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County-Based Medi-Cal Administrative Activities (CMAA ) Overview 2013

County-Based Medi-Cal Administrative Activities (CMAA ) Overview 2013. HealthReach . Medi-Cal is a Partnership. Medi-Cal - Federal government matches eligible state expenditures for Services through its existing provider network as we know it.

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County-Based Medi-Cal Administrative Activities (CMAA ) Overview 2013

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  1. County-BasedMedi-Cal Administrative Activities (CMAA) Overview2013

    HealthReach
  2. Medi-Cal is a Partnership Medi-Cal - Federal government matches eligible state expenditures for Services through its existing provider network as we know it. In California, State DHCS can subcontract for the Administrationof Medi-Cal (CMAA) to counties and certain cities (LGAs) and schools (LECs); These same funds are used for county eligibility expenses (welfare/social services) as well as directly through certain programs i.e. AFLP,CCS Currently, no cap or limit on administrative costs for CMAA Feds will also match funds expended by public entities other than the state; cities, First 5, schools
  3. What is CMAA? OUTREACH Providing information about Medi-Cal and how to apply REFERRALS/ CASE COORDINATION Assisting with access to Medi-Cal services PLANNING/ COLLABORATING Planning for, improving, expanding Medi-Cal covered services Reimbursement from Federal Medicaid to programs that perform MAA
  4. Eligible CMAA Activities Outreach about the Medi-Cal program and its services Assisting with the Medi-Cal application process Medi-Cal/Health related case coordination Arranging and/or providing transportation to Medi-Cal covered services Medi-Cal Program Planning and Contracting
  5. California CMAA BackgroundMedi-Cal Administrative Activities 1990 Initiated by County Health Departments 1991 Signed into law: SB 910 1992 MAC Program 1994 MAC Disallowance 1995 MAC Settlement/MAA
  6. CMAA Hierarchy DHCS
  7. Flow of Funds Public funds expended for documented eligible CMAA activities LGA assembles or reviews eligible claims, reviews certifications and certifies CPE and routes to State (bulk of work done here) State routes to Medicaid/CMS Medicaid pays State, which pays LGA which distributes funds
  8. Medicaid Match Requirement CMAA requires a “certified public expenditure” (CPE) that specifically supports CMAA activities. CPE match funds must be from a (federally allowable) public source (State, county, city, school district, FIRST 5) Counties may claim for “sub-contract” activities performed by county subcontractors, other public entities – cities, FIRST 5, and their community subcontractors, etc.
  9. Medicaid Match FundsSubstance Abuse County General Funds Realignment MAA/TCM Reimbursements Local Public Entity (cities, schools, FIRST 5) State (only) funds Vehicle License Fees Certain Tax Revenues – i.e. Prop 63 Fines – Statham funds Tobacco Settlement Philanthropic Donations
  10. How do you claim MAA?TIME SURVEY
  11. CMAA Fiscal Requirements Quarterly claims submitted to State based on: Verified local match (CPE) Approved claim plan Time survey results Fiscal staff time required to: Review surveys/summarize results Gather and compute fiscal information for insertion into the claim Complete detailed invoice
  12. How is CMAA Reimbursement Calculated? Staff & Other Related Costs X % of claimable activities X % Medi-Cal clients [for discounted activities] = FFP CMAA reimbursement
  13. Assessment of Potential Identify performance of CMAA activities by staff or subcontractors Identify and document public funds that support CMAA Identify percentage of time dedicated to CMAA (Take into account CMAA activities that are “discounted”) Factor associated staff costs by time percentages to determine potential (Take into account CMAA activities that are “discounted”)
  14. Affordable Care Act UCLA estimates 3+ million potentially eligible nonelderly Californians in 2014 1.4 to 2+ Million newly enrolled in Medi-Cal 1 Million to stay uninsured New enrolled population demographics Predominately working age – 18-44 Over half are single, childless adults One in three will have children Predominately people of color w/ 40% Latino One in four will have chronic health problem
  15. CMAA Deferral/New Timelines Began in July 2010 CMS provided audit findings from a sample review of 2008 LGA invoices for select claiming units Findings - CMS wanted time survey to be conducted each quarter, not just one month per year Based on the one finding CMS somehow took the liberty to re-write the entire CMAA program CMS wants CMAA to be based on 2003 MAA School guide (which doesn’t make sense); LGAs fought back and won (somewhat) New CMAA guide will be announced no later than April 30, 2013 (?) and will require a perpetual time survey and dual CMAA Codes Start date July 1, 2013 (?)
  16. Proposed CMAA Codes 16
  17. Questions ? HealthReach 209 920 3572
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