MHMR, MAC and TAFI Training Presentation

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MHMR, MAC and TAFI Training Presentation

  1. 1. MHMR Mental Health and Mental Retardation MAC Financial & TAFI Training
  2. 2. PURPOSE OF MAC <ul><li>Assist State in carrying out Medicaid State Plan </li></ul><ul><li>Reimbursed for Medicaid Administrative Activities </li></ul><ul><li>TAFI - Methodology for claim reimbursement for those Medicaid Administrative activities </li></ul>
  3. 3. MAC Process Determine who performs MAC activities Determine how much reimbursable activity is performed Determine actual costs associated with these activities Apply reimbursement rates to calculate a claim Time Study Participant Identification Time Study MAC Financial Data Collection MAC Claim Calculation
  4. 4. <ul><li>Includes: </li></ul><ul><li>Contact Information & Duties of the trained Program and Financial Contact(s) </li></ul><ul><ul><li>Who will update the time study participant list </li></ul></ul><ul><ul><li>Who will update the financial data </li></ul></ul><ul><li>Time Study Participant Training Structure </li></ul><ul><li>Time Study Compliance & Oversight </li></ul><ul><li>Financial Match & Timelines </li></ul><ul><li>MAC Supporting Documentation File </li></ul><ul><li>Required Signature(s) </li></ul>MAC Implementation (Program Operating Plan)
  5. 5. Contact Information & Duties of the Trained Program and Financial Contact(s) <ul><li>MAC Coordinator (certified) </li></ul><ul><li>Back-up/Assistant MAC Coordinator (certified) </li></ul><ul><li>TAFI Preparer (certified) </li></ul><ul><li>Back – up TAFI Preparer (certified) </li></ul><ul><li>Time Study Participants </li></ul>
  6. 6. Audit File Documentation by Quarter <ul><ul><li>Copies of computations used to calculate financial costs </li></ul></ul><ul><ul><li>Copies of worksheets or spreadsheets reported on the website </li></ul></ul><ul><ul><li>Listing of other costs </li></ul></ul><ul><ul><li>All revenues offset from the claim, by source </li></ul></ul><ul><ul><li>Signed copy of the approved Operating Plan </li></ul></ul><ul><ul><li>Copies of HHSC approved training materials dated by quarter </li></ul></ul><ul><ul><li>Documentation verifying participant training for each quarter </li></ul></ul><ul><ul><li>Quarterly financial certification form </li></ul></ul><ul><ul><li>MAC Program Coordinator’s job description </li></ul></ul>
  7. 7. MAC Claim Components <ul><li>Obtain payroll records from general ledger for quarter </li></ul><ul><li>Identify Individuals for Time Study </li></ul><ul><li>Non-SPMP – Time Studied Staff </li></ul><ul><li>Unstudied Staff </li></ul><ul><li>Direct Charge Staff </li></ul><ul><li>Revenue </li></ul><ul><li>Operating Expenses </li></ul>
  8. 8. Cost Pool Allocation <ul><li>Obtain payroll records from general ledger for quarter </li></ul><ul><li>Identify Individuals for Time Study </li></ul><ul><li>Non-SPMP </li></ul><ul><li>Unstudied Staff </li></ul><ul><li>Direct Charge Staff </li></ul><ul><li>Operating Expenses </li></ul>
  9. 9. Cost Pool Allocation - Operating Expenses <ul><li>Categories: </li></ul><ul><ul><li>Travel and Training Expense </li></ul></ul><ul><ul><li>Depreciation </li></ul></ul><ul><ul><li>Mortgage Interest </li></ul></ul><ul><ul><li>Direct Charge </li></ul></ul><ul><ul><li>All Other Expenses – Medicaid Allowable </li></ul></ul><ul><li>Office of Management & Budget (OMB) Circular A-87 </li></ul>
  10. 10. Cost Pool Allocation - Unallowable Expenses <ul><li>Food for Meetings </li></ul><ul><li>Dues – Chamber of Commerce </li></ul><ul><li>Penalties, Sanctions </li></ul><ul><li>Yellow Page Advertising for sheltered workshop (document destruction, screen printing) </li></ul><ul><li>Litigation Expense </li></ul><ul><li>Mortgage Principal </li></ul><ul><li>*Refer to TAC §355.103- Specifications for Unallowable Costs (Cost Determination Process Rules) </li></ul>
  11. 11. Cost Pool Allocation - Direct Charge Staff <ul><li>A direct charge is made to capture costs that are directly related to the preparation of the TAFI and the MAC claim by staff who are otherwise captured in Cost Pool 4 or by contractors performing certain functions. </li></ul><ul><ul><li>Preparing MAC Time Study materials </li></ul></ul><ul><ul><ul><li>(Making copies of logs, time study calendar, coding summaries from last time study), developing presentation </li></ul></ul></ul><ul><ul><li>Conducting Time Study Training </li></ul></ul><ul><ul><li>Reviewing Logs and Making Corrections </li></ul></ul><ul><ul><li>Pulling UOS for SC, CM & Rehab </li></ul></ul><ul><ul><li>Calculating agency’s Medicaid percentage </li></ul></ul><ul><ul><li>Completing TAFI claim from G.L. (classifying all revenues & expenses center wide in your G.L. into Codes or Cost Pools) </li></ul></ul><ul><ul><li>Entering Expenses, Revenues, UOS into TAFI </li></ul></ul><ul><ul><li>Reviewing and signing Claim </li></ul></ul><ul><ul><li>Mailing claim </li></ul></ul><ul><ul><li>Completing Implementation Plan (June) </li></ul></ul><ul><ul><li>Completing Annual Report (March) </li></ul></ul>
  12. 12. Cost Pool Allocation - Unstudied Staff <ul><li>Unstudied Staff are classified as </li></ul><ul><ul><li>Cost Pool 4: G&A, support staff that support both time studied staff and non-studied staff, program indirect. </li></ul></ul><ul><ul><li>Code 13: Direct Medical staff (Card services), Substance Abuse </li></ul></ul><ul><ul><li>Code 14: Vocational, Residential, MR supported home living, day rehab, respite </li></ul></ul><ul><ul><li>Code 18: Home & Community Based Services (HCS) and Texas Home Living Waiver (TxHLW) </li></ul></ul><ul><ul><li>Code 21: Intermediate Care Facilities (ICF-MRs) </li></ul></ul>
  13. 13. Cost Pool Allocation - Unstudied Code 13 & 14 <ul><li>Unstudied Code 13 </li></ul><ul><ul><li>Staff who provide only Card Medicaid services (and their related support/travel and operating costs) </li></ul></ul><ul><ul><li>Medical, direct service contractors reported in Operating Costs </li></ul></ul><ul><ul><li>ECI program services </li></ul></ul><ul><ul><li>drug costs </li></ul></ul><ul><ul><li>lab expenses </li></ul></ul><ul><li>Unstudied Code 14 </li></ul><ul><ul><li>Vocational </li></ul></ul><ul><ul><li>Non-Medicaid residential </li></ul></ul><ul><ul><li>Residential (including room and board) </li></ul></ul><ul><ul><li>respite services </li></ul></ul><ul><ul><li>Social Services personal items (not covered by a Medicaid program) </li></ul></ul>
  14. 14. Revenue Allocation <ul><li>Revenues - Calculated on cash basis, not accrual </li></ul><ul><li>Identify revenue source by Cost Pool </li></ul><ul><li>Types of Revenues: </li></ul><ul><ul><li>Recognized Revenues </li></ul></ul><ul><ul><li>Unrecognized Revenues </li></ul></ul>
  15. 15. Revenue Allocation -Recognized <ul><li>Recognized revenues are used to offset costs, lowering the amount that the federal government is responsible to pay. Reported in Cost Pool 3(unstudied) or Cost Pool 4. </li></ul><ul><ul><li>Medicaid + State Match </li></ul></ul><ul><ul><li>General Revenue </li></ul></ul><ul><ul><li>Federal Grants </li></ul></ul><ul><ul><li>Medicare & Third Party Insurance </li></ul></ul><ul><ul><li>Client Fees </li></ul></ul><ul><ul><li>Grants from Private Foundations </li></ul></ul><ul><ul><li>Interest Income </li></ul></ul>
  16. 16. Revenue Allocation - Unrecognized <ul><li>Donations </li></ul><ul><li>MAC dollars </li></ul><ul><li>State General Revenue </li></ul><ul><li>FEMA dollars </li></ul><ul><li>Local government funds </li></ul><ul><li>*Unrecognized revenue do not impact the claim amount, but the total amount must be entered into TAFI for reconciliation purposes </li></ul>
  17. 17. Methods of Reporting <ul><li>The first option is a Carve Out reporting method, in which the Center should report cost and revenues as follows: </li></ul><ul><li>Identifying costs and revenues for the MHMR and ECI program; </li></ul><ul><li>Develop your cost and revenue worksheets individually for each program; </li></ul><ul><li>Enter the cost and revenue allocation for the ECI program only in the ECI 2009 TAFI system; </li></ul><ul><li>Allocate all other costs and revenues to the MHMR program in the MHMR 2007 TAFI system; </li></ul><ul><li>If the General Administrative Cost cannot be allocated between MHMR and ECI, report all General Administration cost in the MHMR 2007 TAFI system in cost pool #4. NOTE: General Administration costs will not be reported under the ECI TAFI system; </li></ul><ul><li>Submit your Medicaid Administrative Claim (MAC) individually for each program to HHSC; </li></ul><ul><li>Include in your MAC submission a copy of the last page of your General Ledger to verify reconciliation. </li></ul>
  18. 18. Methods of Reporting Cont’d <ul><li>The Center should evaluate the ECI/MHMR cost and revenues reporting to avoid duplicating the reporting of cost and revenues in either program.  Please consider the following if the Center determines not to utilize a Carve Out reporting method: </li></ul><ul><li>Identifying costs and revenues for the ECI and MHMR program; </li></ul><ul><li>In the MHMR 2007 TAFI system report all ECI cost under Quarterly Cost Data-Unstudied Program Staff, 13-Medical Services; </li></ul><ul><li>In the MHMR 2007 TAFI system report all ECI revenue under Recognized Revenue-Other Revenue cost pool #3; </li></ul><ul><li>In the ECI 2009 TAFI system all MHMR cost are reported under Quarterly Cost Data-Unstudied Program Staff, 13-Medical Services; </li></ul><ul><li>In the ECI 2009 TAFI system all MHMR revenue are reported as Recognized Revenue-Other Revenue cost pool #3; </li></ul><ul><li>Submit your Medicaid Administrative Claim (MAC) individually for each program to HHSC; </li></ul><ul><li>Include in your MAC submission a copy of the last page of your General Ledger to verify reconciliation. </li></ul>
  19. 19. Units of Service <ul><li>Pull Units of Service (UOS) and enter into TAFI </li></ul><ul><ul><li>MR SC: Medicaid UOS Total UOS </li></ul></ul><ul><ul><li>MH CM: Medicaid UOS Total UOS </li></ul></ul><ul><ul><li>MH Rehab: Medicaid UOS Total UOS </li></ul></ul><ul><ul><li>*Suggest comparing UOS from QTR to QTR to obtain variance per QTR </li></ul></ul>
  20. 20. Medicaid Percentage The Medicaid percentage is one of the most critical factors in determining the portion of a program’s cost than can be claimed to MAC. This one factor, or fraction, is multiplied by most all other factors in the formula for constructing a claim and affects almost every dollar claimed (Refer to Medicaid Administrative Claiming Guide to determine your Medicaid Percentage).
  21. 21. Capturing Medicaid Percentage Data <ul><li>Reports should be run within 1-2 weeks of the TAFI due date to assure the most accurate information. </li></ul><ul><li>Reports for Total Clients served should be defined by: </li></ul><ul><ul><li>Unduplicated count </li></ul></ul><ul><ul><li>Date of Service (federal fiscal quarter) </li></ul></ul><ul><li>Reports for Medicaid Eligibility should be defined by: </li></ul><ul><ul><li>Unduplicated count </li></ul></ul><ul><ul><li>Date of service (federal fiscal quarter) </li></ul></ul><ul><ul><li>Coverage type (assuring that QMB, etc. clients are excluded) </li></ul></ul><ul><ul><li>Date of eligibility </li></ul></ul><ul><ul><li>All center reporting units </li></ul></ul><ul><li>Reports for Medicaid Pending should be defined by: </li></ul><ul><ul><li>Still pending at end of quarter </li></ul></ul><ul><ul><li>Did not have eligibility at any time during quarter </li></ul></ul>MEDICAID ELIGIBLE TOTAL PARTICIPANTS LESS INDIVIDUALS PENDING ELIGIBILITY MEDICAID PERCENTAGE
  22. 22. MAC Financial Timeline <ul><li>Claim Due Dates will be extended from 45 days after the Federal Fiscal Quarter to 75 days after the Federal Fiscal Quarter. The following are the due dates for 1 st Federal Fiscal Quarter 2010: </li></ul><ul><li>Federal Fiscal Quarter MAC Claim Due </li></ul><ul><li>1 st Quarter (Oct – Dec) March 15, 2010 </li></ul><ul><li>2 nd Quarter (Jan-Mar) June 15, 2010 </li></ul><ul><li>3 rd Quarter (April-June) September 15, 2010 </li></ul><ul><li>4 th Quarter (July-Sept) December 15, 2010 </li></ul><ul><li>Annual Program Operating Plan due June 15th </li></ul><ul><li>Annual Cost Report due March 15th </li></ul>
  23. 23. TAFI (Time and Financial Information) Presentation
  24. 24. Purposes for TAFI <ul><li>TAFI is a web-based application that assists in the preparation of your MAC (Medicaid Administrative Claiming) claim. </li></ul><ul><li>Collects time study data and costs by service for the determination of an appropriate unit rate per service (setting rates). </li></ul>
  25. 25. Communication Between TAFI Preparer and MAC Coordinator <ul><li>Essential to assure accuracy and best outcome for Center (claim and cost per unit of service for Service Coordination, Targeted Case Management and Rehabilitative Services) </li></ul><ul><li>TAFI preparers should have knowledge of MAC Codes </li></ul><ul><li>Knowledge of Medicaid Percentage Calculation and Unit Of Services reported </li></ul>
  26. 26. TAFI ACCESS & SYSTEM SUPPORT <ul><li>Login access- Rate Analyst will provide forms for TAFI access, VPN access </li></ul><ul><li>Passwords and security issues – HHSC Enterprise IT </li></ul><ul><li>Reporting of system errors and levels of support available </li></ul><ul><ul><li>TAFI error messages – Rate Analyst (First Tier) </li></ul></ul><ul><ul><li>Technical issues regarding connectivity and other uncommon VBScript errors (Second Tier) – Refer to HHSC Enterprise IT – (512) 438-4720 and mention the TAFI web application. </li></ul></ul>
  27. 27. Login Screen (MHMR) TAFI 2007 Password User Name http://mhmrweb02.mhmr.state.tx.us/TAFI2007/Security/Forms/frm_Login.asp Web Address (MHMR Providers): Login d d Refer to the MHMR TAFI Manual at the following address: http://www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Eci/2008EciCrInfo.html
  28. 28. Status of Quarter Red – Closed Quarter – All time study and financial data have been entered Yellow – Reopen Quarter – A correction needed to a previously closed quarter Blue – Open Quarter – The first instance that the quarter was created and in process for completion New – Quarter that has not been created to enter time study and financial data
  29. 29. TAFI Menu The TAFI Menu above lists the menu options that are available within the Time and Financial Information web application. The Data Entry Menu is used to enter unstudied costs not associated with the program. (Unstudied Programs and Staff) Entries also include costs associated with support staff assisting Non-SPMP time studied staff. (Non-SPMP Quarter) Agency-wide costs that are associated with the program are entered in the Cost Pool 4 selection. Unallowable costs are also entered in the menu selection. Time study logs which are entered manually are entered in this menu. (Time Study Data) Lastly, Revenues are reported for all revenue associated with the MHMR center. The General Operations Menu is primarily used to enter new time studied staff information in TAFI. This menu also allows you to copy the previous quarter’s staff information to avoid re-entry. Lastly, a section for contractors to be added in the time study if eligible are also found in this menu. The Reports Menu is used show various costs associated based on your time study results for rate setting time study codes 16 and its subcodes and time study 17 and its subcodes. Also, time studies by service type can be generated. The Final TAFI is what is used to generate your QSI MAC claim. Lastly, the Close Out Menu is when all time study and financial information has been verified and ready to close the quarter and the Utilities Menu is used as an alternative method of uploading the time study information.
  30. 30. Unstudied Programs and Staff (MHMR) - These are for entries for expenses of positions or programs that were not time studied.
  31. 31. Non-SPMP Staff Expenses are for positions that support Non-SPMP staff or time studied staff.
  32. 32. Cost Pool 4 Expenses are for positions that support agency-wide administration of the program.
  33. 33. Unallowable Costs Expenses that are not allowable for the program per the Cost Determination Process Rules.
  34. 34. Units of Service Units of Service are entered for rate setting time study code 16 and 17 and their representative sub codes.
  35. 35. Revenues Revenues are entered following the activity by which it is earned or the expense for which it is a reimbursement .
  36. 36. Increase/Decrease Claim <ul><li>Medicaid percentage </li></ul><ul><li>Time Study participants-10% billable time </li></ul><ul><li>Grouping staff responsibilities-into position/s with 10% billable time </li></ul><ul><li>Increased recognized revenues decreases claim </li></ul>
  37. 37. Reconciliation <ul><li>Reconcile between General Ledger and TAFI </li></ul><ul><li>Reconcile Expenses </li></ul><ul><li>Revenues </li></ul><ul><li>Units of Service </li></ul>
  38. 38. Closing <ul><li>Print out claim </li></ul><ul><li>Close Quarter in TAFI - claims can not be reviewed until Quarter is closed </li></ul>
  39. 39. Claim Submission <ul><li>Submission Documents Required: </li></ul><ul><ul><li>Invoice </li></ul></ul><ul><ul><li>Training Certification Letter (TAFI Preparer) </li></ul></ul><ul><ul><li>Methodology Certification </li></ul></ul><ul><ul><li>Cost Report Certification </li></ul></ul><ul><ul><li>Direct Charge Detail if reported </li></ul></ul><ul><ul><li>Letter explaining major changes in Unstudied Staff, Unit of Service, and Medicaid percentage </li></ul></ul><ul><ul><li>Desk Review Form </li></ul></ul><ul><ul><li>Proforma Documentation </li></ul></ul><ul><ul><li>Variance explanations of +/- 15% from one quarter to the next </li></ul></ul>
  40. 40. <ul><li>Before submitting the TAFI report to us, review the Desk Review Form in Appendix E. </li></ul><ul><li>For example: </li></ul><ul><ul><li>How does the Clerical Salaries and Benefits (CSB) compare to Total Salaries and Benefits (>10%,<50%)? </li></ul></ul><ul><ul><li>Are Total Expenses within 10% of previous quarter? </li></ul></ul><ul><ul><li>Are Cost Pool 4 Expenses within 10% of previous quarter? </li></ul></ul><ul><ul><li>Are there unallowable costs shown? </li></ul></ul><ul><ul><li>If there are any discrepancies or variances, enclose an explanation when you submit the TAFI report. </li></ul></ul>Desk Review
  41. 41. Reopening and Resubmitting <ul><li>Reopening </li></ul><ul><li>A request to reopen a quarter can be emailed to [email_address] (preferred) or on a faxed RA 677 </li></ul><ul><li>Cost reports may only be resubmitted within 60 days of initial submission, unless we set a later date or require it due to a review </li></ul><ul><li>Resubmitting </li></ul><ul><li>In order to for your corrected data to be accepted, you must go through the process of closing the quarter, submitting new certifications and, if needed, sending the new QSI. </li></ul><ul><li>Deadlines for resubmission carry the same sanctions as for regular submissions - all necessary items must be in the office by the deadline in order to avoid deferral. </li></ul>
  42. 42. Purpose of Cost Reporting <ul><li>Ensure adequate financial and statistical data are reported for the determination of reasonable rates so that reasonable access is available to eligible clients for services covered by the program’s goals & objectives and to expend and monitor taxpayer dollars in a reasonable and prudent manner adhering to state and federal laws, standards and regulations. </li></ul>
  43. 43. TCM & Rehab Settle Up <ul><li>Each MHMR provider, whose costs are less than 95% of the amount reimbursed at the interim rate, will be required to pay to HHSC agency 100% of the difference between its allowable costs and 95% of the amount reimbursed at the interim rate for each settle-up service. If an MHMR provider costs exceed the amount reimbursed at the interim rate, HHSC will reimburse the MHMR provider the difference between its allowable costs and the reimbursement at the interim rate up to 125% of the interim rate for each settle-up service. </li></ul>
  44. 44. TCM & Rehab Settle Up <ul><li>If your costs are below 95% of the rate, you pay back the difference between your cost and 95% of the rate. </li></ul><ul><li>Calculate your settle-up costs quarterly so you are prepared. Defer more of your revenues monthly (or book a payable) if you have to payback. Book a receivable if you are expecting a positive settle-up. </li></ul>
  45. 45. <ul><li>Communication is managed predominantly via email, i.e. </li></ul><ul><ul><li>Compliance follow-up </li></ul></ul><ul><ul><li>MAC Financial notification and follow-up </li></ul></ul><ul><li>Confirm with your IT staff to make sure that emails with, @hhsc.state.tx.us pass through firewalls and spam filters </li></ul>Allowing E-mail Messages
  46. 46. Contacts <ul><li>Medicaid Administrative Claiming, Cost Report & TAFI Questions </li></ul><ul><li>Yvonne Moorad - Team Lead – (512) 491-1831 – [email_address] </li></ul><ul><li>Serena Lee - (512) 491-1329 - [email_address] </li></ul><ul><li>TAFI Mailbox: [email_address] </li></ul><ul><li>Time Study </li></ul><ul><li>Beverly Tackett – Team Lead - (512) 491-1740 – [email_address] </li></ul><ul><li>Alex Young – (512) 491-1141 – [email_address] </li></ul>
  47. 47. Mailing Address <ul><ul><li>Overnight/Courier: </li></ul></ul><ul><ul><li>HHSC Rate Analysis </li></ul></ul><ul><ul><li>Mail Code H-400 </li></ul></ul><ul><ul><li>Attn: MHMR/ECI Coordinator </li></ul></ul><ul><ul><li>11209 Metric Blvd. </li></ul></ul><ul><ul><li>Austin, TX 78758-4021 </li></ul></ul><ul><ul><li>Regular Delivery: </li></ul></ul><ul><ul><li>HHSC Rate Analysis </li></ul></ul><ul><ul><li>Mail Code H-400 </li></ul></ul><ul><ul><li>Attn: MHMR/ECI Coordinator </li></ul></ul><ul><ul><li>P.O. Box 85200 </li></ul></ul><ul><ul><li>Austin, TX 78708-5200 </li></ul></ul>
  48. 48. Resources <ul><li>Medicaid Administrative Claiming </li></ul><ul><li>http://www.hhsc.state.tx.us/medicaid/programs/rad/AcuteCare/MAC/MhmrMac.html </li></ul><ul><li>TAFI System </li></ul><ul><li>http://mhmrweb02.mhmr.state.tx.us/TAFI2007/Security/Forms/frm_Login.asp </li></ul><ul><li>Time Study </li></ul><ul><li>http://www.hhsc.state.tx.us/medicaid/programs/rad/AcuteCare/TS/EciTimeStudy.html </li></ul><ul><li>DADS & DSHS </li></ul><ul><li>Insert Link </li></ul>
  49. 49. Important Reminders <ul><li>The MAC POP is due June 15th annually. MAC POP instructions can be found in the Implementation Guide. </li></ul><ul><li>The MHMR provider must ensure that MAC Coordinator training requirements are met so that claims can be processed by HHSC. </li></ul><ul><li>On your MAC Financials, if you notice a variance of +/- 15% between quarters on costs and/or number of providers, submit a variance explanation with your claim. </li></ul><ul><li>New MHMR MAC Claim Due Dates </li></ul><ul><li>Discontinuance of all SPMP Codes as of January 1, 2009. Time Study details should not be entered into the SPMP section of TAFI, please report in the NON-SPMP section of TAFI </li></ul>

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