1 DSD Provider Network Application Technical Assistance and 2008 Fee-For-Service Agreement Contract Administration November 12, 2007 Presented by: Geri Lyday – Administrator, Disabilities Services Division Dennis Buesing – DHHS Contract Administrator Diane Krager – DHHS QA Coordinator Wes Albinger – DHHS Contract Services Coordinator Presentation can be accessed at:

2 DSD Request for Application Purpose of Application: Collect basic agency information to improve business process efficiencies Meet state and federal compliance requirements. Written contracts are required by State Statute if the total amount paid exceeds $10,000 in state and federal funds Incorporated into future contracts with DSD Collect info regarding the capacity of your agency regarding services your agency is currently providing or is proposing to provide within next 2 years

3 Other Potential Uses of Application Information Proposal to expand the Family Care program. Funding is provided for in 2007 – 2009 biennial state budget Shift from the current LTC service delivery system (Home and Community Based Waivers) to a managed care service delivery system (Family Care). May incorporate application information for contracting purposes with agencies applying to provide services for the Family Care program

4 National Provider Identifier: Covered entities under HIPPA are required to use NPIs to identify health care providers in standard transactions. Go to to learn more Federal Employer Identification Number. This is the number the IRS issues for filing of payroll tax forms. If you have no employees, use your social security number Being Medicare/Medicaid certified means you are able to bill Medicare/Medicaid directly for services If Medicaid certified, please provide your number here

5 Complete page 1, Section A, for each site which is currently or proposed to be utilized for services More than one may apply Must have one of these boxes checked if your agency is a corporation

6 Please list agency and your position. For example, you provide in home physical therapy as a physical therapist for ABC agency, and you also work independently as a physical therapist providing in home physical therapy. This must be disclosed to ABC in writing, and a copy of the written notification must be provided with this application.

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8 Disregard ** By listing a service in column C, and checking N in column F, you are indicating that your agency is proposing to provide this service Disregard “CMO”; check Y only if current provider for DSD

9 This page only to be filled out if services in Column C on previous page, are indicated with an “**” by the Service Name With regard to capacity, “unduplicated” refers to the total capacity you have to serve clients, expressed as the number of spaces (slots) you have at the sites you listed on page 1, Part A. Example: an 8 bed CBRF has a capacity of 8. A group activity which has a capacity of 10 people per day has a capacity of 10. A group activity with a capacity of 10 people which runs twice a day with different groups of people has a capacity of 20. Examples would include limited accessibility, restrictions to certain populations, etc. For capacity calculations which do not involve individuals (i.e., Durable Medical Equipment, Home Modifications, etc.,) look for guidance under “Service Name” on Exhibit A

10 By site, if applicable

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13 Applies to all coverages mentioned above

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17 Other Contract Requirements Audit and Accounting Requirements Maintaining Financial Records Audit Requirements and Waiver Procedures

18 Who Must Have an Audit? Audits are required by State Statute if the care & service purchased with State funding exceeds $25,000 per year Statutes allow the Dept. to waive audits. Audits may not be waived if the audit is a condition of state licensure, or is needed to claim federal funding (e.g. Group Foster Care or CCIs) Standards for audits are found in DHFS/DWD/DOC Provider Agency Audit Guide, 1999 Revision (on line at Non-profit providers that receive $500,000 or more in federal awards must also have audit performed in accordance with OMB Circular A-133 Audit of State, Local Governments, and Non-Profit Organizations.

19 Allowable Costs & Allowable Profits or Reserves Per State Statute, ultimately, all agreements with Milwaukee County DHHS for care & services paid with dept. funding are cost reimbursement contracts For-profit providers may retain up to 10% in profit per contract; 7½% of allowable costs, plus 15% of net equity (Allowable Cost Policy Manual, Section III.16)Allowable Cost Policy Manual Nonprofit providers paid on a unit-times- unit-price contract may add up to 5% of contract amount in excess revenues to reserves each yr., up to a cumulative maximum of 10%.

20 Maintaining Financial Records Both Federal and State contracting guidelines require provider agencies to maintain orderly books and adequate financial records Providers should maintain an accurate and up-to-date general ledger and timely financial statements for management & board members Financial Statements must be prepared in conformity with accounting principles generally accepted in the U.S. (GAAP) and on the accrual basis of accounting. Contractor must request, and receive written consent of County to use other basis of accounting in lieu of accrual basis of accounting.

21 Maintaining Financial Records Amounts recorded in the books should be supported by invoices, receipts or other documentation Providers should maintain a separate cost center for each contract, or program/facility within a contract Whenever possible, costs should be charged directly to a contract, all other costs should be allocated using a reasonable and consistent allocation method and supported by an Indirect Cost Allocation Plan Providers must not commingle personal and business funds. A separate checking account should be established & providers should not use personal credit cards for agency business All Provider agencies should maintain and adhere to a board approved, up-to-date Accounting Policy & Procedures Manual and bonus policy

22 Audit Waiver Statutes allow the Dept. to waive audits. Audits may not be waived if the audit is a condition of state licensure, or is needed to claim federal funding (e.g. Group Foster Care or CCI). Waiver request can only be entertained if agency does not need to have an audit according to Federal Audit requirement. Waivers need to be approved on case by case basis by regional office based on a risk assessment ( Funding <$75,000 is considered low risk) Waiver Request S/B submitted DHHS Contract Administration prior to audit due date

23 Audit Waivers DHHS has been approving Audit Waivers for Fee for Service contracts mainly on basis of economic hardship In case of small residential care providers ( Family group home and AFH) county has the authority to grant a waiver. Waiver Form is available at: docid= docid= Audit Waiver Form

24 Contact Information: Cleo Stewart: (414) , Wes Albinger: (414) , Diane Krager: (414) , Sumanish Kalia: (414) , Dennis Buesing: (414) , Presentation can be accessed at:

25 Thank you for your participation. Have a Nice Day