1. How do you determine if your program can claim MAA and/or TCM? Patrick Sutton & David Huey LGA MAA/TCM Annual Conference May 2016

2. AGENDA Buy In Scope of Work Interview prospective participants Revenue Analysis Activity Code Analysis Electronic Time Keeping System Program Considerations

3. Buy In Both MAA and TCM are Medi-Cal cost reimbursement programs that require significant technical work and administrative oversight in order to be done properly. Make sure that your superiors will support you if the decision is made to implement MAA and/or TCM. The support needs to come in the form of dedicated resources to ensure compliance with local, state and federal rules. Contact your local LGA Coordinator to obtain approval and to coordinate program implementation.

4. Scope of Work Clearly identify the program(s) that you will be screening for MAA and/or TCM participation: Is it a whole cost center/budget unit or is it a sub-unit? Are you screening just for MAA or just for TCM or for both? If the decision is made to implement, will it be at the beginning of a FY? At the beginning of a quarter other than Q1?

5. Prospective Participants Now that you have identified the contours of the program, you need to interview prospective participants. Why? To see if their day to day work fits in with MAA and /or TCM time survey activity codes. Need to look beyond what is contained within the job description to find out more about their actual work product. Get a sense of their interest or concerns about participating in MAA/TCM.

6. Revenue Analysis Both MAA and TCM are certified public expenditure (CPE) programs and as such, only certain revenue sources qualify to draw down federal financial participation through MAA/TCM. This is an exceedingly important step when considering whether or not to participate in MAA/TCM.

7. Allowable Revenue Sources Federal revenue sources, with almost no exception, are non-allowable. Discretionary sources of state and local revenue typically do qualify as allowable sources: Realignment (1991 and 2011) County General Fund Mental Health Services Act (MHSA) First 5

8. Offsetting Considerations Public Health divisions typically receive revenue from a multitude of sources, some of which are federal or otherwise unallowable. In certain circumstances, these revenue sources require that they be offset in the TCM cost report or in the MAA invoice. MCH Block Grant MCAH FFP AFLP CalLearn Nurse Family Partnership (NFP)

9. Activity Code Analysis When reviewing a prospective participant’s job description and when interviewing said participant, ascertain if their day to day work lines up with the MAA and/or TCM activity codes. This exercise will flesh out whether or not the participant typically spends significant time performing MAA and/or TCM activities.

10. Activity Code Analysis Reimbursable activities to screen for: Outreach (Medi-Cal, healthcare service) Referral/Coordination/Monitoring (healthcare service) Contract Administration (healthcare contract) Program Planning & Policy Development (healthcare) Arranging or Providing Transportation (healthcare services) Facilitating a Medi-Cal Application Case Management

11. Time Tracking Both MAA and TCM require that participants perpetually time survey for all of their paid time. This is a great deal of work for those units that employ an electronic time keeping system. It has proven overwhelming for many who continued to utilize a paper based approach.  Implement an electronic method for tracking your time

12. MAA Considerations MAA is easier to implement and easier to manage than TCM. Prepare Claiming Plan Start up at the beginning of any quarter Participant must time survey perpetually Less to audit than in TCM o Reconcile time survey results with payroll o Make sure that time surveys are error free o Invoices reconcile with G/L, payroll and time survey results

13. TCM Considerations TCM is a client focused reimbursement program that has its advantages. Covers more than just healthcare services Reimburses for providing “whole-person” case management services For Medi-Cal newly eligibles, TCM reimburses for allowable costs at 100%, sliding down to a final resting spot of 90% in 2020.

14. TCM Considerations TCM requires more oversight and is audited (both programmatically and financially)more frequently than MAA. Here are some items of need: Strong case management system (preferably electronic) Strong financial infrastructure to withstand annual financial audits

15. MAA & TCM? Some brave souls have implemented both MAA and TCM simultaneously. This is completely legitimate and is supported by the fact that they both MAA and TCM share one time survey. Make sure that: Participants are well trained and understand all 32 activity codes well. Keep in mind that TCM is client specific where MAA is typically not. Referral, Coordination & Monitoring vs. TCM

16. QUESTIONS??