DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch 1A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

Introduction  Financial Audits Branch (FAB)  Cost Report Process: Cost Report Submission by LGAs Cost Report Acceptance by FAB New Interim Rate Approval by FAB 2A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

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. 3A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

Cost Report Flow Submission of Cost Report (C/R) C/R Acceptance C/R Acceptance Letter Rate Approval Letter Rate Approval Begin Invoicing TCM Program 4A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports - Submission  TCM Cost Reports due November 1 st Hard Copy FAB, Audit Review and Analysis Section (ARAS) Note: see cost report instruction for cost report mailing address. Soft Copy 5A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports - Submission  Hard Copy – Includes the Following Completed Items: Cover Letter on LGA Letterhead Table of Contents TCM Cost Report Checklist LGA Cost Report Certification Statement CPE Certification and LGA Attestation Statements Cost Report, Funding Schedule, and Allowable CPE Funding Schedule Templates Cost Report Supporting Documents  Organizational Chart Including the Defined Budget Unit (BU), and Listing all Staff & Positions within the BU  A Complete and Comprehensive Narrative Describing the Types of Programs and Services that Are Included in the TCM BU  General Ledger Grouping Schedule for Reported Costs & Funding  Salary and Benefit Costs – Payroll Amounts by Employee  Financial Statements of the TCM Service Provider who Files the Cost Report 6A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports - Submission  Soft Copy – Includes the Following Completed Items: Cost Report Template Funding Schedule Summary of Allowable Funding for Claiming Federal Matching Funds Worksheet Interim Medi-Cal TCM Encounter Payment Rate Calculation Worksheet 2009 Survey Template  List Worksheet  Totals Worksheet  Time Sheets Cost Report Review Tool Template 7A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports - Acceptance  Acceptance Process : Responsibility of ARAS :  Completion of comprehensive checklist: Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions Contact designated LGA Coordinator for missing and/or incorrect items. 8A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports - Acceptance  Top reasons cost report was not accepted upon first review: 1. Incorrect Name Convention of Soft Copy. 2. Soft Copy of Worksheet A did not Match Hard Copy 3. Soft Copy of Cost Report not Submitted 4. Soft Copy of Survey Template not Submitted 5. Soft Copy of Two Funding Schedules not Included 6. Soft Copy of the Cost Report Review Tool not Submitted completely 7. Hard Copy of Certification Statement(s) not Signed 8. Table of Contents not Included in Hard Copy Submission 9. Financial Statements not Included in Hard Copy Submission 9A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports - Acceptance  Acceptance Process : Cost Report 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 10A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports – New Billing Rate Approval  Billing Rate Approval Process : Review of Interim Rate Calculation Sheet Issuance of Billing Rate Approval Letter to LGAs who Participate in TCM Program Purpose of the Letter Is to Establish:  TCM Rate Period (2013/2014)  Rate Per TCM Encounter  TCM Maximum Amount 11A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

Rate Per TCM TCM Rate Period TCM Encounter Maximum Amount FY $ $100, TCM Cost Reports – New Billing Rate Approval Billing Rate Approval Process : (Excerpt from an Approval Letter) 12A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

TCM Cost Reports – New Billing Rate Approval  Billing Rate Approval Process : Approval Letter Issued by A&I, FAB, Special Program Section (SPS) LGA Approval Letter TCM Program Unit* * The Approval Letter authorizes the TCM Program Unit to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount or CAP. 13A&I FAB Information for TCM Cost Report due by Nov. 1, 2013

FAB Contact Information  Audit Review & Analysis Section (ARAS) – Audit Analysis Unit Shun Tong, HPAMI  Phone: (916)   Special Program Section (SPS) – TCM Audit Unit Haisong Peng, HPAMI  Phone: (916)  A&I FAB Information for TCM Cost Report due by Nov. 1, 2013