1. County Based Medi-Cal Administrative Activities (CMAA) Participation Requirements & Process 2016 LGA Consortium Conference

2. Introduction  Dion Andres – Sacramento County LGA  David Huey – formerly from Alameda County LGA and currently, one of the LGA Consultants for the LGA Consortium  Who is in the room?

3. Coordination of CMAA The Puzzle 3 Claiming Units and Plan Amendments Local Governmental Agencies Training Certified Public Expenditures Deadlines Compliance and Audits Communication Program Staff Time Reporting Invoice DHCS Instructions

4. What is MAA?  Under MAA, the federal government reimburses state and local agencies for their costs associated with case management and administrative activities delivered to Medi-Cal eligible individuals.  MAA is not a direct service program like our common notions of Medi-Cal that reimburses doctors and hospitals for health care services.  Instead, participating agencies are reimbursed for their work in linking, connecting, and coordinating services for the benefit of their clients, rather than being direct providers.

5. The History of MAA 1994: federal disallowance of programs 1995: MAC Agreement Authorizes new programs County-Based MAA Targeted Case Management Mental Health MAA  2003: CMS Issues School-Based MAA (SMAA) Manual Separates SMAA from CMAA  2009: CMS invalidates Time Survey  May 2013: CMS approves ‘County Based Medi-Cal Administrative Activities Program Operational Plan’

6. DHCS (external) - Branch Chief - Unit Chief - Analyst LGA (internal) - Program Managers - Fiscal Analysts - IT Staff LGA Consortium (external) - Executive Committee - Consultants - Coordinators Communication Agency/CBO (internal & external) - Coordinators - Staff

7. Basics: Getting Started What are the requirements to participate in MAA? Contract with DHCS Contract with Host County Contract with claiming agencies and vendors - MOU Comprehensive Claiming Plan documentation for each claiming agency (CUFG, Duty Statements, and Activity Code worksheets) Mandatory annual time survey training for all staff Training on on-line TS system (if applicable) MAA invoice submission

8. Basics: Key MAA Codes MAA codes that are 100% allowable under the Medi-Cal program and claimable at the 50% FFP reimbursement  Code 4: Medi-Cal Outreach  Code 8: Facilitating the Medi-Cal Application  Code 12:Code 6: Referral, Coordination, and/or Monitoring  Code 12: Contract Administration  Codes 15 & 16: PP&PD and SPMP PP&PD  Code 19: MAA/TCM Coordination/ Claims Administration Only one staff can code to this per Claiming Unit— without prior DHCS approval  Code 20: MAA/TCM Implementation Training

9. MAA Codes/Activities MAA codes for which the share of costs must be determined by applying the discounted or proportional Medi-Cal share or Medi-Cal percentage  Code 6: Referral, Coordination, and/or Monitoring  Code 10: Non-Emergency, Non-Medical Transport  Code 13: Contract Administration  Codes 17 & 18: PP&PD and SPMP PP&PD

10. Basics: Medi-Cal %  DHCS prefers the use of Actual Client Count (ACC) method  ACC = Number of Medi-Cal Beneficiaries / Number of All Clients Served  County-wide Average (option)  Use for Codes 6, 10, 13, 17, and 18

11. Best Practice: MC % Complete your Activity Code worksheets to document which codes are using ACC.  Explain why you are using and how it is calculated.  Provide back-up for calculated %.

12. Basics: Reallocated Codes Reallocated MAA codes are administrative activities that are reallocated across other activity codes on a proportional basis. Code 21 – General Administration Code 22 – Paid Time Off

13. Best Practice: Time Survey Activity Results  Monitor time survey coding for accuracy and appropriateness to work performed. Time Survey must match your Payroll time sheets. High allocated time to any one code should be reviewed.  Codes 1 and 21: Daily allocation  Code 20 for any training except 1 st time or annual.  Maximize time allocation to a code by accounting for the time preparing for, traveling to and from an activity, and follow- up work, within the code you are performing.

14. Best Practice: Electronic Time Surveys Consider an electronic time survey for your time study management. These are the benefits:  Streamline workflow  Eliminate many paper files  Stores surveys online, for safety and redundancy.  Ease monitoring participant performance  Simplify participant and Supervisor signature  Simplify payroll time survey matching compliance.  Direct Charge software expenses to recover 50% of system costs.

15. Basics: Other Time Survey Requirements  Signature requirements on time surveys Participant and supervisor signatures (blue ink) E-signature for on-line time surveys (PPL 12- 009)  Submission requirements Only time survey results are reported and used for MAA invoices Original hard copy surveys maintained in audit files

16. Basics: CPE (Revenue)  100% certified public expenditures (CPE)  CPE: State, County, or local funds Some federal funds may be allowed MAA/TCM reimbursements are allowable federal CPE  Most federal funds must be offset  Refer to p. 5 of CMAA/TCM Implementation Plan dated 11/05/13

17. Best Practices: COST POOLS  Look at the Cost Pools (a part of the invoice process) when forming Claiming Units to designate agency participation.  Review under-or-over performing Claiming Units to ensure audit compliance.

18. Basics: COST POOLS All claiming unit staff costs are categorized into Cost Pools in the MAA invoice for reimbursement.  Cost Pool 1 –Skilled Professional Medical Personnel (SPMP): limited to Governmental Agencies  Cost Pool 2 – Non–SPMP: time survey staff and support staff to Cost Pool 2  Cost Pool 3 – Non-MAA, Non-Support: Didn’t time survey or direct charge, not in a support classification

19. Basics: COST POOLS All claiming unit staff costs are categorized into Cost Pools in the MAA invoice for reimbursement.  Cost Pool 5 – Direct Charge costs (includes DC staff costs): Specific to the MAA program  Cost Pool 6 – Administrative Costs: General Administrative and Support staff

20. Basic: Direct Charge The following Activity Codes can be direct charged:  Code 4: Medi-Cal Outreach  Code 10: Transportation Costs  Code 15 -18: Program Planning and Policy Development  Code 19: MAA Coordination/Claims Administration

21. Best Practice: Direct Charge  Identify on your Claiming Unit Functions Grid: One code to direct charge per time survey participant or subcontractor  Documentation/ audit back-up: Time log or calendar  Certify your time: DHCS Staff Certification of Direct Charge Time form

22. Summary  Develop program knowledge  Regional Oversight and Responsibility  Manage Deadlines  Policy Guidance and Program Training  Collaborate internally and externally w/ all stakeholders Administration, Claiming Agencies, LGA Consortium, and DHCS  Audit Files

23. Best Practices: Participation Consider being a part of the CMAA GUIDELINES WORKGROUP or an active participant of the LGA Consortium