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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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