Medical Reimbursement Programs for California Transit Systems - PowerPoint PPT Presentation

About This Presentation
Title:

Medical Reimbursement Programs for California Transit Systems

Description:

Title: No Slide Title Author: Chris Bell Last modified by: Meg Created Date: 2/26/2004 9:47:10 PM Document presentation format: On-screen Show Other titles – PowerPoint PPT presentation

Number of Views:148
Avg rating:3.0/5.0
Slides: 46
Provided by: ChrisB188
Category:

less

Transcript and Presenter's Notes

Title: Medical Reimbursement Programs for California Transit Systems


1
Medical Reimbursement Programs for California
Transit Systems
  • Cal ACT Spring Conference
  • April 21, 2008

2
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

3
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

4
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

5
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

6


7
MAA Activities
  1. Outreach
  2. Facilitating Medi-Cal Application
  3. Arranging/Providing Transportation
  4. Contracting for Medi-Cal Services and MAA
  5. MAA Coordination and Claims Administration
  6. Program Planning and Policy Development
  7. MAA Implementation Training

8
Medical Transportation
  • Includes those activities that either arrange or
    provide non-emergency, non-medical transportation
    of Medi-Cal "eligibles" to Medi-Cal services

9
Activities 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

10
Eligible Modes of Transportation
  • Taxis
  • Buses (Mini-Buses, Public Transportation, etc.)
  • Trolleys
  • Cars

11
Ineligible Modes of Transportation
  • Wheelchair Vans (This refers to medical or
    program specific non-public transportation)
  • Ambulances

12
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

13
Medi-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

14
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
    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

15
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 programs
    infrastructure and matchable revenues are
    explored
  • LGA requests approval from the State

16
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

17
Redistributive Funding Stream
  • Federal Government
  • State Government
  • LGA
  • Eventually the Transportation Provider, as one
    of many" claimants, is reimbursed per the invoice

18
Other Claimants
  • Hospitals
  • Probation
  • Health and Human Services
  • Aging and Independent Services
  • Many, many other similar programs

19
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

20
Duties 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

21
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 file
  • Attend the annual MAA Train-the-Trainer session
  • Oversee the completion of the MAA Claim Plan and
    Quarterly Invoice

22
Elements of an Audit File
  • MAA Claim Plan and Amendments
  • Current Organizational Chart and Job Descriptions
    of staff participating in MAA
  • Invoice
  • Contracts

23
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

24
Contracts
  • 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

25
Consultant 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

26
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

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

28
Contents 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

29
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

30
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)

31
Claim Plan Amendments
  • Claim Amendment Checklist
  • LGA Completes the Checklist and other documents
  • Program is provided instructions from LGA
    regarding required submissions

32
MAA Claiming Plan Amendment Checklist
33
MAA Invoice
  • Invoice Worksheet
  • Direct Charge Worksheet
  • Funding Worksheet

34
Invoice Worksheet
  • Incorporates information from the funding and
    direct charge worksheets to produce the basis of
    the claim and amount of reimbursement

35
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

36
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

37
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

38
Invoice Worksheet
  • Time Survey Results (NA)
  • Medi-Cal Percentage
  • Actual expenditures for the quarter covered by
    the invoice
  • Funding sources supporting the expenditures (NA)

39
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

40
Actual Expenditures
  • NO BUDGET ESTIMATES (Actuals only)
  • Must be for quarter claimed
  • Back up report for transportation needs to
    contain trip-by-trip confirmation

41
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

42
Quality Assurance
  • Coordinators Responsibilities
  • Audit File
  • Annual Site Visit
  • MAA Bi-monthly Meeting and Workshop

43
Conclusions
  • 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

44
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

45
THANK YOU!
  • Max Calder
  • 619-595-7037
  • Max.Calder_at_sdmts.com
Write a Comment
User Comments (0)
About PowerShow.com