Medi-Cal Administrative Activities Program Discussion and Update

1. 2017/2018 District SMAA Coordinator Training & Qtr.1 Meeting Region 9 LEC School-Based Medi-Cal AdministrativeActivitiesProgram August 2017

2. Today’s Agenda Welcome & Introduction SMAA 101 RMTS Refresher Training DHCS Discussion/Update Region 9 LEC Update Optional Services Update

3. DHCS Discussion/Update PROGRAM DEFERRAL On June 26, 2012, CMS informed DHCS that the SMAA program is on deferral, because implementation of DHCS’s approved SMAA claiming plan does not comply with federal requirements, including the time study, which is used as a basis for developing invoices.  (…any costs claimed be limited to those that are reasonable and necessary for the proper and efficient administration of the Medi-Cal program...) The deferral was to be applied retroactively. DEFERRAL RESOLUTION On October 14, 2014, DHCS and the CMS agreed to a detailed SMAA cost settlement proposal that included an initial cash payment for deferred claims while subjecting a specific group of invoices to a backcasting methodology. The settlement agreement directed DHCS to apply the following criteria to each unresolved deferred invoice from 2009/10 Q3 through 2014/15 Q2.

4. DHCS Discussion/Update For 2009/10 to 2011/12 claims For 2012/13 to 2013/14 claims (and 2014/15 Q1 & Q2)

5. DHCS Discussion/Update BACKCASTING METHODOLOGY – a cost reconciliation process CMS is requiring DHCS to collect RMTS data to produce a new weighted average in order to recalculate the worker log invoices deferred from previous periods of service spanning fromFY 2009/10 Q3 – FY 2014/15 Q2. • Utilize four quarters of RMTS data to calculate Backcasting %s • 14/15 Q3, 14/15 Q4, 15/16 Q1 and 15/16 Q2 • Removal of unauthorized TSP job classifications • 15% Vendor Fee Limit DHCS created Group#s for submission

6. DHCS Discussion/Update BACKCASTING INVOICE For all backcasted invoices, there are three major areas that must be addressed when completing the backcasting invoice. • RMTS Time Survey Percentages – You must substitute the RMTS time survey percentages for the worker log percentages. • Authorized Job Classifications – You must remove all non-authorized job classifications from the Claiming Unit Function Grid (CUFG) and adjust the costs. • 15% Vendor Fee Limit –You must complete a Vendor Fee Worksheet (VFW) that certifies vendor fees do not exceed 15% of the annual claim amount. DHCS created a Backcasting Invoice template (newest version is 07.15.17) for those districts that need to remove positions. Otherwise the original template can be used. • This invoice calculates a ‘new’ reimbursement amount, deducts what was received as an interim (settlement) payment, deducts any vendor fee adjustment and then provides an amount either due back to DHCS (payback) or an amount payable to the district. DHCS is developing a process for offsetting Backcasting payback amounts to RMTS amounts.

7. DHCS Discussion/Update VENDOR FEE WORKSHEET (VFW) Vendor fees are limited to no more than 15% of the annual SMAA claim amount for each LEA • DHCS created a form to determine if the 15% limit was/is met or exceeded. • 2 versions: one for RMTS and one for Backcasting. The newest versions are dated 08.01.17 It is important that the vendor fees be matched to the quarter in which they were incurred, regardless of when they were paid by the claiming unit or when they were claimed for reimbursement. The VFW is submitted once all vendor fees for a fiscal year have been claimed on an SMAA Invoice. Signed by the LEA and the LEC. • Backcasting: If an adjustment is required, applied to the last Backcasting Invoice for that fiscal year • RMTS: If an adjustment is required, the LEA must submit payment (check) to DHCS along with the form.

8. DHCS Discussion/Update VENDOR FEES These costs are claimed based on date of payment, NOT dates of service Supporting documentation needs to be provided to the LEC along with the RMTS/Backcasting invoices and maintained in the LEA’s Audit File • Appropriate documentation includes: copies of invoices from vendor and proof of payment (copies of check(s) or general ledger reports) showing date of payment and amount • LEA should also maintain a copy of the contract with the vendor for any services to be provided

9. DHCS Discussion/Update INTEGRATION OF LEA BOP INTO RMTS • LEA BOP = LEA Medi-Cal Billing Option Program • SPA 15-021 originally submitted to CMS on September 30, 2015 • The SPA includes an RMTS component for reimbursement of LEA BOP claims based on CMS requirements to implement a ‘combined cost allocation methodology’ • The SPA has not been formally re-submitted to CMS with responses to the additional requests for information (RAIs) for final approval • All LEAs that wish to continue billing the LEA BOP must participate in RMTS • DHCS originally stated 7/1/2017 as target implementation date …..stay tuned…

10. DHCS Discussion/Update RMTS

11. Region 9 LEC Update SMAA STAKEHOLDER MEETING: Save-the-Date • Open to all LEA Coordinators participating in SMAA through a LEC (no vendors) • When? October 5, 2017 9:00am – noon • Where? Downtown Sacramento • Videoconferencing option will be available • Jointly sponsored by the 11 statewide LECs, CCSESA, CDE, and the California Endowment • DHCS has been asked to attend and participate • A more detailed flyer and registration form to come early Sept

12. Region 9 LEC Update Region 9 LEC Due Dates: • RMTS Invoices • Backcasting Invoices • RMTS System • LEA Coding Review & Certification 2017-2018 Program Calendar

13. Region 9 LEC Update Personal Service Contractors • TSPs that are personal service contractors need to be included on the district’s TSP list in order to be considered eligible to claim costs • These costs are claimed based on date of payment, NOT dates of service • Supporting documentation needs to be provided to the LEC along with the RMTS invoice and maintained in the LEA’s Audit File • Appropriate documentation includes: copies of invoices from outside agency/vendor and proof of payment (copies of check(s) or general ledger reports) showing date of payment and amount • LEA should also maintain a copy of the contract with the outside agency/vendor for any services to be provided • Best practices: • a spreadsheet containing all detailed info above • All documents can be submitted to the LEC in advance for review

14. Region 9 LEC Update Data Match According DHCS PPL 16-021 – new MOVEit platform • The Data Match request procedure for the LEA BOP remains the same at this time, allowing LEAs that contract with the LEA BOP to use their Medi-Cal eligibility data obtained through the LEA BOP Data Match request process to develop a Medi-Cal Eligibility Rate (MER) for their SMAA invoices. The Data Match Request file sent to the LEA BOP must include the entire student population. • If the LEA utilizes a third-party vendor that accesses the data, the LEA must have a Data Use Agreement (DUA) in place with any such third party vendor. • Beginning July 1, 2017 all non-contracted LEAs must either complete a fully executed DUA with DHCS OR submit the Data Match files through their LEC

15. Region 9 LEC Mailing Info USPS Mail Address Rosalee Hormuth School-Based Medi-Cal Administrative Activities    Orange County Department of Education  P.O. Box 9050   Costa Mesa, CA 92628-9050 Overnight Mail AddressCounty/District Mail Address Rosalee Hormuth OCDE District #94School-Based Medi-Cal Administrative Activities    Rosalee Hormuth A-1154 Orange County Department of Education 200 Kalmus Drive, A-1154 Costa Mesa, CA 92626

17. Region 9 LECContact Information Program Email: ocdesmaa@ocde.us

18. Any Questions?

19. Optional Services Update • New Audit Binders • Updated Workbook • Secure file server transfer protocol (FTP) • Invoices • MER/Data Match • Time and Attendance Report