Autism Application Technical Assistance

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Autism Application Technical Assistance

• Milwaukee County Department of Health and
  Human Services
• Disabilities Services Division
• June 12, 2008

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DHHS Staff

• Geri Lyday, Administrator, Disabilities Services
  Division
• Liz Kraniak, Supervisor, Disabilities Services
  Division
• Dennis Buesing, DHHS Contract Administrator
• Diane Krager, DHHS Quality Assurance Coordinator
• Wes Albinger, Contract Services Coordinator
• Sumanish Kalia, Contract Administration CPA
  Consultant

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• Some minor revisions have been made to the
  application. If you have already completed the
  application, simply complete the changed sections
  on the new application, as indicated by sections
  with a shaded background.

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National Provider Identifier Covered entities
under HIPPA are required to use NPIs to identify
health care providers in standard transactions.
Go to www.nppes.cms.hhs.gov to learn more.
Federal Employer Identification Number. This is
the number the IRS issues for filing of payroll
tax forms. If you have no employees, use your
social security number.
Being Medicare/Medicaid certified means you are
able to bill Medicare/Medicaid directly for
services.
If Medicaid certified, please provide your number
here.
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Complete Section A for each site which is
currently or proposed to be utilized for services
More than one may apply
Must have one of these boxes checked if your
agency is a corporation
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For example, you provide in home physical therapy
as a physical therapist for ABC agency, and you
also work independently as a physical therapist
providing in home physical therapy. This must be
disclosed to ABC in writing, and a copy of the
written notification must be provided with this
application.
Please list agency and your position.
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By site, if applicable, per Service Description
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Applies to all coverage types
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• Submit this Document with Completed Application.
  Retain a copy in Agency File.
•  
• CERTIFICATION STATEMENT
• RESOLUTION REGARDING INSURANCE COVERAGE
• This is to certify that __________________________
  ________________________________
• (Name of Agency/Organization)
• (1)                 Will retain current
  Certificates of Insurance as required in the
  agency file as indicated above and
• (2)                 Will ensure that Milwaukee
  County is added as an additional insured on
  Certificates of Insurance.
• (3) Will submit a copy of Insurance
  Certificate to
• Dennis Buesing, DHHS Contract Administrator
•   1220 West Vliet Street, Suite 109
• Milwaukee, WI 53205
• (Authorized Signature of Person Completing
  Form) (Date)
•  
•  
• __________________________________________________
  _____________________________
  

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• Submit this Document with Completed Application.
  Retain a copy in Agency File.
•  
• MILWAUKEE COUNTY DEPARTMENT OF HEALTH AND HUMAN
  SERVICES
•  
• Certification Statement-Regarding Individual
  Service Provider Credential/Educational//or
  Experience as Required per MA Waivers Manual
  Standards
•  
•  
•  
• CERTIFICATION STATEMENT
• REGARDING INDIVIDUAL PROVIDER QUALIFICATIONS
• This is to certify that __________________________
  ________________________________
• (Name of Agency/Organization)
•  
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• (1)     will ensure that each service provider
  meets the minimum credential/educational//or
  experience as required per the MA Waivers Manual
  Standards, and
•  

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• Submit this Document with Completed Application.
  Retain a copy in Agency File.
•  
• MILWAUKEE COUNTY DEPARTMENT OF HEALTH AND HUMAN
  SERVICES
•  
• Certification Statement-Resolution Regarding
  Background Checks on
• Employees of DHHS Contract Agencies and
  Agencies/Organizations having
• Reimbursable Agreements that have Direct Regular
  Contact with Clients or Provide Direct Services
  to Children and Youth
•   
• CERTIFICATION STATEMENT
• RESOLUTION REGARDING BACKGROUND CHECKS
• This is to certify that __________________________
  ________________________________
• (Name of Agency/Organization)
•  
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• (1)       will comply with the provisions of
  ss.50.065 and ss.146.40 Wis. Stats. and HFS 12
  and HFS 13, Wis. Admin. Code State of Wisconsin
  Caregiver Program
•  

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Applicable only if you have 50 or more employees
Applicable to All
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Other Contract Obligations

• HFS 94 Patient Rights and Resolution of Patient
  Grievances (http//nxt.legis.state.wi.us/nxt/gatew
  ay.dll?ftemplatesfndefault.htmvidWIDefaultd
  codexjdtop)
• Emergency preparedness and notification
• Right of access and review of service
  documentation-agency, provider, client, and
  fiscal
• Compliance with all laws and regulations for
  client confidentiality, including HIPAA
• Compliance with Service Descriptions and Billing
  procedures in effect during the contract period,
  including revisions and updates

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Overview of Budget Forms and Audit Reporting
Presented By Dennis Buesing, DHHS Contract
Administrator
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Budget Other Forms
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Budget and Other Forms
Form 1 Program Volume Data and Unit Rate
Calculation A separate Form 1 and Unit Rate must
be developed for each Waiver service The term
Program on all budget forms is inter-changeable
with the term Waiver service. Programs/services
funded by site must include separate Form1 for
each site.
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Budget and Other Forms Contd..
Form 2 Form 2A Agency Employee Hours and
Salaries Use Form 2A only
if agency has 14 or fewer employees otherwise use
multiple copies of Form 2 with Form 2A being the
final page. Column 1 - Position Title Enter the
title of each position with any portion of its
time directly allocated to a Waiver service 1
line per employee. If a position is vacant, list
the title of the position and "vacant" under it.
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Budget and Other Forms Contd..

• Form 2 Form 2A Agency Employee Hours and
  Salaries, contd
• Column 2 - Code
• Refer to Form 3S Control Acct No. 7000
  (Salaries). Use the same number as the last digit
  of the Sub-Account No. which corresponds to the
  Acct Description. (e.g., 1 for Executive
  Salaries, 2 for Professional Salaries, 3 for
  Clerical Staff Salaries, 4 for Technical
  Salaries, 5 for Maintenance Employees Wages, 6
  for Temporary Clerical Help, 7 for Student
  Stipends, and 8 for Other Staff Salaries
• NoteThe totals for salaries and employees
  health and retirement benefits should match
  respective totals for Control Accts 7000 7100
  on Form 3S.

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Budget and Other Forms Contd..

• Form 2 Form 2A Agency Employee Hours and
  Salaries, contd
• Column 3 - Ethnic/Race and Gender Codes
• In column 3 enter the code representing the race
  or ethnicity of the employee.
•  Ethnic/Race Codes Gender Codes
• A Asian or Pacific Islander F Female
• B Black M Male
• H Hispanic
• I American Indian
• W White

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Budget and Other Forms Contd
Form 2B Employee Demographic Summary (will fill
automatically from data on Forms 2 2A) Form 2C
Employee Hours Related Information Disclosure
(only applies to agencies whose employees work
for more than one related organization). Forms
3 Form 3S Anticipated Program Expenses
A separate budget tab must me
used for each Waiver service. Fill Form 3S
first! For 2007 Budget column use 2007 actual
expenses. Control account subtotals will
automatically come forward to corresponding
control account on Form 3.
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Budget and Other Forms Contd
Form 4 Form 4S Anticipated Program Revenue A
separate budget tab must me used for each Waiver
service. Please Fill Form 4S first! For 2007
Budget column use 2007 actual revenue. Control
account subtotals will automatically come forward
to corresponding control account on Form 4.
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Budget and Other Forms Contd..
Form 5 Total Agency Anticipated Expenses
Form 5A Total Agency Anticipated
Revenue Report Total Agency expenses on col. B, C
and D. For col. C, 2007 budgeted expenses, use
2007 actual expenses Each respective services
Form 3 expenses will automatically come forward
to its respective column E1 thru E6 of Form 5.
Report Total Agency revenue on col. B, C and
D. Each respective services Form 4 revenue will
automatically come forward to its respective
column E1 thru E6 of Form 5A.
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Budget and Other Forms Contd
Form 6 and 6D Through 6H Indirect Cost
Allocation Plan To be submitted only if Agency
provides more than one service to Milwaukee
County, or one or more services to Milwaukee
County and one or more services to other
purchasers. Or if expenses are allocated to other
functions like fund raising, or allocated between
agency and an affiliate. Allocation Plan document
with formulas are also available on the web.
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Budget and Other Forms Contd
Linked Budget Forms All budget forms Form 1-Form
6 are now available as linked forms with formulas
at http//www.county.milwaukee.gov/rfpinformation
111327.htm Agency can use these linked form to
report up to 6 programs/services or sites without
redoing Form 2, 5 and 6. Other forms are also
linked so numbers automatically carry forward
wherever they are repeated, or whenever
calculated based on another form.
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Audit Reporting
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Contract and Audit Requirements

• Contracts are required for Purchase of Care and
  Services over 10,000 under State Statute 46.036
• Audits are also required by State Statute
  46.036(4)(c ), if the Care services purchased
  with State funding exceeds 25,000 per year
• Statutes require audits to be performed at least
  every other year. County contracts typically
  require annual audits
• Standards for audits are found in DHFS/DWD/DOC
  Provider Agency Audit Guide, 1999 Revision (on
  line at www.dhfs.state.wi.us/grants)
• Non-profit providers that receive 500,000 or
  more in federal awards must also have audit
  performed in accordance with OMB Circular A-133
  Audit of State, Local Governments, and Non-Profit
  Organizations. Fed audit requirements are for an
  annual audit

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Audit Waiver

• Statutes allow the Dept. to waive audits. Audits
  may not be waived if the audit is a condition of
  state licensure, or is needed to claim federal
  funding (Group Foster Care or CCI).
• Waiver request can only be entertained if agency
  does not need to have an audit according to
  Federal Audit requirement.
• Waivers need to be approved on case by case basis
  by regional office based on a risk assessment (
  Funding lt75,000 is considered low risk)
• DHHS has been approving Audit Waivers for Fee for
  Service contracts mainly on basis of economic
  hardship for providers that receive less than
  150,000 from state and a county annually.
• In case of small residential care providers (
  Family Group Home and AFH) county has the
  authority to grant a waiver.
• Waiver Form is available at the bottom of the web
  page at http//milwaukeecounty.org/ContractMgt154
  83.htm

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Allowable Costs Allowable Profits or Reserves

• Per State Statute, ultimately, all agreements
  with Milwaukee County DHHS for client Care
  Services paid with dept. funding are cost
  reimbursement contracts
• For-profit providers may retain up to 10 in
  profit per contract 7½ of allowable costs, plus
  15 of net equity (Allowable Cost Policy Manual,
  Section III.16)
• Nonprofit providers paid on a unit-times-unit-pric
  e contract (i.e. FFS) may add surpluses of up to
  5 of contract amount to reserves each yr., up to
  a cumulative maximum of 10.

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Maintaining Financial Records

• Both Federal and State contracting guidelines
  require provider agencies to maintain orderly
  books and adequate financial records.
• Maintain a uniform double entry accounting system
  and a management information system compatible
  with cost accounting and control systems.
• Providers should maintain an accurate and
  up-to-date general ledger and timely financial
  statements for management board members
• Financial Statements must be prepared in
  conformity with accounting principles generally
  accepted in the U.S. (GAAP) and on the accrual
  basis of accounting. Contractor must request,
  and receive written consent of County to use
  other basis of accounting in lieu of accrual
  basis of accounting.

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Maintaining Financial Records

• Amounts recorded in the general ledger should be
  adequately supported by invoices, receipts or
  other documentation
• Providers should maintain a separate cost center
  or dept. in their general ledger for each
  contract, or program/facility within a contract
• Whenever possible, costs should be charged
  directly to a contract, all other costs should be
  allocated using a reasonable and consistent
  allocation method and supported by an Indirect
  Cost Allocation Plan
• Providers must not commingle personal and
  business funds. A separate checking account
  should be established providers should not use
  personal credit cards for agency business
• All Provider agencies should maintain and adhere
  to a board approved, up-to-date Accounting Policy
  Procedures Manual

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LINKED FORMS TUTORIAL
LINKED FORM WITH SAMPLE DATA
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Contact Info

• Program
• Liz Kraniak, Supervisor, Disabilities Services
  Division [phone]
• Technical
• Diane Krager, DHHS Quality Assurance Coordinator
  [phone]
• Wes Albinger, Contract Services Coordinator
  [phone]
• Budget
• Sumanish Kalia, Contract Administration CPA
  Consultant [phone]

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Thank YouHave a nice day