in this subcategory include staff development and training directed to FTE/contracted personnel under the Special Services Provider category. It could also include health-oriented material such as books or computer software used for staff development. Costs associated with attendance at a health-related conference, including travel, are also included in this subcategory.

Costs associated with screenings or assessments conducted by FTE/contracted personnel identified in the Special Services Provider category are included in this subcategory. Examples of expenditures include cognitive, motor skills, or speech and language assessments, or software necessary to conduct related screenings or assessments.

Costs under this subcategory serve to help low-income students access basic health-related necessities on a limited basis. In the Special Services Provider category, this can include vouchers or costs related to sudden requirements for specialized equipment, emergency accommodations, or unplanned costs related to supporting students with special needs.

(5) Outreach & Enrollment

Expenditures in this category include activities related to identifying, contacting, or assisting eligible students and families with enrolling in health coverage through Medicaid or the Children’s Health Insurance Program (CHIP). This includes costs related to referral services, enrollment support, translation services, insurance outreach activities or events, parenting training and services, or other outreach/enrollment services delivered.

LEAs can hire or contract personnel for outreach services, translation services, or other relevant roles that provide outreach & enrollment services for CHIP or Medicaid enrollment or eligibility screening.

Expenditures under this subcategory include all health-related equipment, materials, and supplies directly related to assisting in identifying and enrolling uninsured or under-insured students and families into Medicaid or CHIP. Purchases in this category can also be for use by FTE/contracted personnel under the Outreach & Enrollment category. Example purchases include general office supplies, educational pamphlets, or other material related to outreach and enrollment.

Expenditures in this subcategory include staff development and training directed to FTE/contracted personnel under the Outreach & Enrollment category. It could also include health-oriented materials such as books or computer software used for staff development, or costs relating to community events relating to Medicaid or CHIP education, outreach, or enrollment. Costs associated with attendance at a health-related conference, including travel, are also included in this subcategory.

Costs associated with screenings or assessments conducted by FTE/contracted personnel identified in the Outreach & Enrollment category are included in this subcategory. This includes screening or assessment costs for Medicaid or CHIP eligibility.

Costs under this subcategory serve to help low-income students access basic health-related necessities on a limited basis. In the Outreach & Enrollment category, this can include vouchers or costs related to urgent efforts to enroll or re-enroll students and families, providing immediate and limited health-related financial assistance, or other interventions not predicted in advance. 

(6) Transportation

Expenditures in this category include transportation services that enable students to receive health services. These costs include those associated with specialized vehicles or specialized equipment, personnel operating specialized vehicles or bus aides assisting specialized populations, or transportation-related safety equipment. Expenses can also include health-related training for transportation related FTE/contracted personnel.

LEAs can hire or contract with a Bus Aide, specialized transportation operator, or other relevant role appropriate for the Transportation category. 

Expenditures in this subcategory include all health-related equipment, materials, and supplies directly related to providing health-related transportation services for students. Purchases in this category can also be for use by FTE/contracted personnel under the Transportation category.

Expenditures in this subcategory include staff development and training directed to FTE/contracted personnel under the Transportation category. It also includes training such as Cardiopulmonary Resuscitation (CPR)/First Aid, emergency response techniques, or other health-oriented training relevant to the Transportation category. Costs associated with attendance at a health-related conference, including travel, are also included in this subcategory.

Costs associated with screenings or assessments conducted by FTE/contracted personnel identified in the Transportation category are included in this section. 

Costs under this subcategory serve to help low-income students access basic health-related necessities on a limited basis. In the Transportation category, this can include vouchers or costs related to providing travel to health services in the community.

Navigating this LSP Component

The Goals & Objectives section of the Local Services Plan (LSP) provides a structured framework for LEAs to outline their overarching program goals and the specific objectives that will help achieve these goals. The monitoring plan is needed to ensure stated goals are achieved and monitored. These goals and objectives are rooted in the needs identified during the Community Health Needs Assessment process. Use the example below as an illustration of a single goal:

Table Note: This goal is for illustrative purposes only. LEA goals will vary widely and should be created in consultation with the local community.

Goals: Goals serve as generalized statements that guide the planning process of the LEA. They are broad in nature and address the health needs that were identified during the Community Health Needs Assessment. For instance, a goal might focus on increasing access to specific health services, such as nursing or mental health services.

Objective(s): Objectives are more explicit than goals and provide a clear roadmap on how the outcomes of a goal will be achieved. They describe the specific health services that the LEA will provide using the reimbursement funds and detail the extent of the service. Objectives can be stated as quantifiable units of service (Example: hire 1.5 FTE School Psychologists). For example, an objective might specify the provision of additional nursing staff or the creation of resources for district staff and families.

Monitoring Plan: The Monitoring Plan outlines the LEA's strategy to document the delivery of the services described in the objectives. This plan is crucial as it demonstrates the performance of the contract. The data collected as part of this plan will be reported in the Reimbursement Spending Report for each school year. The Monitoring Plan should clearly state what data will be collected and the method of collection. For instance, for services like nursing, the number of FTEs delivering services might be tracked and reported.

Navigating this LSP Component

The Assurances Page is a critical component of the Local Services Plan (LSP). It serves as a formal acknowledgment and commitment by the LEA to adhere to the guidelines and requirements set forth by the Colorado Department of Education (CDE) and the Department of Health Care Policy and Financing (HCPF). By signing the Assurances Page, the LEA confirms that they have accurately represented their intentions and will utilize the school Medicaid reimbursement funds in accordance with the outlined plan.

It is essential for LEAs to thoroughly read and understand the assurances before signing. The signed Assurances Page should be submitted to the School Health Services Consultant at CDE. LEAs have the option to submit the LSP electronically, either by scanning and emailing the signed Assurances Page or using electronic document signing capabilities.

The School District Medicaid Coordinator is authorized to sign the Local Services Plan, agreeing to the conditions listed on the form. This person will be identified in your contract as the contact person for the program and will be responsible for ensuring that program funds are spent correctly.

For the latest version of the Part V Assurances Page, visit the CDE School Health Services website.