WebEx Recap

1
.

• WebEx Recap
• Network Provider Training on
• Contract Documents and Other System Changes
• October 17, 2013

2
AGENDA

• Introduction
• New Exhibits and Other Cost Accumulator (OCA)
  Crosswalk Overview
• Exhibit H, Funding Detail
• Exhibit G, Cost Center Funding by OCA
• Budget Flexibility
• Invoice
• Other Related Issues
• Payer of last resort
• Invoice Validation Process
• Adjournment

3
1. Introduction

• Reinstatement of Sequestration GAA Reductions
• All Treatment and Prevention Funding Details will
  be revised and sent out to Providers.
• Reporting changes

4
2. Exhibits Crosswalk Overview

• OCA Crosswalk
• Review of the OCA Crosswalk. The table provides
  a description from the old OCAs cross walked to
  the new OCAs, the related categories and the cost
  centers by program.
• http//sfbhn.org/wordpress/wp-content/uploads/2-OC
  A-Cross-Walk-October-2013.pdf

5
2. Exhibits Crosswalk Overview

• Exhibit H, Funding Detail
• The revised Exhibit H incorporates the new Other
  Cost Accumulators (OCAs) in accordance with the
  Department of Children and Families (DCF)
  Approved Operating Budget (AOB) for fiscal year
  2013-2014
• As an easy reference and for historical purposes,
  a two (2) year history of changes made to the
  Funding Detail will be noted at the bottom of the
  document.

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2. Exhibits Crosswalk Overview

• Exhibit G, Cost Center Funding by OCA
• The format for the Exhibit G has changed.
  Funding is now tracked by OCA and Cost Center.
• The OCA allocations are indicated towards the top
  of the document underneath the Program headings.
• Rates are on the left side of the document. Open
  cost centers will be BOLD and have a rate.
• Highlighted cost centers indicate a TANF eligible
  cost center.
• Providers will allocate the funds for each OCA
  across the open cost centers.

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2. Exhibits Crosswalk Overview

• Budget Flexibility
• Providers will be granted the flexibility to
  shift funds up to 25,000 or thirty (30) percent,
  whichever is higher, between Alcohol and Drug
  Other Cost Accumulators (OCA) and between
  Residential and Non-Residential Cost
  Centers/OCAs.
• Within each OCA there is unlimited flexibility to
  realign funds among cost centers.
• Any shift of funds in excess of the
  aforementioned amounts will require a formal
  contract amendment.

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2. Exhibits Crosswalk Overview

• Invoice
• The format for Exhibit E, Monthly Payment/Advance
  Request, has changed.
• Local Match, Medicaid, First, Second, Third and
  SSI/SSDI units shall be reported on the worksheet
  section of the invoice and backed out.
• The invoice submission date has changed from the
  10th to the 7th calendar day of the month
  beginning with November services.
• The implementation date for the revised invoice
  begins with the November invoice (due December
  7th)
• The invoice validation will be based on the first
  data run, therefore it is advisable to report and
  correct data errors more frequently.
• To obtain a copy of the revised invoice, please
  visit
• http//sfbhn.org/october-17-2013-network-provider-
  training-on-revised-contract-documents-and-other-s
  ystem-changes/

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3. Other Related Issues

• Payer of Last Resort
• Excerpt from the Revised Exhibit B, Method of
  Payment to be amended into all contracts
• Third Party Billing
• a. The Department is always the payer of last
  resort. The ME and the Network Provider
  specifically agree that the Department, through
  the ME, is never a liable third party. The
  Network Provider shall not bill the ME for
  services provided to
• i. Individuals who have third party insurance
  coverage when the services provided are covered
  under the insurance plan or
• ii. Medicaid enrollees or recipients of another
  publically funded health benefits assistance
  program, when the services provided are covered
  by said program, regardless of limitation.
• b. The Network Provider may bill the ME if
  services are provided to
• i. Individuals who have lost coverage through
  Medicaid, or any other publically funded health
  benefits assistance program coverage for any
  reason during the period of non-coverage or
• ii. Individuals who have a net family income at
  or above 150 percent of the Federal Poverty
  Income Guidelines, subject to the sliding fee
  scale requirements in Rule 65E-14.018 F.A.C.
• c. In no event shall Medicaid, any health
  insurance, another publically funded health
  benefits assistance program, or the ME be billed
  for the same service provided to the same
  individual on the same day.

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3. Other Related Issues

• Invoice Validation Process
• Data submission date remains the same 4th
  calendar day of the month following the month of
  services
• The invoice validation will be based on the first
  data run
• The move is toward having real time data in
  order for this to occur providers will need to
  submit data more frequently. Suggested frequency
  is a weekly basis if not more.
• Orphan service reports will be provided weekly to
  providers
• Providers are directed to the Special Allocation
  OCAs and Matching Modifiers table provided.
• Providers with special allocations are required
  to utilize the special modifiers effective
  November 1, 2013. Failure to properly code the
  services will affect the providers ability to
  draw down the funding for the special allocation.
  Similarly, failure to report the proper modifier
  will skew the data for other OCAs.
• The OCA modifier (MODIFIER4) will continue to be
  populated by the SFBHN IT team until further
  notice.
• http//sfbhn.org/wordpress/wp-content/uploads/7-Sp
  ecial-Allocation-OCAs-and-Matching-Modifiers.pdf

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SUMMARY

• Exhibits E, G, and H have been revised to align
  with the AOB and to meet new DCF reporting
  requirements
• Providers will receive their revised Funding
  Detail within a week to start the Amendment
  process
• Data submission date remains the same 4th
  calendar day of the month following the month of
  services
• Invoice Due Date Effective Immediately 7th
  Calendar day of the month beginning with October
  2013 services.
• Utilization of Revised Invoice Template
  Beginning with November 2013 services
• Invoice validation will be based off of the fist
  data run
• Implementation of the new data reporting to
  include Modifiers Beginning with November 2013
  services
• Providers will need to report and correct data
  errors weekly
• All of the documents presented at the meeting are
  posted on the following website
• http//sfbhn.org/october-17-2013-network-provider-
  training-on-revised-contract-documents-and-other-s
  ystem-changes