Targeted Case Management

1. TCM Cost Report Department of Health Care Services (DHCS) Presents Targeted Case Management Cost Report Training August 2009

2. Cost Report TCM Welcome to TCM Cost Report Training 2009 What's Ahead!!! • Introduction to Cost Report Instructions • Step-By-Step of how to build a Cost Report • Audits & Investigation Acceptance and Approval Process

3. Cost Report TCM 2009 Changes!!! AB 2527 New Certification/Attestation Statements Closing -Year Costs “Add-a-Line” button to Templates and Schedules.

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

5. Cost Report TCM TCM Tools & Templates • Tools: • TCM Power Point Presentation • A & I Power Point Presentation • TCM Cost Report Instructions • 2009 Cost Report Check list • Decision Tree Flow Chart

6. Cost Report TCM TCM Tools & Templates • Templates: • TCM 2009 Cost Report Template* • 2008 Time Survey Template* • Cost Report Review Tool* • Funding Schedule* • Certification and Attestation Statements • LGA • Non-LGA LPE

7. Cost Report TCM 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)

8. Cost Report TCM 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)

9. Cost Report TCM 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

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

11. Cost Report TCM 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

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

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

14. Cost Report TCM 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!!!

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

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

17. Cost Report TCM MAA-TCM Combo Time Survey Template (Cont’d) How to name the Electronic Files • Current Year and LGA name • - Abbreviated TCM Program name: • PH-PublicHealth OC-Outpatient Clinics • Link-Linkages AP-Adult Probation • Comm- Community TS-Time Survey • PG-Public Guardian/Conservator

18. Cost Report TCM MAA-TCM Combo Time Survey Template (Cont’d) Example: The 2010 Santa Barbara Linkages Time Survey template becomes: 2010 Santa Barbara Link TS.xls

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

20. Cost Report TCM TCM Cost Report Template (Cont’d) The 9 worksheets in this Template are: • Worksheet A 6. Salaries • Encounters 7. Survey Averaging • Worksheet B 8. Contractors • Worksheets C & C1 9. References • Worksheet D

21. Cost Report TCM 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

22. Cost Report TCM TCM Cost Report Template (Cont’d) Example: The 2009 Santa Barbara Public Health Cost Report template becomes: 2009 Santa Barbara PH CR.xls

23. Cost Report TCM TCM Cost Report Template (Cont’d) • Formula-driven • Enter data in the BLUECells 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 containcomments to help you enter data.

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

25. Cost Report TCM 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.

26. Cost Report TCM 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.

27. Cost Report TCM 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 Sch 1A S&B Sch 1B S&B Sch 2A S&B Sch 2B S&B Sch 2C S&B Sch 2D

28. Cost Report TCM 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

29. Cost Report TCM 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.

30. Cost Report TCM 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.

31. Cost Report TCM 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.

32. Cost Report TCM 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.

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

34. Cost Report TCM S&B Schedule 2A 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 yellowcells. No further entry is needed.

35. Cost Report TCM S&B Schedule 2A (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.

36. Cost Report TCM 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.

37. Cost Report TCM 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.

38. Cost Report TCM 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.

39. Cost Report TCM 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 you need additional lines added to this worksheet, press the associated “Add button” and enter the number of lines to add.

40. Cost Report TCM 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.

41. Cost Report TCM 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 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.

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

43. Cost Report TCM Worksheet C & C1 This worksheet reclassifies the costs based on the time survey results. • Do not enter data onto this worksheet.

44. Cost Report TCM 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).

45. Cost Report TCM 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.

46. Cost Report TCM 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.

47. Cost Report TCM 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.

48. Cost Report TCM 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

49. Cost Report TCM 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.

50. Cost Report TCM Funding Schedule (Cont’d) How to name the Excel file for submission Example: The 2009 Santa Barbara Linkages Funding Schedule template becomes: 2009 Santa Barbara Link FS.xls