Wisconsin Human Services Financial Management Workshop May 8 ...

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Wisconsin Human Services Financial
Management Workshop

May 6, 2010

Long Term Support


HSRS:

What’s new in the Waivers and COP

Sue Liegel
,
Fiscal & Policy Management Specialist

Karla Meyer
,
Contract Specialist

Office of Family Care Expansion


Misty Johnson
,
Research Analyst

Bureau of Long Term Support

Outline



New things:


New Diversion Process


Terminology Review


Your Questions:


Understanding and Using COP post
-
Family Care


Waiver Mandate post
-
Family Care


COP LTS Planning Committee


COP Allowable Average


Contract Cuts


Leave
-
back COP


Reconciliation


HSRS & CARS


Disallowances


Maximum Admin between COP and COP
-
W


COP High Cost


Family Support Program


Fourth Annual Reconciliation Awards

New Processes for Diversions

CRI Diversion


Remove requirement of high risk criteria


Plans go directly to
TMG


Nursing Home Diversion


Can refill vacated slots within 90 days


Slot returns to State after 90 days of non
-
use


$85 per day limit, high risk criteria still applies


Crisis/emergency slots available
-

call Lisa


Plans go directly to
TMG

~~~ See Memo “Changes to CIP II Diversion Processes” ~~~

Terminology Review:

COP vs. MA Waiver

COP


100% (non
-
fed)
state dollars

All MA Waivers


(Non
-
fed) + (fed)


Non
-
fed : Fed ratio
determined by CMS


Non
-
fed generates
Federal funding

~~~See RED handout for schedule of fed/non
-
fed rate during reporting year~~~

Terms to Know:
Fed vs non
-
fed

Non
-
federal funds


Roughly 40% of
total


Comes from
State or County


Used to
generate federal
dollars


aka “match”

Federal funds


Roughly 60% of
total


Comes from MA


Earned in MA
Waiver Programs

Non
-
Fed

Fed

Terms to Know:
Match

Match Source

= Source of non
-
fed funding

State Source

(“State Match”)


Program General Purpose
Revenue (GPR)

County

Sources

(“Local Match”)


Basic County Allocation
(BCA), Local Funds

Terms to Know:
Match


Over Match / “Overage” / “Set aside”


Portion spent over the daily rate. Must use
local match to cover cost.

Daily Rate:

$41.86

Real

“Daily Rate”:

$100 !

Federal Portion is PAID
(MA Waiver)

Non
-
fed Portion is
overmatch

and comes from
COP or Local funds

Overmatch

Overmatch: an Example

$100

$60 Fed PAID

$40 non
-
fed

Excess over contract rolls to BCA

What pushed the cost over?


Allowable services


One
-
time service
expenses


Local match

Now where to?


COP


Community Aids


Act 405 (foster care)

Don’t charge it twice!!


Negative adj to BCA


Positive adj to
match source

Your Questions


Understanding & Using COP post
-
Family Care


COP LTS Planning Committee


COP Allowable Average


Waiver Mandate post
-
Family Care

Understanding COP post
-
Family Care

Fact:


COP used to support Family Care eligible populations
(Eld, DD, PD) is moved to the Family Care budget when
you transition.


It becomes “Family Care” funds and loses the “COP”
identity.


Result:


There is no COP funds for Eld, DD, PD after transition

Understanding COP post
-
Family Care

Result:

Post
-
Family Care, anyone using PURE COP is
not Family Care eligible and ONE of the
following:


a child (<18)


Mentally Ill Adult


AODA Adult


HSRS 1
st

client char
indicates MH or AODA

Side Bar: How to code Mentally Ill on HSRS

Code as Mentally Ill with 1
st

Client
Characteristic

Why?? 1
st

Client Characteristic (Field 8) vs
Target Group (Field 25)


1
st

Client Characteristic (Field 8)


Describes the person


Why the person is eligible


Constant for the whole LTS episode



Target Group (Field 25)


Describes why they need the service


Can differ by SPC

Q
&

A: Use of COP post
-
Family Care

Given a Family Care eligible individual…..


Q: “My MCO will only pay the MA rate. Can I use COP to
cover the remainder?”

Q: “Can I use COP to pay for Guardianship and other things
that the MCO doesn’t cover?”

Q: “Can I use COP to pay full amount or match for CSP
when the MCO doesn’t reimburse the full amount?”

Q: “Can I bill COP for case management provided after
Managed Care enrollment?”

A: No, you must use another local source. There is no COP
for Family Care eligible individuals.

COP 1.67 in Family Care?

Doesn’t exist

Lose MA eligibility = Lose Family Care eligibility

Could use local funds to sustain

The Community Options Program

and the “Questioned Costs”

From the audit guide:
http://www.doa.state.wi.us/docview.asp?docid=7929&locid=3

A recipient of COP services must be:


BOTH Functionally and Financially eligible

Services that are NOT COP allowable:


Purchase land


Build buildings


Services/items for a person who is/will be residing in an RCAC

(Wis. Stat. 50.034(6) )


Services billed but not provided


Administration claims without cost to justify

Services requiring variances:


Services provided in an institution or to an institutional resident


Services provided in a CBRF > 20 beds


CBRF costs over the established limit

The Community Options Program

and the “Questioned Costs”

From the audit guide:
http://www.doa.state.wi.us/docview.asp?docid=7929&locid=3

Program Requirements /
Possible Disallowances
:


COP care management rate needs annual approval (COP Plan Update)


Double billing COP and MA (Forgot to remove the costs??)


Waiver must be used before COP, where possible


Waiver allowable services can NOT be billed 100% COP


COP is funding of LAST RESORT; Waiver Mandate


File must contain ISP signed by COP participant


COP Care Manager must meet training requirements


Financial eligibility reviewed annually


Semi
-
annually if they have a cost
-
share


If cost
-
share, it MUST be applied to COP services


COP Participant must have been a WI resident for 180 days


COP as match for SPC 509(CSP) and/or 510(CCS)


Use blended rate to calculate the match cost


Be careful that there is no double
-
billing

COP LTS Planning Committee


Authority


Policy Decisions


Cost share (deductions)


Program Decisions


Variance approvals


Funding allocation between target groups


Living arrangements


Care plan service limits


Quality Assurance


Post
-
Family Care Structure


COP Committee still required


Members represent remaining target groups


Authority remains the same


May be a sub
-
committee of another County committee

COP Allowable Average

Q: “What is the significance of the COP allowable average?”

Q: “How is it calculated?”




COP Allowable Average required by WI statute (COP
Guidelines Appendix C)


Average COP expenditure ≤ GPR portion of nursing
home


CY 2009: $1,516.02 per month unless a variance is granted
under Section 5.09 B.


Over limit? Variance is possible

COP Allowable Average

Q: “What is the significance of the COP allowable average?”

Q: “How is it calculated?”



Calculation


30.41 x
(straight COP + match + overmatch + admin)


total days of service


Service day is only counted once


Daily amount multiplied by 30.41 to get monthly
average

Waiver Mandate post
-
Family Care

“Does the Waiver Mandate still apply to the remaining
target groups after transition to managed care?”

YES, the Waiver Mandate applies to everyone remaining




The BCA isn't "taken" as part of the county's
transition to managed care.


The county makes the decision about how they pay
the county obligation. Each year after the county
transitions to managed care
-

the county obligation is
reduced until the amount of obligation is no more
than an amount equal to 22% of the county's BCA.


County Obligation and
Basic County Allocation (BCA)

~~~ See Fiscal Memo #3 (Info Memo DLTC 2007
-
13) ~~~

“How much of my BCA will remain after transition to
Family Care?”




90 days before: final transition plan


60 days before: ADRC is functional


TMG/BLTS needs enough time to review & approve
plan, ensure continuity of placement and providers


Work closely and communicate relocation plans to
the ADRC and MCO to avoid plan changes


Relocation/diversion funding is
NOT

available after
transition


Transition Issues:

Relocations/Diversions

~~~ See Fiscal Memo #3 (Info Memo DLTC 2007
-
13) ~~~



Relocation/diversion funding
through MA Waiver is
NOT

available after transition


Transition Issues:


Relocations/Diversions

~~~ See Fiscal Memo #3 (Info Memo DLTC 2007
-
13) ~~~




COP carry over is NOT
available
in the year you
transition

to managed care


Lapsed COP returns to Dept


Transition Issues:

COP Carry Over

~~~ See Fiscal Memo #3 (Info Memo DLTC 2007
-
13) ~~~

Contract Cuts During Transition Year:
Methodology

Aug, 1/12
Jan, 1/12
Feb, 1/12
Mar, 1/12
Apr, 1/12
May, 1/12
Jun, 1/12
Jul, 1/12
Dec, 1/12
Nov, 1/12
Oct, 1/12
Sep, 1/12

1/12
th

of Waiver
service allocation
available each month


1/12
th

of COP A/P
allocation available
each month


1/12
th

of DD COP
spending cap
available each month

Contract Cuts: One Month Transition


Transition date: July 1
st
, 2010


CIP1A, CIP1B, COPW/CIP II contract, COP A/P
allocation, DD COP spending cap will be cut in half;
six months of funding available.


Transition date: September 1
st
, 2011


CIP1A, CIP1B, COPW/CIP II contract, COP A/P
allocation, DD COP spending cap will be cut by 1/3;
eight months of funding available.


Transition date: October 1
st
, 2011


CIP1A, CIP1B, COPW/CIP II contract, COP A/P
allocation, DD COP spending cap will be cut by 1/4;
nine months of funding available.

Contract Cuts: One Month Transition

~~~ See Fiscal Memo #8 (Info Memo DLTC 2008
-
07) ~~~


Contract reductions done by person for:


CRI, NHD


BIW


ICF/MR


Contact Karla Meyer or Lisa Kelly with
questions


See last 2 slides for contact info

~~~ See handout: “COP Leftovers” ~~~

COP Leftovers
(after transition)

:

What’s left and how can I enhance it?

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|||
|||||||

COP

money funds a
person
; it’s
not new

money








Average of COP dollars
expended during two years
prior to transition for:


Children (< 18 in rpt yr)


Mentally ill or AODA


HSRS 1
st

client char = MH or
AODA (regardless of age)


PURE COP (not Waiver)


Admin added to each
year


7% (of identified services)


~~~ See handout: “COP Leftovers” ~~~

How was Leave Back COP Calculated?

~~~ See handout: “COP Leftovers” ~~~




COP
Assessment/Plan

How much?


10% of COP base A/P
allocation

Uses:


Assessments/Plans for COP
eligible target populations
not eligible for Family Care


Children


Mentally Ill


AODA

Refer to Fiscal memo #5

~~~ See handout: “COP
Leftovers” ~~~

How much?


Max of 15% of remaining COP
allocation

Uses:


Risk reserve funds are COP funds


COP guidelines apply


Risk reserve funds may not be used
for Family Care target populations


Risk reserve can only be used for:


COP eligible children


COP eligible adults (MH/AODA)




COP Risk Reserve

“Clarify use of COP Risk Reserve post
-
FC”


More Uses:


Not

for County contribution


Can use for risk reserve
requirement of an MCO that is
County
-
based or Family Care /
LTC District


If you are transitioning:
submit a
plan

for the utilization of COP risk
reserve funds


Counties may request a variance
for DD cap 1 year prior to
transition


Refer to Fiscal memo #2




COP Risk
Reserve

~~~ See handout: “COP
Leftovers” ~~~

Uses:


Start
-
up costs/Home & vehicle
mods/Special equipment


Applicant must be COP eligible
participant


Not waitlist


Project/services must be
completed and paid in full

prior
to participant’s enrollment in
managed care.


Not available for Managed Care
participants


Not available for ADRC’s


Refer to Fiscal Memo #2, #3




COP High
Cost

~~~ See handout: “COP
Leftovers” ~~~

CY2010 Reconciliation

Relations between

HSRS
&

CARS


HSRS


Documentation of
services and expenses


Documentation for
CMS


Reporting by date of
service


NO Admin


CARS


Checkbook



How you get paid



Reporting by date of
payment


MAY have admin

~~~See CHERRY handout: “A Simple Comparison of CARS and HSRS”~~~

COP/ MA Waiver

Disallowances


Unapproved Plan


Eld/PD: TMG by Feb 28


DD: CIS approval


Costs before approved start
date


Unapproved case
management rate
(EVEN AFTER
ROLL TO MC!! Still have COP)


Costs during inpatient stay


Functionally eligible


Lost Nursing Home
Level of Care


Financially eligible


Lost MA eligibility


COP / Waiver costs
after Transition and
Family Care eligible

Inpatient Stay


Allowable costs during inpatient stay:


PERS (112.46)


Case Management (604.xx)


Refunds/voluntary contributions (95.02)


Cost share used for PERS or CM


Anything else will be disallowed!

FAQ: COP High Cost


What is it?


COP awards (non
-
fed)


Straight COP


Non
-
waiver allowable service (ex: dental)


COP Match


Used to earn Fed (MA Waiver)


HSRS coding/ CARS reporting is important!


ONE TIME

funding based on a request for an
exceptional need


Specific person, specific purpose


No, you can’t use left over $ for someone/something
else

FAQ: COP High Cost


How do I report a State
-
matched award?


Report
100%

of expenses on HSRS and CARS to appropriate
Waiver code / profile


Assures you generate the federal portion


How do I report a Local
-
matched award?


Report
100%

of expenses on HSRS and CARS to appropriate local
match and
funding source of
CP

/ profile


Assures it appears on the L
-
016 report
CRUCIAL STEP


Assures you generate the federal portion


Non
-
fed (i.e.
-

COP) rolls to BCA


County charges back to COP


Transparent on HSRS


COP reconciliation forms tell us how you reported it!

~~Ref handout:
COP Award Grid~~

FAQ: COP High Cost Example

COP High Cost award of $10k


State
-
matched (CIPII), Home modification $24k

Right way:


Report $24k to CIPII on HSRS
and CARS

Wrong way:


Report $10k to COP and $14k to
CIPII on HSRS and CARS

$24k CIPII

$14k Fed PAID

$10k non
-
fed rolls

Profile 347

Profile 348

Profile 349

$10k BCA

Profile 561

$10k COP reimbursed

Profile 367

-
$10k BCA

Profile 561

$14k CIPII

$8k Fed PAID

$6k non
-
fed rolls

Profile 347

Profile 348

Profile 349

$6k BCA

Profile 561

-
$6k BCA

Profile 561

$6k COP reimbursed

Profile 367

$10k COP

Profile 367

FAQ: COP High Cost Example

CARS does the work for you



(allocates between fed and non
-
fed)


Don’t touch the fed!!

Family Support Program (FSP)


CY09


only straight FS on the FSP module


Enter FS as match on the LTS module


$3,000 limit (unless Dept variance)

Total=match + straight


FS can NOT be used for:


child in out of home setting


children's foster care


case management / service coordination.


Age Restriction


21st birthday or HS graduation, whichever comes 1
st
.

Family Support Program


Funding of last resort


Admin: up to 10% of the base family support allocation


Carry Over: ~ 5% of the base family support allocation


Can be used as


Straight


As match


Local match CLTS waiver (funding source “FS”)


Autism services not 100% funded


Other than SPCs 512, 609.20, 604 and 619


As overmatch


Remember: $3,000 annual maximum (straight + match +
overmatch)

Family Support

Disallowances


Use of FS to match
Case Management


Exceeds $3k limit
(match + regular)


Not for out of home
placement


Exceeds Age
requirements:


Ends at 21
st

birthday
or HS graduation;
which ever comes 1
st


Fourth Annual

Reconciliation Awards


Sawyer
, Deb
Christians (3/8)


Oneida
, Mary
Rideout (3/10)


Menominee Tribe
,
Alicia Wilke (3/11)


Clark,
Lana
Marshall (2/22)


Burnett,
Jeanne
Young (3/4)


Sawyer
, Deb
Christians (3/5)


COPW/CIPII

CIP 1A/1B/BIW

Fourth Annual

Reconciliation Awards



COP


Sawyer
, Deb
Christians (3/8)


Vernon
, Jean Klousia
(3/10)


Chippewa
, Linda
Hebert (3/12)

Family Support


Taylor
, Russ Blennert
and
Sawyer
, Deb
Christians (3/8)


Chippewa
, Linda
Hebert (3/9)


Vernon
, Jean Klousia
(3/10)

Still Stuck? Help is available!!


County TA visits


Team approach


Submit questions
beforehand


Can ask
specific

county questions


Custom HSRS reports


Electronic version of
L300, L016, L399, L242


Waiting list


Per diem report

Contact us!!



Sue Liegel (608) 266
-
9755

Susan.Liegel@WI.gov

Misty Johnson (608) 267
-
9583

Misty.Johnson@WI.gov

Karla Meyer (608) 266
-
0071

Karla.Meyer@WI.gov


Lisa Kelly (608) 267
-
3659

Lisa.Kelly@WI.gov