New MCAH Director Orientation May 17, 2011 Presented by Stephen Fong, Contract Manager and Linda Nagel, Mendocino Coun

1. New MCAH Director Orientation May 17, 2011Presented byStephen Fong, Contract Manager and Linda Nagel, Mendocino County MCAH Director BUDGET / INVOICE OVERVIEW For the MCAH Director THINGS YOU WANTED TO KNOW, THINGS YOU NEED TO KNOW and THINGS YOU DON’T WANT TO KNOW, BUT HAVE TO HEAR ANYWAY

2. Budget Basics • The budget is a projection of your agency’s cost to complete the MCAH program SOW. • The budget also forecasts the percent of reimbursable Federal Title XIX activities that program staff perform to meet the FFP (Federal Financial Participation) objectives.

3. Brief Budget Summary Five line item budget • Personnel: Staff salaries & benefits. • Operating Expenses: Expenses necessary to run the program. • Capitol Expenditures: Major equipment over $5,000. • Other Costs: Subcontracts, equipment, office furniture. Anything that is not a day to day expense. • Indirect costs: Costs that are not identified as direct cost of the program. Indirect cost are limited to 10% of the total wages not including benefits.

4. Budget basics • What you need to understand: • Funding Sources • Title V Block Grant Funds (Federal) • Agency General Funds • Title XIX Funds (Federal Medicaid/Medi-Cal) • Matchable and unmatchable activities, travel, training, operating expenses • Enhanced activities, and who can claim them • Restrictions, if any, on spending

5. Title V Funds • Title V Funds are Federal Block Grant funds, and are allocated as a fixed amount each year. • Title V Funds are used to reimburse Program expenses incurred for activities consistent with the goals and purposes of the Title V Block Grant.

6. Agency Funds • Agency funds are sometimes necessary to supplement program costs or balance the budget. • Non-federal agency funds should be used to maximize the use of available matching federal funds claimable under Title XIX of the Federal Social Security Act (42 U.S.C., Sec. 1396 et seq.).

7. Title XIX Funds • Title XIX funds are accessed through Federal Financial Participation (FFP) which is a federal program providing reimbursement for activities performed by qualified staff that meet specific Medi-Cal program goals/objectives. • FFP is the funding mechanism under which Title XIX (Medi-Cal dollars) are accessed via matching to reimburse agencies for Medi-Cal administrative activities associated with specific FFP objectives.

8. FFP Objectives There are two objectives in FFP • Assisting individuals eligible for Medi-Cal to enroll in the Medi-Cal program, and/or • Assisting individuals on Medi-Cal to access Medi-Cal providers, care, or services.

9. FFP • Objectives Reimbursement Levels There are two levels of reimbursement for FFP • The first is Enhanced. The only staff that can claim enhanced reimbursement are Skilled Professional Medical Personnel (SPMPs) and clerical support of an SPMP. This is the 75/25 match. • The second is Non-Enhanced. Anyone on the budget can claim Non-Enhanced. This is the 50/50 match. (Every time you hear reimbursement, think FFP objectives)

10. Operating Expenses • Most operating expenses incurred in performing the activities in the SOW are allowable and matchable: • rent, communications, utilities, office supplies, computer maintenance, etc. • A few expenses that are not matchable are: • Educational materials • Incentives / promo items / motivational redirectives • Toll Free lines • SIDS / FIMR Activities and materials (Title V funded) • Allowable budget items that can’t be matched can be budgeted with Title V or Agency funds.

11. When is Travel and Training Matchable? • Travel and Training is matchable when It meets one of the two FFP objectives • Travel to and from: • A matchable activity • Training related to the FFP objectives • Conferences related to FFP objectives • Outreach • Training for • Time Study / FFP training • Staff training to assist clients with Medi-Cal enrollment

12. Enhanced Travel & Training • Training, Travel Time, and Travel Costs can be Enhanced when: • The Training is by a SPMP for SPMPs and relates to either of the two FFP objectives • Travel Time and Travel Costs are to and from an Enhanced training

13. Budget Restrictions • The following is a partial list of “non-claimable” items: • Food • Malpractice Insurance • Purchasing or improving land or buildings • Any costs not directly related to the MCAH Program SOW • All non-claimable items will need to be removed from the budget before it can be approved.

14. Budget: MCAH Director’s Role • You (and your agency’s fiscal agent) must sign your approval of the budget and any budget revisions: “We certify that this budget has been constructed in compliance with all MCAH administrative and program policies.” • You need to provide your fiscal staff with information, in order to develop a budget that meets MCAH Program requirements and your ability to implement the MCAH SOW.

15. Budget: MCAH Director’s Role 1. Determine staffing needs to support MCAH Program SOW. • Percent of each staff’s time in the program • Matchable percentages needed (enhanced, non-enhanced) for each staff • Review averages of previous year’s time study/invoice data • Incorporate changes based on the SOW activities • Revise duty statements as needed

16. Budget: MCAH Director’s Role • Determine Operating expenses needed to support program. MCAH Program Policies & Procedures require: • “Adequate funding for training and meeting expenses, including travel, must be built into the annual budget.” • PSC responsibilities: “Attend a new PSC orientation and a CPSP Annual Statewide meeting and, if funds are available, a regional training.”

17. Budget Strategy Budget building steps: • After determining staffing needs to support SOW, enter all personnel costs. • Next enter all Operating expenses to support program. • Then enter any Other Costs items. (Sub-Ks, minor equipment, etc) • If matching, enter matchable percentages for staff from average of invoice /time study data. • Check balance totals at top of budget to see if over or under budget.

18. Invoices • The MCAH Division reimburses Agencies for actual cost and expenses in meeting the MCAH and FFP program objectives. • Reimbursement is limited to the amounts approved on the MCAH program budget.

19. Invoices: MCAH Director’s Role • You must sign your approval of the invoice: “I certify that I have seen and reviewed this invoice for compliance with MCAH administrative and program policies.” • Sign invoice cover letter. Be sure that Time Study Data Reports for Summary of FFP are attached if you are claiming Title XIX (FFP) funds.

20. Invoicing Due Dates • Invoices are due: • 1st -3rd quarter invoices due 45 days after the end of each quarter • 4th quarter invoice due 90 days after the end of the fiscal year (end of September) • Final supplemental invoice, if necessary, 120 days after the end of the fiscal year (end of October) • If an extension is needed, email your request to your Contract Manager.

21. Invoice Reconciliation Table • A tool to help manage funding, expenditures and future budgets. • Reflects balances between current expenditures and remaining funding. • Should be reviewed when completing invoice to insure funds are available. • Eliminates surprises and identifies the need for budget revisions.

22. Budget Revisions • A budget revision is a change or adjustment in any element of the negotiated and approved MCAH program budget. This includes changes in funding, SOW, personnel and operating cost. • A budget revision request must be submitted in writing to the MCAH Division with an explanation of the changes along with all of the appropriate documents.

23. Audits • State • MCAH programs may be audited every three years • Areas to be audited may be program and/or fiscal compliance with State and Federal requirements. • Performed by Department of Health Care Services Audits & Investigations. • Keep all records for at least 3 years past the final invoice payment for the fiscal year (longer if an audit is in progress).

24. Audits • Federal • The Federal government may audit any State or local government program receiving Federal funds at any time for compliance with Federal program and fiscal compliance. • ALL programs receiving federal funds are responsible for being knowledgeable of and following the Federal rules and requirements.

25. Need Help? • Use the MCAH Policies and Procedures Manuals on the MCAH website to assist you with understanding the various fiscal and program processes. • Contract Managers and Program Consultants are good resources when you have questions.

26. ANY QUESTIONS? ?