1. DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch

2. Introduction:  Financial Audits Branch (FAB)  Cost Report Process: Submission Acceptance Approval

3. Financial Audits Branch (FAB)  Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services  Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.

4. Cost Report Flow: Submission of Cost Report Acceptance Acceptance Letter Approval Approval Letter Begin Invoicing TCM Program

5. TCM Cost Reports - Submission  TCM Cost Reports due November 1 st Hard Copy Audit Review and Analysis Section (ARAS) Soft Copy dhsaitcm@dhcs.ca.govdhsaitcm@dhcs.ca.gov (ARAS)

6. TCM Cost Reports - Submission  Hard Copy* – Includes, but not limited to the following: Cover Letter Certification Statement Cost Report (Signed) / Including Funding Schedule Time Survey Template  List Worksheet  Totals Worksheet  Time Sheets Cost Report Review Tool Supporting Documentation Summary of Allowable Funding for Claiming Federal Matching Funds Worksheet Interim Medi-Cal TCM Encounter Payment Rate Calculation Worksheet *Refer to TCM Cost Report Instructions - 2011

7. TCM Cost Reports - Submission  Soft Copy – Includes the following completed items: Cost Report Template Survey Template  List Worksheet  Totals Worksheet  Time Sheets Funding Schedule Summary of Allowable Funding for Claiming Federal Matching Funds Worksheet Cost Report Review Tool Template

8. TCM Cost Reports - Acceptance  Acceptance Process : Responsibility of ARAS:  Completion of comprehensive checklist:  Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report Hard Copy Soft Copy  Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions

9. TCM Cost Reports - Acceptance  Acceptance Process: Contact designated LGA Coordinator for missing and/or incorrect items. Via email: Hello TCM Coordinator: Please send the requested information via email within the next 24 hours. Thanks, ARAS

10. TCM Cost Reports - Acceptance  Acceptance Process : Acceptance Letter issued by ARAS Acceptance LetterLGA  For each TCM Cost Report (LGA, CBO, and LPE)  Identifies “postmark date” to establish 36- month audit period

11. TCM Cost Reports - Acceptance  Top reasons cost report was not accepted upon first review: 1. Did not include “TCM encounters by month” 2. IRS Form 990 not included 3. Electronic copy of Worksheet A did not match hard copy 4. Complete Table of Contents not included 5. Financial statements for CBO not included 6. Electronic copy of Cost Report not submitted

12. TCM Cost Reports - Acceptance  Top reasons cost report was not accepted upon first review: 7. All pages of the Cost Report Review Tool not submitted 8. Hard copies not signed 9. Incomplete CBO contract (need to include all pages) 10. Certification statements not signed 11. Funding Scheduled not included

13. TCM Cost Reports - Approval  Approval Process : Responsibility of Audit Review and Analysis Section  Identification of “potential” audit issues for future audits  Issuance of Approval Letter

14. TCM Cost Reports - Approval  Approval Process : Approval Letter issued by Audit Review and Analysis Section Approval Letter  One letter issued for each LGA  Purpose of the letter is to establish:  TCM Rate Period (2011/2012)  Rate Per TCM Encounter  TCM Maximum Amount

15. Rate Per TCM TCM Rate Period TCM Encounter Maximum Amount FY 2011-2012 $250.55 $100,220.00 TCM Cost Reports - Approval Approval Process : (Excerpt from an Approval Letter)

16. TCM Cost Reports - Approval  Approval Process : Approval Letter issued by Audit Review and Analysis Section LGA Approval Letter TCM Program* *The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount or CAP.

17. FAB Contact Information  Audit Review & Analysis Section (ARAS) Robert Kvick, Chief  (916) 650-6673  Robert.Kvick@dhcs.ca.gov Robert.Kvick@dhcs.ca.gov Haisong Peng, Supervisor  Haisong.Peng@dhcs.ca.gov Haisong.Peng@dhcs.ca.gov