1. Mental Health MAA Breakout Session Patrick Sutton May 26, 2016

2. MHMAA Background Mental Health MAA (MHMAA) is a State- administered federal Medicaid (Medi-Cal) program which reimburses mental health plans (MHPs) for staff and subcontractor costs when performing: “Activities necessary for the proper and efficient administration of the Medi-Cal State Plan” MHMAA is a cost-based, federal reimbursement program.

3. Breaking News!! The Centers for Medicare and Medicaid Services (CMS) conditionally approved the California MHMAA implementation plan in March 2016. Parallel codes have been added. 18 activity codes in total. New Invoice New Claim Plan format. More DHCS oversight. Time Survey 100% of your time.

4. MHMAA: General Information MHMAA activities can be directed towards both Medi- Cal and Non-Medi-Cal enrollees. Some of the MHMAA activities require that a “discount” be applied when determining reimbursement; this discount is arrived at by using the percentage of Medi- Cal clients served during one month in a quarter. The Federal Financial Participation (FFP) for the majority of MHMAA activity codes is 50%. Two codes (Case Management of a Non-Open Case and Program Planning & Policy Development) have a SPMP option that is available to certain licensed staff (SPMP); these activity codes reimburse at 75%.

5. MHMAA: Activity Codes Medi-Cal Outreach Medi-Cal Eligibility Intake Referrals in Crisis Situations for Non-Open Cases Medi-Cal/Mental Health Contract Administration Case Management of Non-Open Cases Program Planning & Policy Development MAA Coordination & Claims Administration

6. MHMAA: Activity Codes Activity Code Activity DescriptionFFP Rate 1Other ActivitiesU 2Direct Patient CareU 3Outreach to Non-Medi-Cal ProgramsU 4Medi-Cal Outreach –DiscountedPM 5Eligibility Intake for Non-Medi-Cal ProgramsU 6Medi-Cal Eligibility Intake – Not DiscountedTM 7Crisis InterventionU 8Referral in a Crisis Situation for Non-Open Cases, DiscountedPM 9Contract Administration for Non-Medi-Cal ProgramsU 10Medi-Cal Mental Health Service Contract Administration – Not DiscountedTM 11Medi-Cal Mental Health Service Contract Administration – DiscountedPM 12Program Planning and Policy Development for Non-Medi-Cal ProgramsU 13Program Planning and Policy Development – Discounted, Non-SPMPPM 14Program Planning and Policy Development – Discounted, SPMPPM 15Case Management of Open CasesU 16Case Management of Non-Open Cases – Discounted, SPMPPM 17MH MAA Coordination and Claims Administration – Not DiscountedTM 18General AdministrationR

7. Time Tracking Participants are expected to track their time in the following manner: Account for 100% of their paid time. Track both MHMAA time and non-MHMAA time. Track time in one-minute increments (like in the SD/MC billing program).

8. 100% Paid Time Tracking Like the CMAA and TCM programs, MHMAA now expects participants to track all of their paid time. Unlike before, there are now reimbursable and non-reimbursable activity codes. General Administration activity code If you work a 40 hour work week, you should code 40 hours of time in time survey.

9. Medi-Cal Discount % The Medi-Cal Discount Percentage is used to reduce, or discount, activities that benefit both Medi-Cal and non-Medi-Cal individuals, to determine the costs only associated with the Medi-Cal program. Over the past few years, A&I and several MHPs were at loggerheads over what constituted an acceptable Medi-Cal Discount Percentage.

10. Medi-Cal Discount % The Medi-Cal Discount Percentage is calculated on a quarterly basis. Based off of an “unduplicated count”. Pull the numbers for the entire quarter, not just one month during the quarter.

11. Claiming Plan The primary purpose of the Claiming Plan is to identify which job classifications will participate, and which activity codes they have access to. In addition, it also: Specifies what methodology will be used to determine the Medi-Cal discount percentage. Specifies the methodology that will be used to determine costs claimed to MHMAA (time survey, direct charge, etc.).

12. SPMP Skilled Professional Medical Personnel (SPMP) criterion: Only applicable to two activity codes (PPPD & Case Management of a Non-Open Case) Individual must have a professional education and training in the field of medical care or appropriate medical practice (psychiatrists, MD, psychologist, RN, LCSW, MFT) Individual must be performing an allowable activity that requires the specialized knowledge.

13. Open vs. Non-Open Cases Two activity codes (Case Management and Crisis Referral) are focused on Non-Open Cases. Open Case – The client has been entered into the MHP’s clinical billing system and the case is active. Non-Open Case – The client has not been issued a client number and has not been entered into the MHP’s clinical billing system.

14. Allowable Funding Sources As a certified public expenditure (CPE) program, MHMAA expenses may only be paid for with allowable revenue sources that include the following: Realignment (1991 and 2011) County General Fund/ Net County Cost Proposition 63 (MHSA)

15. Allowable Costs In addition to reimbursing MHPs for allowable Salary and Benefits costs, MHMAA also reimburses for its share of:  Internal Indirect Costs  OMB A-87 Costs  Direct Charge Costs

16. Fiscal Considerations Review your most recent Mental Health Cost Report: Have you exceeded the 15% cap on Administrative Claiming? Are you maximizing your UR/QA claim? What percentage of your allowable revenue is being used as match to draw down FFP? How much your MHP’s cost as Code 45 (Outreach Services) and/or Mode 60 (Support Services)?

17. Program Site Reviews DHCS will conduct program site reviews of each MHMAA MHP at least once every four years. DHCS will analyze the following: Time Survey Documentation Invoice Documentation Claiming Plan Documentation

18. Program Site Reviews Outline of a site review: 1.Entrance Conference 2.Interview selected staff members 3.Review of documentation 4.DHCS will request copies of staff licenses 5.Exit Conference a)Results of the site review b)Detail corrective measures c)Opportunity for staff to ask questions 6.Written Summary of Findings (if needed)

19. Program Considerations Which staff should participate? Direct Service Staff – Access units? Others? Administrative and Management Staff Review job classifications to see if specific job duties match up with individual activity codes.

20. State Training DHCS will conduct annual trainings for all MHPs with an approved MHMAA program. Three areas will be focused on: Claiming Plan Training Time Study Training Invoice Training

21. Best Practices Participants should be trained annually, at a minimum. Community Based Organizations (CBOs) are eligible for participation in MHMAA. Analyze recent Cost Reports to see where expenditures are allocated to non- reimbursable activities – potentially MHMAA eligible.

22. Going Forward Gaining support from management will help facilitate the process of securing buy-in from line staff. MHMAA is only being claimed by 16 of the 58 California Counties. This is a very underutilized program.

23. FY 2013/14 MHMAA