DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager

Introduction: Financial Audits Branch (FAB) Cost Report Process: Submission Acceptance Approval Results of Acceptance/Approval Process Audit Issues

Financial Audits Branch (FAB) Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.

Cost Report Flow: Submission of Cost Report Acceptance Acceptance Letter Approval Approval Letter Begin Invoicing TCM Program

TCM Cost Reports - Submission TCM Cost Reports due November 1st Hard Copy Audit Review and Analysis Section (ARAS) Soft Copy dhsaitcm@dhcs.ca.gov (Audits Section – Sacramento)

TCM Cost Reports - Submission Hard Copy* – Includes, but not limited to the following: Cover Letter Certification Statement Cost Report (Signed) / Including Funding Schedule Time Survey Template List Worksheet Totals Worksheet Time Sheets Cost Report Review Tool Supporting Documentation *Refer to TCM Cost Report Instructions - 2008

TCM Cost Reports - Submission Soft Copy – Includes the following completed items: Cost Report Template Survey Template List Worksheet Totals Worksheet Time Sheets Funding Schedule Cost Report Review Tool Template

TCM Cost Reports - Acceptance Acceptance Process : Responsibility of ARAS: Completion of five page checklist: Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report Hard Copy Soft Copy Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions

TCM Cost Reports - Acceptance Acceptance Process: Contact designated LGA Coordinator for missing and/or incorrect items. Via email: Hello TCM Coordinator: Please send the requested information via email within the next 24 hours. Thanks, ARAS

TCM Cost Reports - Acceptance Acceptance Process : Acceptance Letter issued by ARAS Acceptance Letter LGA For each TCM Cost Report (LGA and CBO) Identifies “postmark date” to establish 36-month audit period Letter issued to LGA only. CBOs do not receive a letter.

TCM Cost Reports - Acceptance Top reasons cost report was not accepted upon first review: Did not include “TCM encounters by month” IRS Form 990 not included Electronic copy of Worksheet A did not match hard copy Complete Table of Contents not included Financial statements for CBO not included Electronic copy of Cost Report not submitted

TCM Cost Reports - Approval Approval Process : Responsibility of Audits Section - Sacramento Review of checklist completed by ARAS Identification of “potential” audit issues for future audits Issuance of Approval Letter

TCM Cost Reports - Approval Approval Process : Approval Letter issued by Audits Section – Sacramento Approval Letter One letter issued for each target population served by an LGA Purpose of the letter is to establish: TCM Rate Period (2008/2009) Rate Per TCM Encounter TCM Maximum Amount

TCM Cost Reports - Approval Approval Process : (Excerpt from an Approval Letter) TCM Program Type (06): Public Health Rate Per TCM TCM Rate Period TCM Encounter Maximum Amount FY 2008-2009 $250.55 $100,220.00 400 encounters $250.55 x 400 = $100,220

TCM Cost Reports - Approval Approval Process : Approval Letter issued by Audits Section – Sacramento LGA Approval Letter TCM Program* *The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount.

TCM Cost Reports – 2007-2008 Results Month Approvals . Current Yr Prior Yr Nov 2007 0 0 Dec 2007 25 28 Jan 2008 41 36 Feb 2008 17 35 Mar 2008 16 20 Apr 2008 14 0 May 2008 2 0 Totals 115* 119* *Reflects LGA “Approved” SPA Cost Reports; excludes CBO cost reports.

Audit Issues: Amended Cost Reports Denied Cost Reports Audits: Payments Audits In Process: Certified Public Expenditure Status Future Audits: Desk Field

Questions?

FAB Contact Information Audit Review & Analysis Section (ARAS) Gary Wong, Chief (916) 650-6687 Gary.Wong@dhcs.ca.gov Audits Section - Sacramento Gary Diffenderffer, Supervisor (916) 650-6963 Gary.Diffenderffer@dhcs.ca.gov

DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager