1. 1 Remedial Services Financial and Statistical Report Training January 20, 2009

2. 2 General Overview

3. 3 What is a Financial & Statistical Report? Also called cost report. The purpose of the cost report is: To define the reasonable and proper cost of each RSP service, To establish a per unit payment rate for Medicaid- payable remedial services, and To determine a final reconciliation to actual and allowable RSP cost, also called a settlement amount. Report actual and allowable cost for Group Foster Care, which is used by the DHS Bureau of Purchased Services.

4. 4 Cost Report Submission Costs should be submitted for a 12-month period consistent with the agency fiscal year. Submitted using Form 470-4414, Financial and Statistical Report for Remedial Services. Must be received within 3 months of the end of the agency fiscal year. Failure to submit a complete cost report may result in a reduction of payment, eventually down to $0.

5. 5 Annual Cost Report Overview The cost report must be completed on the accrual basis of accounting. Information to complete the cost report may come from various sources. Personnel, payroll, provider expense records, activity logs, mileage logs, time studies or square footage studies are examples of tools that may be used to compile information to complete the cost report. RSP costs are not reimbursable under other funding sources. Cost incurred for other services shall not be reported as reimbursable for RSP. Regulations regarding the RSP cost report submission are located in Iowa Administrative Code Section 441, Ch. 79.

6. 6 What to Send and Where Per IAC 441 Chapter 79.1(23)(b)(2) Form 470-4414 available on the IME website at http://www.ime.state.ia.us/Providers/Forms.html http://www.ime.state.ia.us/Providers/Forms.html Due within 3 months of the agency fiscal year end. Email completed cost reports and documentation to: costaudit@dhs.state.ia.us (Preferred Method) costaudit@dhs.state.ia.us Mail paper copies to Provider Cost Audit & Rate Setting Unit, PO Box 36450, Des Moines, IA 50315 A signed copy of the Certification Page must be mailed, with original signatures, through US Mail, FedEx, etc. Fax or email is not acceptable.

7. 7 Parent (Consolidated) Cost Report Agencies that are offering RSP using more than one Medicaid provider number must prepare a parent cost report by consolidating all costs and units from the cost reports of each separate RSP provider number within their agency. Include the Tax ID Number on all cost reports and report PARENT as the report type on the Identification Page of the parent cost report.

8. 8 Submission Deadline Extension Per IAC 441 Chapter 79.1(23)(b)(3): A provider may obtain a 30-day extension for submitting the cost report by sending a letter to the IME provider cost audit and rate setting unit before the cost report due date. No extensions will be granted beyond 30 days. Requests can be made through email or US Mail. All requests should include the following: Provider Name Full Provider Number: NPI-Taxonomy-Zip9 Applicable Medicaid Program Reason for request

9. 9 Delinquent Cost Reports Per IAC 441 Chapter 79.1(23)(b)(5): If a provider fails to submit a cost report that meets the requirement of this paragraph, the department shall reduce payment to 76 percent of the current rate. The reduced payment rate shall be paid for no longer than three months, after which time no further payments will be made.

10. 10 Supporting Financial Records Per IAC 441 Chapter 79.1(23)(b)(1): Financial information shall be based on the providers financial records. When the records are not kept on the accrual basis of accounting, the provider shall make the adjustments necessary to convert the information to an accrual basis for reporting. Failure to maintain records to support the cost report may result in termination of the providers Medicaid enrollment.

11. 11 Supporting Financial Records Per IAC 441 Chapter 79.3:A provider of a service that is charged to the medical assistance program shall maintain complete and legible records as required in this rule. Failure to maintain records or failure to make records available to the department or to its authorized representative timely upon request may result in claim denial or recoupment. Per IAC 441 Chapter 79.3(1):A provider of service shall maintain records as necessary to: (1)Support the determination of the providers reimbursement rate under the medical assistance program; and (2)Support each item of service for which a charge is made to the medical assistance program. These records include financial records and other records as may be necessary for reporting and accountability.

12. 12 Supporting Financial Records Per IAC 441 Chapter 79.1(23)(b)(4): Providers of services under multiple programs shall submit a cost allocation schedule, prepared in accordance with the generally accepted accounting principles and requirements specified in OMB Circular A- 87. Costs reported under remedial services shall not be reported as reimbursable costs under any other funding source. Costs incurred for other services shall not be reported as reimbursable cost under remedial services.

13. 13 Financial and Statistical Report

14. 14 Provider Identification Page Reports Provider Information: Agency Name City Provider Number – The full number should be used (NPI-Taxonomy-Zip9) Report Type – Actual, Projected or Parent FYE (Fiscal Year End) Reports Unit Cost Summary This data is pulled from Schedule D. No input is required here.

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16. 16 Certification Page The purpose of the Certification Page is to report agency statistical information and record the signature of the authorized officer of the agency. Must receive a signed Certification Page to consider the cost report complete.

17. 17 Certification Page Agency Information Name of Person to Contact with Questions We will generally try to communicate with your specified contact person; however, some circumstances may require us to direct questions to the Medicaid provider instead of a contracted preparer. Independent Audit Not required, although beneficial. May be requested to submit to IME, if available.

18. 18 Certification Page Agency Information Type of Entity: Government, Non-Profit, Proprietary Type of Control: Individual, Partnership, Corporation, S-Corp Accounting Basis: Accrual, Modified Cash, Cash oThis question refers to how your agency operates. oThe Cost Report must be completed using the accrual basis. oAdjustments to convert to an accrual basis are required if your records are maintained on another basis. The intent of these adjustments is to obtain information concerning the costs of providing services on a basis that is fair and comparable among providers of the service.

19. 19 Certification Page Agency Information

20. 20 Certification Page Statistical Data for Period of Report #2 – If subject to licensure, number of clients licensed for: Required for Group Foster Care services only. #3 – No. of units of service (licensed or staffed) Required for Group Foster Care services only, optional for RSP services. Indicate if you are reporting licensed units or staffed units (bold, underline, circle, etc.).

21. 21 Certification Page Statistical Data for Period of Report #4 – Total number of units of service provided Should equal the sum of Questions 5a and 5b. Does not include units of Other Programs. Includes all units of service provided regardless of whether or not payment has been received (includes denied claims, claims not yet submitted to IME, pending claims, etc.). #5a – DHS Units DHS = IME (Title XIX) #5b – Other Client Units Should be fairly rare

22. 22 Certification Page Statistical Data for Period of Report #6 – Percent of units provided to unit capacity Required for Group Foster Care services. Service Columns A separate column for each RSP or Group Care service. Only complete a column for the services you have provided during the cost report period.

23. 23 Certification Page Statistical Data for Period of Report

24. 24 Certification Page Signatures Signature of Office or Administrator Certifies that the information is true and correct. Also certifies that the cost report was prepared from the records of the facility in accordance with the instructions and that unnecessary expenses were properly excluded. Signature of Preparer (If other than Agency) Statement that the cost report was prepared to the best of knowledge and belief, represents true and accurate data of the agency.

25. 25 Certification Page Signatures

26. 26 Schedule A Revenue Report Total Revenue The Total Revenue column includes all revenues, including those from other programs Should reconcile to General Ledger Revenues Is not limited to just RSP/Group Care DHS = IME A supporting schedule should be submitted for allOther Revenues, Contributions and Government Grants oThe supporting schedule should include at a minimum: Source and amount of income, description of restriction/appropriation (if applicable), purpose and period of grant & applicable program.

27. 27 Schedule A Revenue Report Revenue for Sch D Expense Deduction Income not directly related to the provision of service as well as contributions restricted/appropriated to an individual should offset expense, to the extent of the related expense on Schedule D. oRevenue deductions on Schedule A should reconcile to deductions on Schedule D. oAll Revenue Deductions should be reported, regardless of program. oExamples: Investment/Interest Income Rent Income Food/Phone reimbursement Vending

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29. 29 Schedule B Gross Salaries & Staff Numbers The purpose of Sch B is to report full-time equivalent numbers of staff and wages by job title. Wages reported on Sch B should reconcile to wages reported on Sch D, Column 1. Detail the job titles under each classification with the applicable number of staff, FTEs and Wage information. 1.0 FTE is considered to be 2,080 paid hours. Detailed instructions for calculating FTEs are included in the RSP Provider Manual, page 20.

30. 30 Contracted Staff A supporting schedule for contracted staff should be submitted. Include: Name & Title, Wage Rate, Total hours worked during the period, and Where expense is reported on Sch D

31. 31 Related Party Compensation Per CMS Publication 15-I 902.1 – The allowance of compensation for services of sole proprietors and partners is the amount determined to be the reasonable value of the services rendered regardless of whether there is any actual distribution of the profits of the business. Reasonable Cost for purposes of Medicaid-payable services is defined as that amount of cost or expenses that would ordinarily be incurred by similar providers in similar markets. It is that level of cost which a prudent and cost conscious buyer of goods and services is ordinarily willing to incur in providing these kinds of services (provider manual, page 15). Each provider is responsible for keeping documentation to support their methodology and calculation of reasonable compensation. This should be submitted to IME with the cost report.

32. 32 Related Party Compensation Per CMS Publication 15-I 902.2 – Compensation (for Corporate Owners) may be included in allowable provider cost only to the extent that it represents reasonable remuneration for managerial, administrative, professional and other services related to the operation of the facility and rendered in connection with direct patient care. Services not related to patient care, are not recognized as an allowable cost. Payments found to represent a return on equity capital are not compensation and are in no event allowable as an item of reimbursable cost. Nor are such payments considered as compensation for purposes of determining the reasonable level of reimbursement of the owner.

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34. 34 Schedule C Depreciation & Amortization Expense The purpose of Schedule C is to report information related to depreciable assets. Schedule C includes the original acquisition costs, capital improvements, and depreciation on buildings and equipment owned by the provider. May submit an Asset Depreciation Schedule from your accounting system in lieu of Schedule C. This must include subtotals and reconcile to Schedule D.

35. 35 Schedule C Depreciation & Amortization Expense The total depreciation amounts reported on Sch. C must reconcile to the amounts reported on Sch. D. Any property expenses related to providing room and board are not reimbursable under rule for the RSP program and should be excluded. Depreciation expense must be calculated using the straight-line method. If the agency does not use the straight-line method, the difference between methods should be adjusted in Column 3 of Schedule D so that only Straight-line Depreciation Expense is allocated.

36. 36 Schedule C Depreciation & Amortization Expense To determine the estimated useful life on new assets, the American Hospital Association guidelines should be followed. If a depreciable asset at the time of its acquisition has an estimated useful life of at least two years and a historical cost of at least $5,000, the cost must be capitalized and depreciated over the estimated useful life.

37. 37 Schedule C Depreciation & Amortization Expense When items are purchased as an integrated system, all items must be considered as a single asset when applying the capitalization threshold. Items that have a stand-alone functional capability may be considered on an item-by-item basis. For example, an integrated system of office cubicles must be considered as a single asset; Stand-alone office furniture such as a chairs may be considered on an item-by-item basis.

38. 38 Schedule C Depreciation & Amortization Expense Change of Ownership If a change of ownership occurs, the historical cost of the assets acquired will be the historical cost less depreciation allowed to the previous owner (book value).

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40. 40 Schedule C Related Party Property Cost If property is leased from a related party, information regarding the lessors costs must be submitted on Schedule C. Related party is defined as an ownership related through control, form ownership, capital investment, directorship or other means. Related party property cost is limited to the lessors cost.

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42. 42 Schedule D Expense Report The purpose of Schedule D, is to report total agency expenses and allocate those expenses to the various services provided by an agency. The allocation of costs per service includes all costs for the agency and should be consistent with the costs included on the general ledger.

43. 43 Schedule D Expense Report Direct Cost includes expenses that are identifiable to a specific service. Direct cost could include, but is not limited to: All direct personnel & immediate supervisors involved in a service (salary, benefits and payroll tax), Mileage costs for travel necessary in the provision of service Time spent documenting services provided, Time spent in staff meetings related to a specific service, Occupancy expenses related to space dedicated to a specific service.

44. 44 Schedule D Expense Report Indirect Cost includes expenses that are not identifiable to any specific service. This includes expenses incurred to benefit all functions of the agency. Indirect Cost will be allocated across all programs. Therefore, all expenses included in Indirect Cost must be allowable under all programs. Indirect Costs can include, but are not limited to: oAdministrative and Clerical staff, oOffice supplies, oOccupancy Expense related to general use areas, oProperty or liability insurance.

45. 45 Schedule D Expense Report Provide supporting documentation for the allocation method used in determining indirect costs and in apportioning direct costs (Provider Manual, Page 16). In general, ensure that supporting documentation is maintained for all costs reported and numbers of staff devoted to remedial services and group foster care.

46. 46 Schedule D Expense Report Gross Total – Column 1: Report total operating costs of the agency. Any difference between the amounts shown in this column and the audited financial statements, general ledger or working trial balance must be disclosed in a supplemental schedule. Revenue Adjustments – Column 2: Use this column to offset expense with related revenue. These adjustments come from Schedule A.

47. 47 Schedule D Expense Report Excluded Cost – Column 3: Use this column to remove expense that is not reimbursable under the Medicaid program. This column should not be used to report Other Program Expense. Excluded Cost may include, but is not limited to, the following: Fundraising, Bad Debt, Fines and penalties, Lobbying (includes the portion of certain organization dues apportioned for lobbying), The difference between Straight-Line Depreciation and another method, Promotional advertising/marketing, Mileage expense in excess of the State Reimbursement Rate, Other expenses unallowable per OMB Circular A-87, Att. B.

48. 48 Schedule D Expense Report Excluded Cost – Mileage Limit: Mileage cost is limited to the DHS employee reimbursement rate. Any reimbursement paid to employees in excess of the limit should be excluded in Column 3. The current mileage rate can be found at the Department of Administrative Services website: http://www.das.iowa.gov http://www.das.iowa.gov The policy is located under the Fleet and Mail Services menu o7/1/05 – 12/31/07$0.34 o1/1/08 – Current$0.39

49. 49 Schedule D Expense Report Adjusted Cost – Column 4: This column shows costs that are allowable and allocable to RSP, Group Foster Care, Other Programs and Indirect Expense (Gross Cost - Revenue Deductions - Excluded Cost = Adjusted Cost). RSP Direct Service Cost – Columns 5 to 14: Use these columns to report costs directly associated with RSP services. Group Foster Care Direct Cost – Columns 12 & 13: Use these columns to report cost directly associated with group care service and maintenance. This data is summarized from Supplemental Schedule D-1.

50. 50 Schedule D Expense Report Other Program Direct Cost – Column 14: Use this column to report cost directly associated with any program other than RSP or Group Care. Other Programs may include: oChildrens Mental Health or other HCBS Waivers oLPHA Assessments oPrivate Pay Therapy Services oFamily, Safety, Risk and Permanency Services oEducational Programs You must maintain documentation to support Other Program cost. These documents must be organized, in detail by program or service and in an easily audited format. The IME may conduct periodic audits of this information (Provider Manual, Page 27).

51. 51 Schedule D Expense Report Total Facility Indirect Cost – Column 15: This column includes costs that benefit all functions of the agency and cannot be directly related to any specific service or program. These costs will be allocated to all programs on the last page of Schedule D. All line items may be used to report indirect expense in Column 15.

52. 52 Schedule D Expense Report Total Facility Indirect Cost – Continued: Each agency is responsible for developing an acceptable method of distributing indirect cost to the various programs and supporting its rationale. The standard method is based on the total accumulated direct costs for each program before the indirect cost allocation. If an agency believes that another allocation method is more appropriate, it may be used. However, the agency must submit documentation to support and justify the alternate allocation basis used.

53. 53 Schedule D Expense Report Unit Cost Calculation – Last Page of Sch D: Total Direct + Total Allocated Indirect = Total Expense for each service Revenue Deductions: If deductions were not reported in Column 2, they may be entered here to reduce Total Expense for each Service Units: Total Expense after Deductions is divided by Total Units for each Service oMust include all units of service provided, regardless of whether or not payment has been made

54. 54 Common Expense Issues: Calculation or Completion Errors These errors are the most common reasons why a review is put on hold during preliminary review: Hand-written cost reports are too difficult to read, Other Program Cost is not included, All columns on Schedule D correctly total, Each line cross-foots (totals across), Col. 1 minus Col. 2 minus Col. 3 = Column 4 The sum of Column 5 through Column 15 = Column 4 Sch. A Total Revenue reconciles to Sch. E, Sch. A Revenue Deductions reconcile to Sch. D, Sch. B Total Salary Expense reconciles to Sch. D, Sch. C Total Depreciation Expense reconciles to Sch. D, Sch. D Gross Total Expense reconciles to Sch. E, Sch. D Group Care Expense reconciles to Sch. D-1, Schedules specific to Group Foster Care are included.

55. 55 Common Expense Issues: Benefits & Payroll Tax Employee benefits and payroll taxes should be allocated across direct program expense and indirect expense using the same method as salary expense. Per the Internal Revenue Code, FICA is to be 7.65% of wages up to a specific limit (changes annually). Sole proprietors may only claim the Employer share of FICA for reimbursement, not the Employee share. Report actual FICA expense, not the amount of estimated payments.

56. 56 Common Expense Issues: Personal Property Expense Includes expenses such as Personal Home Office Expense or use of a Personal Vehicle Must be able to support the proportionate amount of time, space or expense that is for business purposes versus personal purposes. This may include square footage calculations or tracking all miles driven. Out of total business expense, must be able to further determine the amount applicable as a direct or indirect expense of each program and that it is a necessary expense for patient care. These calculations must be performed annually.

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63. 63 Supplemental Schedule D-1 Group Care Expense Report The purpose of Supplemental Schedule D-1 is to report expenses related to each level of Group Care Maintenance and Service. These expenses are summarized on Schedule D. Only agencies with multiple levels of Group Care need to complete Schedule D-1. This is optional for agencies that provide one level. After Schedule D-1 is completed, cost in Columns 9 & 10 of Schedule D-1 should equal cost in Columns 13 & 14 of Schedule D.

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66. 66 Schedule E Comparative Balance Sheet The purpose of Schedule E is to report the balance sheet of the provider as of the end of the reporting period. Total assets must equal the total liabilities and equity. Under, Reconciliation of Equity or Fund Balance,, the add and deduct entries should be completed to calculate the current fund balance reported on the balance sheet.

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68. 68 Schedule F Cost Allocation Procedures The purpose of Schedule F is to report other supplemental information related to agency operations and accounting procedures. Cost allocations are required for direct costs benefiting more than one service or service component and for the providers indirect costs. Direct Costs are defined as those which are directly identifiable to services or components. Indirect Costs are defined as those which are not readily identifiable with each service or service component.

69. 69 Schedule F Cost Allocation Procedures The schedule provides questions regarding methods used in allocating expenses which benefit more than one service or service component. The provider should send supporting documentation for the allocation basis of these costs.

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71. 71 Schedule G – Part I Supplemental Allocation Report The purpose of Schedule G Part I is to identify those costs, as allocated to Group Foster Care, eligible for Federal IV-E funding reimbursement by the Department. Schedule G Parts I & II are used to validate Iowas Title IV-E funding assumptions about the allocation of Group Foster Care costs to maintenance and service activities. Only those cost centers for which Iowa is eligible to seek Federal IV-E reimbursement are included. Only agencies with contracts for Group Care Service and Maintenance (Dx6x; Dx9x) must complete Sch G. Sch G will include cost for Group Care only. It will not include RSP cost or Other Program Cost.

72. 72 Schedule G – Part I Supplemental Allocation Report Column C, Direct Costs: Enter the total combined direct cost for Group Care Service and Maintenance from Schedule D for each listed cost center. Benefits and Taxes: These expenses are reported on Schedule D in total for all staff classifications. Therefore, you will need to enter the proportionate expense equal to the percentage of benefits and payroll tax expense applicable to each staff classification listed. Example: Group Care Direct Care Salaries are 30% of Total Group Care Salaries. Therefore, 30% of Total Group Care Benefit and Payroll Tax expense will be reported as Direct Care Benefits and Payroll Tax.

73. 73 Schedule G – Part I Supplemental Allocation Report Column D, Allocation of Indirect Cost: Allocate indirect cost using the following steps: Step 1: Using Schedule D, Divide Total Group Care Indirect Cost by Total Group Care Direct Cost. This will result in a percentage. Step 2: Multiply amounts in Column C of Sch G Part I by the percentage calculated above. Step 3: Determine the proportionate share of Total Facility Indirect Expense from Sch D that is applicable to Group Care. Step 4: Determine the Group Care proportionate share of Indirect Expense for each Cost Center. Step 5: Record the lesser amount from Step 2 and Step 4 as Indirect Cost in Column D of Sch G Part I.

74. 74 Schedule G – Part I Supplemental Allocation Report Column D, Allocation of Indirect Cost Example See handout from the Training portion of the IME Website. The handout is an Excel document entitled G Part I Example

75. 75 Schedule G – Part I Supplemental Allocation Report Column E, Total Costs: Add Column C (Direct Cost) to Column D (Indirect Cost) and enter in Column E. Column F & G, Allocation of Total Cost to Maintenance and CW Service: Allocate Total Cost according to the Provider Manual Instructions, using one of the following methods: As specifically indicated in the manual, Time Study, oTime Studies should be performed at least quarterly, as specified in the provider manual, Square Foot Usage Study, oSquare Foot Usage Studies must be performed annually over at least a two week study of the spaces use.

76. 76 Schedule G – Part I Clarification of Line 2480 Line 2480 Inconsistency Schedule D: Attorneys Fees Schedule G Part I: Formalized Non-Family-Like Recreation Sch. D Instructions: Report Attorneys Fees on Line 2480 Report both Family-Like and Non-Family-Like Recreation Expense in Line 2540 – Recreation and Craft Supplies Non-Family-Like Recreation is not an allowable expense. This will need to be excluded in Column 3 of Sch. D. Sch. G Part I Instructions: Report Family-Like Recreation Expense on Line 2540 Leave Line 2480 blank. Do not report either Attorneys Fees or Non-Family-Like Recreation expense.

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78. 78 Schedule G – Part II Supplemental Allocation Report Remainder of Program Direct Costs: Total Group Care Direct Expense from Sch D less Sch G Part I Column C Direct Expense. Remainder of Program Indirect Costs: Total Group Care indirect Expense from Sch D less Sch G Part I Column D Indirect Expense. All other amounts should calculate automatically. Detailed instructions are in the provider manual, if needed.

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80. 80 Allocation of Staff Time Worksheet The purpose of the Time Study Worksheet is to validate the salary expenses required for the delivery of service. This is an essential part of the review because salaries are the single greatest expense for any provider.

81. 81 Allocation of Staff Time Worksheet Required for all Group Foster Care Providers Beginning in 2007, all childcare and professional social services staff should do 100% time reporting for four days (3 within the school year, 1 during summer). Each odd numbered year thereafter, these staff should do 100% time reporting for two days each quarter of the fiscal year. Providers may want to perform the study more often if necessary to adequately reflect how staff spend their time during the course of the year. Recommended for ALL providers The time study form is not required for all RSP providers; however, all providers are required to be able to support how they have allocated expenses. A time study is the best way to do this.

82. 82 Allocation of Staff Time Worksheet Time spent on all activities should be reflected. This would include Maintenance, Child Welfare Service, Medicaid RSP, Administration, and Other Programs. Total time should equal 100%. The result of the time study should be used to allocate expenses on the cost report.

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84. 84 Determination of Payment Rates Interim Rates Remedial Service Providers will be paid on an interim rate until a finalized rate is established based on an annual cost report. First Year: The interim rate was established by the Iowa Medicaid Enterprise. On-Going: The interim rate is equal to the previous years finalized payment rate.

85. 85 Determination of Payment Rates Finalized Rates The finalized payment rates will be established retrospectively after review of Actual and Allowable Cost per Unit from the annual cost report. Retrospective - the finalized rate becomes effective the first day of the cost report period. Becomes your new Interim Rate. Increased by 1% for services provided on or after July 1, 2008. Subject to a Rate Maximum for FYE 2009, and after.

86. 86 Determination of Payment Rates Rate Maximum Interim and Finalized rates for FYE 2009 and after will be limited by Rate Maximums. Rate Maximums are based on 110% of the average allowable costs. This average will be inflated using the US Consumer Price and applied prospectively. The new Rate Maximums will be made available by July 31 st each year.

87. 87 Determination of Payment Rates Rate Maximum The Fiscal Years Ending 2009 Rate Maximums are as follows (See Informational Letter No. 763): 96152 - $23.84 96153 - $ 6.01 96154 - $27.75 H0037 - $71.85 H2001 - $64.41 H2011 - $22.65 H2014 - $19.76

88. 88 Determination of Payment Rates Example After review of a cost report for the period of 1/1/07 – 12/31/07, the actual and allowable cost per unit for 96152 was $23.71. The FYE 2009 rate maximum for this code is $23.84. The rates would be established as follows: 1/1/07 – 12/31/07$23.71 (finalized rate for the cost report period) 1/1/08 – 6/30/08$23.71 (interim rate) 7/1/08 – 12/31/08$23.95 (interim rate including the 1% increase) 1/1/09 – Open Ended$23.84 (interim rate subject to the Rate Max)

89. 89 Determination of Cost Settlement Amount Cost Settlement is performed by adjusting each individual paid claim. For each claim, payments made at the interim rate are taken back and new payments are made at the finalized rate. This is evidenced by negative amounts on your remittance advice followed by a positive amount for each claim.

90. 90 Determination of Cost Settlement Amount The Settlement Amount is the net of all the negative and positive claims paid for all RSP services. Shown on the last page of the Remittance Advice. Amounts Due Provider will be paid through the usual process. Amounts Due IME will be recouped as new Original Claims are billed.

91. 91 Related Websites

92. 92 Contact Information Iowa Medicaid Enterprise Provider Cost Audit and Rate Setting Unit Email: costaudit@dhs.state.ia.uscostaudit@dhs.state.ia.us Iowa Medicaid Enterprise PO Box 36450 Des Moines, IA 50315 515-725-1108 (Local) 866-863-8610 (Toll-Free)

93. 93 Contact Information Department of Human Services Bureau of Purchased Services Jody Lane-Molnari jlanemo@dhs.state.ia.us 515-281-8369

94. 94 Questions?