Department of Health Care Services DHCS Presents Targeted

Department of Health Care Services (DHCS) Presents Targeted Case Management TCM Cost Report Training July 2008

Housekeeping Items TCM Cost Report § Location of restrooms § Emergency exit § Where to eat § Cell phones and pagers § Questions during the presentation 2

TCM Cost Report Welcome to TCM Cost Report Training 2008 What's Ahead!!! Introduction to Cost Report Instructions • • Step-By-Step of how to build a Cost Report • Lunch • Step-By-Step of how to build a Cost Report (Continued) • Audits & Investigation Acceptance and Approval Process 3

2008 Changes!!! TCM Cost Report v New naming convention for electronic submission of the Cost Report v New DHCS Web page Address http: //www. dhcs. ca. gov/provgovpart/Pages/TCM. a spx 4

Cost Report TCM Cost Report Training Objective By the end of this training you will be able to submit to DHCS(A & I) a complete and accurate Cost Report. 5

TCM Cost Report Training Tools Training packet includes: v v TCM Power Point Presentation A & I Power Point Presentation v TCM Cost Report Instructions v Complete Cost Report Sample v Training Evaluation TCM 6

What is the purpose of a Cost Report? TCM Cost Report v To determine the Actual Total Cost of providing TCM Services v. To establish an Encounter Rate for the provision of TCM Services v To establish the TCM Maximum Amount (CAP) 7

TCM Cost Report Reimbursement Methodology Factors that determine encounter rate: ü Time spent doing/supporting TCM ü Cost of providing/supporting TCM ü Reported and projected valid Encounters ü Federal Medical Assistance Percentage (FMAP) 8

TCM Maximum Reimbursement Calculations TCM Cost Report CAP = Projected # of Medi-Cal Only Encounters X Current Year Billable Rate per TCM Encounter Max Reimbursement Federal Share = CAP X FMAP 9

Preparing the TCM Cost Report • Read all of the Cost Report Instructions • Gather the required documents 10

TCM Cost Report 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 11

MAA-TCM Combo Time Survey Template TCM Cost Report OBJECTIVE: To accurately record and calculate data from the TCM Time Surveys in a standardized format. 12

MAA-TCM Combo Time Survey Template (Cont’d) TCM Cost Report The 3 worksheets in this template are: List Worksheet Totals Worksheets Numbered Worksheet 13

MAA-TCM Combo Time Survey Template (Cont’d) TCM Cost Report 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!!! 14

MAA-TCM Combo Time Survey Template (Cont’d) TCM Cost Report Numbered Worksheets • Data entry • Select the workbook • Do not insert worksheets 15

MAA-TCM Combo Time Survey Template (Cont’d) TCM Cost Report Totals Worksheet • Review accuracy of entered time Survey Information • Analyze Time Survey totals 16

MAA-TCM Combo Time Survey Template (Cont’d) TCM Cost Report 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 17

MAA-TCM Combo Time Survey Template (Cont’d) TCM Cost Report Example: The 2008 Santa Barbara Linkages Time Survey template becomes: 2008 Santa Barbara Link TS. xls 18

TCM Cost Report Template What is the Cost Report Template? • Records prior year Actual Costs • Calculates Per Encounter Rate • Calculates Maximum Reimbursement Amount 19

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 & C 1 9. References 5. Worksheet D 20

TCM Cost Report Template TCM Cost Report (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 PG-Public Guardian /Conservator Comm-Community - CR for Cost Report 21

TCM Cost Report Template (Cont’d) TCM Cost Report Example: The 2008 Santa Barbara Public Health Cost Report template becomes: 2008 Santa Barbara PH CR. xls 22

TCM Cost Report Template TCM Cost Report (Cont’d) • Formula-driven • Enter data in the BLUE 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. 23

TCM Cost Report Template TCM Cost Report (Cont’d) Worksheet A • Enter LGA & Program Information on Worksheet A • Enter Reporting Period 24

TCM Cost Report 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 2 A in the Salaries Worksheet. 25

Survey Averaging Worksheet TCM Cost Report (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. 2 A in the Salaries Worksheet. 26

TCM Cost Report 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. They are labeled as follow: S&B S&B S&B Sch Sch Sch 1 A 1 B 2 A 2 B 2 C 2 D 27

S&B Schedule 1 A TCM Cost Report • 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 28

TCM Cost Report S&B Schedule 1 A (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. 29

S&B Schedule 1 A TCM Cost Report (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. 30

TCM Cost Report S&B Schedule 1 B • 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. 31

S&B Schedule 1 B (Cont’d) TCM Cost Report • 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. 32

TCM Cost Report Salaries & Benefits Total Costs • Note for Later: Total for Schedule 1 B plus total Worksheet D = Total Operating Expenses. 33

TCM Cost Report S&B Schedule 2 A Salary Survey • 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 yellow cells. No further entry is needed. 34

TCM Cost Report S&B Schedule 2 A (Cont’d) Salary Survey • 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. 35

TCM Cost Report Contractor Worksheet Schedule 3 A & 3 B 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. 36

TCM Cost Report Contractor Worksheet Schedule 3 A & 3 B (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. 37

TCM Cost Report Contractor Worksheet Schedule 3 A & 3 B (Cont’d) • Copies of all TCM contracts (CBO’s) must be included with the TCM Cost Report packet submitted to CDHS. 38

TCM Cost Report Worksheet D • Use Worksheet D to report costs that are 100% TCM or 100% Non-TCM. – This worksheet is for operating expenses ONLY, not for labor expenses. – Do not use Columns 2, 3, and 5. – If more rows are required, contact DHCS for a customized template. 39

TCM Cost Report 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. 40

TCM Cost Report Worksheet D (Cont’d) 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 1 B (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 1 B. 41

Worksheet D (Cont’d) TCM Cost Report • Required Documentation - Sufficient documentation must be maintained to substantiate all cost reported as 100% TCM cost 42

TCM Cost Report Worksheet C & C 1 This worksheet reclassifies the costs based on the time survey results. § Do not enter data onto this worksheet. 43

Worksheet C & C 1 (Cont’d) TCM Cost Report • Cell E 26 must equal zero. - If E 26 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 2 D (if imbalance is minus 1, enter positive 1). 44

TCM Cost Report Worksheet C & C 1 (Cont’d) If E 26 is off by more, check ü Time Survey results equal 100% for each TCM staff on S&B Sch 2 A ü 100% was selected for Gen Admin and NTCM on S&B Sch 2 A ü Salaries, Benefits, Operating Costs are correct If you are unable to find the error, contact your TCM Coordinator. 45

TCM Cost Report 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. 46

TCM Cost Report 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. 47

TCM Cost Report Funding Schedule (Cont’d) § When analyzing funding sources for the Budget Unit that provides TCM services, review information from: Ø Ø Ø Scope of work Budgets Contracts Expenditure reports Revenue reports 48

TCM Cost Report 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 methods was used. 49

TCM Cost Report Funding Schedule (Cont’d) How to name the Excel file for submission Example: The 2008 Santa Barbara Linkages Funding Schedule template becomes: 2008 Santa Barbara Link FS. xls 50

TCM Cost Report Worksheet B Only list funding on this worksheet that must be offset against the cost of providing claimable TCM services. 51

TCM Cost Report 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. 52

TCM Cost Report Worksheet B (Cont’d) v Use the Funding Schedule. • Carry over the Total of Step 4 to Column 1 • Carry over the Total of Step 5 to Column 2 53

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). 54

TCM Cost Report 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. 55

TCM Cost Report Worksheet B (Cont’d) v Required Documentation – Define acronyms and abbreviations. – Complete the Funding Schedule. – Describe the allocation methodology used to calculate revenue assigned to TCM Services. 56

Encounter Worksheet TCM Cost Report There are 3 valid types of Encounters üEncounters for Medi-Cal beneficiaries that are reimbursed under the Medi-Cal TCM Program ü Encounters for Medi-Cal beneficiaries that are NOT reimbursed under the Medi-Cal TCM Program ü Encounters to Non-Medi-Cal beneficiaries 57

TCM Cost Report 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. 58

Encounter Worksheet TCM Cost Report (Cont’d) v Enter the number of claimable TCM encounters with Medi-Cal beneficiaries. v Enter the Non-Claimable Medi-Cal encounters. v Enter the number of TCM encounters with non-Medi-Cal persons. 59

Encounter Worksheet TCM Cost Report (Cont’d) v Select increase or decrease from the drop -down box. v Enter the percentage of anticipated change in the number of TCM encounters conducted with Medi-Cal beneficiaries for the current fiscal year. v Explain this increase or decrease in the space provided (be accurate and specific). 60

TCM Cost Report 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. 61

Worksheet A (Cont’d) TCM Cost Report ü Self-check areas - Row 7, Column 4 (Cell F 15), must equal zero. - Row 7, Column 7 (Cell I 15), must match the general ledger and summary. ü And finally… - Make sure that the LGA Coordinator signs Worksheet A before submitting it to DHCS. 62

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. 63

TCM Cost Report Review Tool Cont’d) How to name the Excel file for submission Example: The 2008 Santa Barbara Linkages Cost Report Review Tool template becomes: 2008 Santa Barbara Link RT. xls 64

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. 65

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. 66

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. 67

TCM Cost Report Important Tips ü Do not be overwhelmed ü Start early and read all instructions ü Do not start with Worksheet A ü Begin with the Time Survey Summary Template and the Salary Averaging Worksheet ü Color-code, circle, highlight, or label figures in the Supporting Documentation and the same figures in the worksheets in which they 68 appear

TCM Cost Report Helpful Hints ü Were Proper Templates used? – Time Survey, Cost Report, Funding Schedule, and Review Tool Templates ü Is Worksheet A signed in BLUE ink? ü Is cover letter included, signed in BLUE ink and on County letterhead? ü Is LGA Coordinator contact info in cover letter? ü Are the Time Surveys signed and dated by employees and supervisors? 69

TCM Cost Report Helpful Hints (Cont’d) ü Is an Organization Chart, with employee names, job title, and to whom they report, included? ü Did you include job descriptions for all TCM classifications? ü Did you include copies of CBO contracts? ü Is documentation for Salary & Benefits clearly identified by employee? ü Is the Cost Report Review Tool included? ü Is the encounter rate on Wk. A, Line 20 the same as the enc. Rate on the Cost Review tool? 70

Helpful Hints (Cont’d) TCM Cost Report ü All Required Documentation included? üReview all of your calculations to ensure they flow properly into the fields of the worksheets from the source schedule. ü Is the Cost Report Checklist completed, signed and included? 71

TCM Cost Report The First Year of Participation ☻Either use data from prior year, or ☻Annualize data (allowed in first year only). 72

TCM Cost Report Important Reminders for CBO’s v Copy of Contracts v Financial Statements – Balance sheets & Income Statements for All CBO’s v Other Essential Materials to be included are: ØI. R. S Annual Information Returns for CBO’s (990 Form) ØCBO Bylaws & Articles of Incorporation 73

TCM Cost Report 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 74

TCM Cost Report 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 75

TCM Cost Report Submission of your Cost Report Soft Copy: Email to dhsaitcm@dhcs. ca. gov by November 1: 1. DHCS Time Survey Summary Template 2. DHCS TCM Cost Report Template 3. DHCS Cost Report Review Tool 4. DHCS Funding Schedule Hard Copy: Send your Cost Report postmarked by November 1 76

Where do I mail the Cost Report by November 1? TCM Cost Report Regular U. S. Postal Services Mail Department of Health Care Services Audits & Investigations Audit Review & Analysis Section 1500 Capitol Ave, MS 2109 P. O. Box 997413 Sacramento, CA 95899 -7413 Email to: Overnight or Express Mail: Department of Health Care Services Audits & Investigations Audit Review & Analysis Section 1500 Capitol Ave. MS 2109 Sacramento CA 95814 dhsaitcm@dhcs. ca. gov 77

TCM Cost Report Reference Material • Available on the TCM Website: http: //www. dhcs. ca. gov/provgovpart/Pages/TCM. aspx – 2008 TCM Cost Report Instructions – 2007 MAA/TCM Combo Time Surveys Templates for 30, 60, or 200 Staff – 2008 TCM Cost Report Template – TCM Cost Report Checklist – TCM Cost Report Certification Statement – Link to OMB Circular A-87 – PPL 06 -014, and prior PPLs – All training materials and templates 78

v pro Ap ed $ $ 79