1. MAA & TCM IN PROBATION LGA CONSORTIUM 2016 LGA MAA/TCM ANNUAL CONFERENCE

2. MAA & TCM Medi-Cal Administrative Activities (MAA) provides federal reimbursement for the cost of performing administrative activities that support efforts to identify & enroll potentially eligible individuals into Medi-Cal and to promote access to health care. Targeted Case Management (TCM) provides federal reimbursement for case management services provided to Medi-Cal beneficiaries in target populations.

3. REASONS TO PARTICIPATE “UNCAPPED” FEDERAL REVENUE FOR MAA – NOT CASE SPECIFIC, NO DOCUMENTATION REQUIRED FOR MAA OR TCM – DOESN’T HAVE TO BE A “REASONABLE CANDIDATE” ALMOST ALL STATE REVENUES ARE ELIGIBLE CPE – AB 109 Public Safety Realignment – SB 678 Community Corrections Performance Incentive – JJCPA – Juvenile Justice Crime Prevention Act – JPF – Juvenile Probation Funds – Prop 172 – Half-cent sales tax for Public Safety – YOBG – Youthful Offender Block Grant

4. REASONS TO PARTICIPATE – cont. YOUR AGENCY IS PROBABLY ALREADY DOING MANY OF THE ELIGIBLE ACTIVITIES PERFORMING MAA & TCM ELIGIBLE ACTIVITIES IS A GOOD FIT WITH EBP LEVERAGE FUNDS YOU ARE ALREADY RECEIVING & SPENDING AND RECEIVE FEDERAL REIMBURSEMENT TO DEVELOP ADDITIONAL PROGRAMS AND SERVICES FOR OFFENDERS

5. THINGS TO THINK ABOUT BOTH PROGRAMS REQUIRE A CONTINUOUS TIMESTUDY MAA & TCM DO NOT ALLOW THE USE OF A RMTS SYSTEM TCM REQUIRES A LOT OF DOCUMENTATION YOU MUST FIND A WAY TO OFFSET FEDERAL REVENUES FROM THE CLAIM OR COST REPORT

6. IS MAA AND/OR TCM RIGHT FOR YOUR AGENCY? IS YOUR DEPARTMENT MISSION IN SYNC WITH THE BASICS OF THE PROGRAMS? DOES YOUR DEPARTMENT HAVE THE INFRASTRUCTURE AVAILABLE (ADMIN STAFF, CASE MANAGEMENT SYSTEM, ETC) DO YOU HAVE THE SUPPORT OF MANAGEMENT? MORE IMPORTANTLY, WILL YOU HAVE THE SUPPORT OF STAFF? HAVE YOU DISCUSSED PARTICIPATION WITH YOUR LGA COORDINATOR?

7. MAA: MEDI-CAL ADMINISTRATIVE ACTIVITIES “ACTIVITIES FOR THE PROPER AND EFFICIENT ADMINISTRATION OF THE MEDI-CAL PROGRAM” OUTREACH TO: – POTENTIAL MEDI-CAL ELIGIBLE INDIVIDUALS – MEDI-CAL COVERED HEALTH SERVICES ASSISTING WITH ACCESS: – COORDINATION OF SERVICES – TRANSPORTATION – INTERPRETATION/TRANSLATION – MEDI-CAL APPLICATION ASSISTANCE

8. MAA: MEDI-CAL ADMINISTRATIVE ACTIVITIES NON-REIMBURSABLE ACTIVITIES – LAW ENFORCEMENT/PROBATION ONLY TIME – REFERRALS TO NON MEDI-CAL SERVICES WIC CALFRESH CHILD CARE HOUSING CPS HEALTH EDUCATION GED PROGRAMS JOB TRAINING PROGRAMS – CONTINUING EDUCATION & WORKFORCE TRAINING (IE STC, CORE, PC 832)

9. MAA: MEDI-CAL ADMINSTRATIVE ACTIVITIES PROPORTIONATELY REIMBURSABLE TIME – GENERAL ADMINISTRATION PAID BREAKS COMPLETING TIMECARD/TIMESURVEY OVERHEAD TYPE TASKS GENERAL TRAINING (NOT SPECIFIC TO JOB ASSIGNMENT) PAID TIME OFF – VACATION, SICK, HOLIDAY

10. MAA REIMBURSEMENT CLAIMS CLAIMS COMPLETED AFTER FISCAL YEAR CLOSES RECONCILE ALL EXPENSES FOR CLAIMING UNIT CATEGORIZE EXPENSES TO COST POOLS APPLY TIMESURVEY RESULTS APPLY COUNTYWIDE MEDI-CAL AVERAGE REDUCE BY 50% (FEDERAL FINANCIAL PARTICIPATION)

11. TCM: TARGETED CASE MANAGEMENT TCM PROGRAM PROVIDES CASE MANAGEMENT SERVICES THAT ASSIST MEDI- CAL ELIGIBLE INDIVIDUALS WITHIN A SPECIFIC TARGET GROUP TO GAIN ACCESS TO NEEDED MEDICAL, SOCIAL, EDUCATIONAL AND OTHER SERVICES.

12. TCM: TARGETED CASE MANAGEMENT TARGET POPULATIONS – CHILDREN UNDER THE AGE OF 21 – MEDICALLY FRAGILE INDIVIDUALS – INDIVIDUALS AT RISK OF INSTITUTIONALIZATION – INDIVIDUALS IN JEOPARDY OF NEGATIVE HEALTH OR PSYCHO-SOCIAL OUTCOMES – INDIVIDUALS WITH A COMMUNICABLE DISEASE

13. TCM: TARGETED CASE MANAGEMENT TCM CASE MANAGEMENT SERVICES ARE COMPREHENSIVE AND MUST INCLUDE AT LEAST ONE OF THE FOLLOWING FOUR SERVICE COMPONENTS: – COMPREHENSIVE ASSESSMENT AND PERIODIC REASSESSMENT – DEVELOPMENT OF A SPECIFIC CARE PLAN – REFERRAL AND RELATED ACTIVITIES – MONITORING AND FOLLOW-UP ACTIVITIES

14. TCM: TARGETED CASE MANAGEMENT COMPREHENSIVE ASSESSMENT & PERIODIC REASSESSMENT – TCM provides a comprehensive assessment and periodic reassessment to determine the need for any medical, educational, social or other services. These assessment activities include: Taking client history, identifying the individual’s needs and completing related documentation. Gathering information from other sources such as family, medical providers, social workers and educators to form a complete assessment of the eligible individual

15. TCM: TARGETED CASE MANAGEMENT COMPREHENSIVE ASSESSMENT & PERIODIC REASSESSMENT (CONTINUED): Assessment and periodic reassessment is to be conducted at a minimum of once every six months to determine if an individual’s needs, conditions and/or preferences have changed.

16. TCM: TARGETED CASE MANAGEMENT DEVELOPMENT OF A SPECIFIC CARE PLAN: – A specific care plan is developed by the case manager based on the information collected through the assessment that: Specifies the goals and actions to address the medical, social, educational and other services needed by the individual. Includes activities such as ensuring the active participation of the individual, and working with the individual and others to develop those goals Identifies a course of action to respond to the assessed needs of the eligible individual

17. TCM: TARGETED CASE MANAGEMENT REFERRAL AND RELATED ACTIVITIES – TCM provides referral and related activities to help the eligible individual obtain needed services including: Activities that help link the individual with medical, social, educational providers, or other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

18. TCM: TARGETED CASE MANAGEMENT MONITORING & FOLLOW UP ACTIVITIES – Monitoring and follow up activities/contacts are necessary to adequately address the individual’s needs, and may be done with the individual, family members, service providers or other entities or individuals and may be conducted as frequently as necessary.

19. TCM: TARGETED CASE MANAGEMENT MONITORING & FOLLOW UP ACTIVITIES (CONT) – They include at least one annual monitoring to determine whether the following conditions are met: Services are being furnished in accordance with the care plan Services in the care plan are adequate Changes in the needs or status of the individual are reflected in the care plan Monitoring & follow up activities include making necessary adjustments to the care plan and service arrangements with providers.

20. TCM: TARGETED CASE MANAGEMENT MONITORING & FOLLOW UP ACTIVITIES (CONT). Periodic reviews must be completed at least every six months. These activities may be conducted as specified in the care plan, or as frequently as necessary to ensure execution of the care plan. Monitoring does not include ongoing evaluation or check-in of an individual when all care plan goals have been met.

21. TCM: TARGETED CASE MANAGEMENT TCM ENCOUNTER – An encounter is defined as a face-to-face contact for the purposes of rendering one or more targeted case management service components by a case manager.

22. TCM: TARGETED CASE MANAGEMENT TCM REIMBURSEMENT IS CALCULATED FROM THE FOLLOWING FACTORS: ANNUAL COST REPORT: – The cost report calculates your encounter rate. It takes into account your eligible vs. non-eligible expenses, revenue offsets and percentage of time spent by case managers on TCM activities. The encounter rate is the average cost of performing TCM activities broken down to a unit basis. DOCUMENTED ENCOUNTER – Face to face encounter MEDI-CAL ELIGIBLE INDIVIDUAL – If they aren’t Medi-Cal eligible – you are not paid for that encounter. FMAP (Federal Medical Assistance Percentage) – Typically 50%, although the newly eligible are reimbursed at a higher FMAP.

23. TCM: TARGETED CASE MANAGEMENT TCM REQUIRED PARTICIPATION DOCUMENTS: – TCM ANNUAL PARTICIPATION PREREQUISITE – DUE JULY 1 – TCM PROVIDER PARTICIPATION AGREEMENT – RENEWED EVERY 5 YEARS – ANNUAL TCM COST REPORT – DUE NOVEMBER 1 – MOU BETWEEN YOUR AGENCY AND THE LGA

24. TCM OR MAA – OR BOTH? TCM GENERALLY PROVIDES MORE REVENUE – BUT IT IS MORE WORK INTENSIVE AND REQUIRES MORE DOCUMENTATION. IT IS MORE SIMILAR TO TITLE IVE IN THE REQUIRED DOCUMENTATION ASPECT MAA PROVIDES LESS REVENUE – BUT IT IS EASIER AND DOESN’T REQUIRE AS MUCH DOCUMENTATION

25. RESOURCES CALIFORNIA LGA CONSORTIUM – WEBSITE: WWW.MAA-TCM.COMWWW.MAA-TCM.COM LGA COORDINATOR ROSTER: – WWW.MAA-TCM.COM/ROSTER WWW.MAA-TCM.COM/ROSTER LGA WORKGROUPS DHCS WEBSITE – WWW.DHCS.CA.GOV/PROVGOVPART/PAGES/LOCALGOVERNMENT.ASPX WWW.DHCS.CA.GOV/PROVGOVPART/PAGES/LOCALGOVERNMENT.ASPX TCM Website: www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx MAA Website: www.dhcs.ca.gov/provgovpart/Pages/CMAA.aspx California Code of Regulations California Welfare & Institutions Code – W&I Code Section 14132.44 Code of Federal Regulations – Super Circular – Title 2 of the Code of Federal Regulations APPA on-line training for officers – how to increase outreach – http://appa.academy.reliaslearning.com/Key-Provisions-in-the-Affordable- Care-Act-and-How-Community-Corrections-Can-Increase-Outreach-and-E-.aspx http://appa.academy.reliaslearning.com/Key-Provisions-in-the-Affordable- Care-Act-and-How-Community-Corrections-Can-Increase-Outreach-and-E-.aspx

26. QUESTIONS