California Dept of Health Services CDHS proudly presents

1. California Dept of Health Services (CDHS) proudly presents�

2. The County-Based Medi-Cal Administrative Activities (CMAA) Claiming Plan Amendment Training Show June 2006 Intro: Ask everyone to follow along with their handouts & we will answer questions as we go through each step. Intro: Ask everyone to follow along with their handouts & we will answer questions as we go through each step.

3. Starring�Julie MackoIn The �Da CP� Code

4. ACT I Training Purpose

5. Purpose of This Training: This presentation is going to walk through the review and processing steps to show everyone what the CMAA analysts look for when an amendment is received and the step-by-step process of what we look at when doing our review. CMAA now has an internal policy in place to get approval letters out to counties within 30 days of receiving their amendments. If the counties know what we look for during our review, then you can prepare & send in all the needed information the first time to help facilitate a quick turnaround time. (read two bullets) 30 day policy is a guideline. What is important is that the counties know that approvals will not take months/years like before Counties can now keep their plans up to date because the process is easier and more timely Establishes guidelines for all analyst/counties to follow so that we are consistant.(read two bullets) 30 day policy is a guideline. What is important is that the counties know that approvals will not take months/years like before Counties can now keep their plans up to date because the process is easier and more timely Establishes guidelines for all analyst/counties to follow so that we are consistant.

6. ACT II Review and Approval Steps

7. Steps to a Claiming Plan Amendment County prepares the amendment and mails to CDHS. Amendment is received at CDHS. Logged in by CMAA support staff. Assigned to the Analyst. Analyst reviews. Analyst prepares Approval Letter. Chief of CMAA reviews & signs letter. Approval Letter sent to County via email. Amendment is in place as of the 1st day of the quarter it was received. To sum up, a claiming plan amendment involves 9 steps. (read through each step) Let�s start with step 1To sum up, a claiming plan amendment involves 9 steps. (read through each step) Let�s start with step 1

8. Step 1: County Prepares MAA Claiming Plan Amendment Start by reviewing the Claiming Plan Amendment Checklist. If the change requires an amendment, depending on what is changing, the amendment documents may include: Updated Claiming Unit Functions Grid Duty Statements for new/updated classifications Activity Description Pages for new/ updated activities Copies of new or amended Subcontracts Table of Contents County prepares the amendment This could include: Grid Duty statements Activity pages SubContracts (which means fully executed, CURRENT contracts that pertain to MAA) Table of contents (defined as a list of each claiming unit in a claiming plan) County prepares the amendment This could include: Grid Duty statements Activity pages SubContracts (which means fully executed, CURRENT contracts that pertain to MAA) Table of contents (defined as a list of each claiming unit in a claiming plan)

9. Changes by E-Mail Per the checklist, if the change requires an e-mail, be sure to include all required documentation. Some changes only require an email: change of address, coordinator info, deleting a previously approved activity or contractor. Use the checklist to determine if only an email is needed�..if so, then this training does not apply to those few instances. Some changes only require an email: change of address, coordinator info, deleting a previously approved activity or contractor. Use the checklist to determine if only an email is needed�..if so, then this training does not apply to those few instances.

10. Step 1: County Prepares Amendment (cont.) Will ALWAYS include: Signed, dated Certification Statement. Claiming Plan Amendment Checklist. Cover Letter. No longer necessary to include 2 copies. Will always include: Certification statement Amendment checklist Cover letter (outlines what is changing from the previously approved plan) Do not need 2 copies, we can now approve amendments in house and don�t need to send to CMS for approval Will always include: Certification statement Amendment checklist Cover letter (outlines what is changing from the previously approved plan) Do not need 2 copies, we can now approve amendments in house and don�t need to send to CMS for approval

11. Step 1: County Prepares Amendment (cont.) Best Practices On Grid: New classifications or activities in BOLD Existing classifications that have changed in Italics Use of COLOR to highlight changes Email Send amendment via email in addition to hard copies Mail with your Analyst�s name, the CMAA Unit name and Mail Stop clearly identified on the outside envelope. Helpful hints that make our review easier�.. By color coding, or somehow making them stand out, the changes are easy to identify. Also, if something changed that is NOT highlighted, bolded, etc, it is a quick way of establishing the change was made in error. Email: Speeds things up: if there are any typos, small changes, we can make them in house, then email the form back to the county with a quick note of what was changed and asking their approval. ****will NOT make big changes, delete things, etc. Will request county make the changes and re-submit them as corrected. If sending via email, still need to send a signed certification by mail. On to step 2�.Helpful hints that make our review easier�.. By color coding, or somehow making them stand out, the changes are easy to identify. Also, if something changed that is NOT highlighted, bolded, etc, it is a quick way of establishing the change was made in error. Email: Speeds things up: if there are any typos, small changes, we can make them in house, then email the form back to the county with a quick note of what was changed and asking their approval. ****will NOT make big changes, delete things, etc. Will request county make the changes and re-submit them as corrected. If sending via email, still need to send a signed certification by mail. On to step 2�.

12. Step 2: Amendment is Received by CDHS Goes to the mail room, where it may never be seen again! ALWAYS send with Analyst�s name, CMAA Unit name and Mail Stop clearly written on the outside envelope. May still take a few days to get delivered and distributed. Analysts receive in their �In-box� and give to the support staff to log in. Amendment received by DHS Goes to the mail room where it is never seen again. Get the point??? ALWAYS send with the analyst�s/unit name and Mail Stop clearly identified. Still getting items with no name, addressed to Liz, or not receiving things at all May still take a few days to get delivered, But eventually we receive in our in box. Even though at this point it still needs to go to Alisha to get logged in, we have seen it, we know it is coming, and we can get it on our radar so we can adjust our workload for it.Amendment received by DHS Goes to the mail room where it is never seen again. Get the point??? ALWAYS send with the analyst�s/unit name and Mail Stop clearly identified. Still getting items with no name, addressed to Liz, or not receiving things at all May still take a few days to get delivered, But eventually we receive in our in box. Even though at this point it still needs to go to Alisha to get logged in, we have seen it, we know it is coming, and we can get it on our radar so we can adjust our workload for it.

13. Step 3: Logged in by Support Staff Support staff: Logs it in our central computer files. Creates color-coded tracking cover sheet which: Indicates FY/Quarter it is received. Identifies LGA & claiming unit. The analyst it is assigned to. The date it is logged into the system. Step 3: Goes to Alisha Alisha logs it in to our amendment log for tracking Creates a color-coded tracking sheet for it: Identifies the claiming unit, the LGA, date received, who it was assigned to, the FY & quarter it was received and the date it was logged into the system as received Alisha staples the tracking sheet to a folder, puts all the documents in side and puts in the analysts in box (which brings us to step 4�.)Step 3: Goes to Alisha Alisha logs it in to our amendment log for tracking Creates a color-coded tracking sheet for it: Identifies the claiming unit, the LGA, date received, who it was assigned to, the FY & quarter it was received and the date it was logged into the system as received Alisha staples the tracking sheet to a folder, puts all the documents in side and puts in the analysts in box (which brings us to step 4�.)

14. Step 4: Assigned to the Analyst After log in, it is placed in the county analyst�s In-box. 30-day clock starts from date of log in. Again, 30-days is variable depending on workload, when it was received (such as at the end of the quarter when we get TONS of invoices), vacations, site visit scheduled, training�..all of these can affect this. But at this point, it gets put on our weekly workload summary (along with the date it was received) that Linda reviews and she can track the status of it from that point on.Again, 30-days is variable depending on workload, when it was received (such as at the end of the quarter when we get TONS of invoices), vacations, site visit scheduled, training�..all of these can affect this. But at this point, it gets put on our weekly workload summary (along with the date it was received) that Linda reviews and she can track the status of it from that point on.

15. Step 5: Analyst Reviews Analyst pulls the County binder and flips to the claiming unit that corresponds to the amendment. Copies the existing (�old�) grid. Compares the old grid to the amended (�new�) grid. - looks at each box and identifies the differences for each component. Step 5: Analyst reviews�� Pulls previously approved grid (�OLD�) Copy of the �new� grid Does a side by side comparison This is the interactive training portion of the show. In your hand outs, you have 2 grids. The blue copy represents the �old� grid. The yellow copy represents the �new� grid. We are going to compare these item by item.Step 5: Analyst reviews�� Pulls previously approved grid (�OLD�) Copy of the �new� grid Does a side by side comparison This is the interactive training portion of the show. In your hand outs, you have 2 grids. The blue copy represents the �old� grid. The yellow copy represents the �new� grid. We are going to compare these item by item.

16. Step 5: Analyst Reviews (cont.) Reviews Boxes 1 -7 Is the information still the same? Reviews Box 8 Is the description still the same? Reviews Box 9 Notes ALL differences in list of classifications. Reviews Box 10 For each classification: is SPMP status still the same? Items 1-7 Basic information Box 8: Is the description still the same. If it changed, I would expect to see new activity description pages that accurately reflect the new functions Box 9: Are the classifications the same? Make note of any added classifications or changes on the �new� grid. Note any deletions on the �old� grid. Box 10: Change in status on an existing classification would be cause to question.Items 1-7 Basic information Box 8: Is the description still the same. If it changed, I would expect to see new activity description pages that accurately reflect the new functions Box 9: Are the classifications the same? Make note of any added classifications or changes on the �new� grid. Note any deletions on the �old� grid. Box 10: Change in status on an existing classification would be cause to question.

17. Step 5: Analyst Reviews (cont.) Reviews Box 11: For each classification, are the activities performed the same (existing)? Are there any new activities identified on the grid (new or existing positions)? Analyst makes notes of all the changes and identifies the needed information for each change. Box 11: Take a ruler, and go through each activity for each classification one by one. Making note on the �new� grid when ever there is a change or deletion. Do this whether there are 3 classifications or 30. Circle, check or some how identify any changes for each one. Once we are done, we know from this comparison what back up documentation we expect to see submitted; Need duty statements for new classifications, name changes to classifications, classifications that have new or deleted activities Need activity pages for any new (not previously approved) activities Copies of contracts if sub-contracts identified. Knowing what we need to look for�..Box 11: Take a ruler, and go through each activity for each classification one by one. Making note on the �new� grid when ever there is a change or deletion. Do this whether there are 3 classifications or 30. Circle, check or some how identify any changes for each one. Once we are done, we know from this comparison what back up documentation we expect to see submitted; Need duty statements for new classifications, name changes to classifications, classifications that have new or deleted activities Need activity pages for any new (not previously approved) activities Copies of contracts if sub-contracts identified. Knowing what we need to look for�..

18. Step 5: Analyst Reviews (cont.) Reviews to see if all duty statements are attached: New positions. Existing positions who had new activities added/deleted. Existing positions whose classification on the grid has changed (i.e.: PHN to PHN I/II). We quickly flip through to see if all required duty statements are attached Any classification that has these changes needs to have a new duty statement attached Then we actually review the duty statements�.We quickly flip through to see if all required duty statements are attached Any classification that has these changes needs to have a new duty statement attached Then we actually review the duty statements�.

19. Step 5: Analyst Reviews (cont.) Reviews Duty Statements: Does the title match the grid? Is the duty statement complete? Are MAA activities clearly identified? Do the MAA activities identified correspond with manual descriptions? Do the MAA activities identified correspond with the submitted grid? Are the duties part of an inherent service i.e. physician performing outreach in a clinic. Over all, do the duties seem reasonable for the classification? Some of the questions we ask, items that we look for: Are the titles exactly the same as the grid Are they complete: We want complete duty statements, not ones just showing the MAA duties\ Are MAA activities clearly identified? Big, bold letters that correspond with MAA activities Do they correspond with manual descriptions? The activity statements in manual are nice, general statements that include a range of activities. We like that. If you do get specific or want to use your own language, then make sure to reference MAA and Medi-Cal when describing the duties. Do the MAA activities in Duty statement match what is in the grid (again, go back to the �new� grid and compare for each classification Over all, does it make sense? Do you have a Public Health Director doing the same duties as a clerk? Not saying that would never happen�..but maybe we�d need to question that a little further�.. After review for each one complete, then we move on to activity description pagesSome of the questions we ask, items that we look for: Are the titles exactly the same as the grid Are they complete: We want complete duty statements, not ones just showing the MAA duties\ Are MAA activities clearly identified? Big, bold letters that correspond with MAA activities Do they correspond with manual descriptions? The activity statements in manual are nice, general statements that include a range of activities. We like that. If you do get specific or want to use your own language, then make sure to reference MAA and Medi-Cal when describing the duties. Do the MAA activities in Duty statement match what is in the grid (again, go back to the �new� grid and compare for each classification Over all, does it make sense? Do you have a Public Health Director doing the same duties as a clerk? Not saying that would never happen�..but maybe we�d need to question that a little further�.. After review for each one complete, then we move on to activity description pages

20. Step 5: Analyst Reviews (cont.) Reviews to see if all Activity Pages are included: - For any new activity that is added. - For any changes in staff that would require a change to the Activity Page. - For any change in claiming unit functions that would result in a change in the types of activities performed. We quickly flip through to see if all required activity pages are attached Needed if: Activity was not previously approved Activities that have changes to sub-contractors or require you to individually list staff (activity F only) 3rd statement goes back to item 8 on grid � did the function of the claiming unit change drastically? Then we actually review the activity description pages�. We quickly flip through to see if all required activity pages are attached Needed if: Activity was not previously approved Activities that have changes to sub-contractors or require you to individually list staff (activity F only) 3rd statement goes back to item 8 on grid � did the function of the claiming unit change drastically? Then we actually review the activity description pages�.

21. Step 5: Analyst Reviews (cont.) Reviews Activity Pages - Reviews based on instructions in the LGA manual for each individual activity. Each activity page has its own requirements for getting filled out. We follow the instructions at the bottom of each page and make sure everything if filled out correctly.Each activity page has its own requirements for getting filled out. We follow the instructions at the bottom of each page and make sure everything if filled out correctly.

22. Step 5: Analyst Reviews (cont.) Best Practices: Leave the questions on the Activity Pages, then answer them underneath. Include the statement �Classifications and SPMP status are listed on the Claiming Unit Functions Grid�. If this statement is used, a new Activity F page will not be required for subsequent amendments if that is the only information changing. Leaving the questions: no room for error. Have found counties that skip or mix-up questions. So when I go through the list of questions, the answers make no sense. By writing the question � there is no mistake on what question is being answered and less change that it will get over looked. Activity F only: less work down the line for the county, as a new activity page would not have to be submitted with each amendment if the only thing changing are the classifications. Leaving the questions: no room for error. Have found counties that skip or mix-up questions. So when I go through the list of questions, the answers make no sense. By writing the question � there is no mistake on what question is being answered and less change that it will get over looked. Activity F only: less work down the line for the county, as a new activity page would not have to be submitted with each amendment if the only thing changing are the classifications.

23. Step 5: Analyst Reviews (cont.) Compares findings to the county checklist & cover letter. Prepares internal checklist. Contacts county for any additional information or back up documentation that may be needed. After we look at all the information, We compare what changes we found to what the cover letter/ checklist said. Is there any differences? Internal checklist that we prepare. This is used as the summary for Linda when she reviews. But at this point, we look at ALL duty statements & activity sheets (from previously approved amendments) to: - make sure we have them all on file - they are complete and up to date - any subcontracts referenced are up to date - org charts - table of contents At this point we would contact the county with any/all questions that we had and request any additional information we may need. After we look at all the information, We compare what changes we found to what the cover letter/ checklist said. Is there any differences? Internal checklist that we prepare. This is used as the summary for Linda when she reviews. But at this point, we look at ALL duty statements & activity sheets (from previously approved amendments) to: - make sure we have them all on file - they are complete and up to date - any subcontracts referenced are up to date - org charts - table of contents At this point we would contact the county with any/all questions that we had and request any additional information we may need.

24. Step 6: Approval Letter Analyst prepares Approval Letter: Master grid with all claiming units listed and a summary of what activities each claiming unit is approved for. Will have effective date of amendment. Will show what claiming units were added, amended and/or deleted. This is based on the last approval letter. It is up to the county to review & verify all claiming units are included and information is correct. Prepare approval letter Summary of all approved claiming units and activities Will have effective date of amendment Will show what is being added, amended or deleted Also prepare a summary memo for linda outlining all the changes being made and confirming that all required documentation is on file. Prepare approval letter Summary of all approved claiming units and activities Will have effective date of amendment Will show what is being added, amended or deleted Also prepare a summary memo for linda outlining all the changes being made and confirming that all required documentation is on file.

25. Step 6: Approval Letter (cont.) Analyst routes letter to Chief of CMAA for review, approval and signature. - Linda reviews & makes any changes or necessary edits.

26. Step 7: Letter Gets Signed Linda signs the letter! - Letter is then forwarded to Support Staff for finalization & formatting. Alish add dates, page numbers, confirms correct address for coordinator, formats in adobeAlish add dates, page numbers, confirms correct address for coordinator, formats in adobe

27. Step 8: Letter Released to the County Letter is sent to the County via email. If you have questions about the letter, please contact your county analyst. Do not respond directly to Alisha. Alisha then sends it to the county via email. This is a new and improved approval letter Removed reference to methodology � we look this up in the claiming plan. Removed list of schools. In CMAA, we don�t keep track of what schools are claimed through the LGA. That tracking is done through SMAA. Alisha then sends it to the county via email. This is a new and improved approval letter Removed reference to methodology � we look this up in the claiming plan. Removed list of schools. In CMAA, we don�t keep track of what schools are claimed through the LGA. That tracking is done through SMAA.

28. Step 9: Amendment Effective Amendment is in effect retroactive to the first day of the quarter in which the amendment was received. (this is where you applaud!) Of course, there is always an exception to the rule. First quarter amendments can be received up until November 1st. So, that is how amendments to existing claiming units are reviewed. Lets look at the process for reviewing addition of a totally new claiming unit to the claiming plan:(this is where you applaud!) Of course, there is always an exception to the rule. First quarter amendments can be received up until November 1st. So, that is how amendments to existing claiming units are reviewed. Lets look at the process for reviewing addition of a totally new claiming unit to the claiming plan:

29. Steps to Reviewing Addition of a New Claiming Unit to the Claiming Plan County prepares the amendment and mails to CDHS. Amendment is received at CDHS. Logged in by CMAA support staff. Assigned to the Analyst. Analyst reviews. Analyst prepares Approval Letter. Chief of CMAA reviews & signs letter. Approval Letter sent to County via email. Plan is in place as of the 1st day of the quarter it was received. Well look at that. It is exactly the same. Well look at that. It is exactly the same.

30. Steps to Reviewing Addition of a New Claiming Unit to the Claiming Plan County prepares the claiming plan amendment and mails it to CDHS for review. Amendment documents will include: Claiming Plan Checklist Cover Letter Claiming Unit Functions Grid Activity Description Pages Duty Statements Copies of any Subcontracts Certification Statement Table of Contents Organization Chart However step one is different in that it will always include: (read list) Because it is brand new and we don�t have that information on file yet. However step one is different in that it will always include: (read list) Because it is brand new and we don�t have that information on file yet.

31. New Claiming Unit (cont.) Checklist will need to indicate if the new claiming unit is a Community-Based Organization (CBO). There is a box on the checklist the county prepares that must indicate if it is a CBO or not. That is all I am going to say on CBO�s ? There is a box on the checklist the county prepares that must indicate if it is a CBO or not. That is all I am going to say on CBO�s ?

32. New Claiming Unit (cont.) Time Survey Remember, in order to time survey in a month other than September or October, a request to time survey must be submitted and approved by your analyst. Keep your approval letter in your audit file. If you time surveyed in April for FY 05/06, you will need to time survey again in September or October for FY 06/07. Also, all staff who time survey must attend annual training before the time survey month. Keep your approval letter in your audit file. If you time surveyed in April for FY 05/06, you will need to time survey again in September or October for FY 06/07. Also, all staff who time survey must attend annual training before the time survey month.

33. New Claiming Unit (cont.) The review process for adding a new claiming unit follows the same steps as an amendment to an existing claiming unit. We look at all the same information in the same way. Except this process is easier, because we don�t have to compare each item. And remember�.We look at all the same information in the same way. Except this process is easier, because we don�t have to compare each item. And remember�.

34. Questions while preparing an amendment? Contact your analyst If you have questions while preparing your amendment, pick up the phone and contact your analyst! Now, on to my favorite part of the training�..If you have questions while preparing your amendment, pick up the phone and contact your analyst! Now, on to my favorite part of the training�..

35. Questions & Answers For any questions not answered during this training, please e-mail Julie Macko at Jmacko@dhs.ca.gov Or, in writing to: California Dept of Health Services Medi-Cal Benefits Branch, Attn: Julie Macko Medi-Cal Administrative Activities Unit P.O. Box 997417, MS 4601 Sacramento, CA 95899-7417 Questions.Questions.

36. INTERMISSION