CMAA Claiming Plan New Requirements Carol L. Elliott, Solano Monica Lemelle, San Luis Obispo

Objective “Find out about the new requirements in submitting your claiming plans. Learn how to shape your claiming units to best serve your programs.”

Agenda What is a Claiming Plan? What is a Claiming Unit? What are different ways to create a claiming plan? What needs to be submitted to DHCS and when does it need to be submitted Best practices

What is a Claiming Plan Claiming Plan is used to indicate MAA time survey participants and direct charge staff. Claiming Plan is reported on a Claiming Unit Functions Grid. Claiming Plan members generally share some common programmatic and fiscal characteristics.

What’s the Purpose of the Claiming Plan The CMAA claiming plan describes in detail: The claiming units for which invoices will be submitted. Specific MAA activities each claiming unit will perform. Classifications performing MAA The required documentation each claiming unit will maintain. How the costs relating to MAA will be allocated and documented.

A Good Claiming Plan Easily understood Easily explained Comprehensive Accurately reflects your program’s operations Transparent

CLAIMING PLAN SUBMISSION REQUIREMENTS All proposed amendments must be submitted prior to the beginning of the new quarter. Include the following documents: Claiming Plan Amendment Checklist Comprehensive Claiming Unit Grid (CCUG) Claiming Unit Functions Grid (CUFG) All relevant Activity Sheets All relevant Duty Statements Code 19 justification on letterhead if applicable

MAA/TCM Coordination and Claims Administration (Code 19) Only 1 full time equivalent (FTE) may claim to Code 19 per claiming unit. Code 19 justifications must be submitted when more than one person claims to code 19. The total of claimable time under Code 19 is still limited to 1 FTE. MAA/TCM Claiming Coordination Units who solely direct charge may have multiple FTE staff who claim to code 19. Justifications must be submitted on LGA letterhead prior to beginning of quarter.

CLAIMING PLAN DOCUMENTS Existing LGAs are only required to submit specific portions of the CMAA claiming plan documents to DHCS that are being amended. LGAs participating in the CMAA program for the first time will be required to submit all claiming plan documents to DHCS.

CCUG SUBMISSION REQUIREMENTS Submit to DHCS prior to the beginning of the new quarter:  Q1 – by June 30  Q2 – by Sept 30  Q3 – by Dec 31  Q4 – by Mar 31 When updating, adding, deleting a claiming unit. When increasing or decreasing the time survey frequency. When changing from direct charge to time survey (or vice versa). PPL

CCUG SUBMISSION REQUIREMENTS Must be signed and certified by the LGA MAA Coordinator. Must have an accompanying Claiming Unit Functions Grid for each claiming unit. Must agree with claims submitted to DHCS:  Changes made during or after the claiming quarter has begun must not be included in the quarterly invoice.  Claims that do not agree with the CCUG will be rejected.

Claiming Unit Audit Binder Audit File Checklist Claiming Plan Amendment Checklist CCUG and CUFG Activity Sheets Duty Statements SPMP Questionnaire Org Chart Direct Charge contracts Certification Statement MAA Outreach Materials Time Surveys

What is a Claiming Unit? Basis of MAA invoice submission. Claiming unit includes staff NOT reported on the Claiming Plan. General Admin Direct support who don’t time survey Direct supervisors who don’t time survey Non-claimable staff and costs

Defining the Claiming Unit A claiming unit can be: A program in a county governmental agency within the LGA. A program in a city governmental agency within the LGA. A program in another governmental agency with the LGA’s geographical region. A Community Based Organization (CBO) subcontracted to the LGA specifically to conduct MAA.

Different Claiming Unit Structures Create an efficient way to invoice and monitor claiming unit Choose what’s right for you One Budget Unit One Org Unit One Agency (CBO or LPE)

Defining Claiming Unit Structure Match General Ledger Claim all indirect costs Track revenue Tracking costs Segregate time survey results

Best Practices Structure Claiming Unit to maximize revenue Have high MAA % staff time survey, not direct charge Include management in Claiming Plan Have SPMP direct support NOT time survey

Best Practice: Aggregate time surveys to maximize revenue Aggregate time survey results + High MAA time + Low $: MAA coordination staff + Low MAA time + High $: management ___________________________________ = MAA time higher + $ higher: Higher Reimbursement

SPMP direct support/direct supervision Support staff who provide direct clerical support to SPMP are not required to time survey Direct supervisor to SPMP are not required to time survey Labor costs follow SPMP and go in Cost Pool 1 Include org chart in SPMP audit file to support direct support/direct supervision relationship

Best Practice: Training Issues for Claim Units Claiming Unit ≠ Training Unit Train the trainers Train by geography Train by similar duties – e.g. Nurses, Admin support staff, managers, etc.

Resources Department of Health Care Services website: CMAA website: LGA Consortium website:

Handouts Claiming Plan Amendment Checklist Appendix H – Comprehensive Claiming Unit Grid (CCUG) Appendix I – Claiming Unit Function Grid (CUFG) Appendix J – Activity Sheets Appendix K – Duty Statements Appendix L – SPMP Questionnaire Code 19 example PPL LGA Claiming Plan Amendments