WIMCR Update

1. WIMCR Update Wisconsin Human Services Finance Managers’ Association Annual Conference May 7, 2010

2. WIMCR • Information provided by: • Catherine Lorence, DHS/DES • catherine.lorence@dhs.wisconsin.gov • (608) 267-7130 • Nancy Kimble, PCG • nkimble@pcgus.com • 1-866-913-4232 x4675

3. WIMCR • Information provided in this session • New WIMCR Coordinator • What is WIMCR? • Timeline for CY 09 cost reporting and CY 10 WIMCR payments and adjustments • Changes to WIMCR • CY 08 WIMCR Analyses • Questions

4. New WIMCR Coordinator • Public Consulting Group, Inc. (PCG) became the WIMCR Coordinator effective July 1, 2009. • PCG WIMCR Team: • Nancy Kimble – nkimble@pcgus.com 1-866-913-4232 x4675 • Kandice Marquardt - kmarquardt@pcgus.com 1-866-913-4232 x4668 • Adam Burkin – aburkin@pcgus.com 1-866-913-4232 x4676

5. What is WIMCR? • Wisconsin Medicaid Cost Reporting • Requires annual cost reporting by certified public Medicaid providers for the following services: • Home health services • Medical day treatment services • Outpatient mental health and substance abuse services • Personal care services • Substance abuse day treatment services

6. What is WIMCR? • Community support programs • Case management • Mental health crisis intervention per hour • Mental health crisis stabilization per diem • Prenatal care coordination • Child/adolescent day treatment

7. What is WIMCR? • Cost reports identify actual costs of providing service. • Payments made by Wisconsin Medicaid program to counties based on • Actual cost based rate • Units of service provided to Medicaid eligible clients

8. What is WIMCR? • Three interim payments are made using the prior CY’s actual cost based rate • June of the Current Year • September of the Current Year • June of the Following Year • BCA reductions offset interim payments • Profile 684 – Act 318 Adjustments

9. What is WIMCR? • FINAL payments are made using the actual rate based on Cost Reports • September of the Following Year • CSDRB MOE adjustment to the BCA reduction • CSDRB MOE totals $19.25 million • A 2-tiered calculation with a 2002 CSDRB Lookback

10. Why WIMCR? • Brings additional federal funds into Wisconsin • Recognizes costs of services paid from • County Levy • Community Aids funding • Split between • Counties—approximately 2/3 of increased federal funding • State Medicaid program

11. An example involving Chocolate • WIMCR payment equals 25 chocolates. • LPHD programs generated 15 • HSD programs generated 10 • CSDRB MOE equals 10 chocolates. • LPHD programs generated 6 • HSD programs generated 4 • BCA adjustment equals 15 chocolates. • Who gets what?

12. An example involving Chocolate • HSD • WIMCR Payments of 10 • Less BCA Adjustments of 15 • Plus transfer from LPHD of 9 • Net Payments of 4 Equals the CSDRB MOE • LPHD • WIMCR Payments of 15 • Less transfer to HSD of 9 • Net Payments of 6 Equals the CSDRB MOE

13. Timeline for CY 2010 WIMCR payments • 2009 Cost Reports due June 14th • WIMCR payments and associated BCA adjustments—June 2010 • WIMCR payments, CSDRB MOE adjustment and related BCA adjustments—September 2010.

14. Changes to WIMCR • Cost Reporting for Managed Care • Cost settlement of Medicaid managed care units in addition to Medicaid fee-for-service units of service • Each county that received managed care payments for 2008 and/or 2009 WIMCR services will be required to complete the applicable WIMCR Managed Care Report • Capture all managed care units of service paid by HMOs and Family Care organizations for dates of service during calendar years 2008 and/or 2009

15. Changes to WIMCR Enhancements to the Web Tool Webinar Training and Updated Instruction Manual Expanded Desk Reviews

16. 2009 WIMCR Process 5/7/10: WIMCR website moving to https://www.forwardhealth.wi.gov/wimcr/ Webinar trainings on 2009 WIMCR Cost Reports Tuesday, May 11: 9:00 am – 11:30 am Tuesday, May 11: 1:30 pm – 4:00 pm Wednesday, May 12: 9:00 am – 11:30 am (recorded) Webinar trainings on 2008 and 2009 WIMCR Managed Care Reports Thursday, May 13: 9:00 am – 10:30 am Thursday, May 13: 1:30 pm – 3:00 pm (recorded)

17. 2009 WIMCR Process (cont’d) • Choice of one application/certification per WIMCR service or one application/certification per agency covering multiple WIMCR services • In addition to total cost per unit, system now calculates direct cost per unit, non-direct cost per unit, and overhead cost per unit. • Explanation boxes have been expanded in size. • 6/14/10: Reports are due 2009 WIMCR Cost Reports Revised WIMCR Cost Reports for prior years 2008 WIMCR Managed Care Report, if applicable 2009 WIMCR Managed Care Report, if applicable

18. 2008 WIMCR ANALYSES • Case Management • 106 Cost Reports • Minimum total cost per 15-minute unit: $6.98 • Maximum total cost per 15-minute unit: $210.37 • Top 5 cost reports, representing 45% of total units of service • Minimum total cost per 15-minute unit: $13.19 • Maximum total cost per 15-minute unit: $19.92 • 2009 Desk Review Benchmarks: • Total cost per 15-minute unit under $15.00 • Total cost per 15-minute unit over $30.00

19. 2008 WIMCR ANALYSES (cont’d) • Community Support Program • 58 Cost Reports • Minimum total cost per 15-minute unit: $ 10.00 • Maximum total cost per 15-minute unit: $127.09 • Top 5 cost reports, representing 46% of total units of service • Minimum total cost per 15-minute unit: $16.95 • Maximum total cost per 15-minute unit: $27.16

20. 2008 WIMCR ANALYSES (cont’d) • Community Support Program (cont’d) • 2009 Desk Review Benchmarks: • Total cost per 15-minute unit under $15.00 • Total cost per 15-minute unit over $30.00 • Analyses: Range of total cost per unit by provider type • MDs: $13.82 - $174.44 • PhDs: $ 7.28 - $ 71.22 • RNs: $17.61 - $ 68.05 • Masters: $ 6.22 - $110.08 • Bachelors: $ 4.15 - $ 37.64 • Paraprofessionals: $ 2.64 - $ 43.97

21. 2008 WIMCR ANALYSES (cont’d) • Personal Care Services • 68 Cost Reports • RN Visit assumed to average 1 hour 15 minutes • Minimum total cost per RN visit: $ 26.87 • Maximum total cost per RN visit: $788.97 • Top 5 cost reports, representing 45% of total units of service • Minimum total cost per RN visit: $106.49 • Maximum total cost per RN visit: $167.32 • 2009 Desk Review Benchmarks: • Total cost per RN visit under $125.00 • Total cost per RN visit over $200.00

22. 2008 WIMCR ANALYSES (cont’d) • Personal Care Services (cont’d) • Minimum total cost per PC worker per 15 minutes: $ 2.92 • Maximum total cost per PC worker per 15 minutes: $36.17 • Top 5 cost reports, representing 42% of total units of service • Minimum total cost per PC worker per 15 minutes: $3.57 • Maximum total cost per PC worker per 15 minutes: $5.42 • 2009 Desk Review Benchmarks: • Total cost per PC worker per 15 minutes under $3.00 • Total cost per PC worker per 15 minutes over $6.00

23. 2008 WIMCR ANALYSES (cont’d) • Prenatal Care Coordination • 76 Cost Reports • Minimum total cost per 15 minutes: $ 7.58 • Maximum total cost per 15 minutes: $106.08 • Top 5 cost reports, representing 30% of total units of service • Minimum total cost per 15 minutes: $16.31 • Maximum total cost per 15 minutes: $35.57 • 2009 Desk Review Benchmarks: • Total cost per 15 minutes under $15.00 • Total cost per 15 minutes over $35.00

24. 2008 WIMCR ANALYSES (cont’d) • Prenatal Care Coordination (cont’d) • Average time per Risk Assessment and per Care Plan Minimum = 15 minutes; Maximum = 4 hours • Total Cost per Risk Assessment and per Care Plan Minimum = $9.31; Maximum = $424.30 • Issues identified with number of groups and number of participants

25. WIMCR • Questions?