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FEDERAL FINANCIAL PARTICIPATION (FFP) Comprehensive Perinatal Services Program (CPSP) Annual Meeting November 7, 2012 Jonathan Alspektor, BSBA State of.

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Presentation on theme: "FEDERAL FINANCIAL PARTICIPATION (FFP) Comprehensive Perinatal Services Program (CPSP) Annual Meeting November 7, 2012 Jonathan Alspektor, BSBA State of."— Presentation transcript:

1 FEDERAL FINANCIAL PARTICIPATION (FFP) Comprehensive Perinatal Services Program (CPSP) Annual Meeting November 7, 2012 Jonathan Alspektor, BSBA State of California Contract Manager

2  FFP Definition and Objectives  FFP Requirements  FFP Reimbursement  FFP Decision Tree  FFP Secondary Documentation

3 Federal Financial Participation (FFP) is a Title XIX (Medicaid) program that allows states to receive partial reimbursement for activities that meet FFP objectives. WHAT IS FFP?

4 FFP has two programs: 1.) Targeted Case Management – TCM 2.) Medi-Cal Administrative Activities – MAA  MAA FFP reimburses for activities that primarily involve linking clients to Medi-Cal services and/or coverage.  MCAH FFP is a MAA program. WHAT IS FFP?

5 Qualified Perinatal Services Coordinator (PSC) must:  Be a Skilled Professional Medical Personnel (SPMP) and must meet Federal SPMP requirements not State or County.  Complete SPMP Questionnaire  Complete activities that meet at least one of the two FFP Objectives. FFP REQUIREMENTS

6 Qualified Perinatal Services Coordinator (PSC) must:  Time Study  Adhere to current MCAH Policy & Procedure position requirements FFP REQUIREMENTS

7 There are two FFP personnel classifications: 1.) Skilled Professional Medical Personnel (SPMP)  Education and training at the professional level  Nurses, physicians, Registered Dieticians, etc. 2.) Non-Skilled Professional Medical Personnel (Non-SPMP)  All other personnel FFP PERSONNEL

8 Double-click on image to show full screen example  All SPMPs must complete the SPMP Questionnaire  Determines SPMP or Non-SPMP  Complete once and keep on file for audit purposes. SPMP REQUIREMENTS

9 1.) To assist individuals eligible for Medi-Cal to enroll in the Medi-Cal program and/or 2.) To assist individuals on Medi-Cal to access Medi-Cal providers, care and services. FFP OBJECTIVES

10 Staff claiming FFP reimbursement must keep record of 100% of their time and activities for all programs (including non-MCAH programs) for a minimum of one month each quarter. The “start and stop” time of all activities are required on each time study at a maximum of 30 minute increments. Double-click image to show full screen example FFP TIME STUDY

11  50/50 Non-Enhanced Matching (Non-SPMP) $1 spent =.50 cents reimbursed  75/25 Enhanced Matching (SPMP ) $1 spent =.75 cents reimbursed FFP REIMBURSEMENT

12 Medi-Cal Factor (MCF%)- Medi-Cal paid births as a percentage of live births in each county. Comprehensive Perinatal Services Program (CPSP) is a Medi-Cal program serving only Medi- Cal providers and clients.  PSCs can claim up to 95% of their matchable activities. FFP REIMBURSEMENT

13  Determines if an activity can be matched  Determines the codes than can be claimed for an activity FFP DECISION TREE Double-click image to show full screen example

14 SPMP FFP CODES Enhanced (75/25 Matching) 2: Administrative Medical Case Management (Short Term Only) 3: SPMP Intra/Interagency Coordination, Collaboration and Administration 6: SPMP Training 8: Program Planning and Policy Development 9:Quality Management

15 NON-SPMP FFP CODES Non-Enhanced (50/50 Matching) 1: Outreach 4: Intra/Interagency Collaboration and Coordination 5: Program Specific Administration 7: Non-SPMP Training

16 OTHER FFP CODES 10: Non-Program Specific General Administration 11: Other MCAH Scope of Work Activities that are not matched 12: Paid Time Off

17 FUNCTION CODE 1 Outreach Examples: Informing potential client about the services offered by a CPSP provider Describing range of services, how to access them, and the benefits of preventative health care. FUNCTION CODE EXAMPLES

18 FUNCTION CODE 2 (SPMP) SPMP Administration Medical Case Management Examples: Consulting with a Medi-Cal provider in regards to the client’s or the infant’s health needs. Assisting Medi-Cal client in contacting their physician for clarification on a specific medical condition such as gestational diabetes and its effect on her pregnancy. FUNCTION CODE EXAMPLES

19 FUNCTION CODE 3 (SPMP) SPMP Intra/Interagency Coordination, Collaboration, & Administration Examples: Meeting with Dental providers to develop strategies to increase access to dental services for pregnant women. Community Action and Planning strategy meetings FUNCTION CODE EXAMPLES

20 FUNCTION CODE 4 Non-SPMP Intra/Interagency Collaboration and Coordination Examples: PSC provides assistance to a CPSP Provider with a technical question related to the program i.e. Billing for services to Medi-Cal. FUNCTION CODE EXAMPLES

21 FUNCTION CODE 5 Program Specific Administration Examples: Reviewing reports, documents, and/or legislation for potential impacts to the CPSP programs. Coordinate logistics for outreach services from various programs to prevent duplication of services and encourage optimal use of resources for Medi-Cal clients. FUNCTION CODE EXAMPLES

22 FUNCTION CODE 6 (SPMP) SPMP Training Examples: Develop, conduct, or participate in training for CPSP physicians, nurse practitioners, and office nurses to increase access to Medi-Cal services. Using skilled medical expertise to deliver professional training to health care providers that will improve quality of care. FUNCTION CODE EXAMPLES

23 FUNCTION CODE 7 NON-SPMP Training Examples: Participate in training on data sources, data management and preparation for analysis to improve access to care for Medi-Cal clients. Attending an FFP training FUNCTION CODE EXAMPLES

24 FUNCTION CODE 8 (SPMP) SPMP Program Planning and Policy Development Examples: Identify, recruit, and provide program support for new providers to expand access for CPSP clients. Assisting providers with CPSP clinical requirements and implementation. FUNCTION CODE EXAMPLES

25 FUNCTION CODE 9 (SPMP) Quality Management by Skilled Professional Medical Personnel Examples: Developing training materials for CPSP providers for quality assurance monitoring. Reviewing CPSP provider arrangements to assure continuous provision of required consultant services. FUNCTION CODE EXAMPLES

26 FUNCTION CODE 10 Non-Program Specific General Administration Examples: Agency related activities, such as, fire drills. Staff attend agency meetings and non-program related trainings such as HIPAA, Safety Training, Sexual Harassment. FUNCTION CODE EXAMPLES

27 FUNCTION CODE 11 Other Activities (Included in MCAH SOW) Examples: Attending Child Abuse Prevention Council meetings. Smoking cessation training. FUNCTION CODE EXAMPLES

28 FUNCTION CODE 12 Paid Time Off Examples: Paid time off for a Holiday, sick leave, vacation, or jury duty FUNCTION CODE EXAMPLES

29 FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION Purpose:  The information and data that substantiates and supports reimbursable activities claimed on the Time Study.  Ensures Program Integrity  Informs Auditor

30 FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION Documentation Requirements:  Requirement of All FFP Staff  Evidence of FFP Activities Performed  Provides Audit Trail  Accessible and Available  Records Must Be Retained

31 FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION Example – SPMP Program Planning And Policy Development – Function Code 8 Good  5/21/09 from 12:00-2:00 (when) – Attended the South Bay Prenatal Access Task Group meeting (where). The membership, doctors and nurses (who), discussed and made plans (what) to increase access to prenatal care clinics (why).  Other relevant details might include the meeting agenda and participant list Poor  Met with the South Bay Prenatal Access Task Group about access to prenatal care clinics

32 FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION Supporting Documents:  Job specifications  Duty statements  Organizational chart  Scope of Work

33 FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION Guidelines and Suggestions:  No standardized form but must provide evidence  Notes should be detailed and specific  Attach other types of documentation, such as, agendas, day planner, flyers, client notes, etc.

34 Secondary Documentation can be anything an agency chooses, but it should include the following elements:  Date  Time Spent  Activity  Program FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION

35 Secondary Documentation can be anything an agency chooses, but it should include the following elements:  Identify the client/Program/Event for which the activity was performed  Function Code FEDERAL FINANCIAL PARTICIPATION (FFP) SECONDARY DOCUMENTATION

36 REMEMBER  Secondary documentation must support time study  If not supported, FFP activities cannot be reimbursed

37 MCAH Business Partners Pages/default.aspx RESOURCES

38 QUESTIONS?

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