2009 WIMCR Cost Report Training

1. 2009 WIMCR Cost Report Training May 11-12, 2010

2. Introductions and PCG Contact Information WIMCR Program Overview 2009 WIMCR Cost-Reporting Process Discussion of 2008 Desk Reviews Agenda

3. Introductions and PCG Contact Information • Public Consulting Group, Inc. (PCG) became the WIMCR Coordinator effective July 1, 2009 • PCG WIMCR Team Members • Kandice Marquardt, Business Analyst, Austin, TX 1-866-913-4232 x4668 (kmarquardt@pcgus.com) • Adam Burkin, Business Analyst, Austin, TX 1-866-913-4232 x4676 (aburkin@pcgus.com) • Nancy Kimble, CPA, Specialist III, Austin, TX 1-866-913-4232 x4675 (nkimble@pcgus.com)

4. Introductions and PCG Contact Information (cont’d) • Other PCG WIMCR Team Members • Matt Sorrentino, Senior Consultant - Austin, Texas 1-866-913-4232 x4663 (msorrentino@pcgus.com) • Marc Staubley, Manager - Austin, Texas 1-866-913-4232 x4662 (mstaubley@pcgus.com)

5. WIMCR Program Overview • What is WIMCR? • Wisconsin Medicaid Cost Reporting • Requires annual cost reporting by certified public Medicaid providers (i.e., county agencies) for the following services: • Home Health Services • Medical Day Treatment Services (Adult Mental Health Day Treatment Services) • Outpatient Mental Health and Substance Abuse Services • Outpatient Mental Health and Substance Abuse Services in the Home and Community • Personal Care Services

6. WIMCR Program Overview (cont’d) • WIMCR Services (cont’d) • Community Support Program • Case Management • (Mental Health) Crisis Intervention per Hour • (Mental Health) Crisis Stabilization per Diem • Prenatal Care Coordination • Child/Adolescent Day Treatment • Substance Abuse Day Treatment

7. WIMCR Program Overview (cont’d) • Cost reports identify actual costs to provide all services meeting the service definition, including Medicaid, Medicaid managed care, and non-Medicaid • If a county provides a WIMCR service under two different Wisconsin Medicaid provider identification numbers, it is expected that both cost reports would be exactly the same for the one single service. If that is not the case, the provider should explain why the cost reports are different (e.g., two different programs and explain the differences) in the explanation boxes in the web-based system. • If a county has a Wisconsin Medicaid provider identification number for a WIMCR service for which no Medicaid units (i.e., FFS and/or Managed Care) were delivered, then no cost report is required for that service/Medicaid provider identification number since no Medicaid cost settlement would be processed.

8. WIMCR Program Overview (cont’d) • Payments made by Wisconsin Medicaid program to counties are based on • Actual Cost per Unit per WIMCR Cost Report • Medicaid Units of Service (i.e., fee-for-service (FFS) units prior to 2008 and FFS plus managed care units for 2008 and 2009)

9. WIMCR Program Overview (cont’d) • Three interim payments are made using the prior year’s actual cost per unit • June of Current Year • September of Current Year • June of Following Year Example: Actual Cost per Unit from 2008 Cost Report June 2010; September 2010; June 2011

10. WIMCR Program Overview (cont’d) • Basic County Allocation (BCA) reductions offset interim payments • Profile 684 – Act 318 Adjustments • On occasion: Profile 561 • On occasion: Profile 681 • FINAL payments are made using the actual cost per unit based on Cost Reports • September of the Following Year • Example: Actual Cost per Unit from 2008 Cost Report September 2009

11. WIMCR Program Overview (cont’d) • Community Services Deficit Reduction Benefit (CSDRB) Maintenance of Effort (MOE) adjustment to the BCA reduction • CSDRB MOE totals $19.25 million • A two-tiered calculation with a 2002 CSDRB lookback • Brings additional federal funds into Wisconsin • Recognizes costs of services paid from County Levy and Community Aids funding • Split between counties (approximately 2/3 of increased federal funding) and State Medicaid program

12. WIMCR Program Overview (cont’d) • WIMCR payment equals 25 chocolates • Local Public Health Department (LPHD) programs generated 15 • Human Services Department (HSD) programs generated 10 • CSDRB MOE equals 10 chocolates • LPHD programs generated 6 • HSD programs generated 4 • BCA adjustment equals 15 chocolates • Who gets what?

13. WIMCR Program Overview (cont’d) • HSD • WIMCR payments of 10 chocolates • Less BCA adjustments of 15 chocolates • Plus transfer from LPHD of 9 chocolates • Net payments of 4 equals the CSDRB MOE • LPHD • WIMCR payments of 15 chocolates • Less transfer to HSD of 9 chocolates • Net payments of 6 equals the CSDRB MOE

14. 2009 WIMCR Cost-Reporting Process • 2009 Cost Reports due June 14, 2010 (close of business) • Adjusted cost reports for prior years due June 14, 2010 (Forward to any member of the PCG WIMCR Team the cost report year, the WIMCR service category, the Wisconsin Medicaid Number, and all changes requested to be made.) • 2008 WIMCR Managed Care Report, if applicable, due June 14, 2010 (E-mailing the Excel workbook to any member of the PCG WIMCR Team) • 2009 WIMCR Managed Care Report, if applicable, due June 14, 2010 (E-mailing the Excel workbook to any member of the PCG WIMCR Team)

15. 2009 WIMCR Cost-Reporting Process (cont’d) • 2010 WIMCR Payments • WIMCR payments and associated BCA adjustments – June 2010 (based on 2008 Cost per Unit) • WIMCR payments, CSDRB MOE adjustment and related BCA adjustments – September 2010

16. 2009 WIMCR Cost-Reporting Process (cont’d) • Reporting of Managed Care Units of Service • Cost settlement of Medicaid managed care units in addition to Medicaid fee-for-service (FFS) units of service • Each county that received managed care payment for 2008 and/or 2009 WIMCR services is required to complete the applicable WIMCR Managed Care Report • Report all managed care units of service paid by HMOs and Family Care organizations for dates of service during calendar years 2008 and/or 2009 on a claim-level detail basis

17. 2009 WIMCR Cost-Reporting Process (cont’d) • WIMCR website moved to: https://www.forwardhealth.wi.gov/wimcr/ • If you are not able to log into the website using last year’s User Name and Password, please register as a New User, using a different variation of your name. If you have any problems accessing the system, contact a member of the PCG WIMCR Team. • When you log into the system, check the accuracy of your profile and make any necessary updates, ensuring that the address and telephone numbers are correct. Telephone numbers have no spaces or hyphens/dashes.

18. 2009 WIMCR Cost-Reporting Process (cont’d) • Choice of one application/certification per WIMCR service or one per county agency covering multiple WIMCR services • In addition to total cost per unit, system calculates direct cost per unit, nondirect cost per unit, and overhead cost per unit

19. 2009 WIMCR Cost-Reporting Process (cont’d) • Explanation boxes have been expanded from 200 to 300 characters • Providers are encouraged to provide explanations for each edit that is flagged, including changes in costs and provider types from prior year’s reports • Providers are encouraged to provide information regarding allocation methodology for nondirect costs and for overhead costs (e.g., Nondirect costs are allocated based on direct care staff FTEs as a percentage of total direct care staff FTEs, 12 / 250 = 20.83%)

20. 2009 WIMCR Cost-Reporting Process (cont’d) • No Medicaid claims detail provided on WIMCR site • Some providers were reporting only those Medicaid units shown on the Medicaid claims detail screen • Providers need to maintain documentation of all services delivered

21. Discussion of 2008 Desk Reviews • Overview of Desk Review Process • Items reviewed • Audit Risk Factors • Comparison of Medicaid units with Reported units • Group services • Services by Provider Type • Percentage of Nondirect Service Costs to Direct Service Costs • Percentage of Overhead Costs to Direct Service Costs • Comparison of Total Cost per unit to Medicaid Contracted Rate • Average Time per unit of service that is not reimbursed based on time

22. Discussion of 2008 Desk Reviews (cont’d) • Future WIMCR Cost Report may have an additional field for total paid hours for direct service staff. Until that time, the number of FTEs times the Average Standard Hours per Week should equal the total paid hours for direct care staff. • This calculation should not be less than the reported total direct care staff time converted to hours since total paid hours should include nonbillable time (i.e., time other than direct service time) such as training and paid time off. • FTEs and Average Standard Hours per Week should be reported for both employees and contracted staff.

23. Discussion of 2008 Desk Reviews (cont’d) • Documentation requested • Allocation of Nondirect Service Costs • Allocation of Overhead Costs • Group Services (Number of Groups, Number of Participants in each Group, and Length of each Group Session) • Direct Service Staff Time and Costs (FTEs and Reported units)

24. Discussion of 2008 Desk Reviews (cont’d) • PCG compares the prior year cost report with the current year cost report to identify significant changes in costs from year to year. • Costs are analyzed across a program to identify cost outliers • One outlier would be those providers with total cost per unit above 2 standard deviations • Providers with Total Cost per unit below benchmark • Providers with Total Cost per unit above benchmark • Providers with high Nondirect Service and/or Overhead Costs • Providers with low or no Nondirect Service and/or Overhead Costs • Analyses of 2008 Cost Reports serve as benchmarks for 2009 desk reviews

25. Discussion of 2008 Desk Reviews (cont’d) • Case Management • 106 Cost Reports • Minimum total cost per 15-minute unit: $6.98 • Maximum total cost per 15-minute unit: $210.37 • Top 5 cost reports, representing 45% of total units of service • Minimum total cost per 15-minute unit: $13.19 • Maximum total cost per 15-minute unit: $19.92 • 2009 Desk Review Benchmarks: • Total cost per 15-minute unit under $15.00 • Total cost per 15-minute unit over $30.00

26. Discussion of 2008 Desk Reviews (cont’d) • Community Support Program • 58 Cost Reports • Minimum total cost per 15-minute unit: $ 10.00 • Maximum total cost per 15-minute unit: $127.09 • Top 5 cost reports, representing 46% of total units of service • Minimum total cost per 15-minute unit: $16.95 • Maximum total cost per 15-minute unit: $27.16

27. Discussion of 2008 Desk Reviews (cont’d) • Community Support Program (cont’d) • 2009 Desk Review Benchmarks: • Total cost per 15-minute unit under $15.00 • Total cost per 15-minute unit over $30.00 • Analyses: Range of total cost per unit by provider type • MDs: $13.82 - $174.44 • PhDs: $ 7.28 - $ 71.22 • RNs: $17.61 - $ 68.05 • Masters: $ 6.22 - $110.08 • Bachelors: $ 4.15 - $ 37.64 • Paraprofessionals: $ 2.64 - $ 43.97

28. Discussion of 2008 Desk Reviews (cont’d) • Personal Care Services • 68 Cost Reports • RN Visit assumed to average 1 hour 15 minutes • Minimum total cost per RN visit: $ 26.87 • Maximum total cost per RN visit: $788.97 • Top 5 cost reports, representing 45% of total units of service • Minimum total cost per RN visit: $106.49 • Maximum total cost per RN visit: $167.32 • 2009 Desk Review Benchmarks: • Total cost per RN visit under $125.00 • Total cost per RN visit over $200.00

29. Discussion of 2008 Desk Reviews (cont’d) • Personal Care Services (cont’d) • Minimum total cost per PC worker per 15 minutes: $ 2.92 • Maximum total cost per PC worker per 15 minutes: $36.17 • Top 5 cost reports, representing 42% of total units of service • Minimum total cost per PC worker per 15 minutes: $3.57 • Maximum total cost per PC worker per 15 minutes: $5.42 • 2009 Desk Review Benchmarks: • Total cost per PC worker per 15 minutes under $3.00 • Total cost per PC worker per 15 minutes over $6.00

30. Discussion of 2008 Desk Reviews (cont’d) • Prenatal Care Coordination • 76 Cost Reports • Minimum total cost per 15 minutes: $ 7.58 • Maximum total cost per 15 minutes: $106.08 • Top 5 cost reports, representing 30% of total units of service • Minimum total cost per 15 minutes: $16.31 • Maximum total cost per 15 minutes: $35.57 • 2009 Desk Review Benchmarks: • Total cost per 15 minutes under $15.00 • Total cost per 15 minutes over $35.00

31. Discussion of 2008 Desk Reviews (cont’d) • Prenatal Care Coordination (cont’d) • Average time per Risk Assessment and per Care Plan Minimum = 15 minutes; Maximum = 4 hours • Total Cost per Risk Assessment and per Care Plan Minimum = $9.31; Maximum = $424.30 • Issues identified with number of groups and number of participants

32. Conclusion Any Questions?