Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of...

84
Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents

Transcript of Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of...

Page 1: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

Targeted Case Management

TCM Cost Report

Cost Report Presentation September 2011

Department of Health Care Services (DHCS)Presents

Page 2: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

2

Welcome to 2011 TCM Cost Report

PresentationWhat's Ahead!!!

• Introduction to Cost Report Instructions

• Step-By-Step of how to build a Cost Report

• Audits & Investigation Acceptance and Approval Process

TCM Cost Report

Page 3: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

3

2011 Changes!!!1. New Supplemental Worksheet “Interim Medi-Cal

TCM Encounter Payment Rate Calculation (IR)”

2. Use 2009 MAA-TCM Time Survey

3. Averaging Staff for Cost Report due Nov.1, 2011- staff who were “TCM direct supervisors of case managers” or “direct support staff to case managers” in FY 2010/11 who did not time survey in the FY 2009/10

4. On the Cover Letter identified unique program names of all Cost Report submitted to DHCS

5. A “Add-Time Survey” button was added to Combined MAA-TCM Time Survey Template

TCM Cost Report

Page 4: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

FYI

While new target populations are in effect beginning July 1, 2011, all costs for providing TCM in FY 2010/11 must be filed irrespective of what target population they pertain to. Costs for FY 2010/11 must still be filed separately for each target population for Public Health, Outpatient Clinic, Public Guardian, Linkages, Adult Probation, and Community just as they have been in the past.

Next year, costs will be filed for providing services to the new target populations of Children Under the Age of 21, Medically Fragile Adults, Individuals At Risk of Institutionalization, Individuals in Jeopardy of Negative Health or Psycho-Social Outcome, Individuals with Communicable Diseases. Additionally, costs will not be filed separately for each target population as one reimbursement rate will be established for each LGA. Further information will be provided with next year’s Cost Report Instructions.

TCM Cost Report

Page 5: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

5

Cost ReportTraining Objective

By the end of this presentation you will be able to submit to DHCS(A & I) a complete and accurate Cost Report.

TCM Cost Report

Page 6: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

6

Tools & Templates

TCM

Tools: TCM Power Point Presentation A & I Power Point Presentation TCM Cost Report Instructions Cost Report Check list Decision Tree Flow Chart

TCM Cost Report

Page 7: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

7

Tools & Templates

TCM

Templates: TCM 2011 Cost Report Template* 2009 Time Survey Template* Cost Report Review Tool* Funding Schedule* Summary of Allowable Funding for Claiming

Federal Matching Funds Interim Medi-Cal TCM Encounter Payment

Rate Calculation Certification and Attestation Statements

LGANon-LGA LPE

TCM Cost Report

Page 8: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

8

What is the purpose of a Cost Report?

To determine the Actual Total Cost of providing TCM Services

To establish an Encounter Rate for the provision of TCM Services

To establish the TCM Maximum Amount (CAP)

TCM Cost Report

Page 9: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

9

Reimbursement Methodology

Factors that determine encounter rate:

Time spent doing/supporting TCM

Cost of providing/supporting TCM

Reported and projected valid Encounters

Federal Medical Assistance Percentage (FMAP)

TCM Cost Report

Page 10: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

10

TCM Maximum Reimbursement Calculations

CAP = Projected # of Medi-Cal Only Encounters X Current Year Billable Rate per TCM Encounter

Max Reimbursement Federal Share = CAP X FMAP

TCM Cost Report

Page 11: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

11

Preparing the TCM Cost Report

• Read all of the Cost Report Instructions

• Gather the required documents

TCM Cost Report

Page 12: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

12

Summary of Steps

• Define Budget Unit

• Determine Methodology (two ways to allocate costs)

• Classify Staff

• Complete Time Survey Template

• Classify/Analyze Expenses and Revenues

• Analyze TCM Encounter Logs

• Prepare Cost Report Review Tool

TCM Cost Report

Page 13: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

13

MAA-TCM Combo Time Survey Template

OBJECTIVE:

To accurately record and calculate data from the TCM Time Surveys in a standardized format.

TCM Cost Report

Page 14: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

14

MAA-TCM Combo Time Survey Template (Cont’d)

The 3 worksheets in this template are:

1. List Worksheet

2. Numbered Worksheet

3. Totals Worksheet

TCM Cost Report

Page 15: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

15

MAA-TCM Combo Time Survey Template (Cont’d)

List Worksheet• At the top of this worksheet enter:

• Name of the LGA

• Name of the TCM Program, and• Time Survey month and year

Do not enter any other information on this worksheet!!!

TCM Cost Report

Page 16: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

16

MAA-TCM Combo Time Survey Template (Cont’d)

Numbered Worksheets

• Data entry

• Select the workbook

• Add-Time Survey worksheets

TCM Cost Report

Page 17: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

17

MAA-TCM Combo Time Survey Template (Cont’d)

• Review accuracy of entered time Survey Information

• Analyze Time Survey totals

Totals Worksheet

TCM Cost Report

Page 18: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

18

MAA-TCM Combo Time Survey Template (Cont’d)

How to name the Electronic Files-Current Year and LGA name

- Abbreviated TCM Program name:

PH-Public Health OC-Outpatient Clinics

Link-Linkages AP-Adult Probation

Comm- Community TS-Time Survey

PG-Public Guardian/Conservator

TCM Cost Report

Page 19: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

19

MAA-TCM Combo Time Survey Template (Cont’d)

Example:

The 2009 Santa Barbara Linkages Time Survey template becomes:

2009 Santa Barbara Link TS.xls

TCM Cost Report

Page 20: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

20

TCM Cost Report Template

• Records prior year Actual Costs

• Calculates Per Encounter Rate

• Calculates Maximum Reimbursement Amount

What is the Cost Report Template?

TCM Cost Report

Page 21: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

21

TCM Cost Report Template (Cont’d)

The 9 worksheets in this Template are:

1. Worksheet A 6. Salaries

2. Encounters 7. Survey Averaging

3. Worksheet B 8. Contractors

4. Worksheets C & C1 9. References

5. Worksheet D

TCM Cost Report

Page 22: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

22

TCM Cost Report Template (Cont’d)

How to name the Excel file for submission

-Current Year and LGA name

-Abbreviated TCM Program name:

PH-Public Health Link-Linkages

OC-Outpatient Clinic AP-Adult Probation

CR for Cost Report Comm- Community

PG-Public Guardian/Conservator

TCM Cost Report

Page 23: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

23

TCM Cost Report Template (Cont’d)

Example:

The 2011 Santa Barbara Public Health Cost Report template becomes:

2011 Santa Barbara PH CR.xls

TCM Cost Report

Page 24: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

24

TCM Cost Report Template (Cont’d)

• Formula-driven

• Enter data in the BLUEBLUE Cells Only!

• Green and yellow cells automatically calculate.

• Some cells are formatted with a drop-down box.

• Cells with a red triangle in the upper right corner contain comments to help you enter data.

TCM Cost Report

Page 25: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

25

TCM Cost Report Template (Cont’d)

• Enter LGA & Program Information on Worksheet A

• Enter Reporting Period

TCM Cost Report

Worksheet A

Page 26: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

26

Survey Averaging Worksheet

This worksheet calculates the averaged time survey percentages for the four time survey categories. The categories are:

-TCM

-General ADMIN

-Other/Direct Services/MAA

-PTO

These percentages automatically flow into the Averaged section of Salaries & Benefits Schedule 2A in the Salaries Worksheet.

TCM Cost Report

Page 27: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

27

Survey Averaging Worksheet (Cont’d)

• Obtain the total number of hours for each of the four time survey categories from the List Worksheet in the TCM Time Survey Summary Template.

• The hours entered into the BLUE cells will automatically link to the Averaged section of the Salaries Worksheet.

• Verify that the results of the Survey Averaging Worksheet appear correctly in the Averaged section of Salaries & Benefits Sch. 2A in the Salaries Worksheet.

TCM Cost Report

Page 28: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

28

Salaries Worksheet

• The Salaries worksheet consists of 6 Salaries & Benefits Schedules (S&B Sch) that are marked in the upper-right where the schedule ends.

S&B Sch 1AS&B Sch 1BS&B Sch 2AS&B Sch 2BS&B Sch 2CS&B Sch 2D

They are labeled as follow:

TCM Cost Report

Page 29: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

29

S&B Schedule 1A

• List all staff for the budget unit that provides TCM services.

• The employees will be listed in one of the four categories on the worksheet.

Time Surveyed to TCM Averaged ADMIN NTCM

TCM Cost Report

Page 30: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

30

S&B Schedule 1A (Cont’d)

• The Role column helps DHCS understand what function the employee performs in the program

• Select the Role from the drop-down box for Time-Surveyed and Averaged employees

• OPTIONAL: For clarity, add notes in the Notes column.

TCM Cost Report

Page 31: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

31

S&B Schedule 1A (Cont’d)

• The Classification column must have an entry for each employee.

• Complete the BLUE Salaries & Benefits column. List each employee’s salaries and benefits. ADMIN staff and NTCM staff may be entered as aggregated amounts (see instructions); the staff must still be listed on a separate page.

• GREEN cells are Cost Report formulas.

TCM Cost Report

Page 32: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

32

S&B Schedule 1B

• If you can separate an individual employee’s expense in your accounting records, you may enter them in the BLUE column titled Operating Expenses By Employee.

• At the bottom of that column, enter the source name of the document from which you obtained the Operating Expenses by Employee, if used.

TCM Cost Report

Page 33: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

33

S&B Schedule 1B (Cont’d)

• If you cannot separate expenses by employee, enter the total allowable direct and indirect operating expenses in the BLUE cell at the bottom of the column labeled Distributed Operating Expenses.

• At the bottom of that column, enter the name of the supporting document from which you obtained the amount entered in Distributed Operating Expenses.

TCM Cost Report

Page 34: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

34

Salaries & Benefits Total Costs

• Note for Later: Total for Schedule B plus total Worksheet D = Total Operating Expenses.

TCM Cost Report

Page 35: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

35

S&B Schedule 2A

• Enter the time survey results from the TCM Time Survey Summary Template. Enter your percentage to two decimals and do not round up (enter 9.85%, not 10.00%).

• Since you have already completed the Time Survey Averaging worksheet, the averaged time survey results are in the yellowyellow cells. No further entry is needed.

Salary Survey

TCM Cost Report

Page 36: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

36

S&B Schedule 2A (Cont’d)

• For the ADMIN staff, select 100% under Gen Admin from the drop-down box.

• For the NTCM staff, select 100% under Other/Direct/MAA from the drop-down box.

• After completing the Cost Report, if there is an error message on Worksheet A, Line 7, Column 7, it is most often because this step was not completed.

Salary Survey

TCM Cost Report

Page 37: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

37

Contractor WorksheetSchedule 3A & 3B

This worksheet records the costs of CBO’s that have contracted with LGAs to provide TCM services.

• Non-Specific Contract - Staff are required to time-survey to identify the TCM costs in the total contract amount.

• Specific Contract - Staff are NOT required to time-survey because the contract specifies the total cost of TCM separate from the total cost of non-TCM.

TCM Cost Report

Page 38: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

38

Contractor Worksheet Schedule 3A & 3B (Cont’d)

• Data Entry

Non-Specific - enter under Total Costs the amount from Worksheet A, Line 7, Column 7, on the CBO Cost Report. Enter under TCM Costs per Analysis, the amount from Worksheet A, Line 19, on the CBO Cost Report.

Specific - enter under both columns the specific amount of the contract to provide TCM services.

TCM Cost Report

Page 39: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

39

Contractor Worksheet Schedule 3A & 3B

(Cont’d)

• Copies of all TCM contracts (CBO’s) must be included with the TCM Cost Report packet submitted to CDHS.

TCM Cost Report

Page 40: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

40

Worksheet D

• Use Worksheet D to report costs that are 100% TCM or 100% Non-TCM.

TCM Cost Report

– This worksheet is for operating expenses ONLY, not for labor expenses.

– Do not use Columns 2, 3, and 5.

– If you need additional lines added to this worksheet, press the associated “Add button” and enter the number of lines to add.

Page 41: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

41

Worksheet D (Cont’d)

– Enter the account titles in the Description column for each cost.

– Enter 100% TCM Costs in column 1, such as contract services purchased to design TCM documentation software or vehicle costs for exclusive use by TCM case managers to conduct home visits.

– Enter 100% non-TCM Costs and Unallowable Costs in column 4.

TCM Cost Report

Page 42: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

42

Worksheet D (Cont’d)TCM Cost Report

Treatment of Office of Management Budget (OMB) Circular A-87 from the Countywide Cost Allocation Plan (CWCAP) and other Overhead Costs:

–Report OMB A-87 and other overhead costs on Salaries & Benefits Schedule 1B (Salaries worksheet).

–Your Auditor’s office has a copy of your approved OMB A-87 CWCAP, which is required documentation for the Salaries & Benefits Schedule 1B.

Page 43: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

43

Worksheet C & C1

This worksheet reclassifies the costs based on the time survey results.

Do not enter data onto this worksheet.

TCM Cost Report

Page 44: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

44

Worksheet D (Cont’d)

• Required Documentation

- Sufficient documentation must be maintained to substantiate all cost reported as 100% TCM cost

TCM Cost Report

Page 45: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

45

Worksheet C & C1 (Cont’d)

• Cell E26 must equal zero.- If E26 is off by $2 or less, balance the error by entering the opposite amount in the bottom row of the middle column (AJ) of S&B Sch 2D (if imbalance is minus 1, enter positive 1).

TCM Cost Report

Page 46: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

46

Worksheet C & C1 (Cont’d)

If E26 is off by more, check Time Survey results equal 100% for

each TCM staff on S&B Sch 2A 100% was selected for Gen Admin

and NTCM on S&B Sch 2A Salaries, Benefits, Operating Costs

are correct

If you are unable to find the error, contact your TCM Coordinator.

TCM Cost Report

Page 47: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

47

Funding Schedule

Local Government Agency - Federal funding that supports the provision of TCM Services, must be offset.

Community Based Organization - Federal and private funding that supports the provision of TCM Services, must be offset.

TCM Cost Report

Page 48: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

48

Funding Schedule (Cont’d)

Step 1: List all funding sources that support the Budget Unit.

Step 2: List amounts that support the Budget Unit.

Step 3: Determine which sources support TCM encounters – Yes or No.

TCM Cost Report

Page 49: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

49

Funding Schedule (Cont’d)

When analyzing funding sources for the TCM Budget Unit that provides TCM services, review information from:

Scope of work Budgets Contracts Expenditure reports Revenue reports

TCM Cost Report

Page 50: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

50

Funding Schedule (Cont’d)

How to calculate the specific amount?Step 4: If “Step 3” is yes, list funds from “Step 2 “that supports TCM encounters provided to anyone.

Step 5: Calculate which portion of funding support provision of all TCM services. (Total Unallowable Revenues X Average % TCM Hrs)

Step 6: Explain your method in step 6 if other method was used.

TCM Cost Report

Page 51: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

51

Funding Schedule (Cont’d)

How to name the Excel file for submission

Example:

The 2011 Santa Barbara Linkages Funding Schedule template becomes:

2011 Santa Barbara Link FS.xls

TCM Cost Report

Page 52: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

52

Summary of Allowable Funding for Claiming Federal Matching

Funds

• Construct a summary of the total salaries, benefits, operating costs, and funding shown in the Cost Report, that identifies these costs in the supporting documents

New Slide

TCM Cost Report

Page 53: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

53

Worksheet B

Only list funding on this worksheet that must be offset against the cost of providing claimable TCM services.

TCM Cost Report

Page 54: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

54

Worksheet B (Cont’d)

Enter the following information:

Description: Enter the title of the funding provided by the funding source to be offset.

Source: Enter Federal, Private Foundation, Private Donation, or Client Fees. If the funding comes from multiple sources, include that information.

TCM Cost Report

Page 55: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

55

Worksheet B (Cont’d)

Use the Funding Schedule.

• Carry over the Total of Step 4 to Column 1

• Carry over the Total of Step 5 to Column 2

TCM Cost Report

Page 56: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

56

TCM Cost Report Worksheet B (Cont’d)

Total Unallowable Funding for TCM: Enter the total amount of the contract, grant, or allocation from the Funding Schedule.

Total Assigned to TCM Services: Amount of the Total Revenue in column 1 that pays for the provision of all TCM services from Funding Schedule (Step 5).

Page 57: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

57

Worksheet B (Cont’d)

Note: Funding that supports time spent on, and coded to any activity, other than TCM is not reported on Worksheet B.

Stop

If staff coded to “Other/Activities” when performing case management funded by another funding source, that funding is not reported on Worksheet B.

TCM Cost Report

Page 58: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

58

Worksheet B (Cont’d)

Required Documentation

– Define acronyms and abbreviations.– Complete the Funding Schedule. – Describe the allocation methodology used to calculate revenue assigned to TCM Services.

TCM Cost Report

Page 59: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

59

Encounter Worksheet

There are 3 valid types of Encounters

Encounters for Medi-Cal beneficiaries that are reimbursed under the Medi-Cal TCM Program

Encounters for Medi-Cal beneficiaries that are NOT reimbursed under the Medi-Cal TCM Program

Encounters to Non-Medi-Cal beneficiaries

TCM Cost Report

Page 60: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

60

Encounter Worksheet (Cont’d)

This worksheet uses the numbers of Claimable Medi-Cal, Non-Claimable Medi-Cal, and non-Medi-Cal TCM encounters (from the prior year Encounter Log) to calculate the projected number of Claimable Medi-Cal TCM encounters for the current fiscal year.

TCM Cost Report

Page 61: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

61

Encounter Worksheet (Cont’d)

Enter the number of claimable TCM encounters with Medi-Cal beneficiaries.

Enter the Non-Claimable Medi-Cal encounters.

Enter the number of TCM encounters with non-Medi-Cal persons.

TCM Cost Report

Page 62: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

62

Encounter Worksheet(Cont’d)

Select increase or decrease from the drop-down box.

Enter the percentage of anticipated change in the number of TCM encounters conducted with Medi-Cal beneficiaries for the current fiscal year.

Explain this increase or decrease in the space provided (be accurate and specific).

TCM Cost Report

Page 63: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

63

Worksheet A

Provides a summary of the reported TCM and non-TCM costs for the reporting period and calculates the TCM per-encounter rate (Line 20) and the maximum amount of claims for reimbursement (Line 22), before factoring the FMAP.

TCM Cost Report

Page 64: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

64

Worksheet A (Cont’d)

Self-check areas

- Row 7, Column 4 (Cell F15), must equal zero.

- Row 7, Column 7 (Cell I15), must match the general ledger and summary.

And finally…

- Make sure that the LGA Coordinator or other individual duly authorized signs Worksheet A before submitting it to DHCS.

TCM Cost Report

Page 65: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

65

Interim Medi-Cal TCM Encounter Payment Rate Calculation

• From each of the cost reports containing 100% of each TCM targeted population’s cost enter:

1) Total TCM Reported Encounters [from Worksheet A, line 14] and

2) Adjusted Allowable Case Manager Costs [from Worksheet A, line 19] into the Interim Medi-Cal TCM Encounter Payment Rate Calculation Worksheet

New Slide

TCM Cost Report

Page 66: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

66

Interim Medi-Cal TCM Encounter Payment Rate

Calculation (Cont’d)

How to name the Excel file for submission

Example:

The 2011 Santa Barbara Interim Medi-Cal TCM Payment Rate calculation Worksheet becomes:

2011 Santa Barbara IR.xls

TCM Cost Report

Page 67: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

67

TCM Cost Report Review Tool

Verify the Operating Expenses by following the instructions on the Operating Expenses page. You will also create a ratio of Operating Expenses to Salaries and Benefits on this page.

TCM Cost Report

Page 68: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

68

TCM Cost Report Review Tool (Cont’d)

How to name the Excel file for submission

Example:

The 2011 Santa Barbara Linkages Cost Report Review Tool template becomes:

2011 Santa Barbara Link RT.xls

TCM Cost Report

Page 69: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

69

TCM Cost Report Review Tool (Cont’d)

LGA Coordinators must ensure that the Cost Report packet is complete, before submitting it electronically to DHCS.

On the Salaries & Benefits tab, enter the totals from the TCM Cost Report Template for TCM, ADMIN, and NTCM salaries and benefits and the page number of the supporting document that details these totals.

TCM Cost Report

Page 70: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

70

TCM Cost Report Review Tool (Cont’d)

On the Encounter per Case Manager page, enter the names of all case managers and the total number of valid encounters for each of them.

You will also enter information from the Cost Report that will generate figures for Hours per Encounter and Cost per Encounter Hour to compare with previous averages.

TCM Cost Report

Note: Worksheet A, Line 20 should equal the Encounter Rate on the Cost Report Review Tool.

Page 71: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

71

TCM Cost Report Review Tool (Cont’d)

You will enter information from the Cost Report that will generate figures for Hours per Encounter and Cost per Encounter Hour to compare with averages from the previous years.

TCM Cost Report

Page 72: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

72

Important Tips

Do not be overwhelmed Start early and read all instructions Do not start with Worksheet A (Only enter

County & Program Name Begin with the Time Survey Summary

Template and the Salary Averaging Worksheet

Color-code, circle, highlight, or label figures in the Supporting Documentation and the same figures in the worksheets in which they appear

TCM Cost Report

Page 73: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

73

Were Proper Templates used?

– Time Survey, Cost Report, Funding Schedule, Summary of Funding, Interim Medi-Cal Enc. Payment Rate Calculation, and Review Tool Templates

Is Worksheet A signed in BLUEBLUE ink? Is cover letter included, signed in BLUEBLUE ink

and on County letterhead? Is LGA Coordinator contact info in cover

letter? Are the Time Surveys signed and dated by

employees and supervisors?

Helpful HintsTCM Cost Report

Page 74: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

74

Is an Organization Chart, with employee names, job title, and to whom they report, included?

Did you include job descriptions for all TCM classifications?

Did you include copies of CBO/LPE contracts? Is documentation for Salary & Benefits clearly

identified by employee? Is the Cost Report Review Tool included? Is the encounter rate on Wk. A, Line 20 the

same as the enc. Rate on the Cost Review tool?

Helpful Hints (Cont’d)TCM Cost Report

Page 75: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

75

All Required Documentation included?

Cover Letter? Review all of your calculations to

ensure they flow properly into the fields of the worksheets from the source schedule.

Is the Cost Report Checklist completed, signed and included?

Helpful Hints (Cont’d)TCM Cost Report

Page 76: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

76

The First Year of Participation

☻Either use data from prior year, or

☻Annualize data (allowed in first year only).

TCM Cost Report

Page 77: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

77

Closing-Year Costs

● TCM Service Provider ceasing to provide TCM services

● Filing a Closing-Year Costs in a Cost Report Template

TCM Cost Report

Closing Year Costs

Page 78: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

78

Important Reminders for CBO’s

Copy of Contracts Financial Statements – Balance sheets

& Income Statements for All CBO’s Other Essential Materials to be included

are: I.R.S Annual Information Returns for

CBO’s (990 Form) CBO Bylaws & Articles of

Incorporation

TCM Cost Report

Page 79: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

79

Packaging of your Cost Report

1. Cover letter on LGA letterhead and signed by the LGA

2. Required TCM Cost Report Template Submit one Cost Report per program

3. Required TCM Time Survey Summary Template

4. Table of Contents Enhanced Table of Contents Number all pages

TCM Cost Report

Page 80: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

80

Packaging of your Cost Report (Cont’d)

5. Tab and label

6. Ensure that all Essential Materials and Supporting Documents are included

7. Completed TCM Cost Report Checklist

8. Method of assembling your Cost Report

TCM Cost Report

Page 81: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

81

Submission of your Cost Report

TCM Cost Report

Hard Copy: Send your Cost Report postmarked by November 1

Soft Copy: Email to [email protected] by November 1:

Page 82: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

82

Where do I mail the Cost Report by November 1?

Regular U.S. Postal Services Mail:

Department of Health Care Services

Audits & InvestigationsAudit Review & Analysis Section1500 Capitol Ave, MS 2109P.O. Box 997413Sacramento, CA 95899-7413

Overnight or Express Mail:

Department of Health Care Services

Audits & InvestigationsAudit Review & Analysis

Section1500 Capitol Ave. MS 2109Sacramento CA 95814

Email to: [email protected]

TCM Cost Report

Page 83: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

83

TCM Cost Report Reference Material

• Available on the TCM Website: http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx

– 2011 TCM Cost Report Instructions

– 2009 MAA/TCM Combo Time Surveys Templates

– 2010 TCM Cost Report Template

– TCM Cost Report Checklist

– TCM Cost Report Certification Statement

– Link to OMB Circular A-87

– PPLs

– All training materials and other required templates

TCM Cost Report

Page 84: Targeted Case Management TCM Cost Report Cost Report Presentation September 2011 Department of Health Care Services (DHCS) Presents.

84

Approved

$$