Medical Reimbursement Programs for California Transit Systems

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Medical Reimbursement Programs for California
Transit Systems

• Cal ACT Spring Conference
• April 21, 2008

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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

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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

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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

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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

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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

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Medical Transportation

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

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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

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Eligible Modes of Transportation

• Taxis
• Buses (Mini-Buses, Public Transportation, etc.)
• Trolleys
• Cars

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Ineligible Modes of Transportation

• Wheelchair Vans (This refers to medical or
  program specific non-public transportation)
• Ambulances

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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

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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

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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

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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

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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

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Redistributive Funding Stream

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

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Other Claimants

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

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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

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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

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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

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Elements of an Audit File

• MAA Claim Plan and Amendments
• Current Organizational Chart and Job Descriptions
  of staff participating in MAA
• Invoice
• Contracts

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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

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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

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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

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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

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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

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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

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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

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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)

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Claim Plan Amendments

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

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MAA Claiming Plan Amendment Checklist
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MAA Invoice

• Invoice Worksheet
• Direct Charge Worksheet
• Funding Worksheet

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Invoice Worksheet

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

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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

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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

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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

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Invoice Worksheet

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

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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

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Actual Expenditures

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

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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

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Quality Assurance

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

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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

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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

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THANK YOU!

• Max Calder
• 619-595-7037
• Max.Calder_at_sdmts.com