Transcript No Slide Title

Medical Reimbursement Programs
for California Transit Systems
Cal ACT Spring Conference
April 21, 2008
Definitions / More Alphabet Soup

MAA: Medi-Cal Administrative Activities. Activities
that have been identified as necessary for the
proper and efficient administration of the MediCal 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
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
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
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
MAA Activities
1.
2.
3.
4.
5.
Outreach
Facilitating Medi-Cal Application
Arranging/Providing Transportation
Contracting for Medi-Cal Services and MAA
MAA Coordination and Claims
Administration
6. Program Planning and Policy Development
7. MAA Implementation Training
Medical Transportation
Includes those activities that either
arrange or provide non-emergency,
non-medical transportation of Medi-Cal
"eligibles" to Medi-Cal services
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
Eligible Modes of Transportation
Taxis
Buses (Mini-Buses, Public
Transportation, etc.)
Trolleys
Cars
Ineligible Modes of Transportation
Wheelchair Vans (This refers to
“medical” or program specific nonpublic transportation)
Ambulances
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
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 isn’t the case
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
Diego’s 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
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
program’s infrastructure and matchable
revenues are explored
LGA requests approval from the State
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
Redistributive Funding Stream
Federal Government
State Government
LGA
Eventually the Transportation Provider,
as “one of many" claimants, is
reimbursed per the invoice
Other Claimants
Hospitals
Probation
Health and Human Services
Aging and Independent Services
Many, many other similar programs
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
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
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
Elements of an Audit File
MAA Claim Plan and Amendments
Current Organizational Chart and Job
Descriptions of staff participating in
MAA
Invoice
Contracts
Invoice Components
Supporting source documentation for
the quarterly invoice
Methodology used to calculate MediCal percentages
Documentation supporting
transportation / direct charge costs
MAA invoices for prior three years
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
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
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
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 program’s invoice
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
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
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)
Claim Plan Amendments
Claim Amendment Checklist
LGA Completes the Checklist and other
documents
Program is provided instructions from
LGA regarding required submissions
MAA Claiming
Plan Amendment Checklist
MAA Invoice
Invoice Worksheet
Direct Charge Worksheet
Funding Worksheet
Invoice Worksheet
Incorporates information from the
funding and direct charge worksheets
to produce the basis of the claim and
amount of reimbursement
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
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
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
Invoice Worksheet
Time Survey Results (NA)
Medi-Cal Percentage
Actual expenditures for the quarter
covered by the invoice
Funding sources supporting the
expenditures (NA)
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%
Actual Expenditures
NO BUDGET ESTIMATES (Actuals only)
Must be for quarter claimed
Back up report for transportation
needs to contain trip-by-trip
confirmation
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
Quality Assurance
Coordinator’s Responsibilities
Audit File
Annual Site Visit
MAA Bi-monthly Meeting and Workshop
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
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
THANK YOU!
Max Calder
619-595-7037
[email protected]