1. Program Issues, Contract Requirements or Payments Contact Tina Bumgarner Tina.Bumgarner@ncmail.net (704) 462-2686 Cost Report & Time Study questions Contact Mike Thompson Mike.Thompson@ncmail.net (919) 855-3684 2009 IV-E Foster Care Cost Report Training

2. Medicaid Services Medicaid services reporting questions Contact Christal Kelly Christal.Kelly@ncmail.net (919) 855-4218 NC Department of Health and Human Services Division of Medical Assistance 2501 Mail Service Center Raleigh, NC 27699-2501

3. Agenda 1)Rate Setting Process 2)Cost report package 3)Foster Care definitions 4)Relationship between the Time Study and the Cost Report 5)Daily Supervision vs Foster Care Activities/Social Service 6)Tips

4. Rate Setting Process Agencies must qualify through the Division of Social Services Agencies submit their Audit, Cost Report and Time Study to Office of the Controller Cost Report and Time Study are reviewed by Office of the Controller

5. Cost Report Package In order to obtain a foster care rate, an agency must submit the following no later than the due date (March 16, 2009) * Residential Treatment and Foster Care Cost Report * Documentation of Child Care days * Financial Audit * Time Study participation * Supplemental Schedules/Reports Agencies should perform a self check on the cost report using the: * Rate Review Work Sheet

6. Cost Report Basics  Cost report is based on the audit  Child care days must be separated by service  Total expense on Schedule C must match audit  The expense for each program in the audit should match that program on the cost report  Admin should be reported in the admin column, unless it is allocated in the audit

7. Audit Requirements Audits must show both revenues and expenditures. Revenues must be broken out by fund type. Expenditures must show a separation between administrative costs and program costs. Administrative costs must also delineate between management and fund-raising costs. Program costs must be delineated by type as well as identify specific allowable foster care costs within each type.

8. Terms for Cost Reporting Therapeutic vs. treatment or Foster Care? Medical necessity and Medicaid authorization for mental health service

9. Terms for Cost Reporting Foster Care Maintenance Payment Payment to cover the cost of, and the cost of providing: Food Clothing Shelter Daily Supervision School supplies Personal Incidentals Liability Insurance Travel to the child’s home for visitation Includes reasonable administration and operation for institutional care

10. Non-Allowable Costs: Items Not Covered by IV-E Funding §Recreation other than the occasional expense allowed in Personal Incidentals §Expenses not directly related to providing room, board, supervision and necessary administration, such as swimming pools, gymnasiums, chapels/churches, housing other than the residential facilities occupied by the children in care. §Medical and social services treatment or services §Educational expenses other than school supplies §Gifts §Food served at banquets, or training

11. Recreation is NOT an allowable item of expense, except where it clearly substitutes for daily supervision – CWPM 8.3B.1 (1)d.CWPM 8.3B.1 (1)d A child’s personal incidentals can include the reasonable and occasional cost of such items as tickets or other admission fees for sporting, entertainment or cultural events or dues for clubs. – CWPM 8.3B.1 (2)

12. Successful Time Study Participation Only time performing FC/SS activities is reported on time study All time performing as FC/SS is reported on time study Communication is key Ensure participants have the definitions

13. Daily Supervision vs FCA/SS §Daily supervision – performing routine day- to-day care and supervision of children. §Foster Care Activities/Social Services – performing activities described in the Foster Care Service Definitions, such as case management, referral to services, etc.

14. Daily Supervision vs FCA/SS Daily Supervision §NOT reported on the Time Study §Expense is reported on lines 14-16 of the Cost Report FCA/SS §IS reported on the Time Study §Expense is reported on lines 18-20 of the Cost Report

15. Time Study - General Instructions Required by federal regulations To document allowable activities for inclusion in the rates Participation is based on activities, not title or position. Use DSS Definitions of Foster Care Activities

16. Time Study to Cost Report relationship Time Study determines the allowable portion of activities Time Study determines the allowable portion of activities FCA/SS salary expense is multiplied by non-allowable percentage FCA/SS salary expense is multiplied by non-allowable percentage The non-allowable expense is removed during cost analysis The non-allowable expense is removed during cost analysis The time study does not separate daily supervision from FCA/SS The time study does not separate daily supervision from FCA/SS

17. Agency staff will collect the reports, verify that all entries are complete and Program Codes are correct. Agencies are requested to submit the completed time sheets to the Controller’s Office, to be received by March 16, 2009. Retain a copy of the daily work sheets for your files and audit purposes and mail (paper originals) or email (Excel) sheets to: DHHS FC Rate Setting Office of the Controller 2019 Mail Service Center Raleigh, North Carolina 27699-2019 mike.thompson@ncmail.net Time Study - General Instructions

18. Agency ID - Changed to DSS Agency ID; auto fill Time Study - Specific Instructions Agency Totals Worksheet Agency Name - Dropdown list Service Type - Residential or Family Foster Placement

19. Agency ID and Name – from Agency Totals Worksheet Time Study - Specific Instructions Employee Worksheets Employee Last & First Name – text Date - Enter the numeric date. Excel is limited to numbers 1-31, dropdown list Line Number - Pre-printed Description of Activity - Enter category from Foster Care Activities Definitions; dropdown list Minutes - Enter in 15 or multiples of 15. Excel limited to multiples of 15 from 15 – 720. Service and Program Codes – Entered automatically based on Description of Activity

20. Allocation of Program Code A It is used to allow for the inclusion of time/expense allocated to social service activities not detailed in O or Z such as expense for absences due to sickness or vacation. The Time sheets have been modified to capture this information. For example: Allowed Non-allowed AbsencesTotal % Minutes A DayZ O A 1 employee went home sick 120 15 345480 2240240 The remainder of this employee’s time was spent in task not expensed (allocated) to social service activities. 3360 120480 End of Month Total720 135 345120 A Allocation% 84.210526% 15.7894737% 100. % A Minutes Allocated 290.52632 54.4737345 End of Month Total1010.5263 189.4741200

21. Time Study - General Instructions Use DSS Definitions of Foster Care Activities Agency staff will collect the reports, verify that all entries are complete and Program Codes are correct. Submit the completed time study workbook to the Controller’s Office, to be received by March 16, 2009. Retain a copy of the time study workbook for your files and audit purposes T ip - Participants can combine minutes of the same activity performed on a single day.

22. Tips Please submit everything that you can electronically Please do not send hardcopies of anything submitted electronically If your agency does not provide any of the treatment services that must be reported on Schedule C-1, use the smaller cost report Be sure to include any supplemental schedules used to complete the report If “Other Programs” tie in total from the audit to the cost report, the total of “Other Programs” can be entered on line 88

23. All information, forms and schedules for completing the Residential Treatment and Foster Care Cost Report are available at http://www.ncdhhs.gov/control/ under Program Specific Information for: Look for Residential Treatment and Foster Care in the list to link to pertinent information.

24. Questions