School Health Services Program FY 2024-25 Reimbursement Spending Report to CDE

Form Login Account:

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form. Enter numbers only in fields requesting a number, do not type words. Use tab key or mouse to move to next box. Select the categories where your district spent funds, this will populate the forms with the items you need to answer. If no funds were spent on a category, do not select it. No need to enter zeros.

CDE Accessibility Statement

Select your District/BOCES name from the list below: * 🛈

Medicaid Coordinator First Name: *

Medicaid Coordinator Last Name: *

Medicaid Coordinator Email Address: *

Medicaid Coordinator Phone Number: *

Administrative Expenditures

Instructions

Select the administrative category that received reimbursement funds in the section below. If there were no administrative expenses, do not select any category. By selecting an admin category, you will be required to provide the total expenditure amount and a brief narrative of what is included in the total amount.

As a reminder, it is recommended that total administration costs not exceed 20% of total expenditures for a program. This is exempt for new districts/BOCES participating in the School Health Services program. For questions or concerns, contact Tyler Marsh (marsh_t@cde.state.co.us)

For help on this section, visit the Administrative Expenditures section of the CDE School Health Services Learning Tool.

Program Administration Category Expenditures 🛈

FTE/Contracted Personnel	Equipment/Material/Supplies
Professional Development/Trainings	Other Administrative Costs

FTE/Contracted Personnel * 🛈

Description of Expenditures * 🛈

0/200 words

Equipment/Materials/Supplies * 🛈

Description of Expenditures * 🛈

0/200 words

Professional Development/Training * 🛈

Description of Expenditures * 🛈

0/200 words

Other Administrative Costs * 🛈

Description of Expenditures * 🛈

0/200 words

Total Administrative Expenditures:

$0.00

Health Services Expenditures

Instructions

Select the Health Service category that received reimbursement funds in the section below. If there were no Health Service expenses, do not select any category. Selecting a Health Service category will populate only relevant questions that require a response which includes providing a narrative. If you need further assistance, please contact Tyler Marsh (marsh_t@cde.state.co.us)

For help on this section, visit the Health Services Expenditures section of the CDE School Health Services Learning Tool.

Select the Health Service Category(s) in which your district/BOCES spent money:

Nursing

Nursing Category Expenditures * 🛈

FTE/Contracted Personnel Expenditure * 🛈

# of FTE * 🛈

Equipment/Material/Supplies Expenditure * 🛈

Professional Development/Training Expenditure * 🛈

Screenings/Assessments Expenditure * 🛈

Assistance/Emergency Funds Expenditure * 🛈

Total Nursing Expenditure 🛈

$0.00

Please include narratives for each selected subcategory. Copy and paste the following labels for organization:

FTE/Contracted Personnel:

Equipment/Material/Supplies:

Professional Development/Trainings:

Screenings/Assessments:

Assistance/Emergency Funds:

Category-Specific Narrative information
(Enter narrative in the space below. Hover over the question mark for help.) * 🛈

Mental Health

Mental Health Category Expenditures * 🛈

FTE/Contracted Personnel Expenditure * 🛈

# of FTE * 🛈

Equipment/Material/Supplies Expenditure * 🛈

Professional Development/Training Expenditure * 🛈

Screenings/Assessments Expenditure * 🛈

Assistance/Emergency Funds Expenditure * 🛈

Total Mental Health Expenditure 🛈

$0.00

Please include narratives for each selected subcategory. Copy and paste the following labels for organization:

FTE/Contracted Personnel:

Equipment/Material/Supplies:

Professional Development/Trainings:

Screenings/Assessments:

Assistance/Emergency Funds:

Category-Specific Narrative information
(Enter narrative information in the space below. Hover over the question mark for help.) * 🛈

Student Health

Student Health Category Expenditures * 🛈

FTE/Contracted Personnel Expenditure * 🛈

# of FTE * 🛈

Equipment/Material/Supplies Expenditure * 🛈

Professional Development/Training Expenditure * 🛈

Screenings/Assessments Expenditure * 🛈

Assistance/Emergency Funds Expenditure * 🛈

Total Student Health Expenditure 🛈

$0.00

Please include narratives for each selected subcategory. Copy and paste the following labels for organization:

FTE/Contracted Personnel:

Equipment/Material/Supplies:

Professional Development/Trainings:

Screenings/Assessments:

Assistance/Emergency Funds:

Category-Specific Narrative information
(Enter narrative information in the space below. Hover over the question mark for help.) * 🛈

Special Services Provider

Special Services Provider Category Expenditures * 🛈

FTE/Contracted Personnel Expenditure * 🛈

# of FTE * 🛈

Equipment/Material/Supplies Expenditure * 🛈

Professional Development/Training Expenditure * 🛈

Screenings/Assessments Expenditure * 🛈

Assistance/Emergency Funds Expenditure * 🛈

Total Special Service Providers Expenditure 🛈

$0.00

Please include narratives for each selected subcategory. Copy and paste the following labels for organization:

FTE/Contracted Personnel:

Equipment/Material/Supplies:

Professional Development/Trainings:

Screenings/Assessments:

Assistance/Emergency Funds:

Category-Specific Narrative information
(Enter narrative information in the space below. Hover over the question mark for help.) * 🛈

Outreach & Enrollment

Outreach & Enrollment Category Expenditures * 🛈

FTE/Contracted Personnel Expenditure * 🛈

# of FTE * 🛈

Equipment/Material/Supplies Expenditure * 🛈

Professional Development/Training Expenditure * 🛈

Screenings/Assessments Expenditure * 🛈

Assistance/Emergency Funds Expenditure * 🛈

Total Outreach & Enrollment Expenditure 🛈

$0.00

Please include narratives for each selected subcategory. Copy and paste the following labels for organization:

FTE/Contracted Personnel:

Equipment/Material/Supplies:

Professional Development/Trainings:

Screenings/Assessments:

Assistance/Emergency Funds:

Category-Specific Narrative information
(Enter narrative information in the space below. Hover over the question mark for help.) * 🛈

Transportation

Transportation Category Expenditures * 🛈

FTE/Contracted Personnel Expenditure * 🛈

# of FTE * 🛈

Equipment/Material/Supplies Expenditure * 🛈

Professional Development/Training Expenditure * 🛈

Screenings/Assessments Expenditure * 🛈

Assistance/Emergency Funds Expenditure * 🛈

Total Transportation Expenditure 🛈

$0.00

Please include narratives for each selected subcategory. Copy and paste the following labels for organization:

FTE/Contracted Personnel:

Equipment/Material/Supplies:

Professional Development/Trainings:

Screenings/Assessments:

Assistance/Emergency Funds:

Category-Specific Narrative information
(Enter narrative information in the space below. Hover over the question mark for help.) * 🛈

Summary of Expenditures

Total Administrative Expenditures: 🛈

$0.00

Total Health Service Expenditures: 🛈

$0.00

Total Health Service FTE: 🛈

0.00

Total Funds Expenditure for FY 2023-24: 🛈

$0.00

Annual Notifications & Intent to Continue Participation

For help on this section, visit Other RSR Sections in the CDE School Health Services Program Learning Tool.

1. Public agencies (e.g. public school districts) must provide written notification to parents prior to accessing a child's public benefits for the first time, and annually thereafter. Satisfying this requirement may vary by public agency.

The full list of requirements for the annual notification to parents may be found on the U.S. Department of Education website. Please consult your district's legal team concerning questions related to the relevant regulations of the annual notice.

* 🛈

I understand and acknowledge the above information, and annual notifications HAVE been sent to parents/legal guardians for this reporting period.

I understand and acknowledge the above information, but annual notifications HAVE NOT been sent to parents/legal guardians for this reporting period.

2. Does your district intend to continue its participation in the School Health Services program for the next fiscal year (FY 2026-27)?

If the "NO" option is selected, the medicaid coordinator listed on this report will receive a follow-up for confirmation.

* 🛈

YES, our school district DOES intend to continue its participation in the School Health Services program.

NO, our school district DOES NOT intend to continue its participation in the School Health Services program.