California Dept of Health Services CDHS proudly presents

1. California Dept of Health Services (CDHS)proudly presents�

2. The County-Based Medi-Cal Administrative Activities (CMAA) Invoice Training Show June 2006 Intro: Ask everyone to follow along with their handouts & jot down any questions as we go. We will have a Question and Answer period at the end, and people can refer to the page/slide number as necessary. Intro: Ask everyone to follow along with their handouts & jot down any questions as we go. We will have a Question and Answer period at the end, and people can refer to the page/slide number as necessary.

3. Starring� Vickie Cooley-Soto & Thaya Lopes-Jones  In �Mission: Invoiceable�

4. ACT I Training Purpose

5. Purpose of this training: This presentation is going to walk through our invoice review and approval processing steps to show everyone what the CMAA analysts look for when reviewing an invoice. CMAA now has an internal policy in place to get invoices approved within 90-days of receiving them. If the counties know what CDHS looks for during our review, then you can prepare & submit complete and correct invoices the first time to help facilitate a quick turnaround time. 1. I want to begin with the intent of this training module. The purpose is to make you aware of what we look for/at when reviewing your invoices. With the goal of providing you with insight about what we examine in our review process. This should expedite the review/approval/payment process. 2. I�m sure you are aware that there is an �invoice workgroup� that is beginning to gear back up. Today�s forum is not intended to address issues that are under review such as reformatting or formulas contained within the detail portion of the invoice. Once we have consensus on the proposed changes and the revised invoice has been thru the approval and testing process we will address training for that revised invoice form if it is deemed appropriate. I do encourage you to email Vickie Cooley with any issues or technical questions you�d like to have explained in later training and or the LISTSERVE broadcast format. We definitely want to know what your issues are. 3. 90-day policy is guideline�..some may take longer. But the important thing is that Counties know (with very few exceptions) that approvals will not take months or years as they once did. Our goal ultimately is to be able to process an invoice within 30-days of receipt. 4. We have established guidelines for all analysts to follow, so we are doing the same level of review for each county.1. I want to begin with the intent of this training module. The purpose is to make you aware of what we look for/at when reviewing your invoices. With the goal of providing you with insight about what we examine in our review process. This should expedite the review/approval/payment process. 2. I�m sure you are aware that there is an �invoice workgroup� that is beginning to gear back up. Today�s forum is not intended to address issues that are under review such as reformatting or formulas contained within the detail portion of the invoice. Once we have consensus on the proposed changes and the revised invoice has been thru the approval and testing process we will address training for that revised invoice form if it is deemed appropriate. I do encourage you to email Vickie Cooley with any issues or technical questions you�d like to have explained in later training and or the LISTSERVE broadcast format. We definitely want to know what your issues are. 3. 90-day policy is guideline�..some may take longer. But the important thing is that Counties know (with very few exceptions) that approvals will not take months or years as they once did. Our goal ultimately is to be able to process an invoice within 30-days of receipt. 4. We have established guidelines for all analysts to follow, so we are doing the same level of review for each county.

6. ACT II Review and Approval Steps

7. Steps to Reviewing an Invoice: LGA prepares the invoice and mails to CDHS. Invoice is received/date stamped at CDHS. Logged in by CMAA support staff. Assigned to the Analyst. Analyst reviews. Analyst submits invoice to CMAA Chief with completed coversheet. Chief reviews and signs Summary Invoice. Invoice is sent to CDHS Accounting for payment. Invoice gets paid by the State Controller�s Office within 30 days of receipt and approval by Accounting. These 9 elements are the same basic process for all analysts. These 9 elements are the same basic process for all analysts.

8. Step 1: LGA Prepares the Invoice This will include: Summary Invoice on letterhead, signed by MAA Coordinator. Detailed worksheet pages. 2 checklists (one for the Summary Invoice and one for the Detail Invoice). Variance letter (as appropriate). (Handout) Supporting documents w/1st Quarter invoice. 1. These Checklists should be used AFTER you have completed the invoice package, they are intended to ensure that you have checked the items line by line that we will be reviewing. 2. It is important to remember to sign the invoice pages in BLUE ink, by the LGA coordinator or an approved alternate. 3. Effective with the 04/05 invoices, include a variance documentation letter if required in accordance with PPL 05-009. 4. Supporting documentation needs to be submitted with all 1st qtr invoices. Refer to manual page 8-1-21. This is your audit file documents. We require submission of these docs for 1st quarter only.1. These Checklists should be used AFTER you have completed the invoice package, they are intended to ensure that you have checked the items line by line that we will be reviewing. 2. It is important to remember to sign the invoice pages in BLUE ink, by the LGA coordinator or an approved alternate. 3. Effective with the 04/05 invoices, include a variance documentation letter if required in accordance with PPL 05-009. 4. Supporting documentation needs to be submitted with all 1st qtr invoices. Refer to manual page 8-1-21. This is your audit file documents. We require submission of these docs for 1st quarter only.

9. Step 1: LGA Prepares the Invoice (cont.) MUST be postmarked within 18 months of the end of each quarter. (refer to your handouts for a quick reference chart). Do NOT need to include multiple copies. 1. In your handouts we have included a chart with the Due Dates for MAA Invoices. You MUST submit invoices prior to the �Due Date From LGA� or you risk not receiving payment for the period. (refer to PPL 06-005 regarding Late Invoices) NOTE: These due dates apply only to LGAs, LEAs have a different set of due dates! 2. As with the Claiming Plan training, the requirement for multiple copies is out dated. Only one copy is required.1. In your handouts we have included a chart with the Due Dates for MAA Invoices. You MUST submit invoices prior to the �Due Date From LGA� or you risk not receiving payment for the period. (refer to PPL 06-005 regarding Late Invoices) NOTE: These due dates apply only to LGAs, LEAs have a different set of due dates! 2. As with the Claiming Plan training, the requirement for multiple copies is out dated. Only one copy is required.

10. Step 1: LGA Prepares the Invoice (cont.) Best Practices: Mail with Analyst�s name clearly identified on the outside envelope. Send all 4 quarters of a fiscal year at once, when feasible. Do not wait until the due date to submit the invoices. Allow time for CDHS review and possible corrections. 1. If possible to submit all 4 quarters at once, it streamlines the review process for us. Your invoices are more likely to be processed in a timely fashion if they are not in that �last minute� mailing flurry when we are literally buried in invoices. I wish I had taken photos of Alisha�s cubicle on March 15th � every surface and the floor was covered in stacks of mail! Remember, first in first out�..1. If possible to submit all 4 quarters at once, it streamlines the review process for us. Your invoices are more likely to be processed in a timely fashion if they are not in that �last minute� mailing flurry when we are literally buried in invoices. I wish I had taken photos of Alisha�s cubicle on March 15th � every surface and the floor was covered in stacks of mail! Remember, first in first out�..

11. Step 2: Invoice is Received by CDHS Goes to the mail room, where it may never be seen again ALWAYS send with your Analyst�s name clearly written on the outside envelope. May still take a few days to get delivered and distributed. Analysts receive in their �in-box� and give to the support staff to log in. At this point it is on our radar so we can adjust our workload. Ok, really we just add you to that 9-mile long queue we always seem to have! In your handouts we have provided a page with our correct unit name and address including the mail stop. This is the address everyone should be using for mail. ALWAYS include the name of your analyst. At this point it is on our radar so we can adjust our workload. Ok, really we just add you to that 9-mile long queue we always seem to have! In your handouts we have provided a page with our correct unit name and address including the mail stop. This is the address everyone should be using for mail. ALWAYS include the name of your analyst.

12. Step 3: Logged in by Support Staff Support staff: Logs it into our central computer files. Creates color-coded tracking cover sheet which: Indicates FY/Quarter it is received. Identifies LGA & claiming unit. The analyst it is assigned to. The amount of the invoice. The contract number. The amount left on the LGA contract. Amounts paid in previous quarters. The date it is logged into the system. Pretty self explanatory. How many of you have a tracking system in place to give you a declining funding balance as you invoice against your total contract amount? You MUST be tracking your funding as the FY goes along and each time you submit an invoice so that if you funds begin to get low, you can request an amendment to your funding amount in a timely fashion. Keep in mind that the amendment process for amending a contract takes MONTHS! Additionally, you should be tracking to ensure that you�ve invoiced for all 4 quarters for each of your approved claiming units well in advance of the 18 month cut off.Pretty self explanatory. How many of you have a tracking system in place to give you a declining funding balance as you invoice against your total contract amount? You MUST be tracking your funding as the FY goes along and each time you submit an invoice so that if you funds begin to get low, you can request an amendment to your funding amount in a timely fashion. Keep in mind that the amendment process for amending a contract takes MONTHS! Additionally, you should be tracking to ensure that you�ve invoiced for all 4 quarters for each of your approved claiming units well in advance of the 18 month cut off.

13. Step 4: Assigned to the Analyst After log in, it is placed in the county analyst�s In-box. 90-day clock starts from date of log in. Again 90 day clock is variable. Depending on workload, when it is received (such as at the end of the quarter when we get all our invoices�.that would take priority) Vacation, site visit schedules, etc. But at this point it gets put on our weekly workload summary that Linda reviews, and she can track the status of it from that point on. Again I�d like to reiterate that our ultimate goal is to turn invoices around in a 30-day period.Again 90 day clock is variable. Depending on workload, when it is received (such as at the end of the quarter when we get all our invoices�.that would take priority) Vacation, site visit schedules, etc. But at this point it gets put on our weekly workload summary that Linda reviews, and she can track the status of it from that point on. Again I�d like to reiterate that our ultimate goal is to turn invoices around in a 30-day period.

14. Step 5: Analyst Review We begin by pulling the LGA binder and referring to the claiming unit that corresponds to the invoice. We first make note of what activities this claiming unit is approved for and compare that to what is included in the Activity results %. We also check to see if there are SPMP approved for the Claiming Unit. If there are none approved, there should not be any %�s recorded in this column. We make note of how many SPMP are approved and how many Non SPMP are in the unit. We then use those figures to make an assessment of your Cost Pools 1 and 2 salaries. ( Total salary / 3 / # of staff) If they do not appear to be reasonable, we would make a note of it and it would need to be explained by the county. This training is geared towards LGAs so some of the wording may not apply to CBOs. At this point we would also confirm if any Direct Charges were approved in your claiming plan. We would also confirm the Medi-cal Methodology to be used for each activity. Note: More often than not this area of the invoice gets skipped, but it is important and should be filled out. We first make note of what activities this claiming unit is approved for and compare that to what is included in the Activity results %. We also check to see if there are SPMP approved for the Claiming Unit. If there are none approved, there should not be any %�s recorded in this column. We make note of how many SPMP are approved and how many Non SPMP are in the unit. We then use those figures to make an assessment of your Cost Pools 1 and 2 salaries. ( Total salary / 3 / # of staff) If they do not appear to be reasonable, we would make a note of it and it would need to be explained by the county. This training is geared towards LGAs so some of the wording may not apply to CBOs. At this point we would also confirm if any Direct Charges were approved in your claiming plan. We would also confirm the Medi-cal Methodology to be used for each activity. Note: More often than not this area of the invoice gets skipped, but it is important and should be filled out.

15. Step 5: Analyst Review (cont.) Reviews the Summary Invoice Is it on LGA Letterhead? Does it have the correct: Contract number Period of service Claiming unit name Invoice number If you follow the Checklist for the summary invoice, this should be very self explanatory. Have you used the correct contract number? Did you double check the Period of service? Claiming Unit Name, should be spelled out EXACTLY as it appears on your approved claiming unit grid. Please do not use acronyms. If you follow the Checklist for the summary invoice, this should be very self explanatory. Have you used the correct contract number? Did you double check the Period of service? Claiming Unit Name, should be spelled out EXACTLY as it appears on your approved claiming unit grid. Please do not use acronyms.

16. Step 5: Analyst Review (cont.) Compares totals on the Summary Invoice to be reimbursed to Page 2 of the Detail Summary Worksheet: Do the totals match exactly what is to be reimbursed for each category? Are the totals rounded to the nearest dollar? This is pretty straight forward. At this point we are just checking to ensure that the detail and summary pages match and there are no rounding issues.This is pretty straight forward. At this point we are just checking to ensure that the detail and summary pages match and there are no rounding issues.

17. Step 5: Analyst Review (cont.) Checks totals on Summary Invoice to make sure there are no rounding issues. Is it signed and dated by the LGA Coordinator? Your summary invoice should be in whole dollars. If you have amounts to be reimbursed at both 50% and 75% double check to be sure that line 3 is correct. Often times it will be $1 off due to the rounding issues. The Summary Invoice and the Detail invoices must be signed by the MAA/TCM Coordinator, the program administrator or the LGA fiscal officer. The detail invoice should be signed by the person who prepared it but also by one of the three individuals listed above. Your summary invoice should be in whole dollars. If you have amounts to be reimbursed at both 50% and 75% double check to be sure that line 3 is correct. Often times it will be $1 off due to the rounding issues. The Summary Invoice and the Detail invoices must be signed by the MAA/TCM Coordinator, the program administrator or the LGA fiscal officer. The detail invoice should be signed by the person who prepared it but also by one of the three individuals listed above.

18. Step 5: Analyst Review (cont.) Review Page 1 of the Detail Summary Worksheet -Compares Activity Percentage results for SPMP to approved activities. - Do the totals look reasonable for the amount of SPMP staff performing that activity? NOTE: 75% reimbursement applies only to activity F (PP&PD) for SPMP staff. Review Activity Results Percentages for both SPMP and Non-SPMP, these should match the claiming unit grid. NOTE: Skilled Professional Medical Personnel= SPMP Verify that they are not claiming SPMP unless it is approved in their claiming plan. These percentages are based on their time survey so should remain the same for all 4 quarters, since the counties time survey only one time per year. If there is any discrepancy in the percentages, no matter how small, the invoice must go back to the county for correction. The only time these % would change over the course of the year is if the county had requested and been approved to time survey an additional period during the year. �Indicate Methodology used to Determining Medi-Cal discount percentage�, these are check boxes and should match what is on your approved activity sheet for each activity. The invoice check boxes should NOT be left blank. If the LGA Coordinator has not filled in the information, it can be determined from the claiming unit plan on the activity detail pages. We do fill this information in for the LGA and notify you by e-mail. We would like to see this already filled in when we receive the invoice. If you are using the CWA, all 4 quarters %�s will remain the same. Conversely, if you are using the ACC, each quarter would most likely vary. This is subject to Audit and Site ReviewReview Activity Results Percentages for both SPMP and Non-SPMP, these should match the claiming unit grid. NOTE: Skilled Professional Medical Personnel= SPMP Verify that they are not claiming SPMP unless it is approved in their claiming plan. These percentages are based on their time survey so should remain the same for all 4 quarters, since the counties time survey only one time per year. If there is any discrepancy in the percentages, no matter how small, the invoice must go back to the county for correction. The only time these % would change over the course of the year is if the county had requested and been approved to time survey an additional period during the year. �Indicate Methodology used to Determining Medi-Cal discount percentage�, these are check boxes and should match what is on your approved activity sheet for each activity. The invoice check boxes should NOT be left blank. If the LGA Coordinator has not filled in the information, it can be determined from the claiming unit plan on the activity detail pages. We do fill this information in for the LGA and notify you by e-mail. We would like to see this already filled in when we receive the invoice. If you are using the CWA, all 4 quarters %�s will remain the same. Conversely, if you are using the ACC, each quarter would most likely vary. This is subject to Audit and Site Review

19. Step 5: Analyst Review (cont.) Reviews Page 1 of the Detail Summary Worksheet -Compares Activity Percentage results for non-SPMP to approved activities. - Do the totals look reasonable for the amount of non-SPMP�s performing that activity? At this point in the review we would look at the numbers of SPMP and Non SPMP staff and determine if the salaries reported look to be reasonable.At this point in the review we would look at the numbers of SPMP and Non SPMP staff and determine if the salaries reported look to be reasonable.

20. Step 5: Analyst Review (cont.) Reviews Page 1 of the Detail Summary Worksheet: Reviews the Medi-Cal discount percentages For each activity: compares to the activity description page for the methodology approved. If using CWA: compares to the PPL for the applicable fiscal year We compare the methodology that is approved in your Claiming Unit activity pages for each approved activity. If you are using the CWA we also compare the appropriate PPL County Wide Averages to what you have listed on your invoice. If the methodology on your invoice does not match your Claiming Unit plan, a corrected invoice must be submitted. We compare the methodology that is approved in your Claiming Unit activity pages for each approved activity. If you are using the CWA we also compare the appropriate PPL County Wide Averages to what you have listed on your invoice. If the methodology on your invoice does not match your Claiming Unit plan, a corrected invoice must be submitted.

21. Detail Invoice Review Page 1Cost Pools Reviews page 1 of the Detail Summary Worksheet: Review CP 1 salaries: Do totals seem reasonable for the number of SPMP�s approved on the grid? Review CP 2 salaries: Do totals seem reasonable for the number of Non-SPMP�s approved on the grid? Review CP 3 salaries: Do totals seem reasonable for the total number of people in the claiming unit? Are there direct charges? Review CP 6 salaries: Do totals seem reasonable for the total number of people provided in the backup documentation (1st quarter only)? For each of the cost pools that are populated, we do a simple math analysis to determine if the dollars reported seem to be reasonable. Total salary is divided by 3 to get a monthly amount That result is then divided by the number of staff from your grid. If the amounts seem reasonable it is accepted. If it seems illogical we will call the county for an explanation.For each of the cost pools that are populated, we do a simple math analysis to determine if the dollars reported seem to be reasonable. Total salary is divided by 3 to get a monthly amount That result is then divided by the number of staff from your grid. If the amounts seem reasonable it is accepted. If it seems illogical we will call the county for an explanation.

22. Step 5: Analyst Review (cont.) Reviews Page 2 of the Detail Summary Worksheet: - Is the sheet signed and dated by the LGA Coordinator? Self explanatory. Is it signed by the LGA coordinator Is it signed in BLUE ink Is it dated Compare the total lines on this page to the summary invoice to ensure they are the same. Self explanatory. Is it signed by the LGA coordinator Is it signed in BLUE ink Is it dated Compare the total lines on this page to the summary invoice to ensure they are the same.

23. Step 5: Analyst Review (cont.) Reviews Funding Sources Worksheet: List ALL funding sources of the claiming unit Funds that are NOT offset are: LGA Local Funds MAA reimbursements We do a cursory review of the funding page. Mainly we are checking to ensure that your have sufficient dollars in funds other than Federal or private. It is your responsibility to ensure that you are not DOUBLE DIPPING. Detailed information of the funding source worksheet are detailed in the manual on page 8-1-11.We do a cursory review of the funding page. Mainly we are checking to ensure that your have sufficient dollars in funds other than Federal or private. It is your responsibility to ensure that you are not DOUBLE DIPPING. Detailed information of the funding source worksheet are detailed in the manual on page 8-1-11.

24. Step 5: Analyst Review (cont.) Reviews Direct Charge Worksheet Are all Classifications clearly listed under Section 3? Does it match with what is approved in the activity pages of the claiming plan? Is there a Medi-Cal/Certified time factor entered? Does it correspond with what is approved in the activity pages of the claiming plan? Are any other direct charges clearly explained and accounted for in the claiming plan? Do totals seem reasonable for the total number of people in the claiming unit? Are there direct charges? The purpose of Direct Charge is to capture costs determined through methodologies other than the time survey. If you are going to Direct Charge is must be identified in the approved MAA claiming plan and must be tracked throughout the fiscal year. It is very important to maintain a detailed audit file for any costs that are DC. The 5 allowable categories that can be direct charged is outlined in the MAA manual on page 8-1-15. Note: When determining which costs are to be direct-charged, remember that those costs cannot appear anywhere else on the MAA detail invoice because this would result in duplicate claiming.The purpose of Direct Charge is to capture costs determined through methodologies other than the time survey. If you are going to Direct Charge is must be identified in the approved MAA claiming plan and must be tracked throughout the fiscal year. It is very important to maintain a detailed audit file for any costs that are DC. The 5 allowable categories that can be direct charged is outlined in the MAA manual on page 8-1-15. Note: When determining which costs are to be direct-charged, remember that those costs cannot appear anywhere else on the MAA detail invoice because this would result in duplicate claiming.

25. ACT III Corrections and Revisions

26. Corrections and Revisions Corrected invoices When an error is discovered by the analysts review prior to payment, a Corrected invoice is required. Revised Invoices When an invoice has been received and paid and then an error is found, a Revised invoice is required. Submitting Revised or Corrected invoices is discussed in detail in the manual 8-6-1. Both of these situations would require a new MAA summary Invoice and checklist. A cover letter should accompany either of these clearly describing what necessitated the change. Please give your analyst a heads-up email if you discover an error and know you will be sending a corrected invoice! There is a different MAA SUMMARY INVOICE for corrected or revised invoices. You must submit both detail and summary invoices, and these should be accompanied with a cover sheet explaining what precipitated the corrections or revision.Submitting Revised or Corrected invoices is discussed in detail in the manual 8-6-1. Both of these situations would require a new MAA summary Invoice and checklist. A cover letter should accompany either of these clearly describing what necessitated the change. Please give your analyst a heads-up email if you discover an error and know you will be sending a corrected invoice! There is a different MAA SUMMARY INVOICE for corrected or revised invoices. You must submit both detail and summary invoices, and these should be accompanied with a cover sheet explaining what precipitated the corrections or revision.

27. Step 6: Submission of Invoice for Manager Approval Analyst submits invoice to manager: Manager will act as a double check to ensure that all data contained in the summary and detail invoice checklists are consistent with the invoice that is being submitted for payment.

28. Step 7: Invoice is Submitted to CDHS Accounting Unit Accounting reviews and approves the Summary Invoice then forwards to the State Controller�s Office for payment.

29. Step 8: $$$$ are Released to LGA Mission Accomplished! . .

30. How To Contact Us If you have questions regarding the invoice process that were not covered in this training, please send an email to: Vickie Cooley-Soto @ Vcooley@dhs.ca.gov Mailing address is: California Department of Health Services Benefits Branch Medi-Cal Administrative Activities Unit Attn: Vickie Cooley-Soto P.O. Box 997417, MS 4601 Sacramento, CA 95899-7417 If you have technical questions about the invoice, please email those questions, problems, issues to me. The Invoice Workgroup will becoming active again after all the summer training sessions are over. I want to know what your issues are, so please feel free to email questions or comments to me to brought to the workgroup sessions. If you have technical questions about the invoice, please email those questions, problems, issues to me. The Invoice Workgroup will becoming active again after all the summer training sessions are over. I want to know what your issues are, so please feel free to email questions or comments to me to brought to the workgroup sessions.

31.