Medical Reimbursement Programs for California

Transit Systems Cal ACT Spring Conference

April 21, 2008

Definitions / More Alphabet Soup

MAA: Medi-Cal Administrative Activities. Activities that have been identified as necessary for the proper and efficient administration of the Medi-Cal program

MAA Claim Plan – A plan submitted to the

State identifying staff, the MAA activities

they will perform, and the methodology used

for reimbursement for the various activities

More Definitions…

MAA Claiming Unit – A Claiming unit is a

grouping of staff based on budgetary unit(s)

within an agency affiliation. Claiming units

are identified in the MAA claim plan

MAA Invoice – The mechanism used to

request MAA reimbursable costs from the

State

Yes, In Fact, More Definitions…

CMS – Center for Medicare and Medicaid Services

CMS is the Federal Agency that sets policies and procedures for the MAA program and provides the reimbursement for MAA

Definitions Concluded For Now

MAA Claim Plan – A plan submitted to the State identifying staff, the MAA activities they will perform, and the methodology used for reimbursement for the various activities

MAA Invoice – The mechanism used to request MAA reimbursable costs from the state

Acrobat Document

MAA Activities

1. Outreach2. Facilitating Medi-Cal Application3. Arranging/Providing Transportation4. Contracting for Medi-Cal Services and MAA5. MAA Coordination and Claims

Administration6. Program Planning and Policy Development7. MAA Implementation Training

Medical Transportation

Includes those activities that either arrange or provide non-emergency, non-medical transportation of Medi-Cal "eligibles" to Medi-Cal services

Activities that Accomplish This

Making an appointment for transportationArranging for someone to transport the

individualTransporting the IndividualAccompanying the individual when it is

medically necessary by an aide or attendantProviding bus and trolley tokens for the

individual to get to a Medi-Cal appointment

Eligible Modes of Transportation

TaxisBuses (Mini-Buses, Public

Transportation, etc.)TrolleysCars

Ineligible Modes of Transportation

Wheelchair Vans (This refers to “medical” or program specific non-public transportation)

Ambulances

Target Population

Transportation can be provided to Medi-Cal only clients or all clients that need transportation to a Medi-Cal covered service

Target Population must be described in the Claim Plan

Medi-Cal / Essence of Intergovernmental RelationsIn California there seems to be a

misperception that public transportation providers are not eligible for Medi-CaL reimbursement

Fortunately, this isn’t the case

State & Local Participation

Although MAA is a federal program, the State of California, Department of Health Services, MAA/TCM Branch administers it. The County of San Diego’s LGA works with the State on MAA matters and directly with the CMS program

The LGA is responsible for the administration of the MAA program at the local level. All MAA providers must go through the LGA to participate in the program and to receive MAA reimbursement

How to Participate in MAA

As Provided by the LGA, the Prospective Provider Questionnaire, must be completed to the LGA for review

If preliminary requirements are met, a meeting is set-up with the LGA where the program’s infrastructure and matchable revenues are explored

LGA requests approval from the State

Participation / Payment

Once Claim Plan approved by State a program can invoice, retroactively to the identified quarter

Rate of reimbursement varies given the nature of 4 way redistributive funding

Redistributive Funding Stream

Federal GovernmentState GovernmentLGAEventually the Transportation

Provider, as “one of many" claimants, is reimbursed per the invoice

Other Claimants

HospitalsProbation Health and Human ServicesAging and Independent ServicesMany, many other similar

programs

The Transportation Providers Responsibilities as Claimant / Coordinator

MAA Coordinator: Employee appointed to act as representative on MAA matters and to ensure program adheres to MAA County, State, and Federal Guidelines

Maintenance of the Audit File

Duties Associated with MAA Coordinator

Main contact with LGA on MAA matters

Attend MAA provider meetings held by the LGA

Attend MAA workshopsCoordinate any requests for MAA

site visit

Duties Continued

Maintain and up-date the MAA Guidelines provided by the LGA

Communicate changes in MAA policies and procedures to appropriate staff

Establish and maintain the MAA audit fileAttend the annual MAA Train-the-Trainer

sessionOversee the completion of the MAA Claim

Plan and Quarterly Invoice

Elements of an Audit File

MAA Claim Plan and AmendmentsCurrent Organizational Chart and

Job Descriptions of staff participating in MAA

InvoiceContracts

Invoice Components

Supporting source documentation for the quarterly invoice

Methodology used to calculate Medi-Cal percentages

Documentation supporting transportation / direct charge costs

MAA invoices for prior three years

Contracts

MOA with the LGACopies of staffing sub-contracts

If any of the above items are not located in the audit file, a notation must be made in the file where the item is stored

Consultant Services (Not Mine)

The LGA contracts with a consultant to assist the LGA with various activities including;

Training and technical assistanceAssistance to providers in developing

procedures for managing their MAA program

Technical assistance to providersParticipation in bi-monthly provider

meetings

Consultant Services Continued…

Assistance to new providers in preparation of the claim plan and Quarterly invoice

Requests for the consultant must go through the LGA and must be reviewed and approved in advance by the LGA

Purpose of MAA Claim Plan

Provide a description of the types of MAA activities that will be performed

Categories of staff that will perform them

Completed Plan contain the information that will be used to create the program’s invoice

Contents of the Claim Plan

Certification StatementGeneral Description of the Claiming Unit

FunctionsDescription of Claiming UnitStaffing Grid (NA)Activity Codes that staff may code to (NA)The Claim Plan Review Record

Local and State Review

LGA Review: LGA submits all claim plans to the state, develops timelines for submission and notifies programs of any new requirements

State Review: Claim Plans must be submitted to the State no later than October 31 for the first quarter of the State Fiscal Year and by the last day of any subsequent quarter

Continued

State reviews all Claim Plans and either approves the Plan or requests additional information from the LGA

Significant concerns or open questions are forwarded up to the CMS for review (Feds)

Claim Plan Amendments

Claim Amendment ChecklistLGA Completes the Checklist and

other documentsProgram is provided instructions

from LGA regarding required submissions

MAA Claiming Plan Amendment Checklist

Acrobat Document

MAA Invoice

Invoice WorksheetDirect Charge WorksheetFunding Worksheet

Invoice Worksheet

Incorporates information from the funding and direct charge worksheets to produce the basis of the claim and amount of reimbursement

Direct Charge Worksheet

Most pertinent part of invoice to public transportation providers

Worksheet that displays costs that can be charged to MAA using a methodology identified in the Plan

For example, Contracted Costs minus Revenues for the Quarter

Direct Charges Continued Editorial

Balancing between all “attributable costs” and integrity of Audit File

MTS simply uses purchased transportation after revenues are deducted

Fully Allocated Cost Recovery is of diminishing proportional limited return

Funding Worksheet

Not pertinent for MTS invoice that only captures direct costs

Used to display funding sources for costs reported

Sorted by Medi-Cal, federal, state general fund, etc.) and cost pool

Invoice Worksheet

Time Survey Results (NA)Medi-Cal PercentageActual expenditures for the quarter

covered by the invoiceFunding sources supporting the

expenditures (NA)

Medi-Cal Percentage (Two Methods)

LGA will supply the Countywide average (Percentage for prior FY)

A Case Count can be used per a methodology described in the approved Claim Plan

MTS has an FFP rate of 50%

Actual Expenditures

NO BUDGET ESTIMATES (Actuals only)

Must be for quarter claimedBack up report for transportation

needs to contain trip-by-trip confirmation

Direct Charge Worksheet

Costs of transportation services for Medi-Cal clients going to medical based appointments are recorded here

Direct charges recorded on the invoice much be described in the Claim Plan

Quality Assurance

Coordinator’s ResponsibilitiesAudit FileAnnual Site VisitMAA Bi-monthly Meeting and

Workshop

Conclusions

Very Dynamic and Subject to ChangeThe LGA may be reluctant due to lack of

awareness, risk management concern or official agency policy

Current State & Federal Legislative Proposals and Budget Recommendations jeopardize the future

These same Realities complicate Universal and Consistent Awareness

Metaphorically Speaking…

Medi-CAL is like ADA insofar as being the subject of ubiquitously inconsistent interpretation from entities with varying, dynamic and unclear levels of authority

THANK YOU!

Max Calder619-595-7037

Max.Calder@sdmts.com