Department of Health Care Services Health Care Low Income Health Program (LIHP)

1. Department of Health Care ServicesHealth Care Low Income Health Program (LIHP) Time Study Training Train the Trainers 2013

2. Table of Contents • Department of Health Care Services (DHCS) Goals • Time Study Overview • Purpose of the Time Study • Claiming Time on the Time Study • How to Time Study for Best Results • Sample Time Study Sheet • Secondary Documentation • Best Practices • Preparing for Training Day

3. DHCS Goals For This Training Today’s presentation will help you: • Identify how to complete the Time Study form. • Understand how to report HCCI/MCE LIHP administrative activities (LIHP AA) under the appropriate time study codes. • Conduct local time study training. • Record LIHP time accurately. • Stress the importance of the time study to staff.

4. Time Study Overview • The Time Study is the primary mechanism to identify and categorize LIHP AA performed. • The Time Study is the basis for developing administrative activities (AA) that may be reimbursable under the LIHP program. • The Time Study must capture 100% of all time and activities performed by LIHP contractor employees. • Counties must time study according to the LIHP AA Implementation Plan.

5. Time Study Overview • The Time Study form is considered a legal document which verifies the actual time spent performing LIHP AA used to compile the invoice. • The Time Study form is used to identify, measure, and allocate employee time for LIHP reimbursable activities. • Time Study codes distinguish each activity an employee is engaged in during a Time Study period.

6. Time Study Overview Frequency based on number of time study participants. • 0-99 participants: Each work day, Continuous • 100-199 participants: 20 consecutive work days, per month for 3 months • 200-399 participants: 10 consecutive work days, per month for 3 months • 400+ participants: 5 consecutive work days, per month for 3 months

7. The Purpose of the Time Study What is the purpose of the Time Study? • To identify time spent on the performance of LIHP AA and non-LIHP AA. • To capture time by individuals performing LIHP AA. • Results are used to determine the amount of LIHP AA invoice. • To ensure appropriate LIHP AA claiming and that no duplicate AA payments occur. • It is a Federal requirement.

8. Who Should Time Study Which employees should time study? • All LIHP AA contractors and certain subcontractor employees participating in LIHP AA. • Support staff who directly support time study staff completing a time study do not have to complete a time study and can still be included on the invoice in the appropriate cost category. • All employees in classifications identified on the claiming “staffing grid” must time study.

9. Who Should Time Study • Staff positions funded 100% by federal dollars may not participate in the LIHP AA program, because the Federal Government is already paying its share of costs. • All counties who have subcontracts for administrative activities that are non-specific.

10. Staff Training • All staff who time study MUST participate in an annual time study training. • Annual time study training cannot be claimed during any time study period. • Staff who are filling out a time study form for the first time must attend training before time study period.

11. Time Study Activities that are Directly Reimbursable • LIHP outreach. • Development of screening and enrollment process and procedures. • Programming development and planning costs. • Enrollment of individuals into LIHP. • Care and case management.*

12. * Case Management • In the following situations only, some local LIHPs will be considered health care services costs and will be claimed pursuant to Attachment G, Supplement 1. • LIHPs with approve capitation rates. • LIHPs with case management services approved as add on services in their programs.

13. * Case Management- Cont. • LIHPs that incorporate case management services into health care services subcontracts. • LIHPs that reimburse for case management services to network providers that are medical homes for LIHP enrollees.

14. Time Study Activities Reimbursed through Indirect Cost Rate 6) Development and maintenance of data collection and quality monitoring system. 7) Data collection and analyses of reports, studies or surveys required by DHCS/CMS. 8) Developing, monitoring, and administering contracts. 9) Operations of the LIHP administrative function (e.g. accounting, personnel).

15. All Activity Codes All activity codes may also include completion of paperwork, clerical activities, training, or staff travel required to perform these activities, including initiating and responding to e-mail and voicemail.

16. Four Indicators • U Unallowable: activity not allowable as administration under the LIHP. • TL Total LIHP Administration 100% LIHP share: activity is wholly attributable to the LIHP and as such is not subject to the application of discounting by the proportional LIHP share percentage.

17. Indicators • PL Proportional LIHP Share: activity is allowable as administration under the LIHP program, but the LIHP share of costs must be determined by applying the LIHP percentage of the service population that has been determined for the LIHP claiming unit. This discounts the costs by the proportional LIHP share of LIHPP.

18. Indicators • R Reallocated Activities: activities which are reallocated across other codes based on the percentage of all other time spent on allowable/unallowable administrative activities. Federal Financial Participation (FFP) is provided at 50% of the reallocated proportionate LIHP share. A single calculation of reallocation is made for the entire period claim, based on the total LIHPP-claimable costs of all employees who perform LIHP AA and who participated in that period’s time study.

19. Activity Codes • Code 1 Other Programs/Activities. (U) • Code 2 Direct Medical Services. (U) • Code 3 Non-LIHP Outreach. (U) • Code 4 LIHP Outreach. (TL) • Code 5 Developing Screening/Enrollment Processes and Systems for Non-LIHP Programs. (U)

20. Activity Codes • Code 6 Developing Screening/Enrollment Processes and Systems for LIHP Programs. (PL) • Code 7 Facilitating Enrolling Individuals to Non-LIHP Programs. (U) • Code 8 Facilitating Enrolling Eligible low-income, uninsured persons into LIHP Health Care Coverage Programs. (TL)

21. Activity Codes • Code 9 Program Planning, Policy Development, and Interagency Coordination Related to Non-LIHP Services. (U) • Code 10 Program Planning, Policy Development, and Interagency Coordination Related to LIHP Health Care Services. (PL)

22. Activity Codes • Code 11 Providing Care and Case Management to Individuals not Receiving LIHP Covered Services. (U) • Code 12Providing Care and Case Management To Individuals Receiving LIHP Covered Services. (PL) • Code 13 General Administration/Paid Time Off. (R)

23. Code 1: Other Programs/Activities (U) • Activities that are not related to administrative activities for LIHP program and not included in any other activity listed on time study. • Administrative activities captured through indirect cost rate.

24. Code 2: Direct Medical Services (U) • Direct Care • Medical/Dental treatment • Chemical Dependency Counseling Includes and not limited to: • Providing medical/dental/mental health counseling treatment services. • Conducting medical/dental/mental health/chemical dependency assessment/evaluations/preparing reports. • Providing health care/personal aid services.

25. Code 2: Direct Medical Services (U) • Providing speech, occupational, physical & other therapies. • Developing a treatment plan for a patient if provided as part of a medical or service. • Activities that are services or components of medical services.

26. Code 2: Direct Medical Services (U) • Providing specialty care, preventive health services. • Participating in or providing training to enhance skills needed for provision of the above services. • Providing case management services as applicable. Using: Activities that are an integral part or an extension of a medical service, should be reported with this code.

27. Code 2: Direct Medical Services (U) • Activities that are part of a direct service are not claimable as an administrative activity. • Activity codes and indicators will indicate if the activities are for direct services.

28. Code 3: Non-LIHP Outreach (U) Activities that inform individuals and promotes participation in non-LIHP programs and how to access the non-LIHP programs. Includes: • Informing families about non-LIHP programs such as Medi-Cal, Healthy Families, Access for infants and Mothers (AIM) program. • Informing families about non-LIHP wellness programs and how to access them.

29. Code 3: Non-LIHP Outreach (U) • Scheduling and promoting activities that educate non-LIHP individuals about healthy lifestyles and practices. • Conducting outreach campaigns that encourage persons to access social, educational, legal or other services not covered by LIHP.

30. Code 3: Non-LIHP Outreach (U) • Developing and distribution of non-LIHP outreach materials. • Performing various broad-spectrum wellness programs. • Participating in outreach training to improve delivery of non-LIHP services.

31. Code 4: LIHP Outreach (TL) Initial activities that inform eligible or potentially eligible individuals about the LIHP programs and services and how to access them Includes providing: • Outreach campaigns to low income, uninsured population at or below 200% FFP. • Contact and identify uninsured patients who recently utilized health care services.

32. Code 4: LIHP Outreach (TL) • Scheduling, and promoting LIHP activities. • Health screenings. • Promoting the use of preventive LIHP services. • Participating in outreach trainings to improve the delivery of LIHP services. • Developing LIHP outreach materials. • Expanding LIHP referral sources and contacts.

33. Code 5: Developing Processes/Systems for Non-LIHP Programs (U) This code should be used when: • Developing screening, eligibility and assessment processes for non-LIHP programs. • Establishing referral protocols to non-LIHP programs. • Developing/verifying initial and continuing eligibility for non-LIHP programs.

34. Code 6: Developing Screening/Enrollment Processes/Systems for LIHP Programs (PL) This code should be used when: • Developing screening and eligibility criteria and assessment processes. • Developing and Implementing LIHP enrollment processes. • Developing procedures for the Deficit Reduction Act of 2005 needed for LIHP. • Developing identification card system and unique Enrollee identifier for LIHP enrollee.

35. Code 6: Developing Screening/Enrollment Processes/Systems for LIHP Programs (PL) • Developing and/or expanding e-medical record system. • Developing policies and procedures to transition persons into LIHP from existing county indigent programs. • Implementing policies and procedures to inform LIHP enrollees of their rights. • Establishing referral protocols to existing Medi-Cal, Healthy Families, and AIM programs.

36. Code 7: Enrolling Individuals Into Non-LIHP Programs (U) Time spent assisting an individual in the non-LIHP eligibility and enrollment process. Includes the following: • Verifying current eligibility status. • Explaining the non-LIHP programs eligibility rules (i.e., Medi-Cal, Healthy Family, AIM). • Gathering any information needed in advance of the non-LIHP programs for referrals.

37. Code 7: Enrolling Individuals Into Non-LIHP Programs (U) • Providing non-LIHP programs orientation, materials and informing individuals of their rights. • Assisting in collecting non-LIHP information and documents. • Assisting individual’s in completing non-LIHP applications including translation activities.

38. Code 7: Enrolling Individuals Into Non-LIHP Programs (U) • Making referrals for coordinating, and monitoring the delivery of scholastic vocational and non-health related examinations. • Participating in a meeting/discussion to coordinate or review a patient’s need for non-LIHP covered services.

39. Code 8: Enrolling Eligible Low- Income/Uninsured persons into LIHP Health Care Coverage Programs (TL) Time spent on the following: • Verifying current eligibility status. • Providing program orientation to LIHP enrollees. • Gathering any information related to LIHP eligibility. • Assisting enrollees with documents for LIHP application. • Providing forms/packaging for all LIHP eligibility determinations.

40. Code 8: Enrolling Eligible Low- Income/Uninsured persons into LIHP Health Care Coverage Programs (TL) • Assisting enrollees in completing LIHP application and translation activities. • Assisting with appropriate medical homes. • Determining eligibility, including citizenship and identity verification of LIHP enrollees.

41. Code 9: Program Planning, Policy Development & Interagency Coordination (PPPD) Related to Non-LIHP Services (U) Activities associated implementing a non-LIHP monitoring and oversight system. Includes: • Identifying gaps or duplication of non-medical LIHP services. • Developing strategies to access or increase the capacity of non-LIHP programs. • Developing procedures for tracking requests for assistance with non-LIHP services and the providers of such services

42. Code 9: Program Planning, Policy Development & Interagency Coordination (PPPD) Related to Non-LIHP Services (U) • Developing policies/procedures for providing transportation of individuals to non-LIHP services. • Evaluating the need for non-LIHP services to specific populations. • Performing collaborative activities with other agencies to improve collaboration of early identification of medical problems not addressed by programs and services.

43. Code 9: Program Planning, Policy Development & Interagency Coordination (PPPD) Related to Non-LIHP Services (U) • Defining the scope of each agency’s non-medical service. • Developing translation materials for non-LIHP delivery. • Developing a non-LIHP customer service system which includes a grievance procedures.

44. Code 10: Program Planning, Policy Development & Interagency Coordination (PPPD) Related to LIHP Services (PL) Should be used when developing and implementing a LIHP and oversight system. Includes: • Identifying gaps or duplication of medical/mental health services to LIHP clients. • Performing collaborative activities with other agencies. • Developing polices and procedures for providing transportation for LIHP services. • Expanding LIHP program prior authorization/utilization procedures.

45. Code 10: Program Planning, Policy Development & Interagency Coordination (PPPD) Related to LIHP Services (PL) • Developing translation materials. • Developing LIHP customer, which includes a grievance procedure. • Evaluating the need of services for specific populations.

46. Code 11: Providing Care/Case Management to Individuals not Receiving LIHP Services (U) Time spent assessing clients’ needs and designing a system of care. Includes : • Making referrals and assessments for Non-LIHP clients. • Assisting with transportation to non-LIHP covered services. • Follow-up to ensure prescribed non-LIHP covered services were received. • Coordinating completion of prescribed non-LIHP covered services. • Coordinating the delivery of medical services not covered by LIHP for clients with special needs.

47. Code 12: Providing Care/Case Management to Individuals Receiving LIHP Services (PL) Time spent identifying and assessing clients’ needs and developing/implementing a system of care. Includes : • Designing appropriate care plans. • Coordinating/monitoring access and delivery of LIHP covered services. • Providing a centralized contact person to help LIHP enrollees navigate through the health system.

48. Code 12: Providing Care/Case Management to Individuals Receiving LIHP Services (PL) • Advising /referring clients for necessary health care services covered by LIHP. • Arranging non-emergency transportation for clients to LIHP covered services. • Providing follow-up contact to ensure prescribed LIHP services received. • Coordinating the completion of the prescribed LIHP services. • Coordinating the delivery of medical services covered by LIHP for clients with special needs.

49. Code 13: General Administration/Paid Time Off (R) Activities that capture job duties that support time for primary job and administrative activities related to LIHP program includes: • Hiring and training staff performing LIHP activities. • Providing oversight of LIHP administrative functions and training activities. • Expanding administrative functions for LIHP purposes. • Paid vacation, sick leave, lunch breaks and other paid time not at work. • Attending or conducting general, non-medical staff meetings. • Developing and monitoring program budget. • Providing instructional leadership, site management. • Reviewing departmental or unit procedures and rules. • In-service orientations and program presentations. • Time filling out the Time Study Form.

50. Assure No Duplicate Payments • LIHPs may not claim FFP for the costs of allowable AA that have been or should have been reimbursed through an alternative mechanism or funding source. • LIHPs will document that the worker log time study is used to capture 100 percent of the LIHP AA and is not used for any other program. • LIHPs must provide assurance to DHCS of non-duplication through their administrative claims and the claiming process. • LIHPs are required to describe in their claiming plan the internal controls they will use to avoid duplicate payments.