Federal Financial Participation Training

1. Federal Financial ParticipationTraining Brought to you by the “Good Folks” at MCH

2. Agenda • The FFP User’s Guide • Everything you want to know about Federal Financial Participation • Documentation • Got Questions????

3. FFP User’s Guide • Provides FFP rules & requirements • User’s Friendly • Handy Reference Tool • Contains Frequently Asked Questions • Keep your notes on FFP and • It’s free!

4. Purpose FFP Time Study Page 6-7

5. Background • Identify low or no income women and children that had no means or access to health care. • Link women and children of need to care, providers and/or services to ensure safe and healthy pregnancy, birth and growth.

6. FFP Objectives • To assist individuals eligible for MediCal to enroll in the MediCal program and/or • To assist individuals on MediCal to access MediCal services. Page 6

7. FFP Requirements • The program (MCH, BIH, &/or AFLP/ASPPP) has been approved by MCH to use FFP. • FFP allowed activities are performed. • Staff performing certain FFP activities meets FFP professional qualifications. • All activities performed by staff are documented via quarterly time studies & secondary documentation. • There are qualifying funds to draw down match (non-federal funds i.e. local county/city funds). • The proportion of the program target population, which is Medi-Cal eligible. Page 8

8. Reimbursement Program – Staff – Activity - Time • Program – Approved FFP program (MCAH, AFLP, ASPPP, BIH) • Staff – SPMP or Non-SPMP • Activity – Must meet the FFP Objectives “All activities may be MCAH claimable but not all are FFP matchable.” • Time – The “start and stop” time.

9. Reimbursement For every local/agency dollar “$” spent on Program+Staff+Activity+Time + Title 19 - FFP will match a dollar “$” or three dollars “$$$” depending the staff & activity. x MediCal Factor “%” = Title 19/FFP Reimbursement total “$$$$” dollars to your program.

10. Personnel Classifications • Skilled Professional Medical Personnel SPMP • Non-Skilled Professional Medical Personnel Non-SPMP

11. Skilled Professional Medical Personnel SPMP are defined as “…physician, dentist, nurses, and other specialized personnel who have professional education and training in the field of medical practice and who are in an employer-employee relationship with the Medicaid program. It does not include other non-medical health professionals such as public program administrators, medical analysts, lobbyists, senior managers, or administrators of public assistance programs or the Medicaid program.” 42 CFR 432.2

12. SPMP Qualifying Enhanced Activities Enhanced , matching rate of 75% is available for SPMP and directly supporting clerical staff if the following criteria are met: • Activities are directly related to the administration of the Medicaid program. Excluding medical assistance. • Activities must only be by a qualified SPMP. • SPMP in a position that have duties & responsibilities that require those professional medical knowledge & skills. • Identified as an employee and/or contractor on the budget. • Supporting staff such as secretarial, stenographic, file/records clerk and copying staff who provide clerical services that are directly necessary for the completion of the professional medical responsibilities and function of the SPMP. SPMP staff must directly supervise the supporting staff and evaluate the performance of the staff’s work 42 CFR 432.50 (d)

13. Non-Skilled Professional Medical Personnel “All other program staff that perform activities that are an integral part in meeting the program goals and objectives.”

14. FFP Components • Population wide, publicly available, or documented statistics. • Direct documentation of MediCal beneficiary number. MediCal Factor Time Study • Primary documentation of FFP • Determine billable to MCH • Monitor Activities • Documents ALL activities • Secondary documentation required Page 13

15. “The FFP Time Study Rules” 1. Everyone matching must Time Study. 2. Time Study all activities including non-MCAH programs. 3. Must Time Study for at least one month per quarter. 4. Secondary Documentation is required. 5. Approved Time Study Form. 6. Time Study daily is a “Good Thing”. 7. Time Study must be reviewed & approved by a supervisor.

16. “The FFP Time Study Rules” 8. Maintenance & storage of Time Study sheets & secondary documentation is required for three years*. 9.Absences for greater than 2 weeks. Exception can be made with the MCAH Branch permission. 10. Prep & travel time for an activity is coded the same as the activity. 11. Paid time off. 12. Lunch – It’s your time! No coding. 13. Breaks! Absorbed into the activity. Page 16-18

17. Function Codes/FFP Activities • Outreach • SPMP Administration Case Management • SPMP Intra/Inter Agency Coordination, Collaboration & Administration • Non-SPMP Intra/Inter Agency Coordination, Collaboration & Administration • Program Specific Administration • SPMP Training • Non-SPMP Training • SPMP Program Planning & Policy Development • Quality Management by SPMP • Non-Program Specific General Administration • Other Activities • Paid Time-Off

18. Function Code #1OutreachNon-Enhanced Activity • This function is to be used by all staff when performing activities that inform MediCal eligible or potentially eligible individuals, as well as other clients, about health services covered by MediCal and how to access the health programs. Activities include a combination of oral and written informing methods which describe the range of services available through the MediCal program and the benefits of preventive or remedial health care offered by the MediCal program. • This code is also used by Non-SPMP for Administrative Case Management. Page 21

19. Function #2SPMP Administrative Medical Case ManagementEnhanced Activity • This function is to be used only by skilled professional medical personnel when participating in medical reviews; assessing the necessity for and types of medical care associated with medical case management and case coordination activities required by individual MediCal beneficiaries. Page 22

20. Function Code #3SPMP Intra/Interagency Coordination, Collaboration, & AdministrationEnhanced Activity • This function is to be used only by skilled professional medical personnel when performing collaborative activities that involve planning and resource development with other agencies which will improve the cost effectiveness of the health care delivery system and improve availability of medical services. Page 23

21. Function Code #4Non-SPMP Intra/Interagency Collaboration & CoordinationNon-Enhanced Activity • This function is to be used by non-SPMP staff when performing activities that are related to program planning functions, including collaborative and intra/interagency coordination activities. Page 24

22. Function Code #5Program Specific AdministrationNon-Enhanced Activity • This function is to be used by all staff when performing activities that are related to program specific administration which are identifiable and direct charged to the program. Office related general task. Page 25

23. Function Code #6SPMP TrainingEnhanced Activity • This function is to be used only when training is provided for or by skilled professional medical personnel and only when the training activities directly relate to the SPMP’s performance of specifically allowable SPMP administrative activities. Page 26

24. Function Code #7Non-SPMP TrainingNon-Enhanced Activity • This function is to be used by all staff when training relates to non-SPMP allowable administrative activities and to the medical care of clients. Page 27

25. Function Code #8SPMP Program Planning & Policy DevelopmentEnhanced Activity • This function is to be used by onlyby skilled professional medical personnel and only when performing program planning and policy development activities. The SPMP’s tasks must officially involve program planning and policy development, and those tasks must be identified in the employee’s job description/duty statement. Page 28

26. Function Code #9Quality Management by SPMPEnhanced Activity • This function is to be used by only by skilled professional medical personnel and only when performing quality management activities such as monitoring the authorization for medical services (utilization review) process, ongoing program assessment and evaluation, and the development of standards and protocols. Page 29

27. Function Code #10Non-Program Specific General AdministrationAllocated-Share of cost by all programs • This function is to be used by all staff when performing non-program specific administrative activities that relate to multiple functions or to no specific, identifiable functions due to the general nature of the activities. Page 30

28. Function Code #11Other ActivitiesOther programs/funds or activities* not matchable with FFP Funds • This function is to be used by all staff to record time performing activities which are not specific to the administration of the MediCal program. *Exceptions Page 31

29. Function Code 11- Exceptions • Any activity that does meet the FFP objectives. • Any activity on behalf of a non-MCAH program. These type of activities are considered FFP exceptions. These activities may be MCAH claimable but are not FFP matchable or Function Code 11.

30. Any direct clinical services. Anticipatory Guidance/Activities Social Activities Childhood Safety Domestic Violence* Job Development School related activities Housing need activities Fetal Infant Mortality Review – FIMR Parenting Day Care SIDs Transportation* Translation Routine Developmental Testing (i.e.Denver) Nutrition Many more….. * May be OK Function Code 11 examples

31. Function Code #12Paid Time OffAllocated - Share of cost by all programs • This function is to be used by all staff to record usage of paid leave, holiday, vacation, sick leave and so on. Page 32

32. Secondary Documentation • Basic Documentation • Requirements • Guidelines • Styles • Do’s and Don’t • Secondary Documentation • Privacy & Confidentiality

33. Secondary Documentation • “If it wasn’t documented is wasn’t done”. • Definition – The recording of information/data, action and/or outcome for future reference. • Why document? • Job requirement • Professional responsibility • Legal protection • Evaluation

34. Secondary Documentation • Supports the information on the Time Study. • Provides sufficient information to distinguish different activities and programs. • Link client specific activities to a case file. • Documentation should support the Function Code chosen. • Clearly identifies the clients or entity for which the activity or services is provided (i.e. MediCal number). • Identifies the program for which the activity is performed.

35. Secondary DocumentationRequirements • Standard Format • 1/2 hour increments i.e. 8:30 - 9:00 • Common abbreviations i.e. HV-Home Visit • Document “as you go” is best! • Complete weekly • Meet and discuss FFP questions/issues. • Staple all documents together i.e. agenda • Remember the “KISS” principle. Page 19

36. Secondary DocumentationExamples • Let’s take a few minutes and look at the following documentation examples. • Can you tell which ones are OK? • Can you make suggestions on how to improve them?

37. Secondary Documentation Examples • 8:00 AM – 9:30 AM HV – L Simpson – Prenatal F/U to pre-term labor • 10:00 AM – 2:00 PM Dental Task Force Quarterly meeting. • 11:00 AM – 11:30 AM T/C S Evans specialist referral appt. • 1:30 PM – 3:30 PM Work on Outreach presentation. • 4:30 PM – 5:00 PM HV reminder calls for tomorrow 3 clients. • 1:00 PM – 5:00 PM CTO

38. Secondary Documentation Examples • 10:00 AM – 11:00 AM HV T Hall review child safety & specialist referral. • 2:00 PM – 5:30 PM Assisted M Reams into Women’s Shelter. • 1:00 PM – 5:00 PM Attended Breast feeding workshop. • 9:00 AM – 11:00 AM Attend Bioterrorism training • 9:00 AM – 10:00 AM Staff meeting. • 2:00 PM – 4:00 PM Dental Appt.

39. Secondary Documentation Guidelines • Legible • Concise • Accurate • Complete • Organized • Timely

40. Types of Record Documentation • APIE – Assessment Plan Implementation & Evaluation • CBE - Charting by exception • SOAP – Subjective , Objective, Assessment and Plan • Computerized client records • Focus Charting • PIE – Problem Intervention & Evaluation • Flow Charting

41. Do’s and Dont’s • Do use only black or blue ink. • Do write legibly(Legibly). • Do chart to date (i.e. 02/14/03) and time (i.e. 2:00 pm or 1400). • Do write clear concise and simple sentences (i.e. See Jane run.) • Do correct errors by a simple cross through & your initials by correction (i.e. changed drsg. x 2 3 cac).

42. Do’s and Dont’s • Don’t use pencil. • Don’t use white out. • Don’t use Liquid Paper/Dryline. • Don’t scratch out errors.

43. Privacy & ConfidentialityTime Studies/Secondary Documentation/Clients Records • Definitions • Rules and requirements • Know your organization rules & requirements. • Professional (i.e. Licensure) • HIPPA – Federal protection. • State regulatory requirements

44. Time Study Readiness • Attend Time Study Training • Discuss & Review the Time Study process in your office • Create FFP “Cheat Sheets” • Gather all the necessary materials. • Review Information • Ready Set go!

45. Got Questions?Send your questions to:Your program consultant and contract manager.