1 Michelle K. to open up presentation PPLs...September / October 2014 1 Michelle K. to open up...

$Page 1: 1 Michelle K. to open up presentation PPLs...September / October 2014 1 Michelle K. to open up presentation September / October 2014 2 MK to introduce each staff at conference \ 猀琀愀昀昀$
Presented by: Department of Health Care Services Safety Net Financing Division Audits and Investigations Division Targeted Case Management Units

1 September / October 2014

Presenter

Presentation Notes

Michelle K. to open up presentation


Presenter

Presentation Notes

MK to introduce each staff at conference (staff will wave to audience) TCM Program side: Sara Schmid Candace Banks Tara Shuster (new AISA) Aaron Singh Jesse Gailbrath (?) A&I TCM side: Haisong Peng Mony Sor Michelle give mic to Sara for next slide

Housekeeping

Housekeeping Formatting of the Presentation

Questions (If time allows…)

Write questions on the provided note cards Place filled out note cards in the box on registration table during the day


Presenter

Presentation Notes

SARA: Housekeeping * Bathrooms * Breaks 10:45 & 3:00 (15 minutes) * Lunch 12:00-1:00 TARA: Formatting: On your agendas, there have been a few changes to the schedule. For instance, Worksheet C will be presented prior to Worksheet B, and Worksheet F will be presented prior to Worksheet D. Each presenter will present their portion of the Cost Report template. Along with their presentation, we will have a Scenario. When you hear the word “scenario”, please keep in mind that it is referring to a Sample County with sample data. THIS IS JUST A SAMPLE. Once each Worksheet has been presented, an exercise corresponding to that Worksheet will be presented. A majority of these exercises should be considered “comprehension” exercises or questions. Questions: You can see that we have that little parens there that says “If time allows”. We want make a disclaimer: we are presenting a completely new Cost Report Template and we have packed a lot of material here for you guys in just 2 days. While we have time planned for questions, it is possible that the schedule may shift around. On your tables we have placed multiple note cards. Write down your questions on these note cards and during breaks and lunch, submit you note cards to either the box in the registration area or up here. So, should we reach a point in the presentation where we can answer questions, please note that questions with a simple answer will be answered. Questions that are not as simple will be answered at a later time. Also, while we have quite a few auditors here, they are not available for questions. Now that the housekeeping has been swept over, I hand the mic off to Haisong Peng.

•

New Cost Report Changes

Consolidation - Report Costs for all Service Providers in a Single Cost Report per an LGA.

• Recognition - Proper Revenue and Expense Matching.

Reconciliation - Include a Reconciliation Procedure Required by SPA #10-010.

•

• Simplification – Linked Worksheets.

September / October 2014 4

Presenter

Presentation Notes

Haisong

Consolidation: Old Cost Report Format


Presenter

Presentation Notes

Haisong

Consolidation: New Cost Report Format


Presenter

Presentation Notes

Haisong

Recognition Old Cost Report Format New Cost Report Format


Presenter

Presentation Notes

Haisong

Reconciliation

TCM SPA # 10-010

• LGAs will be reimbursed for their allowable cost incurred for providing TCM services rendered to target populations.

• Interim payments will be reconciled to reimbursable cost through a reconciliation process.


Presenter

Presentation Notes

Haisong

Simplification Old Cost Report Format CBO was required to file CBO cost report.

TCM Expenses were allocated based on individual Time Survey.

LGAs were required to transfer data manually from unlinked schedules, such as funding schedule and allowable funding schedule.

New Cost Report Format CBO is not required to file an individual cost report. Funding payment to a CBO is required.

TCM Expenses are allocated based on Averaged Time Survey.

•

•

•

•

•

• All data will flow through correctly between tabs in one master workbook (enter data only in the purple cells). 9 September / October 2014

Presenter

Presentation Notes

Haisong

New Cost Report Components I. Information Worksheet

II. TCM Program Cost for Services Provided by the Governmental Entities

Worksheet A – Salaries, Benefits, and Other Expenses Worksheet A-1 – Provider’s Reclassifications Worksheet A-2 – Provider’s Adjustments Worksheet B - Cost Allocations

Worksheet C – Time Survey PTO Redistribution


Presenter

Presentation Notes

Haisong

New Cost Report Components (cont.) III.TCM Program Costs for Services Provided by the

Non-Governmental Subcontractors Worksheet E – Contributing Public Agency

Payments to Non-Governmental Subcontractors for the Provisions of TCM Services.

Worksheet E-1 – Non-Government Subcontractors Funding Adjustments.


New Cost Report Components (cont.)

IV.Allowable Funding / Revenues Eligible for FFP Worksheet D – CPE Funding to the Governmental

entities in providing TCM services. Worksheet D-1 – Funding Adjustments to the

Governmental Entities. Worksheet E – CPE Funding to the Non-

Government Subcontractors for the Provisions of TCM Services.

Worksheet E-1 – Non-Government Subcontractors Funding Adjustments.


Presenter

Presentation Notes

Haisong

New Cost Report Components (cont.)

V. Summary of Encounters Worksheet F – Summary of TCM Encounters

VI.Summary of Program Rate, Reimbursable Cost, Reconciliation of Interim Payment, and New Interim Medi-Cal TCM Encounter Payment Rate (IMTEPR) Worksheet G – Summary


Presenter

Presentation Notes

Haisong


Presenter

Presentation Notes

Haisong introduces Patrick for Information Worksheet

Part I - Provider Cost Report Certification

Part II – Provider Identification


Presenter

Presentation Notes

Patrick

Information Worksheet: Part I- Provider Cost Report Certification

Reporting Period: • The year the

services were provided.

• NOT the year the cost report is filed.


Presenter

Presentation Notes

Patrick

Information Worksheet Part II – Provider Identification Input

Developing a Budget Unit For all intents and purposes, a Budget Unit is the

equivalent to a cost center.

The Medicare Provider Reimbursement Manual (CMS 15-1, 2302.8) defines a Cost Center as, “An organizational unit, generally a department or its subunit, having a common functional purpose for which direct and indirect costs are accumulated, allocated and apportioned”.

Your allocated external and internal indirect costs should appear in your TCM budget unit’s general ledger. 17 September / October 2014

Presenter

Presentation Notes

Patrick

Information Worksheet: Part II - Provider Identification Input

Developing a Budget Unit (cont.)

A TCM Budget Unit is defined as the organizational unit identifiable within an the LGA organization chart and general ledger that provides TCM and other non-TCM services by staff within this unit.

A TCM Budget Unit should include 100% labor costs of all staff within this unit as well as non-labor costs incurred for providing all services for which this unit is responsible.


Information Worksheet Part II – Provider Identification Input

19

Enter the following data on the appropriate lines and columns identified by the purple cells.

• LGA Name • Reporting Period (ex. July 1, 2011 through

June 30, 2012) • LGA and/or Local Governmental

Subcontractor (if applicable) • Name of Private Non-governmental TCM

Subcontractor (if applicable) • Number of Non-governmental Entities

(if applicable) September / October 2014

Presenter

Presentation Notes

Patrick


Presenter

Presentation Notes

Patrick


Presenter

Presentation Notes

Patrick introduces Mony for Worksheet A

Total Expenses per Governmental Entity – Salaries, Benefits, and

Other Expenses


Presenter

Presentation Notes

Mony

Worksheet A Total Expenses per Governmental Entity –

Salaries, Benefits, and Other Expenses

Purpose: Worksheet A provides for recording the trail balance of expense accounts from your accounting books and records for a defined TCM budget unit. It also provides for the necessary reclassifications and adjustments to certain expenses for the provisions of TCM services.


Presenter

Presentation Notes

Mony



Line Descriptions: TCM Line - For labor and non-labor costs related to the provision of TCM services. Non-TCM Line - For labor and non-labor costs NOT related to the provision of TCM services.


Presenter

Presentation Notes

Mony Each define budget unit cost is broken down into four cost categories on W/S A: TCM, Non-TCM, General and Amin and Indirect cost. TCM Line – Labor and Non-labor costs related to TCM Non-TCM - Labor and Non-labor costs not related to TCM TCM and Non-TCM are direct costs.


Salaries, Benefits, and Other Expenses Line descriptions (cont.)

General & Admin Line - Represents the cost of activities that are necessary and supports the overall operation of the TCM services as a whole within the defined budget unit. Indirect Line - Represents any cost that cannot be directly identified with a single cost objective.


Presenter

Presentation Notes

Mony General and Admin - are costs generated by activities that are necessary and supports the overall operations of a business unit that provide TCM services. Indirect – Cost that is not directly identifiable to any cost objective. General & Admin and Indirect cost are indirect costs that are subject to cost allocations


Salaries, Benefits, and Other Expenses Indirect Cost vs. Direct Cost:

• The direct assignment of costs must be made as part of the county’s accounting system with costs recorded in the ongoing normal accounting process (Medicare Provider Reimbursement Manual 15-1, 2307).

• This means that costs are to be recorded on a regular basis throughout the accounting period, not only as period ending adjusting entries.

INDIRECT COST + DIRECT COST = FULL COST


Presenter

Presentation Notes

Patrick’s slide…. Mony?



Column descriptions: • Salaries and Benefits • Other • Other Expense by Employee • Other Expense by Program • TCM Expense outside the budget unit


Presenter

Presentation Notes

Mony W/S A Columns are categorized by Salaries, Benefits, Other, Other Expense by Employee, Other Expense by Program and TCM Expense Outside the Budget Unit. (show W/S A electronic file). Salaries and Benefits – Columns 1 and 2 are used to report salaries and benefits expenses recorded in the general ledger of the defined budget unit. Other – Column 3 - This column is used to report non-labor expenses recorded in the general ledger of the defined budget unit. Other Expense by Employee - Columns 6, 11, and 17 are used to report some non-labor expenses that can be directly assigned by employee. No input on worksheet A. Other Expense by Program - Columns 7, 12 and 18 are used to report some Other costs that can be directly identified as 100% TCM program costs, 100% Non TCM program costs, or 100% General & Admin costs. No input required on Worksheet A. TCM Expense outside the budget unit - Columns 13 and 19 are used to report expenses outside the budget unit. These costs will be covered in Worksheet A-2.



Input Instructions : 1. Columns 1, 2, and 3 – Enter Salaries, Benefits, and

Other costs from an LGA’s general ledger and records for the identified budget units.

2. Column 4 – This column is the total of columns 1, 2 and 3. Cells are formula-driven.

3. Columns 5 through 21 – Cells are formula-driven.


Presenter

Presentation Notes

Mony briefly explain col 5-21 Columns 1, 2, and 3 – The costs to be put in these columns are from an LGA’s general ledger and records for the identified budget units. Expenses subtotaled in Line 5, Column 1 equals to the total salaries recorded in the general ledger of Budget Unit 1. Expenses subtotaled in Line 5, Column 2 equals to the total benefits recorded in the general ledger of this budget unit. Expense subtotaled in Line 5, Column 3 equals to the total non-labor expenses in the general ledger of this budget unit. Column 4 – This column is the total of columns 1, 2 and 3. Cells are formula-driven. Expenses subtotaled in Line 5, Column 4 equals to the total expenses recorded in the general ledger of Budget Unit 1.



Total Cost on Worksheet A, Column 4, Line 5 should reconcile to total expenses recorded in the general ledger of the TCM Budget Unit.


Presenter

Presentation Notes

Mony The budget unit’s Salaries and Benefits needs to be broken down into TCM staff, Non TCM staff or General & Admin staff. TCM Staff - These are staff who time-survey to TCM. They are TCM case managers, their direct supervisors, and their direct support staff. Non TCM Staff – These are staff, within the budget unit that provides TCM services, who neither provided nor supported the provision of TCM services. These staffs did not time survey and were present during the time survey period. Examples - staff that provide direct medical care, transportation, pharmacy, MAA, and other services that are not TCM. ADMIN Staff – These are managerial and administrative staff that supports the management, personnel, and budget needs of the TCM budget unit. Their costs are part of the budget unit.


Presenter

Presentation Notes

Let’s go back to the Scenario for Worksheet A and see how Worksheet A is filled out. Break for lunch when above is completed.

Provider’s Reclassification


Presenter

Presentation Notes

Mony

Worksheet A-1

Provider’s Reclassifications

Purpose:

The purpose of Worksheet A-1 is for the reclassification of certain costs for proper allocations under cost findings.


Presenter

Presentation Notes

Mony The purpose of W/S A-1 is to reclassify to comply with certain costs to affect proper allocation under cost finding.

Worksheet A-1 Provider’s Reclassifications

Types of Reclassifications:

Reclassification of Other Expenses by Employee Reclassification of Other Expenses By Program

Direct Costing. Reclassification of Indirect Line Cost to

General and Admin Line for Proper Cost Allocation Basis.


Presenter

Presentation Notes

Mony Reclassification of Other Expenses by Employee - If incurred cost can be directly assigned to an employee, the cost should go to the line under which employee belongs under “Other by Employee” Column Reclassification of Other Expenses By Program - If incurred cost can be directly assigned to a program, Other costs may be identified as 100-percent TCM program cost or 100-percent Non TCM program cost that will not be further redistributed needs to be reclassified to the proper cost category. Reclassification for proper cost allocation- Costs that remain on the Indirect Line are subject to applying Direct Labor Cost of a Budget Unit (Worksheet A, Column 16) as an allocation basis to allocate the direct cost.


Input Instructions:

1) Select a Budget Unit to input a reclassification.

2) Select the Cost Center under the Column 1 “Drop Down” menu which needs reclassification.

3) Choose the appropriate Column (2, 3, 4, 5, and/or 6) and input data from which the cost needs to be reclassified (negative amount).


Presenter

Presentation Notes

Mony Input Instruction for W/S A-1 : 1. Select the appropriate BU that needs reclassification. 2. Select the cost center that needs reclassification using the dropdown list. 3. Select the appropriate column (Salaries, Benefits, Other Expense by Employee, Other Expense by Program or Other (1, 2, 3, 4 or 5) and enter the amount to be reclassified to and follow the same instruction for amounts to be reclassified from. Please provide explanation for reclassification on column 8. Repeat as necessary The reclassification flows to W/S A in the appropriate line and column. Make sure the Worksheet A-1 reclassifications match with Worksheet A column 5 through 8. Worksheet A, column 9, reclassification subtotal should be ALWAYS equal to $0.


Worksheet A-1 Input Instruction (cont.):

4) Choose the appropriate Column (2, 3, 4, 5, and/or 6) and input data to which the cost needs to be reclassified (positive amount).

5) Enter the explanation of reclassification in Column 8.

Subtotal should always equal to zero.


Presenter

Presentation Notes

Mony


Presenter

Presentation Notes

Mony

Provider’s Adjustment


Presenter

Presentation Notes

Mony

Worksheet A-2

Provider’s Adjustments Purpose:

The purpose of Worksheet A-2 is for the LGA to enter expense adjustments to reflect actual costs in providing TCM services.

• The LGA is responsible for properly recording allowable and non-allowable cost in the TCM Cost Report.


Presenter

Presentation Notes

Mony An adjustment is defined as a transaction which must be made to adjust expenses or offset revenue from the book to comply with Medi-Cal reimbursement guidelines. When adjustments are necessary: 1) Those needed to adjust expenses to reflect actual expense incurred. 2) Those items which constitute recovery of expense through sales, charges, fees, etc. 3) Those items needed to adjust expenses in accordance with the Medicare principles of reimbursement regarding non allowable expenses 4) Those items which are provided separately in the cost apportionment process, such as to include TCM program cost from outside the budget unit.

Worksheet A-2 Provider’s Adjustments

Examples for Common Adjustments:

Adjustment for Eliminating LGA Funding Payment to TCM Subcontractors:

To avoid the duplication of cost recognition, funding payments to LGA subcontractors for the provision of TCM services that were recorded as expenses in an LGA TCM BU’s general ledger need to be adjusted in this worksheet.


Presenter

Presentation Notes

Mony, see instruction on pg. 22 Direct TCM Cost outside of the Budget Unit can be added to TCM Cost Report only if: 1. The TCM services were provided by a non-TCM Budget Unit within a governmental entity 2. The cost incurred by the non-TCM Budget Unit was not included in the total TCM Budget Unit’s general ledger 3. The cost incurred by a non-governmental TCM subcontractor cannot be included under this cost category. A governmental entity that reports TCM expenses outside the budget unit in the Cost Report must also meet the following conditions: 1. The expenses were incurred by the qualified TCM staff 2. Staff outside a TCM budget unit who performed the TCM services during the year would be required to conduct a perpetual Time Survey 3. allowable TCM expense outside the budget unit consists of labor costs and direct chargeable non-labor costs incurred by the qualified TCM Staff outside the TCM budget unit in providing TCM services. Please note: Backup documentation is kept in the audit file Breakdown of Total Salaries Expense into TCM, Non-TCM, and G&A cost lines is available upon request .


Examples for Common Adjustments (cont.):

Adjustment to include TCM program cost outside the TCM budget unit: • Contain 100% TCM program costs, including

labor and non-labor costs. • Three Criteria. • Three Conditions.


Presenter

Presentation Notes

Mony Per 1995 MAC Agreement with CMS, costs outside the TCM reporting budget unit can be added to the Cost Report to properly reflect the actual cost in providing TCM services should only contain 100% TCM program costs, including labor and non-labor costs. Must meet 3 criteria 1 - The TCM services were provided by a non-TCM Budget Unit within a governmental entity. The non-TCM Budget Unit and the TCM Budget Unit can be identified in the same governmental entity’s organizational chart. 2. Costs incurred by the non-TCM Budget Unit were not included in total TCM Budget Unit’s general ledger. 3. Costs incurred by a non-governmental TCM subcontractor cannot be included under this cost category. Must also meet 3 the conditions 1. The expenses were incurred by the qualified TCM staff, such as a direct TCM Case Manager, TCM Supporting Staff, and a direct TCM supervisor 2. the staff outside of a TCM budget unit who performed the TCM services during the year would be required to conduct a perpetual Time Survey following CMS approved CMAA/TCM time survey methodology, 3. the allowable TCM expense outside of the budget unit consists of labor cost and direct chargeable non-labor cost incurred by the qualified TCM Staff outside the TCM budget unit in providing TCM services


Three Criteria must be met: 1. The TCM services were provided by a non-TCM

Budget Unit within a governmental entity. The non-TCM Budget Unit and the TCM Budget Unit can be identified in the same governmental entity’s organizational chart.

2. Costs incurred by the non-TCM Budget Unit were not included in total TCM Budget Unit’s general ledger.

3. Costs incurred by a non-governmental TCM subcontractor cannot be included under this cost category.


Presenter

Presentation Notes

Mony


Three Conditions must be met: 1. The expenses were incurred by the qualified TCM staff,

such as a direct TCM Case Manager, TCM Supporting Staff, and a direct TCM supervisor.

2. The staff outside of a TCM budget unit who performed the TCM services during the year would be required to conduct a perpetual Time Survey following CMS approved CMAA/TCM Time Survey Methodology.

3. The allowable TCM expense outside of the budget unit consists of labor cost and direct chargeable non-labor cost incurred by the qualified TCM Staff outside the TCM budget unit in providing TCM services.


Presenter

Presentation Notes

Mony


Examples for Common Adjustments (cont.):

Adjustments of non-allowable expense:

• Cost not allowed per the OMB Circular A-87 and other federal and state requirements.


Presenter

Presentation Notes

Mony Examples of non-allowable expense: 1) Cost of Alcoholic Beverages 2) Donations to Local Charities 3) Tickets to Sports Events 4) Golf Club Membership Fees 5) Lobbying Expense

Worksheet A-2 Provider’s Adjustment

Input Instructions: 1) Analyze expenses recorded in the general ledger

and determine which expense needs to be adjusted.

2) Select a Budget Unit needing adjustment in Column 1.

3) Select the Cost Center under the Column 1 “Drop Down” menu which needs adjustment.


Presenter

Presentation Notes

Go to excel file of the cost repot and open W/S A-2. Demonstrate above by pointing to the correct location

Worksheet A-2 Provider’s Adjustment

Input Instructions (cont.)

4) Choose the appropriate Column (2, 3, 4, 5, 6, and/or 7) and input data to make the adjustment.

5) Enter a minus sign in front of an amount to make a Cost Reduction.

6) Provide an explanation for the adjustment in Column 9.


Presenter

Presentation Notes

Mony


Presenter

Presentation Notes

Mony Break

Worksheet A, A-1, A-2 The Relationship of Worksheet A, A-1, and A-2


Presenter

Presentation Notes

Mony The purpose of Worksheet A is for a governmental entity to capture and report incurred cost in providing TCM services. These costs are from the provider’s trial balance of accounts, accounting book and other record for the define budget unit as indicated by the flow chart. Worksheet A also allows for reclassifications and adjustments of certain expenses. Reclassifications and adjustments are not input on W/S A; it flows from W/S A-1 and A-2. *I would like to also emphasize that Non-governmental subcontractors costs are not reported on W/S A, A-1, or A2. Will discuss shortly. Mony give presentation to Patrick to present Worksheet A, A-1, & A-2 exercises.


Presenter

Presentation Notes

Mony Patrick presents the exercises for Worksheet A, A-1, & A-2

PTO Redistribution per Time Survey


Worksheet C PTO Redistribution per Time Survey

Purpose: To redistribute PTO percentage to TCM, Non-TCM, and General & Admin.


Presenter

Presentation Notes

This worksheet is used on W/S B, Part II for TCM Expense Subject to Time Survey Allocation. (TCM, Non-TCM, and General and Admin is subject to Time Survey allocation.)

Worksheet C

PTO Redistribution per Time Survey

Input Instructions:

1) Enter data only in column 1 for each budget unit per CMAA/TCM time survey result for the reporting period.


Presenter

Presentation Notes

Column 2 and 3 requires no input. The result in column 3 will flow to W/S B, Part II.



Presenter

Presentation Notes

Mony

Cost Allocations


Presenter

Presentation Notes

Mony

Worksheet B Cost Allocations

Purpose:

Worksheet B is for allocating budget unit costs to TCM and Non-TCM cost categories. This is done in a 3 part allocation process using 4 schedules from Worksheet B.

Worksheet B is auto-populated. No input necessary.


Presenter

Presentation Notes

Mony


Part I Indirect Cost Allocation – Based on Direct Labor Costs among TCM, Non-TCM & General and Administrative


Presenter

Presentation Notes

Mony No input necessary on W/S B. The cells auto populate.

Worksheet B Part I

The allocation basis is the labor costs

by line descriptions from WKST A, Column

16


Presenter

Presentation Notes

Mony

Worksheet B: Cost Allocations Part I

Indirect Cost Allocation – Based on Direct Labor Costs among TCM, Non-TCM & General and Administrative

Part II

Time Survey Allocation – Based on Time Survey Results


Presenter

Presentation Notes


Worksheet B Part II This percentage

carries over from WKST C, PTO Redistribution column.


Presenter

Presentation Notes

Mony Time survey results PTO Redistribution percentage from W/S C flows to W/S B, Column 11. Column 10 identifies TCM Expense Subject to Time Survey Allocation.



Part II


Part III General & Administration Allocation – Based on direct program

Cost (TCM vs Non-TCM costs)


Presenter

Presentation Notes


Worksheet B Part III

Allocation basis is the total direct program cost.


Presenter

Presentation Notes

Mony Column 19 identifies G & A Cost Subject to Allocation using the percentage calculated on column 18.



Part II


Part III General & Administration Allocation – Based on direct program

Costs (TCM vs. Non-TCM costs)

Part IV TCM Program Costs for TCM Services Provided by Governmental

Entity 62 September / October 2014

Presenter

Presentation Notes


Worksheet B Part IV

Total Net Expenses, WKST B, Column 26, should ALWAYS reconcile to WKST A, Column 21, Total Net Expenses.

NO VARIANCES September / October 2014 63

Presenter

Presentation Notes

Mony After all allocations of indirect costs, Worksheet B, Total Net Expense on Line 26 for each budget unit should always reconcile to reconcile to Worksheet A, column 21, Total Net Expenses for each TCM budget unit without any variance.


Net Reported Expenses

Prior to Cost Allocations

(W/S A, Column 21)

Indirect Cost Allocation (W/S

B, Part I)

Time Survey Allocation (W/S

B, Part II)

Overhead Allocation (W/S

B, Part III)

TCM

Non-TCM

(W/S B, Column 26)


Presenter

Presentation Notes

Mony The purpose of Worksheet B is for allocating budget unit costs to TCM and Non TCM cost categories. This allocation involve three parts on W/S B. Par I, Part II and Part III as demonstrated by the flow chart.


Presenter

Presentation Notes

Mony hands out to Patrick.


Presenter

Presentation Notes

Patrick hands out to Program.

If time permits… September / October 2014 67

Presenter

Presentation Notes

Tara and Sara

Presented by: Department of Health Care Services

• Safety Net Financing Division • Targeted Case Management Unit

• Audits and Investigations Division • Targeted Case Management Audit Unit


Presenter

Presentation Notes

Michelle K. to open up presentation


Presenter

Presentation Notes

Tara and Sara Reminder from yesterday: Questions…only if time allows.

Summary of Encounters (LGA & Subcontractors)


Worksheet F Summary of Encounters (LGA and

Subcontractors)

Purpose:

Worksheet F is used to summarize the total TCM encounters that will be used to determine the cost per encounter on Worksheet G.


Presenter

Presentation Notes

Tara


Subcontractors) Encounter Definition:

An encounter is defined as a face-to-face contact, or a telephone contact, with the beneficiary for the purpose of rendering one or more TCM service components by a TCM case manager. A telephone contact may be reimbursed in lieu of a face-to-face contact only when TCM services are provided and when hazardous travel conditions preclude a face-to-face encounter. September / October 2014 72

Presenter

Presentation Notes

Tara See TCM Service SPAs for further information.

Worksheet F Summary of Encounters (LGA and Subcontractors)

TCM Encounters

TCM encounters must be identified on Encounter Logs and must classified into 3 categories: 1. Claimable TCM Medi-Cal Only Encounters:

Encounters include all TCM Medi-Cal encounters with a claimable status.

2. Non-claimable TCM Medi-Cal Only Encounters: Encounters consist of TCM Medi-Cal encounters that are

not reimbursable through TCM program. For example: a TCM Medi-Cal encounter is reimbursed

through 1915(C) Waiver which is not reimbursable due to duplication of services.

Include this encounter in the TCM encounter log.


Presenter

Presentation Notes

Tara NOTE: 3 Encounter Categories ARE: Claimable TCM Medi-Cal Only Encounters: Encounters include all TCM Medi-Cal encounters with a claimable status. 2. Non-claimable TCM Medi-Cal Only Encounters: Encounters consist of TCM Medi-Cal encounters that are not reimbursable through TCM program. For example: a TCM Medi-Cal encounter is reimbursed through 1915(C) Waiver. Make sure include this encounter in the TCM encounter log. 3. TCM Non-Medi-Cal Encounters: Encounters received a non-eligible status due to Medi-Cal ineligibility. See AID codes for more information.


Subcontractors)

TCM Encounters (cont.)

3. TCM Non-Medi-Cal Encounters:

Encounters received a non-eligible status due to Medi-Cal ineligibility.

All TCM encounters classified above SHALL be

included in the TCM encounter log.


Worksheet F Part I – TCM Encounter Summary

TCM Services Provided by Governmental Entity

TCM service provider is required to continuously maintain and update encounter logs on an ongoing basis for each business day.

Using the encounter log(s), tally the TCM total

number of encounters by each reported budget unit and classify among the 3 Encounter Categories.


Presenter

Presentation Notes

All TCM encounters classified above SHALL be included in the TCM encounter log. All 3 encounter categories.

Worksheet F Part I – TCM Encounter Summary

TCM Services Provided by Non-Governmental Subcontractor(s) of an LGA

If the TCM services were provided by a contractor of an LGA, summarize the TCM encounters in the 3 Encounter Categories and enter the types of encounters by each contractor in the Contractor’s Section of Worksheet F, Part I.


Presenter

Presentation Notes

Tara Regardless of reimbursable or non-reimbursable of an encounter, all TCM encounters SHALL be maintained in the encounter log.


Subcontractors) Input Instructions for Worksheet F Part I

1) Input number of encounters in columns 1, 2, and 4 in Part I per each TCM service provider (purple cells).

2) Using the encounter log(s), tally and classify the TCM total number of encounters by each reported budget unit among the 3 encounter categories shown by the three red arrows.


Presenter

Presentation Notes

Tara

Worksheet F Part II - Summary of Claimable Medi-Cal TCM

Encounter

Purpose:

Part II of Worksheet F is used to classify the total claimable Medi-Cal TCM encounters into different FMAP categories during a cost report period. • If more than 1 FMAP rate is available during the

period, FFP is calculated by applying different FMAPs.


Presenter

Presentation Notes

Sara Note: Once the input is done on Part II, the total claimable Medi-Cal TCM encounters should equal to Part I, Column 1, Line 19, Total Claimable.

Worksheet F Part II - Summary of Claimable Medi-Cal

TCM Encounter

Maintaining the TCM Encounter Log to Substantiate the Provided TCM Services

A TCM service provider needs to maintain a TCM encounter log to capture all TCM encounter related services that were provided during the service period.


Presenter

Presentation Notes

Sara LGA and its subcontractor are required to maintain an up-to-date TCM encounter log to support the provided services. The TCM encounter log helps to determine the actual rate in providing TCM services, as well support the LGA in claiming FFP.

Worksheet F Part II - Summary of Claimable Medi-Cal

TCM Encounter LGA TCM billing staff shall ensure:

1) All claimable encounters entered into TCM System should agree with the records in the TCM encounter log.

2) The TCM encounter log must be updated with any changes from TCM System.

3) TCM payment received from the State should be reconciled to the Invoice submitted.

4) LGA must update the TCM System for paid encounters once payment is received.


Presenter

Presentation Notes

Sara Sara please call vivian on bullet 4. Note: For better results for when a payment has been received from the state: go into the TCM System payment has been received for invoices and mark the encounter with a “paid” status in the TCM System. This status will show DHCS that Federal Reimbursement for the encounters have been received by the LGA. It is the responsibility of the LGA to change the status in the System


Subcontractors) Input for Worksheet F, Part II: 1. Input different FMAP rate on Columns 1-4 of Part

II.

2. Make sure Part II, Column 5, Line 2, equals to Part I, Column 1, Line 19.

Note: Input number of claimable TCM Medi-Cal encounters under each FMAP rate.


Presenter

Presentation Notes

Sara


Presenter

Presentation Notes

Sara

Certified Public Expenditure (CPE) to Governmental Entity for

the Provisions of TCM Services


Worksheet D CPE to Governmental Entity for the Provisions of

TCM Services

Purpose:

This worksheet is ONLY used by governmental entities, such as an LGA and/or Local Public Entity (LPE).

This worksheet determines if the funding is Certified Public Expenditure (CPE) eligible for the provision of TCM services for Federal Financial Participation (FFP) match, as required by 42 CFR Section 433.51, W&I code 14132.44(f), and 22 CCR Section 51535.7.


Presenter

Presentation Notes

Replaced three schedules in old template. Matching principle – expense with funding revenue for a TCM BU. Utilize year-end adjusted WTB.

Worksheet D CPE to Governmental Entity for the Provisions

of TCM Services Required Information and Supporting Documentation for this Worksheet (but is not limited to): Year-end adjusted Working Trial Balance (WTB) for

a TCM Budget Unit.

Documents that can help to determine the nature of each funding/revenue the Budget Unit utilized in providing the services.


Presenter

Presentation Notes

Matching principle – expense with funding revenue for a TCM BU. Utilize year-end adjusted WTB.


TCM Services

Columns to be Discussed: Columns 1 & 2 - Funding Name and

Contributing Agency Column 4 - Total Funding Column 5 - Funding Restricted to Non-TCM Column 7 - Percentage of Funding Allocation to

TCM

Column 10 - Net Public Funding to TCM



TCM Services Column Descriptions

Columns 1 & 2 - Funding Name and Contributing Agency

Follow Budget Unit General Ledger Record. Briefly List the Contributing Agency in Column 2.

Column 4 - Total Funding

Total Funding Should equal to General Ledger with no variances.


Presenter

Presentation Notes

Haisong

Worksheet D CPE to Governmental Entity for the

Provisions of TCM Services

Column Descriptions (cont.)

Column 5 - Funding Restricted to Non-TCM Identify the Funding Restriction through

Supporting Documents.

Column 7 - Percentage of Funding Allocation to TCM

Establish a Proper Allocation Basis. Introduce Direct Program Cost Allocation Basis – Cost Report Instruction has an Illustration.


Worksheet D CPE to Governmental Entity for the Provisions of TCM

Services

Column Descriptions (cont.)

Column 10 - Net Public Funding to TCM

Represents CPE for the Provision of TCM Services. CPE Supported Medi-Cal Portion of the Services eligible for FFP.


Presenter

Presentation Notes

Haisong

Worksheet D CPE to Governmental Entity for the Provisions of TCM

Services

Input Instructions

1) Only input data in columns 1, 2, 3, 4, 5 &7 2) AFTER Adjustment is Completed in

Worksheet D-1, click “Update” button on this Worksheet

3) Keep supporting documentation in audit files


Presenter

Presentation Notes

The rest of the Columns are auto-populated.


Funding Adjustments to Governmental Entity


Worksheet D-1 Funding Adjustments to Governmental Entity

Purpose:

This worksheet is designed to allow the reduction /increase of funding revenue for a TCM Budget Unit for CPE determination

Examples for Common Adjustments

Eliminate funding that does not meet CPE requirements. Include funding source which supports direct TCM expense outside the Budget Unit.



Funding Source which Supports Direct TCM Expense outside the TCM Budget Unit

Three Criteria and three Conditions to add direct TCM expense outside TCM Budget Unit onto Cost Report (please refer to Worksheet A-2 slides for detail information).

Matching Principle - report matching funding revenue for incurred expense.

Keep supporting documentation to substantiate the funding adjustment



Input Instructions: 1) Input data in all 4 Columns. 2) Case Sensitive for Column 1 Input – same input as

Worksheet D, Column 1 for a Worksheet D line adjustment.

3) Click “Update” button on Worksheet D.

An Error Message will appear if the “Update” button in Worksheet D is NOT clicked.




Funding Payments to Non-Governmental Subcontractors for

the Provisions of TCM Services


Worksheet E Funding Payments to Non-Governmental

Subcontractors for the Provision of TCM Services

Purpose: This Worksheet is designed for the non-governmental subcontractor(s) that provided TCM Services in the reporting period.

Report Funding Payment from Funding Contributor(s) to

the Non-Governmental Subcontractor(s) in the reporting period. Payment should represent the actual funding in providing

TCM services for a particular service/reporting period.


Worksheet E Funding Payments to Non-Governmental

Subcontractors for the Provision of TCM Services

Input Instructions:

1) Only Input Data in Columns 1, 2, 3, 4, 5 & 7.

2) AFTER Adjustment is Completed in Worksheet E-1, click “Update” button on this Worksheet.

3) Keep Supporting Documentation in Audit File.


Presenter

Presentation Notes

Once adjustments are completed in Worksheet E-1, THEN click “Update” button.


Funding Adjustments to Non-Governmental Subcontractors


Worksheet E-1 Funding Adjustments to Non-Governmental

Subcontractors Purpose:

Worksheet E-1 is designed for reporting funding adjustments for TCM services provided by the Non-Governmental Subcontractor(s).

Worksheet E-1 has the same format as Worksheet D-1



Subcontractors

Examples for Common Adjustments:

Eliminate funding that does not meet CPE requirements.

Include funding source that support the direct TCM Expense incurred by the LGA staff.



Subcontractors Funding Source to Support the Direct TCM Expense Incurred by the LGA Staff

The LGA does not provide TCM Encounter Related Services.

Three Conditions

1. Qualified TCM staff. 2. Time Survey Conducted. 3. 100% Direct TCM Cost.

The LGA does NOT need to report the incurred expenses in Worksheet A and A-2.



Subcontractors

Input Instructions: 1) Input data in all 4 Columns. 2) Column 1 is case sensitive – this is the same

input as Worksheet E, Column 1 for Worksheet E line adjustment .

3) Click “Update” button on Worksheet E. An Error Message will appear if the “Update” button

in Worksheet E is NOT clicked.




Calculation of Reimbursement Settlement


Worksheet G Calculation of Reimbursement Settlement

Purpose:

Worksheet G serves three functions:

Calculate Maximum Medi-Cal reimbursement per individual budget unit/subcontractor.

Calculate the TCM reimbursement settlement.

Determine the newly established interim Medi-Cal TCM encounter payment rate (IMTEPR).


Worksheet G Calculation of Reimbursement Settlement

Structure Overview:

Part I – Summary of Medi-Cal Reimbursement per Individual Budget Unit/Subcontractor.

Part II – Summary of LGA TCM Reimbursement Settlement.

Part III – Newly Established Interim Medi-Cal TCM Encounter Payment Rate (IMTEPR).


Worksheet G Part I

Summary of Medi-Cal Reimbursement per Individual Budget Unit/Subcontractor

Total Program Cost and Encounter Rate.

Maximum Medi-Cal Reimbursement.


Worksheet G Part II

Summary of LGA TCM Reimbursement Settlement

Report Interim Payment Received. Balance Due LGA or State (Subject to DHCS Audit).


Worksheet G Part III

Newly Established Interim Medi-Cal TCM Encounter Payment Rate (IMTEPR)

Establish a global IMTEPR for interim billing in

the new billing cycle.

Interim payments per new IMTEPR are subject to settlement reconciliation.


Worksheet G Calculation of Reimbursement

Settlement

Input Instructions:

1. Only input in Part II of this Worksheet: Interim Payment Other Coverage

Payment received from other TCM payer sources, such as a private insurance carrier, Medi-Cal client insurance deductible, or others.

Return to DHCS an overpayment received during the interim period, such as overpayment for an encounter.




Cost Report Submittal Instructions Each LGA shall submit only one Cost Report to the following email address: [email protected].

Submit the following:

1. Cost Report - Excel version) 2.

Cost Report - PDF version with signed (in blue ink) Provider Cost Report Certification Page

3.

Signed LGA Certification Statement


mailto:[email protected]

Cost Report Submittal Instructions (cont.)

4. Signed Non-LGA Local Public Entity Certification and Local Governmental Agency Attestation Statements .

NOTE: All forms may be found on the TCM website once the Cost Report Template and Instructions are released: http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx


http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx

Cost Report Submittal Instructions (cont.)

Cost Report packages must be emailed no later than November 1 of each

fiscal year.


Presenter

Presentation Notes

Michelle’s portion

If time permits… September / October 2014 121

Presenter

Presentation Notes

Tara and Sara


Presenter

Presentation Notes

Tara and Sara

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