Long-Term Employment Supports Cost Survey

1. February 27 & March 1, 20192019 Long-Term Employment Supports Cost Surveyby: Tammy Martin, Krista Stephani, and Michal Slavkovsky

2. Contact information For questions related to completing the cost survey, please contact: Michal Slavkovsky, Senior Manager Myers and Stauffer LC (800) 336-7721 idcostsurvey@mslc.com

3. Housekeeping • Webinar is being recorded. • Link to the recording and webinar materials will be available by 3/12/19 at: http://www.mslc.com/Idaho/Downloads.aspx Select “Employment Services”

4. agenda • Cost Survey Timeline • Cost Survey IDAPA Rules • Cost Survey Form • Step-by-Step Walkthrough of Cost Survey

5. Cost Survey timeline

6. Cost survey idapa rules • IDAPA 16.03.10.037.04 states, “Cost Survey. The Department will survey one hundred percent (100%) of providers. Providers that refuse or fail to respond to the periodic state surveys may be disenrolled as a Medicaid provider. The Department will derive reimbursement rates using direct care staff costs, employment related expenditures, program related costs, and indirect general and administrative costs in the reimbursement methodology, when these costs are incurred by a provider. The Department will conduct cost surveys customized for each of the services defined in Section 038 of these rules. (4-4-13)”

7. Cost survey idapa rules • IDAPA 16.03.10.037.04.a states, “Wage rates will be used in the reimbursement methodology when the expenditure is incurred by the provider type executing the program. Wages will be identified in the Bureau of Labor Statistics website at www.bls.gov when there is a comparable occupation title for the direct care staff. When there is no comparable occupation title for the direct care staff, then a weighted average hourly rate methodology will be used. (4-4-13)” • IDAPA 16.03.10.037.04.b.i states, “For employer related expenditures: The Bureau of Labor Statistics’s report for employer costs per hour worked for employee compensation and costs as a percent of total compensation for Mountain West Divisions will be used to determine the incurred employer related costs by each provider type. The website for access to this report is at www.bls.gov. (4-4-13)”

8. Cost survey idapa rules • IDAPA 16.03.10.037.04.b.ii states, “For employer related expenditures: The Internal Revenue Service employer cost for social security benefit and Medicare benefit will be used to determine the incurred employer related costs by provider type. The website for access to this information is at www.irs.gov. (4-4-13)” • IDAPA 16.03.10.037.04.c states, “Cost surveys to collect indirect general, administrative, and program related costs will be used when these expenditures are incurred by the provider type executing the program. The costs will be ranked by costs per provider, and the Medicaid cost used in the reimbursement rate methodology will be established at the seventy-fifth percentile in order to efficiently set a rate. (4-4-13)”

9. Extended employment services (ees) Providers • While there are no requirements to participate for providers who provide employment services solely through EES to non-Medicaid clients, we are encouraging your participation to improve data accuracy regarding costs. • Vocational Services of Idaho (VSI) is also strongly supporting this survey and encourages all agencies to participate.

10. Cost Survey form

11. Brief description of cost survey sections (tabs)

12. TITLE • Provider name, address, fiscal year reported on, and provider numbers

13. INSTRUCTIONS • General information about how the template works, filing instructions, survey completion training, definitions and instructions for completing the survey. • We recommend printing this and keeping it handy during survey completion.

14. SCHEDULE 1 – GENERAL AND QUESTIONS • General questions about each provider and steps to determine who needs to complete a survey.

15. SCHEDULE 2 – DATA SOURCES AND INSTRUCTIONS • Data gathering needs and summary of backup support provided with your survey.

16. SCHEDULE 3 – SCHEDULE OF EXPENSES • Schedule of expenses. This is where all of your costs of conducting business will be reported.

17. SCHEDULE 4 – SCHEDULE OF UNITS • This is where you will report billable units for each program being surveyed.

18. SCHEDULE 5 – DIRECT EMPLOYMENT SERVICES STAFF HOURLY WAGE INFORMATION • Hourly wages paid to direct employment staff in January 2019. • Letter notifying of the revision to Schedule 5 of the survey was sent out on 02/26/19 and revised cost survey was uploaded to http://www.mslc.com/Idaho/Downloads.aspx Select “Employment Services”

19. SCHEDULE 6 – OTHER STAFFING DOCUMENTATION • Employee turnover statistics and other staffing questions.

20. SCHEDULE 7 – CERTIFICATION STATEMENT • Certification statement page that needs to be filled and signed

21. Step by Step Walkthrough of Excel Cost Survey

22. An agency’s experience with cost study completion – presented by Katherine Hansen, executive director of community partnerships of Idaho, inc. • Staff Time and Expertise • Schedule 3 Tools and Tips • Other Ideas for a Successful Completion

23. SCHEDULE 3 Completion – 3 things to remember • Hardest and most time consuming to complete • Myers and Stauffer is here to assist you • YOU CAN DO IT!

24. SCHEDULE 3 – Tools needed • Income (Profit & Loss) Statement • Billable hours report by employee by program (CSE, EES, and Others). • Payroll Report • Schedule 3 instructions for proper classification of costs

25. SCHEDULE 3 – Profit & loss statement • This will most likely vary among agencies • Some agencies might have P&L statement for each program they operate; • Example: The “Employment Services” program has separate accounting records, which would show revenues and costs related to all the Employment Services related programs (CSE, EES, VR). Then they would have a separate department for Corporate office, which would allocate a % of the cost to the survey • Some providers might have just one P&L statement, which would probably require a bit more work to fill out the survey but the process would be very similar

26. SCHEDULE 3 – Billable hours Report • Hopefully, agencies will have some sort of report that would show the amount of billable hours by employee by program (CSE, EES, and Other)

27. SCHEDULE 3 – payroll report • Will identify your employees and possibly their jobs titles • Will be used for classification of the employees into categories (Direct, Indirect – Program Related Expenses, EES Unique, G&A, Building) • Will contain other information that will be used to fill out a portion of Employee Related Expenses (ERE) Section V of Schedule 3

28. SCHEDULE 3 – cost survey instructions • We recommend printing the instructions and have them available as you go through the survey • This will be very useful tool for filling out Schedule 3 as it has definitions and other valuable info

29. SCHEDULE 3 – suggested steps to complete it • Use your payroll report to identify your employees • Classify the employees into categories (Direct, Indirect – Program Related Expenses, EES Unique, G&A, Building) • Create a list of employees showing their billable hours by program (CSE, EES, and Other)

30. SCHEDULE 3 – suggested steps to complete it - continued • Unless your payroll report shows hours and wages by each program category, you will need to calculate wages related to programs by using billable hours by program allocation %. • For direct care staff, you will most likely see that their billable hours are less than their total hours on payroll report. This would be most likely due to some of their time spent on non-billable duties such as training and other program related activities. You will want to classify non-billable wages as Indirect-PRE unless some A&G duties were performed by these employees.

31. SCHEDULE 3 – suggested steps to complete it - continued • Summarize total wages and hours by each category • Split between Regular and Overtime wages and hours as these will be reported separately on each line • Identify Employee Related Expenses (ERE) from payroll report such as holiday, vacation, sick, and bonuses that will be reported in Section V

32. SCHEDULE 3 – suggested steps to complete it - continued • At this point you should be able to fill out Section A Wages related to Direct Employment Services Staff

33. SCHEDULE 3 – suggested steps to complete it – Section B • Contracted services– Include expenses related to direct care contracted staff. • There may be examples when agencies would have clients that would perform VR type of work in the community and the agency would pay them as contracted employees. These types of cost would be reported on P&L statement and might be related to Evaluations that needed to be done before the clients can start the employment and be categorized under CSE or EES. This would be basically VR type of expense. Since these would fall under contracted services Other Program, agencies should report this expense as such in Section B, Contracted Staff, Other Column.

34. SCHEDULE 3 – suggested steps to complete it – Section C • Indirect Program Related Wages (excludes paid leave and bonuses) • Per our exercise related to classification of wages into various categories we would identify Indirect - Program Related wages and report them on applicable lines – see examples below. • Vocational Coordinator • Program Manager • Employee tracking services authorizations, scheduling staff, and performing other program related duties. • Special Category – Indirect related wages for Direct Service Staff

35. SCHEDULE 3 – suggested steps to complete it - Section D - Allocation % • Indirect wages for Direct Staff – Indirect wages could be allocated among various programs based on their direct wages. • Indirect Wages for PRE staff (program manager, vocational coordinator, etc.) would be allocated using one of the methods outlined under Section D – billed units, interviews of staff, or time study. You may find out that different people spend different % on programs, so you will want to allocate their wages using appropriate allocation %s. • Summarize allocated wages by programs and calculate their allocation % for Section D reporting where those % will be entered. • Report %s on line 36.

36. SCHEDULE 3 – Section E, G, H, I, J • Using P&L statement, next exercise would be to go by each cost category and identify them into various categories – PRE other expense, G&A, Employee Related Benefits, Building Cost based on instructions and definitions. • During this exercise, you may need to allocate corporate overhead if you keep track of that cost separately.

37. SCHEDULE 3 – Section K – Building Occupancy and property costs • Cost survey is set up so that these types of costs can be allocated to PRE and G&A • Allocation – 2-step approach • Allocate between PRE & G&A (by expense type) • Allocate between CSE, EES, and Other (by program)

38. SCHEDULE 3 – Section K – Building Occupancy and property costs Allocation Methods • Square footage • Billable hours • Worked Hours • Direct Allocation • Any reasonable method that would allocate the cost reasonably between G&A and PRE and various programs

39. SCHEDULE 3 – Section l – non-reimbursable costs • This section is used for reporting of non-allowable costs, as defined in Provider Reimbursement Manual. • In general, any expenses that are not related to providing client services should be excluded from calculating total allowable expenses for the program. • Examples of these costs are noted in the survey.

40. SCHEDULE 3 – Total Expenses and Reconciliation to supporting financial records • Enter the total expenses from P&L statements (might be a combination of multiple statements that were used to fill out the survey) to line 131. • Line 133 will show a message that will let you know if you reconciled within reasonable tolerance. If you are not within tolerance, you will need to get through your support and fix possible reporting errors.

41. SCHEDULE 3 – Sections m, n, o • These sections are driven by set-up formulas so you do not need to enter information into this section. • Please review this section to verify that results appear reasonable, based on your knowledge of your agency and operations.

42. SCHEDULE 3 – End Result Groups and summarizes expenses into 4 different categories: • Direct Employment Services Staff • Indirect – Program Related Expenses (PRE) • General and Administrative Expenses (G&A) • Non-Reimbursable Expenses

43. Questions? • Any questions asked during this presentation will be documented on a FAQ document that will be posted to the Myers and Stauffer website, along with the recorded version of the training. • The FAQ will be updated as questions are asked by providers.