Wisconsin Human Services Financial Management Workshop May 6, 2010

1. Wisconsin Human Services Financial Management WorkshopMay 6, 2010

2. Outline New things: New Diversion Process Terminology Review Your Questions: Understanding and Using COP post-Family Care Waiver Mandate post-Family Care COP LTS Planning Committee COP Allowable Average Contract Cuts Leave-back COP Reconciliation HSRS & CARS Disallowances Maximum Admin between COP and COP-W COP High Cost Family Support Program Fourth Annual Reconciliation Awards

3. New Processes for Diversions CRI Diversion Remove requirement of high risk criteria Plans go directly to TMG Nursing Home Diversion Can refill vacated slots within 90 days Slot returns to State after 90 days of non-use $85 per day limit, high risk criteria still applies Crisis/emergency slots available- call Lisa Plans go directly to TMG

4. Terminology Review:COP vs. MA Waiver COP 100% (non-fed) state dollars All MA Waivers (Non-fed) + (fed) Non-fed : Fed ratio determined by CMS Non-fed generates Federal funding

5. Terms to Know: Fed vs non-fed Non-federal funds Roughly 40% of total Comes from State or County Used to generate federal dollars aka �match�

6. Terms to Know: Match Match Source = Source of non-fed funding

7. Terms to Know: Match Over Match / �Overage� / �Set aside� Portion spent over the daily rate. Must use local match to cover cost.

8. Overmatch: an Example

9. Your Questions Understanding & Using COP post-Family Care COP LTS Planning Committee COP Allowable Average Waiver Mandate post-Family Care

10. Understanding COP post-Family Care

11. Understanding COP post-Family Care

12. Side Bar: How to code Mentally Ill on HSRS Code as Mentally Ill with 1st Client Characteristic Why?? 1st Client Characteristic (Field 8) vs Target Group (Field 25) 1st Client Characteristic (Field 8) Describes the person Why the person is eligible Constant for the whole LTS episode Target Group (Field 25) Describes why they need the service Can differ by SPC

13. Q & A: Use of COP post-Family Care

14. COP 1.67 in Family Care? Doesn�t exist Lose MA eligibility = Lose Family Care eligibility Could use local funds to sustain

15. The Community Options Program and the �Questioned Costs� From the audit guide: http://www.doa.state.wi.us/docview.asp?docid=7929&locid=3 A recipient of COP services must be: BOTH Functionally and Financially eligible Services that are NOT COP allowable: Purchase land Build buildings Services/items for a person who is/will be residing in an RCAC (Wis. Stat. 50.034(6) ) Services billed but not provided Administration claims without cost to justify Services requiring variances: Services provided in an institution or to an institutional resident Services provided in a CBRF > 20 beds CBRF costs over the established limit

16. The Community Options Program and the �Questioned Costs� From the audit guide: http://www.doa.state.wi.us/docview.asp?docid=7929&locid=3 Program Requirements / Possible Disallowances: COP care management rate needs annual approval (COP Plan Update) Double billing COP and MA (Forgot to remove the costs??) Waiver must be used before COP, where possible Waiver allowable services can NOT be billed 100% COP COP is funding of LAST RESORT; Waiver Mandate File must contain ISP signed by COP participant COP Care Manager must meet training requirements Financial eligibility reviewed annually Semi-annually if they have a cost-share If cost-share, it MUST be applied to COP services COP Participant must have been a WI resident for 180 days COP as match for SPC 509(CSP) and/or 510(CCS) Use blended rate to calculate the match cost Be careful that there is no double-billing

17. COP LTS Planning Committee Authority Policy Decisions Cost share (deductions) Program Decisions Variance approvals Funding allocation between target groups Living arrangements Care plan service limits Quality Assurance Post-Family Care Structure COP Committee still required Members represent remaining target groups Authority remains the same May be a sub-committee of another County committee

18. COP Allowable Average Q: �What is the significance of the COP allowable average?� Q: �How is it calculated?� COP Allowable Average required by WI statute (COP Guidelines Appendix C) Average COP expenditure = GPR portion of nursing home CY 2009: $1,516.02 per month unless a variance is granted under Section 5.09 B. Over limit? Variance is possible

19. COP Allowable Average Q: �What is the significance of the COP allowable average?� Q: �How is it calculated?� Calculation 30.41 x (straight COP + match + overmatch + admin) total days of service Service day is only counted once Daily amount multiplied by 30.41 to get monthly average

20. Waiver Mandate post-Family Care �Does the Waiver Mandate still apply to the remaining target groups after transition to managed care?�

21. The BCA isn't "taken" as part of the county's transition to managed care. The county makes the decision about how they pay the county obligation. Each year after the county transitions to managed care - the county obligation is reduced until the amount of obligation is no more than an amount equal to 22% of the county's BCA.

22. 90 days before: final transition plan 60 days before: ADRC is functional TMG/BLTS needs enough time to review & approve plan, ensure continuity of placement and providers Work closely and communicate relocation plans to the ADRC and MCO to avoid plan changes Relocation/diversion funding is NOT available after transition

23. Relocation/diversion funding through MA Waiver is NOT available after transition

24. COP carry over is NOT available in the year you transition to managed care Lapsed COP returns to Dept

25. Contract Cuts During Transition Year: Methodology

26. Contract Cuts: One Month Transition

27. Contract Cuts: One Month Transition

29. Average of COP dollars expended during two years prior to transition for: Children (< 18 in rpt yr) Mentally ill or AODA HSRS 1st client char = MH or AODA (regardless of age) PURE COP (not Waiver) Admin added to each year 7% (of identified services)

30. How much? 10% of COP base A/P allocation Uses: Assessments/Plans for COP eligible target populations not eligible for Family Care Children Mentally Ill AODA Refer to Fiscal memo #5

34. CY2010 Reconciliation

35. Relations between HSRS & CARS HSRS Documentation of services and expenses Documentation for CMS Reporting by date of service NO Admin

36. COP/ MA Waiver Disallowances Unapproved Plan Eld/PD: TMG by Feb 28 DD: CIS approval Costs before approved start date Unapproved case management rate (EVEN AFTER ROLL TO MC!! Still have COP) Costs during inpatient stay

37. Inpatient Stay Allowable costs during inpatient stay: PERS (112.46) Case Management (604.xx) Refunds/voluntary contributions (95.02) Cost share used for PERS or CM Anything else will be disallowed!

38. FAQ: COP High Cost What is it? COP awards (non-fed) Straight COP Non-waiver allowable service (ex: dental) COP Match Used to earn Fed (MA Waiver) HSRS coding/ CARS reporting is important! ONE TIME funding based on a request for an exceptional need Specific person, specific purpose No, you can�t use left over $ for someone/something else

39. FAQ: COP High Cost How do I report a State-matched award? Report 100% of expenses on HSRS and CARS to appropriate Waiver code / profile Assures you generate the federal portion How do I report a Local-matched award? Report 100% of expenses on HSRS and CARS to appropriate local match and funding source of CP / profile Assures it appears on the L-016 report CRUCIAL STEP Assures you generate the federal portion Non-fed (i.e.- COP) rolls to BCA County charges back to COP Transparent on HSRS COP reconciliation forms tell us how you reported it!

40. FAQ: COP High Cost Example COP High Cost award of $10k State-matched (CIPII), Home modification $24k

41. FAQ: COP High Cost Example CARS does the work for you (allocates between fed and non-fed) Don�t touch the fed!!

42. Family Support Program (FSP) CY09 � only straight FS on the FSP module Enter FS as match on the LTS module $3,000 limit (unless Dept variance) Total=match + straight FS can NOT be used for: child in out of home setting children's foster care case management / service coordination. Age Restriction 21st birthday or HS graduation, whichever comes 1st.

43. Family Support Program Funding of last resort Admin: up to 10% of the base family support allocation Carry Over: ~ 5% of the base family support allocation Can be used as Straight As match Local match CLTS waiver (funding source �FS�) Autism services not 100% funded Other than SPCs 512, 609.20, 604 and 619 As overmatch Remember: $3,000 annual maximum (straight + match + overmatch)

44. Family Support Disallowances Use of FS to match Case Management Exceeds $3k limit (match + regular) Not for out of home placement

45. Fourth Annual Reconciliation Awards Sawyer, Deb Christians (3/8) Oneida, Mary Rideout (3/10) Menominee Tribe, Alicia Wilke (3/11)

46. Fourth Annual Reconciliation Awards

47. Still Stuck? Help is available!! County TA visits Team approach Submit questions beforehand Can ask specific county questions

48. Contact us!!