Title: Medical Reimbursement Programs for California Transit Systems
1Medical Reimbursement Programs for California
Transit Systems
- Cal ACT Spring Conference
- April 21, 2008
2Definitions / 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
3More 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
4Yes, 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
5Definitions 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
6 7MAA Activities
- Outreach
- Facilitating Medi-Cal Application
- Arranging/Providing Transportation
- Contracting for Medi-Cal Services and MAA
- MAA Coordination and Claims Administration
- Program Planning and Policy Development
- MAA Implementation Training
8Medical Transportation
- Includes those activities that either arrange or
provide non-emergency, non-medical transportation
of Medi-Cal "eligibles" to Medi-Cal services
9Activities that Accomplish This
- Making an appointment for transportation
- Arranging for someone to transport the individual
- Transporting the Individual
- Accompanying the individual when it is medically
necessary by an aide or attendant - Providing bus and trolley tokens for the
individual to get to a Medi-Cal appointment
10Eligible Modes of Transportation
- Taxis
- Buses (Mini-Buses, Public Transportation, etc.)
- Trolleys
- Cars
11Ineligible Modes of Transportation
- Wheelchair Vans (This refers to medical or
program specific non-public transportation) - Ambulances
12Target 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
13Medi-Cal / Essence of Intergovernmental
Relations
- In California there seems to be a misperception
that public transportation providers are not
eligible for Medi-CaL reimbursement - Fortunately, this isnt the case
14State 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
Diegos 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
15How 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 programs
infrastructure and matchable revenues are
explored - LGA requests approval from the State
16Participation / 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
17Redistributive Funding Stream
- Federal Government
- State Government
- LGA
- Eventually the Transportation Provider, as one
of many" claimants, is reimbursed per the invoice
18Other Claimants
- Hospitals
- Probation
- Health and Human Services
- Aging and Independent Services
- Many, many other similar programs
19The 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
20Duties Associated with MAA Coordinator
- Main contact with LGA on MAA matters
- Attend MAA provider meetings held by the LGA
- Attend MAA workshops
- Coordinate any requests for MAA site visit
21Duties 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 file
- Attend the annual MAA Train-the-Trainer session
- Oversee the completion of the MAA Claim Plan and
Quarterly Invoice
22Elements of an Audit File
- MAA Claim Plan and Amendments
- Current Organizational Chart and Job Descriptions
of staff participating in MAA - Invoice
- Contracts
23Invoice 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
24Contracts
- MOA with the LGA
- Copies 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
25Consultant Services (Not Mine?)
- The LGA contracts with a consultant to assist the
LGA with various activities including - Training and technical assistance
- Assistance to providers in developing procedures
for managing their MAA program - Technical assistance to providers
- Participation in bi-monthly provider meetings
26Consultant 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
27 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 programs invoice
28Contents of the Claim Plan
- Certification Statement
- General Description of the Claiming Unit
Functions - Description of Claiming Unit
- Staffing Grid (NA)
- Activity Codes that staff may code to (NA)
- The Claim Plan Review Record
29Local 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
30Continued
- 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)
31Claim Plan Amendments
- Claim Amendment Checklist
- LGA Completes the Checklist and other documents
- Program is provided instructions from LGA
regarding required submissions
32MAA Claiming Plan Amendment Checklist
33MAA Invoice
- Invoice Worksheet
- Direct Charge Worksheet
- Funding Worksheet
34Invoice Worksheet
- Incorporates information from the funding and
direct charge worksheets to produce the basis of
the claim and amount of reimbursement
35Direct 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
36Direct 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
37Funding 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
38Invoice Worksheet
- Time Survey Results (NA)
- Medi-Cal Percentage
- Actual expenditures for the quarter covered by
the invoice - Funding sources supporting the expenditures (NA)
39Medi-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
40Actual Expenditures
- NO BUDGET ESTIMATES (Actuals only)
- Must be for quarter claimed
- Back up report for transportation needs to
contain trip-by-trip confirmation
41Direct 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
42Quality Assurance
- Coordinators Responsibilities
- Audit File
- Annual Site Visit
- MAA Bi-monthly Meeting and Workshop
43Conclusions
- Very Dynamic and Subject to Change
- The 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
44Metaphorically 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
45THANK YOU!
- Max Calder
- 619-595-7037
- Max.Calder_at_sdmts.com