DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager

Introduction:  Financial Audits Branch (FAB)  Cost Report Process: Submission Acceptance Approval

Financial Audits Branch (FAB)  Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services  Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.

Cost Report Flow: Submission of Cost Report Acceptance Acceptance Letter Approval Approval Letter Begin Invoicing TCM Program

TCM Cost Reports - Submission  TCM Cost Reports due November 1 st Hard Copy Audit Review and Analysis Section (ARAS) Soft Copy (Audits Section – Sacramento)

TCM Cost Reports - Submission  Hard Copy* – Includes, but not limited to the following: Cover Letter Certification Statement Cost Report (Signed) / Including Funding Schedule Time Survey Template  List Worksheet  Totals Worksheet  Time Sheets Cost Report Review Tool Supporting Documentation *Refer to TCM Cost Report Instructions

TCM Cost Reports - Submission  Soft Copy – Includes the following completed items: Cost Report Template Survey Template  List Worksheet  Totals Worksheet  Time Sheets Funding Schedule Cost Report Review Tool Template

TCM Cost Reports - Acceptance  Acceptance Process : Responsibility of ARAS:  Completion of five page checklist:  Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report Hard Copy Soft Copy  Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions

TCM Cost Reports - Acceptance  Acceptance Process: Contact designated LGA Coordinator for missing and/or incorrect items. Via Hello TCM Coordinator: Please send the requested information via within the next 24 hours. Thanks, ARAS

TCM Cost Reports - Acceptance  Acceptance Process : Acceptance Letter issued by ARAS Acceptance LetterLGA  For each TCM Cost Report (LGA, CBO, and LPE)  Identifies “postmark date” to establish 36- month audit period

TCM Cost Reports - Acceptance  Top reasons cost report was not accepted upon first review: 1. Did not include “TCM encounters by month” 2. IRS Form 990 not included 3. Electronic copy of Worksheet A did not match hard copy 4. Complete Table of Contents not included 5. Financial statements for CBO not included 6. Electronic copy of Cost Report not submitted

TCM Cost Reports - Acceptance  Top reasons cost report was not accepted upon first review: 7. All pages of the Cost Report Review Tool not submitted 8. Hard copies not signed 9. Incomplete CBO contract (need to include all pages) 10. Certification statements not signed 11. Funding Scheduled not included

TCM Cost Reports - Approval  Approval Process : Responsibility of Audits Section - Sacramento  Review of checklist completed by ARAS  Identification of “potential” audit issues for future audits  Issuance of Approval Letter

TCM Cost Reports - Approval  Approval Process : Approval Letter issued by Audits Section – Sacramento Approval Letter  One letter issued for each target population served by an LGA  Purpose of the letter is to establish:  TCM Rate Period (2009/2010)  Rate Per TCM Encounter  TCM Maximum Amount

TCM Program Type (06): Public Health Rate Per TCM TCM Rate Period TCM Encounter Maximum Amount FY $ $100, TCM Cost Reports - Approval Approval Process : (Excerpt from an Approval Letter)

TCM Cost Reports - Approval  Approval Process : Approval Letter issued by Audits Section – Sacramento LGA Approval Letter TCM Program* *The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount.

FAB Contact Information  Audit Review & Analysis Section (ARAS) Robert Kvick, Chief  (916)   Audits Section - Sacramento Gary Diffenderffer, Supervisor  (916) 

DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager