Targeted Case Management (TCM) Cost Report Instructions for 2004 Presented By: LGA MAA/TCM Coordinators LGA MAA/TCM Consultant State of California, Department of Health Services

Important Changes! Standardized Table of Contents Budget Unit Descriptions Cost Allocation Method Description Small Budget Unit Time Surveys Summary Template Complete Organizational Chart Summary of Costs and Revenues LGA Coordinator Review Tool Funding Schedule Operating Expenses Detail Abbreviations, Key Terms, Resources

Overview Training Packet Includes: –Registration Card –(3) Question Cards –TCM Cost Report Instructions –TCM Cost Report Template –TCM Power Point Handout of Presentation –TCM Cost Report Checklist –Funding Schedule –LGA Coordinator Review Tool

Overview Result: You will be able to complete the cost report using the Excel templates.

Overview Required TCM Cost Report Format Annual TCM Cost Report –Submit one TCM cost report per program area. –Postmark and to DHS by November 1.

Overview Reimbursement Methodology –How much will we get? Cost of Providing TCM. Federal Medical Assistance Percentage. Timely Postmark to DHS.

Overview TCM Maximum Reimbursement Limit (Cap) –Encounter rate multiplied by the projected number of Medi-Cal encounters. –Cap x FMAP = Maximum Reimbursement

Preparing the TCM Cost Report Read the Changes to the Cost Report Instructions Read the Overview Read the Helpful Hints Read First Year of Participation

Preparing the TCM Cost Report Gather the Essential Materials –Time Surveys Summary Template –TCM Cost Report Template –Funding Schedule –Operating Expenses Schedule –Certification Statement –TCM Cost Report Checklist –LGA Coordinator Review Tool

Preparing the TCM Cost Report Gather the Required Supporting Documents –Organizational Chart –FY General Ledger Revenues/funding sources Salaries and benefits Services and supplies/operating expenses –FY Final Budget (part related to TCM only) –FY Summary of Costs and Revenues –FY Payroll Details for Staff on Cost Report –Community-Based Organization Contracts (if any) –Interagency Agreements on CBO Funding (if any) –Signed Time Survey Forms

Preparing the TCM Cost Report Summary of Steps –ID the Smallest Part of the LGA that Provides TCM –Describe the LGA’s Cost Allocation/Accounting Method –Classify Staff as TCM, Averaged, ADMIN, NTCM –Complete Time Surveys Summary Template –Analyze General Ledger for TCM Revenues & Costs –Classify Revenues & Costs as TCM or NTCM –Enter Amounts in the TCM Cost Report Template –Construct Summary of Revenues and Costs –Analyze the LGA TCM Encounter Log –Certify, Package, and Submit the TCM Cost Report

Preparing the TCM Cost Report Two Giant Steps Include the LGA name, TCM program, and reporting period in the certification statement, on Worksheet A (only), and on each support document. On the TCM Cost Report Template, fill in the BLUE cells only!

Preparing the TCM Cost Report Step-By-Step –Define the Budget Unit –Classify Salaries and Benefits TCM Averaged ADMIN NTCM –Classify TCM Contractor Costs Specific Non-Specific –Classify Operating Expenses Direct Indirect

Preparing the TCM Cost Report Step-By-Step Analyze the Time Surveys –Barbershop Analogy –Enter Data into the Time Surveys Summary Template

The Barbershop Analogy A Simple Example to Demonstrate: 1.The development of a cost rate. 2.The use of time survey results in the allocation of costs between two activities (programs). 3.The use of Revenue Offset and it’s effect on the cost rate.

A Simple Cost Rate A itemized invoice is not given to customers when they pay for a haircut at Bill’s Barber Shop. The hair cut rate is determined as follows: Total Annual Operating Costs + Total Annual Salary of Barber Bill = Total Annual Costs of doing business  Estimated # of haircuts given in a year = Amount to charge for a haircut

The Time Survey Many customers have requested color treatment services (highlights and lowlights) Barber Bill completes a time survey during his first month of offering both services: The results are as follows: 40% = 64 hours spent on giving haircuts 60% = +96 hours spent on giving color treatments 160 total hours worked in the month

Applying Time Survey Results His costs are as follows: Salary & Benefits = $30,000 Other Operating = $20,000 Haircutting supplies = $1,000 Color treatment supplies = $3,000

Applying Time Survey Results Costs are allocated upon time survey results as follows: Cost Haircut ColorTreatment Salary $12,000 ($30K*40%) $18,000 ($30K*60%) Other Oper. $8,000 ($20K*40%) $12,000 ($20K*60%) Supplies $1,000 $ 3,000 Total $21,000 $33,000

Projection of Annual Services Based on historical information, he projects that he will do 1000 haircuts. Based on an interest survey given to his customers, the projected number of color treatments will be 500.

Rate Calculations To calculate the charge for each service, he divides the total cost by the number of projected services to calculate a haircut rate and a color treatment rate: –Haircut rate $21,000 / 1000 haircuts = $21.00 –Color treatment rate $33,000 / 500 color treatments = $66.00

Revenue Offset Barber Bill is awarded a $1,000 federal grant which will subsidize his haircut services. The conditions of the grant are that he must offset the grant from the rates he charges his customers.

Revenue Offset Haircut ColorTreatment Total Cost:$21,000 $33,000 Revenue to Offset:- $1,000 Adjusted Costs:$20,000$33,000 Services Provided:  1,000  500 Rate charged: $20.00 $66.00

Revenue Offset On the TCM cost report (Worksheet B), only the portion of federal and private revenues that support the provision of TCM services to Medi- Cal beneficiaries must be offset. Use the Funding Schedule to calculate this specific amount. Normally, multiply the amount of unallowable revenues by the averaged percentage of TCM hours from the Salary Averaging worksheet multiplied by the ratio of Medi-Cal Only to total encounters reported on the top of the Encounters Methodology worksheet.

Preparing the TCM Cost Report Step-By-Step Provide one cover letter on letterhead for each cost report Carefully review the TCM Cost Report Checklist, sign, and include it in the transmittal to SDHS. Ensure that all required documents are included and that the Excel templates have been ed. Keep a complete audit file of supporting documentation for the TCM Cost Report.

Questions

TCM Time Surveys Summary Template Purpose : To accurately record and calculate data from the TCM Time Surveys in a standardized format. Data will be entered from the staff’s original signed Time Surveys. There are 5 worksheets in the Time Survey Template: List, Totals, Blank, Numbered Sheets and End.

TCM Time Surveys Summary Template Name the Excel file using: –The LGA name –Abbreviated TCM program name: PH-Public Health, OC-Outpatient Clinics, Link-Linkages, PG-Public Guardian/Conservator, AP-Adult Probation, and Comm-Community. –TS for Time Survey –Example: the Alameda Public Public Health Time Surveys becomes Alameda PH TS.xls

TCM Time Surveys Summary Template List Worksheet –At the top of this worksheet, enter the name of the LGA, the name of the TCM Program, and the time survey month and year. This information flows to the other worksheets. –Do not enter any other information on this worksheet. –This worksheet summarizes and lists the results of the time survey month by employee and time survey category.

TCM Time Surveys Summary Template Totals Worksheet –Use this worksheet to analyze possible data entry errors of the numbered time survey worksheets. –The formulas in this worksheet calculate the total number of staff in each TCM classification and unit, and the total number of hours in each time survey category.

TCM Time Surveys Summary Template Blank Worksheet –Do not enter data on this worksheet. This is only a placeholder.

TCM Time Surveys Summary Template Numbered Worksheets –These worksheets are for data entry of each employee’s Time Survey. –Select the workbook that includes the number of employees who time-surveyed: 30, 60, and 200. –Do not insert worksheets into this workbook. –You may delete unused worksheets.

TCM Time Surveys Summary Template Numbered Worksheets (Cont.) –Sort Time Surveys alphabetically. –Enter one Time Survey per worksheet starting with worksheet 1. –Identify the employee classification (Case Manager, Supervisor, or Support Staff) by using the drop-down box in one of the three classification boxes. –Enter the month and year of the time survey. –Enter the employee name, last name first.

TCM Time Surveys Summary Template Numbered Worksheets (Cont.) –Enter the employee’s: –Job classification –Employee number –Program and claiming unit –Claiming unit location –After all employee information is entered in the top section of the time survey, enter the employee’s time survey results.

TCM Time Surveys Summary Template Numbered Worksheets (Cont.) –Enter the number of hours recorded by the employee for each activity on each day. –The formulas calculate the total number of hours per day, per activity. –After all the data has been entered, analyze the data using the List and Totals worksheets. –When the data is complete, enter the percentages from the List worksheet onto Salaries & Benefits Schedule 2A and the total hours for each category on the Salaries Averaging worksheet.

TCM Time Surveys Summary Template End Worksheet –Do not use this worksheet. It is a placeholder.

TCM Cost Report Template This is a standardized template for LGAs to record the prior year’s total actual cost of providing TCM services in each TCM program. This template calculates the per- encounter rate and the maximum amount of reimbursement an LGA may receive as federal reimbursement for the current fiscal year’s Medi-Cal Only TCM encounters.

TCM Cost Report Template 1.Worksheet A 2.Encounters 3.Worksheet B 4.Worksheets C & C1 5.Worksheet D 6.Salaries 7.Survey Averaging 8.Contractors 9.References The 9 worksheets in this workbook are:

TCM Cost Report Template Name the Excel file using: –The LGA name –Abbreviated TCM program name: PH-Public Health, OC-Outpatient Clinics, Link-Linkages, PG-Public Guardian/Conservator, AP-Adult Probation, and Comm-Community. –CR for Cost Report –Example: the Mendocino Public Guardian Cost Report becomes Mendocino PG CR.xls

TCM Cost Report Template This is a formula-driven template. Do not enter data except where instructed. Do not alter the formulas in any way. Enter data only in the BLUE cells! The formulas automatically calculate amounts for the green and yellow cells. Leave these cells alone.

TCM Cost Report Template Some cells are formatted with a drop-down box. The drop-down is not visible on the screen until you click on the cell. Cells with a red triangle in the upper right corner contain comments to help you enter data. Place your cursor over the cell to read the message.

Survey Averaging Worksheet This worksheet calculates the averaged time survey percentages for the four time survey categories. These percentages automatically flow into the Averaged section of Salaries & Benefits Schedule 2A in the Salaries worksheet. Obtain the total number of hours for each of the four time survey categories from the List worksheet in the TCM Time Surveys Summary Template.

Survey Averaging Worksheet Survey Averaging Worksheet (Cont.) The hours entered into the BLUE cells will automatically link to the Averaged section of the Salaries worksheet (yellow cells in the Salary Survey columns). Verify that the results of the Survey Averaging worksheet appear correctly in the Averaged section of Salaries & Benefits Schedule 2A in the Salaries worksheet.

Salaries Worksheet The Salaries & Benefits Schedules (Salaries worksheet) contain the BLUE cells in which to enter staff names and classifications; staff salaries, benefits, and operating costs; and time survey results.

Salaries Worksheet 1.S&B Sch 1A 2.S&B Sch 1B 3.S&B Sch 2A 4.S&B Sch 2B 5.S&B Sch 2C 6.S&B Sch 2D The Salaries worksheet consists of 6 Salaries & Benefits Schedules (S&B Sch) that are marked in the upper-right where the schedule ends.

Salaries & Benefits Schedule 1A List all staff for the budget unit that provides TCM services. If you need to add rows, carefully follow the Excel rules for to insert of rows where needed for each staff classification. First, use the Insert/Rows function. Then, as described in the general instructions, use the Edit/Paste Special/Formulas function to copy formulas from blank rows in that classification.

Salaries & Benefits Schedule 1A Time Surveyed to TCM Averaged ADMIN NTCM The employees will go into one of the four categories listed on the worksheet.

Salaries & Benefits Schedule 1A The Role column helps DHS understand what function the employee performs in your program. Select the Role from the drop-down box for Time-Surveyed and Averaged employees. OPTIONAL: For clarity, add notes in the Notes column.

Salaries & Benefits Schedule 1A The Classification column must have an entry for each employee. Select the appropriate choice from the drop- down box, as described in the cost report instructions.

Salaries & Benefits Schedule 1A 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) and listed on a separate page. Green cells are cost report formulas. Do not enter data into them or change them.

Salaries & Benefits 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.

Salaries & Benefits Schedule 1B 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.

Salaries & Benefits Schedule 1B The cost report will automatically allocate the Distributed Operating Expenses amount to all of the listed employees based on their salaries and benefits, proportionate to the Total salaries and benefits. Include indirect costs (OMB A-87, departmental, etc.) with Distributed Operating Expenses on Salaries & Benefits Schedule 1B.

Salaries & Benefits Schedule 1B See instructions for Worksheet D for costs that are: –Not allowable per OMB A-87 –Not for the employees listed in this worksheet –100% TCM –100% NTCM

Salaries & Benefits Schedule 2A Salary Survey Enter the time survey results for your Time Surveyed to TCM staff from the TCM Time Surveys Summary Template. Enter your percentage to two decimals and do not round up (enter 9.85%, not 10.00%). If you have already completed the Time Survey Averaging worksheet, the averaged time survey results are in the yellow cells. No further entry is needed.

Salaries & Benefits Schedule 2A 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.

Break Time Please return in 15 minutes. Thank you

Salaries & Benefits Schedules 3A & 3B Contractor Worksheet This worksheet records the costs of CBOs that have contracted 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.

Salaries & Benefits Schedules 3A & 3B Contractor Worksheet Data Entry –For 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. –For Specific, enter under both columns the specific amount of the contract to provide TCM services.

Salaries & Benefits Schedules 3A & 3B Contractor Worksheet Copies of all TCM contracts with Community-Based Organizations (CBOs) must be included with the TCM Cost Report packet submitted to DHS.

Worksheet D Use this worksheet to report costs that are 100% TCM or 100% Non-TCM. –Do not use Columns 2, 3, and 5. –If more rows are required, insert them immediately below the first blank blue row or above the last blank blue row and renumber the rows in column A.

Worksheet 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.

Worksheet D Treatment of OMB Circular A-87 (from the County Cost Allocation Plan) and other Overhead Costs: –Report OMB A-87 and other overhead costs on Salaries & Benefits Schedule 1B (Salaries worksheet). –Your Auditor’s Office has copy of your approved OMB A-87 CCAP, which is required documentation for the Salaries & Benefits Schedule 1B.

Worksheet D Required Documentation –Additional documentation may be required for 100% TCM costs.

Questions

Worksheets C & C1 This worksheet reclassifies the costs based on the time survey results. Do not enter data onto this worksheet.

Worksheets C & C1 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). –If E26 if 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’re unable to find the error, contact your TCM Coordinator or the TCM Consultant.

Worksheet B Use the Funding Schedule. –List all revenues that support the budget unit that provides TCM services. –ID federal and private funding sources. –Calculate what portion of those revenues support the provision of TCM services to Medi-Cal beneficiaries. Only list revenue on this worksheet that must be offset against the cost of providing TCM services to Medi-Cal beneficiaries only.

Worksheet B When analyzing funding sources for the budget unit that provides TCM services to Medi-Cal beneficiaries only, review information from: Scope(s) of work Budgets Contracts Expenditure reports Revenue reports

Worksheet B Enter the following information: –Description: Enter the title of the revenue provided by the funding source to be offset. –Source: Enter Federal, Private Foundation, Private Donation, or Client Fees. If the funding comes from multiple sources, include that information. –Total Revenue: Enter the total amount of the contract, grant, or allocation. –Total Assigned to TCM Services: Amount of the Total Revenue in column D that pays only for the provision of TCM services to Medi-Cal beneficiaries only.

Worksheet B Note: Revenue that supports time spent on and coded to any activity other than TCM is not reported on Worksheet B. If staff coded to “Other/Activities” when performing case management funded by another revenue source, then that revenue is not reported on Worksheet B.

Worksheet B Required Documentation –Define acronyms and abbreviations. –Complete the Funding Schedule. –Describe the allocation methodology used to calculate revenue assigned to TCM Services provided to Medi-Cal beneficiaries only. (Normally, multiply the amount of unallowable revenues by the averaged percentage of TCM hours from the Salary Averaging worksheet multiplied by the ratio of Medi-Cal Only to total encounters reported on the top of the Encounters Methodology worksheet.)

Questions

Encounters Worksheet This worksheet uses the numbers of Medi- Cal Only and non-Medi-Cal TCM encounters (from the prior year’s Encounter Log) to calculate the projected number of Medi-Cal Only TCM encounters for the current fiscal year.

Encounters Worksheet Enter the fiscal year in which the encounters were conducted. Enter the number of TCM encounters with Medi-Cal beneficiaries, including those conducted by CBOs, if applicable. Enter the number of TCM encounters with non- Medi-Cal persons, including those conducted by CBOs, if applicable.

Encounters Worksheet Select increase or decrease from the drop- down box. Enter the percentage of anticipated change in the number of TCM encounters conducted with Medi-Cal beneficiaries for the current fiscal year. Explain this increase or decrease in the space provided.

Worksheet A Provides a summary of the reported TCM and non-TCM costs for the reporting period and calculates the TCM per- encounter rate (Line 20) and the maximum amount of claims for reimbursement (Line 22), before factoring the FMAP.

Worksheet A Enter the LGA name. Enter the Program name. Enter the reporting period (July 1, June 30, 2004).

Worksheet A Self-check areas –Row 7, Column 4 (Cell F15), must equal zero. –Row 7, Column 7 (Cell I15), must match the general ledger and summary. And finally… –Make sure that the appropriate person signs Worksheet A before submitting it to DHS.

Helpful Hints Don’t be overwhelmed. Start early and read all the instructions. Don’t start with Worksheet A. Begin with the Time Surveys Summary Template and the Salary Averaging worksheet. Color-code, circle, highlight, or label figures in the supporting documentation and the same figures in the worksheets in which they appear.

The First Year of Participation Either use data from prior year, or Annualize data (allowed in first year only).

Questions

TCM Cost Report Checklist Available on the TCM Website:

LGA Coordinator Review Tool LGA Coordinators must ensure that the cost report packet is complete before submitting it to DHS. Enter the totals from the TCM Cost Report Template for TCM, ADMIN, and NTCM salaries and benefits and the page number of the supporting document that details these totals. Do the same for operating expenses.

TCM Cost Report Reference Material Available on the TCM Website: –2004 TCM Cost Report Instructions –TCM Time Surveys Summary Templates for 30, 60, or 200 Staff –2004 TCM Cost Report Template –TCM Provider Manual, Section 4 –TCM Cost Report Checklist –TCM Cost Report Certification Statement –Link to OMB Circular A-87 –PPL , PPL , and other PPLs.

Questions