1. MHMAA: Growing Your Program
April 18, 2017
Patrick Sutton
LGA MAA/TCM Annual Conference

2. AGENDA MHMAA – California Perspective
Other Federal Reimbursement Programs
Mental Health Cost Report
Things to Consider
General Points
Management – Talking Points

3. MHMAA – California Perspective
In FY 2015/16, only 13 LGAs participated in the MHMAA program.
Those 13 LGAs received a total of $ million in federal reimbursement in FY 15/16.
Alameda LGA received 46.9% of all MHMAA payments in FY 15/16 ($9.582 million out of $ million).

4. FY 15/16 MHMAA Payments Received

5. MHMAA: Medi-Cal Enrollee Analysis
LGA
MHMAA Receipts
Medi-Cal Enrollees
Per Person Amount
Alameda/Berkeley
$10,699,775
434,445
$24.63
Contra Costa
$721,257
275,842
$2.62
Los Angeles
$3,235,178
4,164,388
$.78
Napa
$129,825
32,601
$3.98
Orange
$808,445
909,221
$.89
San Diego
$605,364
901,892
$.67
San Francisco
$471,029
224,889
$2.09
San Luis Obispo
$67,417
62,114
$1.09
San Mateo
$213,750
156,875
$1.36
Santa Clara
$409,766
448,709
$.91
Santa Cruz
$807,389
80,193
$10.07
Sonoma
$2,276,896
127,711
$17.83
The Medi-Cal Enrollee figures are taken from PPL (FY 15/16 Qtr. 4) – LGA CWA FY Spreadsheet

6. MHMAA – What makes it different?
Unlike some other Mental Health federal reimbursement programs, MHMAA is focused on non-direct service activities including:
Medi-Cal Outreach
Medi-Cal Eligibility Intake
Referral in a Crisis Situation for Non-Open Cases
Contract Administration
Program Planning and Policy Development
Case Management of Non-Open Cases
MHMAA Coordination & Claims Administration

7. Other Federal Reimbursement Programs
In Mental Health, there are several different federal reimbursement programs, in addition to MHMAA:
Direct Services
Utilization Review/ Quality Assurance
Administrative Support

8. Other Federal Reimbursement Programs
Direct Services covers services provided by direct service provides – case management/brokerage, treatment services, medication support, etc.
Administrative Support covers services provided in the administration of the total county mental health program.
Utilization Review covers the evaluation of the necessity and appropriateness of the use of all reimbursed medical services, procedures and facilities. It also includes review of appropriateness of admissions, services ordered and provided, length of stay and discharge practices.

9. Other Federal Reimbursement Programs
There is the potential for overlap between the different reimbursement programs, specifically Administrative Support and MHMAA.
Remember that while Administrative Support is discounted by a Medi-Cal Discount %, certain MHMAA activity codes are not (e.g. Medi-Cal Outreach, Medi-Cal Eligibility Intake, etc.).

10. Mental Health Cost Report
Includes all costs, funding and services provided by the Mental Health Plan (MHP).
It serves as the source for a MHP’s fiscal year-end cost information.
It computes the cost per unit to each Service Function – MHMAA falls under Mode 55.

11. Mental Health Cost Report
MHMAA is included.
All MHMAA quarterly invoices must be submitted by the time the cost report is due (typically12/31), and the units of service identified on the cost report must match the invoiced units.

12. Mental Health Cost Report
When reviewing the cost report to see if there is the potential for claiming MHMAA, be on the look out for the following:
Has your MHP expenditures for Administrative Support exceeded the 15% cap?
Are there expenditures in Mode 45 - Outreach that would in fact better suited for Mode 55 - MHMAA (Medi-Cal Outreach)?
Has your MHP considered permitting your service provider to participate in MHMAA?

13. Things to Consider
Like all aspects of the Mental Health Cost Report, MHMAA is audited annually by Audits & Investigations (A&I). In order to prevent audit findings make sure to:
Keep a detailed audit binder.
Ensure that time surveys are signed off on.
Units of Service (UOS) on the quarterly invoices add up to the total UOS that appear on the Cost Report.
Necessary infrastructure (personnel, technology, etc.)
You are very familiar with the requirements laid out in the MHMAA Implementation Plan.
This list is not intended to be all-inclusive. There are additional items laid out the implementation plan that must be followed.

14. General Points CBOs can participate in MHMAA.
MHMAA has both discounted and non-discounted activity codes – UR/QA, Administrative Support and Direct Services do not have non-discounted activities.
Many MHPs do not realize that some if not much of the Outreach they categorize as Mode 45 (non-reimbursable) may be a better fit with Mode 55 (MHMAA).
We can look forward to more DHCS site visits in the coming years – be prepared.

15. Management – Talking Points
Your management staff may be wary about participating in MHMAA. Here are some suggestions on how to break the ice:
All the cool MHPs are doing MHMAA – all joking aside, there are some real success stories out there and you should mention this to your management.
MHMAA does not require the same level of documentation is does Direct Services – outside of the time survey, the participant is not required to keep additional supporting documentation.

16. QUESTIONS