Targeted Case Management

1. TCM Cost Report Department of Health Care Services (DHCS) Presents Targeted Case Management Cost Report Training August 2007

2. What you need to know & remember while you are here!!! Cost Report TCM • Location of restrooms • Emergency exit • Where to eat • Cell phones and pagers • Questions during the presentation

3. Cost Report TCM Welcome to TCM Cost Report Training 2007 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 (Cont’d) • Audits & Investigation Acceptance and Approval Process

4. 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)

5. Cost Report TCM Important Changes!!! • New Department name • Cost Report Review Tool – submit electronically • Cost Report Review Tool – corrected • Funding Schedule – submit electronically • Worksheet B – column 3 was deleted • Cover Letter – signed by the LGA Coordinator

6. Cost Report TCM 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

7. Cost Report TCM TCM Training Tools • Training packet includes: • TCM Power Point Presentation • A & I Power Point Presentation • TCM Cost Report Instructions • TCM Cost Report Template • Time Survey Template

8. Cost Report TCM TCM Training Tools (Cont’d) • TCM Cost Report Review Tool • TCM Cost Report Checklist • Funding Schedule • Sample of a Good Cost Report

9. Cost Report TCM TCM Training Tools (Cont’d) • Cost Report Decision Tree and questions • Certification Statement • Got Questions? • Evaluation

10. Cost Report TCM DHCS 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.

11. Cost Report TCM Packaging of your Cost Report • 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

12. Cost Report TCM 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

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

14. 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 Overnight or Express Mail: Department of Health Care Services Audits & Investigations Audit Review & Analysis Section 1500 Capitol Ave. MS 2109 Sacramento CA 95814 Cost Report TCM Where do I mail the Cost Report by November 1? Email to: dhsaitcm@dhcs.ca.gov

15. Pieces of the Puzzle

16. Cost Report TCM Reimbursement Methodology • What are the factors? • Time spent doing/supporting TCM • Cost of providing/supporting TCM • Reported and projected valid Encounters • Federal Medical Assistance Percentage (FMAP) • Timely submission of Invoices

17. Cost Report TCM TCM Encounters 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

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

19. Questions?

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

21. Cost Report TCM Decisions? • Define Budget Unit • Methodology One or Two (two ways to allocate cost) • Classifying Salaries & Benefits • Classifying Contractor Costs • Classifying Operating Expenses • Indirect Expenses

22. Cost Report TCM Summary of Steps • ID the smallest unit of the program that provides TCM • Describe the program’s Cost Allocation/Accounting Methods • Classify staff as TCM, ADMIN, NTCM • Complete Time Survey Summary Template

23. Cost Report TCM Summary of Steps (Cont’d) • Analyze General Ledger for TCM Revenue & Costs • Classify Revenues & Costs as TCM or NTCM • Enter amounts in the TCM Cost Report Template • Construct Summary of Revenues and Costs

24. Cost Report TCM Summary of Steps (Cont’d) • Analyze the TCM Programs Encounter Logs • Analyze key figures using the Cost Report Review Tool for audit risk assessment • Include cover letter, completed Check List and Table of Contents • Certify, package, and submit the TCM Cost Report

25. 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.

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

27. 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!!!

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

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

30. Cost Report TCM MAA-TCM Combo Time Survey Template (Cont’d) How to name the Excel file - The LGA name - Abbreviated TCM Program name: PH-PublicHealth OC-Outpatient Clinics Link-Linkages AP-Adult Probation Comm- Community PG-Public Guardian/Conservator

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

32. ? ? TCM Questions? ???? ??? Questions?

33. 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?

34. Cost Report TCM About Cost Report Template The 9 worksheets in this Template are: • Worksheet A • Encounters • Worksheet B • Worksheets C & C1 • Worksheet D 6. Salaries 7. Survey Averaging 8. Contractors 9. References

35. Cost Report TCM Cost Report Presentation • The Cost Report templates will be presented in the order in which you complete the worksheets. About the presentation:

36. Cost Report TCM About Cost Report Template (Cont’d) How to name the Excel file for submission - The 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

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

38. Cost Report TCM About 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.

39. Cost Report TCM Cost Report Template • Enter LGA & Program Information on Worksheet A • Enter Reporting Period Worksheet A

40. 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.

41. 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.

42. 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

43. 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

44. 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.

45. 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.

46. 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.

47. 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.

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

49. 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.

50. 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.