24.0 CMS-64 Reporting

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New Mexico
OmniCaid

System Documentation

July 31
, 2010



© Affiliated Computer Services, Inc. (ACS)

2010

Narrative
24
.
1


1

ACS® and the ACS design are trademarks of ACS Marketing LP in the US
and/or other countries. XEROX® and XEROX and Design® are trademarks
of Xerox Corporation in the United States and/or other countries.




24.0 CMS
-
64 Reporting



24.1. CMS
-
64 Reporting

Narrative


24.1.1 Subsystem Overview


The CMS
-
64 is a
series of
quarterly
report
s

created by

ACS for
the
S
tate of New Mexico.
These
reports are used by the
St
ate
to track expenditures for the purpose of
see
k
ing

reimbursement of
funds from
CMS
. T
he
S
tate is entitled to
this reimbursement
under

Title XIX of the Social
Security Act (Medicaid).


All CMS
-
64
reports are
generated
based on the federal fiscal calendar (i.e.
federal
fiscal quarter,
federal
fiscal ye
ar).


The CMS
-
64
reports
track expenditures for the quarter being reported
on
,

as well as expenditures
for

previous fiscal years
.

They

also track
collections
and/
or refunds received

for current quarters
and prior fiscal years
. T
he e
xpenditures reported on

the CMS
-
64 forms are actual documented
and
supported Medicaid
e
xpenditures

as defined by CMS
.


Adjusted expenditures
related to
State providers
,

as well as
claims that are voided
as a
result of
stale dated

warrant
s

or provider returned
warrant
s

are repor
ted as prior period adjustments

to
the

current

quarter. All other adjust
ed expenditure
s are
considered current quarter expenditures.
They are
reported
during
the quarter that the adjustment occurred

(i.e. the current quarter)
.


In
general terms, t
he CMS
-
6
4 reports are created
using

the COGNOS reporting tool. The
COGNOS reporting tool
us
es

data extracted from the MAD data warehouse fedcms64 table

to
generate a series of
CMS
-
64 related
summary reports. Each of these
COGNOS
summary reports
has “drill down” ca
pability to
underlying
COGNOS
detail

level reports.



The
underlying data from the fedcms64 data warehouse table that is used to produce the CMS
-
64
reports
is
extracted
from the OmniCaid weekly claims processing files
. This data is extracted

by a
series of

jobs
on the IBM mainframe and
then
loaded into the fedcms64 table
. This is done

on a
weekly basis

every Friday night
.



H
istorical
data was used for the initial load of the fedcms64 table. This data
is available

back to
the beginning of March 2004 (Quart
er 2).


In addition to the
quarterly
CMS
-
64 COGNOS reports created by ACS,
anyone with the
appropriate access to Cognos, including state of New Mexico personnel at ASD and/or MAD, can
run any or all of the CMS64 reports and/or run “ad hoc” queries agains
t the data warehouse at any
time.




New Mexico
OmniCaid

System Documentation

July 31
, 2010



© Affiliated Computer Services, Inc. (ACS)

2010

Narrative
24
.
1


2

ACS® and the ACS design are trademarks of ACS Marketing LP in the US
and/or other countries. XEROX® and XEROX and Design® are trademarks
of Xerox Corporation in the United States and/or other countries.




24.1.2
Main
CMS
-
64 Reports


As per federal reporting requirements, ACS generates the following CMS
-
64 reports using
COGNOS:

1.

Form 64.9 Base


2.

Form 64.9 Family Planning Waivers for Medical Assistance

3.

Form 64.21U State
Child Health Expenditures (SCHP)

4.

Form 64.9 Waivers for Medical Assistance Payments

5.

Form
64.10 Expenditures
for State and Local Administration of the Medical Assistance
Program


Expenditures for each of these above reports are broken out
by two different cr
iteria
:

1.

B
y t
he federally funded program
.

The

federally funded programs are

shown in the
column headings of
each

report.

2.


By

the

federally defined

lines of service
. These are commonly referred to as

“Federal
Category of Service” or

FCOS. The

FCOS
are shown

in the row headings of each report.



The
main
64.9
Base,
64.9
Family Planning and
64.21U
State Child Health Expenditure reports
are further broken down into the following components:

1.

Current Quarter report


2.

Line 10
-
B Prior Period
Net
Negative Adjustment

report


3.

Line 8


Prior Period Net Positive Adjustments
report

4.

TPL report


Both the Line 10
-
B prior period adjustment report and the Line 8 prior period adjustment report
are further
broken out by federal fiscal year.


The main 64.9 Waivers for Medical Ass
istance Payments reports are further broken down into the
following components:

1.

Disabled and Elderly
(DE)
Waiver
Payments report

2.

Developmentally Disabled (DD)
Waiver
Payments report

3.

AIDS
Waiver
Payments report

4.

Medically Fragile (MF)

Waiver

Payments report

5.

Mi Via ICF/MR
Waiver
Payments report

6.

Mi Via NF
Waiver
Payments report


The main
64.10 Expenditures for State and Local Administration of the Medical Assistance
Program

reports are further broken down into the following components:

1.

Disabled and Elderly Wa
iver (DE)
Waiver

Administration

report

2.

Developmentally Disabled (DD)
Waiver

Administration

report

3.

AIDS
Waiver

Administration

report

4.

Medically Fragile (MF)
Waiver

Administration

report

5.

Mi Via ICF/MR
Waiver

Administration

report

6.

Mi Via NF
Waiver

Administrati
on

report



New Mexico
OmniCaid

System Documentation

July 31
, 2010



© Affiliated Computer Services, Inc. (ACS)

2010

Narrative
24
.
1


3

ACS® and the ACS design are trademarks of ACS Marketing LP in the US
and/or other countries. XEROX® and XEROX and Design® are trademarks
of Xerox Corporation in the United States and/or other countries.




Examples
of these
CMS
-
64

COGNOS reports
are

demonstrated
in section
24.3 CMS
-
64
Subsystem Reporting Functionality
.


The criteria for determining the data contained in each of these
COGNOS
reports are explained in
more detail in section
24.5


C
MS
-
64 Subsystem exhibits
.


24.1.3 Supplemental CMS
-
64 Reports


In addition to the main
CMS
-
64
reports

outlined in the prior section,
ACS produces

several other
supplemental
CMS
-
64
reports
. These
supplemental

reports
are
:

1.

Encounters

reports

2.

Provider List

r
eports

3.

P
resumptive
E
ligibility

r
eport

(PE)

4.

Prior Period Adj
ustment Summary
reports

5.

SCHP F
ederally
Q
ualified
H
ealth
C
enter
report
(FQHC)


The Encounters reports
detail

expenditures

for the Current
, Prior Period Negative and Prior
Period Posit
i
ve

quarterly
p
eriods. Each of these reports is produced

for the Base, Family Planning
and the State Child Health Expenditure programs
.

The data on these reports are similar in format
to the Main CMS
-
64 reports.


The

Provider List reports
detail

expenditures

for the Curr
ent, Prior Period Negative and Prior
Period
Positive

quarterly
periods
.

Each of these reports is produced for the
Base, Family
Planning and the State Child Health Expenditure programs.
These reports
provide data broken out
by individual providers and
are
at the detail leve
l.


The P
resumptive
E
ligibility (PE)

report
details

expenditures

for the
Current
Quarter
for the
Base

program

only
.


The Prior Period Adjustment Summary reports
detail

expenditures
for the Prior Period Negative
and Prior Period
Positive

q
uarterly
periods for the Base, Family Planning and the State Child
Health Expenditure programs.


The
Federally Qualified Health Center (
FQHC
)

report
details

expenditures
for the Current
Quarter

for the State Child Health Expenditure program only.


24.1.
4
R
eimbursement Hierarchy of CMS
-
64 Related Expenditures


The expenditures detailed on the 64.9 Base, 64.9 Family Planning and 64.21U State Child Health
Expenditure reports
are categorized
based on a
predefined
hierarchy

that has been
determined by
federal
f
unding

requirements.


Th
e order of th
is

hierarchy

is

determined

by the

percentage of federal
funding

allocated to

each
respective
Medicaid program
.


This hierarchy is also used to determine the CMS
-
64 Column ID. The CMS
-
64 Column ID is
used by COGNOS to
determine where to put particular data on the COGNOS report.

New Mexico
OmniCaid

System Documentation

July 31
, 2010



© Affiliated Computer Services, Inc. (ACS)

2010

Narrative
24
.
1


4

ACS® and the ACS design are trademarks of ACS Marketing LP in the US
and/or other countries. XEROX® and XEROX and Design® are trademarks
of Xerox Corporation in the United States and/or other countries.






This hierarchy, which is shown below,
runs
from highest level of federal
funding
to lowest level
of federal
funding
.

1.

64.9
Base
r
eport
-

Indian Health Services (IHS)
. For data
to
fall into this
hierarchy, it
must

have

any

one
of the following:

a.

Cost Center
=
86715 (Indian Health Services)

or

b.

Provider Type
=
221 (Indian Health Services Hospital)

or

c.

Indian Health Service Provider (P
-
IHS
-
IND on the claim
=

‘Y’)

2.

64.9 Family Planning report
-

Family P
lanning Waiver Enhanced FMAP
. For data
to
fall
into this hierarchy, it must

which
must
have
both

of the following:

a.

Category of Eligibility
=
029 (Family Planning)

and

b.

Category of Service
=
60 (Family Planning)

3.

64.9 Family Planning report
-

Family Planning
Waiver Standard FMAP
. For data
to
fall
into this hierarchy, it must

have
both

of the following:

a.

Category of Eligibility
=
029 (Family Planning)

and

b.

Category of Service
n
ot
=
60 (Non
-
Family Planning)

4.

64.9
Base
r
eport

-

Family Planning Services for non
-
Fami
ly Planning Receipts
.

For data

to

fall into this hierarchy, it must

have
both

of the following:

a.

Category of Eligibility not
=
029 (Non
-
Family Planning)

and

b.

Category of Service
=
60 (Family Planning)

5.

64.21U
State Child Health Expenditures
report

-

Standard

FMAP.
For data
to
fall into
this hierarchy, it must have
any

one
of the following:

a.

Category of Eligibility 071 (SCHIP
)
and
Federal Match 1 (Regular FFP)

or

b.

Cost Center 86774

or

c.

Cost Center 86736

6.

64.9
Base Report


Breast & Cervical Cancer Services. For d
ata to fall into this
hierarchy, it must have the following:

a.

Cost Center 86775 (Breast & Cervical Cancer Services)

7.

64.9
Base Report


Standard FMAP
.

For data to fall into this hierarchy, it must have the
following:

a.

Be any claim
not meeting any of the crit
eria above
.


It should be noted that this hierarchy
does not apply

to:

1.

64.9 Waiver claims (Claim type = W),

2.

Financial claims associated with 64.9 Waiver claims (Claim type = F with waiver related
cost centers)

3.

64.10 Waiver Administration claims (Claim type

= X)

4.

Financial claims associated with 64.10 Waiver Administration claims (Claim type = F
with waiver administration related cost centers).