DEPARTMENT OF HEALTH CARE SERVICES

1. DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

2. Introduction • Financial Audits Branch (FAB) • Cost Report Process: • Cost Report Submission by LGAs • Cost Report Acceptance by FAB • New Interim Rate Approval by FAB A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

3. Financial Audits Branch (FAB) • Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services • Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent. A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

4. Cost Report Flow Submission of Cost Report (C/R) C/R Acceptance C/R Acceptance Letter Rate Approval Letter Rate Approval Begin Invoicing TCM Program A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

5. TCM Cost Reports - Submission • TCM Cost Reports due November 1st Hard Copy FAB, Audit Review and Analysis Section (ARAS) Note: see cost report instruction for cost report mailing address. Soft Copy dhsaitcm@dhcs.ca.gov A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

6. TCM Cost Reports - Submission • Hard Copy – Includes the Following Completed Items: • Cover Letter on LGA Letterhead • Table of Contents • TCM Cost Report Checklist • LGA Cost Report Certification Statement • CPE Certification and LGA Attestation Statements • Cost Report, Funding Schedule, and Allowable CPE Funding Schedule Templates • Cost Report Supporting Documents • Organizational Chart Including the Defined Budget Unit (BU), and Listing all Staff & Positions within the BU • A Complete and Comprehensive Narrative Describing the Types of Programs and Services that Are Included in the TCM BU • General Ledger Grouping Schedule for Reported Costs & Funding • Salary and Benefit Costs – Payroll Amounts by Employee • Financial Statements of the TCM Service Provider who Files the Cost Report A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

7. TCM Cost Reports - Submission • Soft Copy – Includes the Following Completed Items: • Cost Report Template • Funding Schedule • Summary of Allowable Funding for Claiming Federal Matching Funds Worksheet • Interim Medi-Cal TCM Encounter Payment Rate Calculation Worksheet • 2009 Survey Template • List Worksheet • Totals Worksheet • Time Sheets • Cost Report Review Tool Template A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

8. TCM Cost Reports - Acceptance • Acceptance Process : • Responsibility of ARAS: • Completion of comprehensive checklist: • Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions • Contact designated LGA Coordinator for missing and/or incorrect items. A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

9. TCM Cost Reports - Acceptance • Top reasons cost report was not accepted upon first review: • Incorrect Name Convention of Soft Copy. • Soft Copy of Worksheet A did not Match Hard Copy • Soft Copy of Cost Report not Submitted • Soft Copy of Survey Template not Submitted • Soft Copy of Two Funding Schedules not Included • Soft Copy of the Cost Report Review Tool not Submitted completely • Hard Copy of Certification Statement(s) not Signed • Table of Contents not Included in Hard Copy Submission • Financial Statements not Included in Hard Copy Submission A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

10. TCM Cost Reports - Acceptance • Acceptance Process : • Cost Report Acceptance Letterissued by ARAS Acceptance LetterLGA • For each TCM Cost Report (LGA, CBO, and LPE) • Identifies “postmark date” to establish 36-month audit period A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

11. TCM Cost Reports – New Billing Rate Approval • Billing Rate Approval Process : • Review of Interim Rate Calculation Sheet • Issuance of Billing Rate Approval Letter to LGAs who Participate in TCM Program • Purpose of the Letter Is to Establish: • TCM Rate Period (2013/2014) • Rate Per TCM Encounter • TCM Maximum Amount A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

12. TCM Cost Reports – New Billing Rate Approval Billing Rate Approval Process : (Excerpt from an Approval Letter) Rate Per TCM TCM Rate Period TCM EncounterMaximum Amount FY 2013-2014 $250.55 $100,220.00 A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

13. TCM Cost Reports – New Billing Rate Approval • Billing Rate Approval Process : • Approval Letter Issued by A&I, FAB, Special Program Section (SPS) LGA Approval Letter TCM Program Unit* *The Approval Letter authorizes the TCM Program Unit to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount or CAP. A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

14. FAB Contact Information • Audit Review & Analysis Section (ARAS) – Audit Analysis Unit • Shun Tong, HPAMI • Phone: (916) 650-6687 • Email: Shun.Tong@dhcs.ca.gov • Special Program Section (SPS) – TCM Audit Unit • Haisong Peng, HPAMI • Phone: (916) 323-4307 • Email: Haisong.Peng@dhcs.ca.gov A&I FAB Information for TCM Cost Report due by Nov. 1, 2013