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Consumer Directed Service Agency (CDSA) Financial Errors Monitoring Guide DADS Form 1723, Instructions, and Appendices.

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Presentation on theme: "Consumer Directed Service Agency (CDSA) Financial Errors Monitoring Guide DADS Form 1723, Instructions, and Appendices."— Presentation transcript:

1 Consumer Directed Service Agency (CDSA) Financial Errors Monitoring Guide DADS Form 1723, Instructions, and Appendices

2 DADS Form 1723 Demographic Information 1. Consumer and Employer 2. CDSA Provider Agency 3. Monitor,Review Date, Review 3. Monitor, Review Date, Review Period, Review Type Period, Review Type Contract Monitoring Guide - Page 1

3 Financial Errors 2.TERMINATION of CDS during first 90 days – CDSA bills: (SFY / SFY ) a)0 – 30 Days = $ / $ b)31 – 60 Days = $89.01 / $90.00 c)61 – 90 = $29.67 / $30.00 Contract Monitoring Guide - Page 1 Note: 1.ORIENTATION by CDSA to Employer/DRP – Not a billed service

4 Review documentation of services delivered with service delivery dates during the review period for each service area in CDS: 1. 1.Timesheets, 2. 2.Receipt, 3. 3.Invoices, and 4. 4.Documentation of a) a)Withholding and Accrual, OR b) b)Deposit and Payment Contract Monitoring Guide - Page 1 ERROR #1 Reimbursement of services not documented as being delivered

5 Error #1 Reimbursement of services not documented as being delivered Withholdings and Accruals Must be billed only one time. May be billed either: 1.withholding/accrual 1.At time withholding/accrual is made, OR 2.deposit/payment 2.At time of deposit/payment of the withheld or accrued amount. Withholding Withholding = Employee and Employer share for taxes Accruals Accruals = Employer Unemployment Taxes, Benefits (Bonus, Administrative Purchases) Contract Monitoring Guide - Page 1

6 Error #1 Reimbursement of services not documented as being delivered Withholdings and Accruals MUST be budgeted, Contract Monitoring Guide - Page 1 MUST be withheld or accrued only from WORKED hours MUST be billed only one time.

7 ERROR #3 Reimbursement of services not delivered to the consumer. Services delivered that were: 1.Not authorized, 2.* Not allowable, 3.Provided on behalf of someone other than the consumer. * Refer to Appendix XI and program- specific requirements/guidelines. Contract Monitoring Guide - Page 1

8 ERROR #4 Reimbursement of services when the consumer was not eligible. Services delivered when the consumer was not eligible for : 1.The program, 2.The * program service, 3.The funding source, or 4.Participation in CDS. * Refer to program-specific requirements/guidelines. Example: Not eligible for our-of-home respite. Contract Monitoring Guide - Page 1

9 ERROR #5 Reimbursement in excess of spending- limit for administrative expenses by the employer Budgeted amount for Administrative Expenses: Budget will not be VALID if in excess of spending limit established by HHSC Budget will not be VALID if in excess of spending limit established by HHSC Budget calculates the spending limit based on payment rules for CDS. Budget calculates the spending limit based on payment rules for CDS. Contract Monitoring Guide - Page 1

10 ERROR #6 CDSA is reimbursed in excess of allowable CDSA-portion of the service rate Budgeted amount for CDSA-portion is calculated in the budget based on: The program, The program, The service, and The service, and The service delivery date (SFY) The service delivery date (SFY) Appendix VI: SFY 2004 – 2005 and SFY Contract Monitoring Guide - Page 1

11 Appendix XIV Financial Monitoring Worksheet #1 Financial Review Month: June 2005 REIMBURSEMENT / PAYMENT HISTORY

12 Appendix XIV Financial Monitoring Worksheet # 1 Financial Review Month: June 2005 REIMBURSEMENT / PAYMENT HISTORY

13 Appendix XIV Financial Monitoring Worksheet # 1 Financial Review Month: June 2005 REIMBURSEMENT / PAYMENT HISTORY EQUIVALENT UNITS FOR CALENDAR REVIEW MONTH

14 DADS Form 1723 – Page 2 Financial Review Month: June 2005 DADS Form 1723 – Page 2 Financial Review Month: June 2005 Appendix VI – Service Groups, Service Codes, Billing Codes and Partial Billing Appendix VIII – Calculating Employers Maximum Admin. Expense Amount Appendix VII – FY 2004 – 2005 Community-Based Payment Option

15 DADS Form 1723 – Page 2 Financial Review Month: June 2005 DADS Form 1723 – Page 2 Financial Review Month: June 2005 Fiscal Audit Sample – Billing and Reimbursement History = $ Review Period Timesheets - $ Calculated Reimbursement Overage = $ 40.00

16 Appendix XIV Financial Monitoring Worksheet # 1 Financial Review Month: June 2005

17 Appendix XIV Financial Monitoring Worksheet # 1 Financial Review Month: June 2005 Calculation of non-reimbursable, excess Employer Portion Amount (paid and accrued) for Employees.

18 Appendix XIV Financial Monitoring Worksheet # 1 Financial Review Month: June 2005 Calculation of Employer Contributions for Excess Hours reimbursed for Employees Gross Pay = # Hours Worked times Hourly Rate + Benefits + Overtime

19 Appendix XIV Financial Monitoring Worksheet # 1 Financial Review Month: June 2005 Calculation of Employer Contributions for Excess Hours reimbursed for Employees Gross Pay = # Hours Worked times Hourly Rate + Benefits + Overtime

20 Appendix XIV Financial Monitoring Worksheet # 5 and # 6 No Administrative Expense Budgeted for June 05

21 Appendix XIV Financial Monitoring Worksheet # 5 and # 6

22 Financial Review Month: June 2005

23 DADS Form 1723 – Page 2 Financial Review Month: June 2005 DADS Form 1723 – Page 2 Financial Review Month: June 2005 F# 5. The provider agency is reimbursed in excess of the maximum amount allowed for employer-related administrative expenses. (Employer-Related Administrative Expenses: advertising/recruiting, training, criminal investigation checks, equipment, copy, mail, travel costs, supplies, uniforms, Hep B vaccinations, CPR) DADS applies the error to the total amount reimbursed in excess of the maximum amount allowed and/or budgeted for the cost. [Employer Portion / 1.10] Maximum Admin: Accrued + Total = $ 0.00 $ Amount Reimbursed: $ 0.00 = Excess Amount Reimbursed : $ 0.00

24 DADS Form 1723 – Page 2 Financial Review Month: June 2005 DADS Form 1723 – Page 2 Financial Review Month: June 2005 F# 6. The provider agency is reimbursed in excess of the allowable CDSA portion. DADS applies the error to the total dollar amount reimbursed in excess of the allowable CDSA portion. X CDSA Reimbursed Amount: $ Reimbursable Amount: $ = Excess Amount Reimbursed: $ 4.86 Note: The calculation worksheet is available in Appendix XIV of the Consumer Directed Services Handbook.

25 DADS Form 1723 – Page 1 DADS Form 1723 – Page 1 Texas Department of Aging and Disability Services Consumer Directed Services Consumer Directed Services Agency (CDSA) Financial Errors Form 1723 August 2005 Case Record Summary of Financial Errors 100% Financial Recoupment

26 DADS Form 3687 – Page 1 DADS Form 3687 – Page 1 Texas Department of Aging and Disability Services Provider Agency Findings of Fiscal Monitoring Review Form 3687 June 2001

27 DADS Form 3687 – Page2 DADS Form 3687 – Page2 Texas Department of Aging and Disability Services Form 3687 June 2001

28 Reimbursement CDSA Responsibilities Reimbursement CDSA Responsibilities Verification: Spending Limits Withholdings Benefits Hourly Wages Overtime Allowable Program-specific Funding SourceValidation: Budget: VALID Status Budgeted Item Service Provider: Qualified Eligible Documentation of Service Delivery – Program Specific and CDS Criteria 1. Budget Verification and Validation

29 Reimbursement CDSA Responsibilities Reimbursement CDSA Responsibilities Verification: Budgeted Allowable Reasonable Necessary Year-to-Date Program-specific Funding SourceValidation: Service Provider: Qualified / Maintained Eligible / Maintained Documentation of Service Delivery – Timesheets, Invoices, and Receipts Program Specific Criteria CDS Criteria Employer-Approved 2. Spending Verification and Validation

30 CDSA Financial Monitoring Comments Q & A


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