MAA Manual DMH 6 6 08

County Financial Program SupportAUGUST 2002

MAA Instruction Manual

Manual Order Number: MAA-20012002-100

Specifications contained herein are subject to change and these changes will be reported in subsequent release notes and new editions.

August 2002, Department of Mental Health, State of California

All rights reserved. The Department of Mental Health documentation often refers to hardware and software products by their trade names. In most, if not all cases, these designations are claimed as trademarks or registered trademarks by their respective companies.

California Department of Mental Health, County Financial Program Support MAA- I


GENERAL CONTACT INFORMATION

By Mail:Department of Mental HealthCounty Financial Program Support1600 9th Street, Room 120Sacramento, CA 95814

By Telephone or FAX:916.654.2314 – Support916.653.9269 – FAX916.654.3117 – IT Help Desk

SPECIFIC CONTACT INFORMATION

If you are having technical problems with the MAA Instruction Manual and need technical assistance, send email to: [email protected], [email protected], or call 916.654.2314.

If you want to contact a Department of Mental Health Division or Office, please use the Division/Office Directory, located at http://www.dmh.ca.gov.

California Department of Mental Health, County Financial Program Support MAA- II

mailto:[email protected]

mailto:[email protected]


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California Department of Mental Health, County Financial Program Support MAA-III


TO ALL USERS

Enclosed is the Medi-Cal Administrative Activities (MAA) Instruction Manual. The Manual is designed to assist Local Government Agencies (LGA) in the implementation of their MAA programs. Please note that the actual requirements of the MAA program are contained in the federal statute and regulations, the agreement between the federal Centers for Medicare and Medicaid Services, the Department of Health Services (DHS), and the Department of Mental Health (DMH), the Welfare and Institutions Code, and Title 22 of the California Code of Regulations. As the need to clarify the MAA program requirements arise, please be advised that program requirements will be addressed in updates to this manual.

The LGAs are advised to adhere to the information provided in this manual. If you have any questions or suggestions regarding the information contained in the manual, please contact Antoinette Reed or Marilyn Liddicoat at (916) 654-2314.

Sincerely

STAN JOHNSONChiefCounty Financial Program Support

Enclosures

California Department of Mental Health, County Financial Program Support MAA- IV


California Department of Mental Health, County Financial Program Support MAA-V


California Department of Mental Health, County Financial Program Support MAA - VI


CHAPTER 1

Introduction

Table of Contents

Subject PageHow to use this Manual MAA 1-1

California Department of Mental Health, County Financial Program Support


How To Use This Manual

The Medi-Cal Administrative Activities (MAA) Instruction Manual is your primary reference for information about MAA program participation requirements. You should consult this manual before seeking other sources of information.

Organization The manual is organized into eight chapters:

1. Introduction2. Medi-Cal Background3. MAA Glossary4. MAA Overview5. MAA Claiming Plan6. Determining the Medi-Cal Percentage7. MAA SD/MC Quarterly Claims8. MAA Guides And Examples

Numbering System The bottom of each page has a unique number that identifies the chapter and page. For example, the number MAA 2-1 indicates the MAA Chapter 2, Page 1.

Manual Replacement Pages When changes occur in MAA, the State Department of Mental Health (DMH) will issue Instruction Manual Updates and manual replacement pages. All manual replacement pages will be dated. Each bulletin will contain specific instructions for updating your manual. It is important to insert or replace manual pages when they arrive. This will ensure that all current information remains in your manual. Pages that have been replaced should be maintained in a separate audit file.

Telephone Inquiries If you have any questions about the contents of your instruction manual, please call (916) 654-2314.

California Department of Mental Health, County Financial Program Support MAA – 1-1


CHAPTER 2

Medi-Cal Background

Table of Contents

Subject PageOverview of the Medicaid Program MAA 2-1



Medi-Cal Background

Overview of theMedicaid Program The Medicaid program is a national health care program designed

to furnish medical assistance to families and to aged, blind and disabled individuals, as well as individuals whose income and resources are insufficient to meet the cost of necessary medical services. The program, which was established under Title XIX of the Social Security Act, is administered by the Centers for Medicare and Medicaid Services (CMS) of the federal Department of Health and Human Services (DHHS). Medicaid is a state/federal partnership under which the federal government establishes basic program rules. Each state then administers the program based upon the federal rules. However, states are free to develop their own rules and regulations for program administration within the confines of the federal rules. Medicaid is called Medi-Cal in California.

States must meet certain federal requirements in order to participate in the Medicaid program. However, states that meet these requirements receive federal funding in the form of federal financial participation (FFP) for all Medicaid expenditures. Each state has an established Federal Medical Assistance Percentage (FMAP) amount, which is paid by DHHS for most program expenditures, although that amount may be higher for certain specific types of expenditures. The FMAP for California is approximately 50 percent and may change annually.

The primary requirements imposed on states that wish to participate in the Medicaid program relate to eligibility for the program and to services covered by the program. Federal Medicaid law defines certain categories of eligible individuals and specific types of health care coverage which must be provided by any state that wishes to operate a Medicaid program. Title XIX also offers a variety of optional eligibility groups and types of service which a state may or may not choose to cover. In addition, the federal government establishes general standards by which states must operate their Medicaid programs; however, development of program options and the details of program operation and administration are the responsibility of the states themselves.

California Department of Mental Health, County Financial Program Support MAA – 2-1


CHAPTER 3

Medi-Cal Administrative Activities (MAA) Glossary

Table of Contents

Subject PageMAA Glossary MAA 3-1



Medi-Cal Administrative Activities (MAA) Glossary

Advisory Committee County/City and professional organization representatives, designated by Local Governmental Agencies (LGA) participating in the Medi-Cal Administrative Activities (MAA), to assist the Department of Health Services (DHS) and Department of Mental Health (DMH) in the formulation of program policy.

Allowable Time Time spent by identified personnel doing activities that are claimable as allowable MAA as determined by direct charge documentation.

Audit File A file of documentation supporting the LGA’s MAA claims. This documentation will be retained for a minimum of five years after the end of the quarter in which the expenditures where incurred.

Centers for Medicare The federal agency which oversees the Medicaid program.And Medicaid Services (CMS) Formerly known as Health CareFinancing Administration (HCFA)

Claimable Activities Activities determined as allowable MAA.

Claiming Plan A description of activities claimed as allowable MAA. Each LGA participating in MAA must submit a claiming plan to the State DMH.

Claiming Unit A legal entity, such as a department or subcontractor performing MAA whose costs can be segregated as a separate budget unit.

California Department of Mental Health, County Financial Program Support MAA- 3-1


Direct Charge Direct invoicing of certain costs identified as 100 percent allowable. These costs are entered in the Direct Charge section of the MAA invoice. Direct charges must be itemized and explained in back-up documentation to be included in the audit file.

Enhanced Functions Enhanced functions are those MAA which are performed by a SPMP and require the medical expertise of a SPMP. The cost of time spent by SPMP performing these activities is reimbursed at the enhanced rate of 75 percent.

Federal Financial Participation The proportion of allowable cost to be reimbursed by (FFP) the federal government.

Local Governmental Agency A county or chartered city.

MAA Coordinator The person designated by the LGA to coordinate the MAA program.

Medi-Cal Administrative A program which allows LGAs to draw down federalActivities (MAA) reimbursement for activities necessary for the proper and

efficient administration of the Medi-Cal State Plan.

Medi-Cal Percentage: The proportion of a county’s population who are Medi-Cal beneficiaries.

Quarterly Summary Invoice The summary or aggregate of costs on each quarterly MAA detail invoice. Prepared by an LGA on behalf of all claiming entities or programs within its jurisdiction, and is the amount to be subject to FFP reimbursed to the LGA for the quarter. The LGA must provide DMH with a complete invoice and expenditure information no later than December 31st following the fiscal year for which a claim is being submitted.

Revenue Funding received by an LGA or program.

Revenue Offset The required deduction of revenue from an LGA’s claim for allowable MAA costs.

Single State Agency The state agency charged with administering the Medicaid program. In California, the single state agency is the Department of Health Services.



Skilled Professional Medical An employee of a public agency who has completed aPersonnel (SPMP) two-year or longer program leading to an academic degree

or certification in a medically related profession and who is in a position that has duties and responsibilities requiring those professional medical knowledge and skills.

State Medicaid Plan A comprehensive written statement submitted by the State describing the nature and the scope of its Medicaid Program and giving assurance that it will be administered in conformity with the specific federal requirements. The State Plan serves as a basis for federal financial participation (FFP) in the program.

State Plan Amendments (SPAs) The vehicle used to amend, add or delete material from the California State Medicaid Plan.



CHAPTER 4

Medi-Cal Administrative Activities (MAA)Overview

Table of Contents

Subject PageMAA Overview MAA 4-1



Medi-Cal Administrative Activities (MAA) Overview

Pursuant to Welfare and Institutions Code, Section 14132.47, Medi-Cal Administrative Activities (MAA) became a covered Medicaid benefit effective January 1, 1995. MAA are administrative activities necessary for the proper and efficient administration of the Medi-Cal program.

To participate in MAA, each LGA must submit a comprehensive claiming plan for each claiming unit performing MAA to DMH. The MAA claiming plan must describe in detail each category of MAA the LGA is claiming for, the claiming units for which claims will be submitted for, the supporting documentation the claiming unit will maintain and the development and documentation of the costs relating to MAA. The claiming plan is reviewed and approved by DMH, DHS and CMS. Costs for MAA are only claimable when the activities are identified in an approved MAA claiming plan.

The claiming plan remains in effect from year to year until amended by the LGA. A claiming plan must be amended each time the scope of MAA are significantly changed, a new claiming unit is established, or a new type of activity is undertaken, or a claiming unit is no longer participating. All claiming plan amendments are subject to DMH, DHS and CMS review and approval. An LGA may submit amendments to its claiming plan anytime. The effective date of the amendment is the first day of the quarter in which the amendment is submitted.

Allowable MAA may or may not be directed solely to the Medi-Cal population. Therefore, the costs associated with allowable MAA may be discounted. The discounting methodology is measured on an actual “head count” or as a percentage based on the total number of Medi-Cal recipients and the total number of all individuals served by the LGA. Countywide averages or other methods approved by DMH, DHS and CMS may be used to calculate the Medi-Cal percentage discount. The Medi-Cal discounting methodology must be identified in the MAA claiming plan. See Chapter 6, Determining the Medi-Cal Percentage, for further information.

In general, costs associated with MAA are matched at the federal financial participation (FFP) rate. Both the DMH and DHS require LGAs to certify the availability and expenditure of one hundred (100) percent of the non-federal share of the cost of performing MAA. The funds expended for this purpose must be from the LGA’s general fund or from funds allowed under federal law and regulation.

Claims for MAA reimbursement are submitted by the LGA to DMH. Each claim is prepared on a separate detailed quarterly invoice for each program, clinic, non-governmental entity or contractor claiming MAA costs. The LGA will also prepare and submit a quarterly summary invoice. The quarterly summary invoice is an aggregate of all detailed invoices for each program. The form for the detailed invoice blends the cost and revenue data elements into one spreadsheet that allows for the computation of the claim, adjusting for all necessary revenues and applying activity and Medi-Cal discount percentages. The LGA must provide DMH with complete invoice and expenditure information no later December 31st following the fiscal year for which a claim is being submitted. All invoices and expenditure information must be submitted to DMH prior to or with the county’s cost report for the current fiscal year. DMH will either approve the claim, return the claim for revision and/or correction, or deny the claim. An LGA can request a reconsideration of the DMH decision to deny a claim. The request must be filed in writing and within thirty (30) days after the receipt of the written California Department of Mental Health, County Financial Program Support MAA- 4-1


notice of denial. The review process is limited to a programmatic or accounting reconsideration based upon additional supporting documentation submitted to the DMH.

The DHS has delegated authority through an interagency agreement to the Department of Mental Health (DMH) to administer the MAA program when allowable MAA are performed by participating county mental health programs. Participating county mental health programs will submit their MAA claiming plan directly to DMH. DMH will review the claiming plan, and upon approval, will forward each claiming plan to DHS and CMS for additional review and approval. Participating county mental health programs will also submit MAA invoices directly to DMH for processing. Invoices approved by DMH will be submitted to DHS for payment.

The following activities are allowable MAA for a more detailed description of these activities, please see Chapter 5, MAA Claiming Plan, of the manual.

(A) Medi-Cal Outreach - Informing Medi-Cal eligibles or potential Medi-Cal eligibles about Not Discounted Medi-Cal services, including Short-Doyle/ Medi-Cal services. (Mode 55, SFC 01-03) Assisting at-risk Medi-Cal eligibles or potential Medi-Cal eligibles to

understand the need for mental health services covered by Medi-Cal.Actively encouraging reluctant and difficult Medi-Cal eligibles or potential Medi-Cal eligibles to accept needed mental health and health services.

(A) Medi-Cal Outreach - Informing at-risk populations about the need for and availability of Discounted Medi-Cal and non-Medi-Cal mental health services. (Mode 55, SFC 17-19) Telephone, walk-in, or drop-in services for referring persons to

Medi-Cal and non-Medi-Cal mental health programs.

(B) Medi-Cal Eligibility Intake Screening and assisting applicants for mental health services with Not Discounted the application for Medi-Cal benefits. (Mode 55, SFC 04-06)

(C) Referral in Crisis Situation Intervening in a crisis situation by referring to mental health For Non-Open Cases services. Discounted (Mode 55, SFC 11-13)

(D) Medi-Cal/Mental Health Identifying and recruiting community agencies as Medi-Cal contract Service Contract providers.

Administration Developing and negotiating Medi-Cal provider contracts.(Mode 55, SFC 07-08) Monitoring Medi-Cal provider contracts.Not Discounted Providing technical assistance to Medi-Cal contract agencies

regarding county, state and federal regulations.



(D) Medi-Cal/Mental Health Identifying and recruiting community agencies as mental health Service Contract service contract providers serving Medi-Cal and non-Medi-Cal Administration clients. (Mode 55, SFC 14-16) Developing and negotiating mental health service contracts serving

Discounted Medi-Cal and non-Medi-Cal clients.Monitoring mental health service contract providers serving Medi-Cal and non-Medi-Cal clients.Providing technical assistance to mental health service contractagencies regarding county, state and federal regulations.

(E) Program Planning and Policy Developing strategies to increase system capacity and to close

Development service gaps. Discounted Interagency coordination to improve delivery of mental health

(Mode 55, SFC 24-26 & services to seriously mentally ill adults or seriously emotionallySFC 35-39) disturbed children or adolescents.

(F) Case Management of Gathering information about an individual’s health and mental Non-Open Cases health needs. Discounted Assisting individuals to access Medi-Cal covered physical health (Mode 55, SFC 21-23 and mental health services by providing referrals, follow-up, and &SFC 31-34) arranging transportation for health care.

(G) Training SPMP training, given or received, which improves the skill levels of Discounted SPMP staff members in performing allowable SPMP enhanced (Mode 55, SFC 27-29) Medi-Cal Administrative Activities, specifically SPMP program

planning and development and SPMP program planning and development and SPMP case management of non-open cases.

(H) MAA Coordination and Drafting, revising, and submitting MAA claiming plans. Claims Administration Serving as liaison with claiming programs within the LGA and with

Not Discounted the state and federal governments on MAA.(Mode 55, SFC 09) Monitoring the performance of claiming programs.

Administering LGA claiming, including overseeing, preparing, compiling, revising, and submitting MAA claims to the state. Attending training sessions, meetings, and conferences involving MAA.Training LGA program and subcontractor staff on state, federal, and local requirements for MAA claiming.Ensuring that MAA claims do not duplicate Medi-Cal claims for the same activities from other providers.



CHAPTER 5

Medi-Cal Administrative Activities (MAA)Claiming Plan Requirements

Table of Contents

Subject PageMAA Claiming Plan Requirements MAA 5-1Certification Statement MAA 5-3Claiming Unit Functions & Instructions MAA 5-4Documents Required for each MAA MAA 5-24Claiming Plan Preparation Check-List MAA 5-26Claiming Plan Amendment Check-List MAA 5-31Examples for MAA Coding MAA 5-33



Medi-Cal Administrative Activities Claiming Plan Requirements

In accordance with Welfare and Institutions Code Section 14132.47, all local governmental agencies (LGAs) participating in MAA, are required to submit a comprehensive MAA claiming plan package to the Department of Mental Health (DMH) for review and approval by DMH, DHS and the federal Centers for Medicare and Medicaid Services (CMS). A claiming plan package consists of separate claiming plans for each claiming unit performing MAA. LGAs must submit three claiming plan packages to the DMH. One copy each will be forwarded to DHS and CMS for their review.

A claiming plan and any subsequent amendments will remain in effect from year to year. A claiming plan must be amended each time the scope of MAA is significantly changed or a new type of activity is undertaken. For example, a claiming plan must be amended when a new outreach campaign or program is instituted, or a new claiming unit performing MAA is created. An LGA may submit amendments to any of its claiming plans at any time. Amendments are subject to DMH, DHS and CMS approval. The DMH will notify LGAs in writing of the approval/disapproval of all amendments. Claims should only be made under amended claiming plans when these have been approved and are effective for the period claimed.

The effective date of the approved claiming plan and any subsequent amendments shall be no earlier than the first day of the calendar quarter in which the claiming plan is submitted.

To facilitate the review process, a standardized claiming plan format for use by LGAs and claiming units has been developed and is included with the instructions. This format must be utilized by LGAs intending to claim MAA.

Following the submission of claiming plans or amendments, DMH will review the claiming plans or amendments and forward the results of their review along with two sets of the claiming plans or amendments to DHS. DHS will review the claiming plans or amendments and will forward their recommendations and one copy of the plans or amendments to CMS for review. CMS will notify the DHS in writing of the results of their review. DHS will then notify DMH who will notify the LGAs in writing of the approval/disapproval of their claiming plans or amendments. The DMH and DHS will provide technical assistance to LGAs, upon request, in the event of disapproval.

Invoices submitted to the DMH without an approved claiming plan or that do not agree with the approved claiming plan in effect for the period claimed or that do not agree with the MAA invoice instructions, will be rejected and returned to the LGA.

To assist the LGAs in the preparation and submission of MAA Claiming Plan and Amendments,a MAA Claiming Plan Preparation Check-list and an Amendment Check-list have been developed and are included in the Manual. The Preparation Check-list is to ensure your plan is complete and complies with the standard format.

The Amendment Check-list is required to be completed and accompany the MAA Claiming Plan Amendments along with a cover letter from the LGA indicating the changes. The check-list is not an all-inclusive listing of claiming plan amendment situations. If a circumstance arises that is not listed on the check-list, please explain the situation under number 28 of the checklist or attach an additional explanation. Amendments should be submitted as a comprehensive package for the entire LGA and must contain a revised “Certification Statement” with a new date and signature. Also, be sure that the Table of Contents is resubmitted to reflect any changes. Only the pages of the existing MAA Claiming Plan that are changing need to be amended and submitted to DMH. Please do not resubmit the entire MAA Claiming Plan

California Department of Mental Health, County Financial Program Support MAA -5-1


INSTRUCTIONS FOR LOCAL GOVERNMENTAL AGENCIES (COUNTY OR CHARTERED CITY)

Attach to the front of the entire claiming plan package:

1. A Table of contents, listing by section each claiming unit included in the claiming plans.2. A county/chartered city organization chart showing all departments, programs, and subcontractors

participating in MAA.

Claiming plan packages are to be submitted to:

Department of Mental HealthCounty Financial Program Support1600 Ninth Street, Room 120Sacramento, CA 95814

NOTE: It is recommended that claiming plan packages be submitted by express mail service in order to ensure delivery.

Complete the Certification Statement of the standardized claiming plan by entering:

1. The name of the LGA.

2. The LGA's address.

3. The MAA coordinator's phone number.

4. The typed name of the MAA coordinator.

5. The signature of the MAA coordinator.

6. The title of the MAA coordinator.

7. The date the claiming plan package is signed.



CERTIFICATION STATEMENT

(1) Local Governmental Agency (LGA): (County or Chartered City)

(2) LGA Address: (3) LGA Medi-Cal Administrative Activities Coordinator's Phone Number:

In signing this certification, I am certifying that the information provided herein is true and correct and accurately reflects the performance of the Medi-Cal Administrative Activities described in this claiming plan.

I am also certifying that invoices submitted to the state Department of Mental Health for reimbursement shall be based on the approved claiming plan and shall be submitted in accordance with the MAA invoice instructions. Any knowing misrepresentation of the activities described herein may constitute violation of the federal False Claims Act.

I understand that this claiming plan shall be subject to the review and approval of the state Department of Mental Health, the state Department of Health Services and the federal Centers for Medicare and Medicaid Services.

________________________________________ __________________________________________

(4) Typed Name (5) Signature(Medi-Cal Administrative Activities Coordinator) ( Medi-Cal Administrative Activities Coordinator)

_________________________________________ _________________________________________(6) Title (7) Date

MEDI-CAL ADMINISTRATIVE ACTIVITIES TO BE CLAIMED

(Refer to Attached Pages _____ to _____)



CLAIMING UNIT FUNCTIONS

(1) LOCAL GOVERNMENTAL AGENCY: __________________________________________________ SUBMITTAL DATE: ______________ (COUNTY OR CHARTERED CITY)

(2) NAME OF CLAIMING UNIT (LEGAL ENTITY): (3) NO. OF STAFF:

(4) ADDRESS:

(5) CONTACT PERSON:

(6) ADDRESS: (If different than above) (7) PHONE NUMBER

(8) DESCRIPTION OF CLAIMING UNIT FUNCTIONS:

(10) NUMBER (11) MEDI-CAL ADMINISTRATIVE ACTIVITIES OF (ENTER NUMBER OF STAFF UNDER EACH

(9) STAFF JOB CLASSIFICATIONS STAFF ACTIVITY)

NONSPMP SPMP A B C D E F G H

A = Medi-Cal Outreach E = Program Planning and Policy DevelopmentB = Medi-Cal Eligibility Intake F = Case Management of Non-Open Cases

C = Referral in Crisis Situations for Non-Open Cases G = TrainingD = Mental Health Services Contract Administration H = MAA Coordination & Claims Administration

DMH USE ONLY

CP Reference No. ____________ Original Approval Date: Amendment Approval Date:



INSTRUCTIONS FOR CLAIMING UNIT

Methods for Allocating Costs

In order for local governmental agencies (LGAs) to claim the costs of Medi-Cal administrative activities (MAA) performed by thereporting claiming units, the following methods for allocating costs have been approved by the Department of Health Services (DHS):

1. Actual staff time as reported and documented in Mode 55 Service Function Codes (SFC).2. Direct charges. Direct charging based on employee salaries must be supported by a signed certification statement. Direct

charging for non-salaried costs must be supported by receipts for actual costs incurred.

Using the Standardized Claiming Plan Format

On the following pages, forms for each of the allowable MAA are provided. A description of the MAA and instructions for preparing the claiming plan are on the reverse of each form. The forms may be used by claiming units for the preparation of claiming plans. The claiming plan information must be presented in the same order as requested in the instructions.

Each claiming unit is required to provide the information requested beginning on page MAA 5-4 of the standardized claiming plan format. (The numbers shown below correspond to the numbers shown on page MAA 5-4 of the standardized claiming plan format.) Complete page MAA 5-4 of the standardized claiming plan by entering:

1. The name of the LGA, and the claiming plan submittal date.2. The name of the claiming unit performing MAA.3. The total number of staff employed in the claiming unit.4. The claiming unit's address.5. The name of the claiming unit contact person.6. The address of the claiming unit contact person.7. The phone number of the claiming unit contact person.8. A brief description of the specific functions performed by the claiming unit.9. The job classifications for each of the staff performing MAA for which an invoice will be submitted. If some staff in a

classification are considered skilled professional medical personnel (SPMP) and other staff are considered non-SPMP, enter the information for SPMP staff on one line and enter the information for non-SPMP staff in the same job classification on a separate line.

10. The number of staff who are SPMP or non SPMP.11. The number of staff performing MAA by type of activity.

Each claiming unit must attach to its claiming plan:

1. The documents required to support each of the MAA the LGA intends to claim for federal matching funds. The documents required are listed on the instructions provided for each MAA. Identify the MAA supported by each submitted document by placing on the front of each document the letter assigned to the MAA. The letters assigned to the MAA are listed at the bottom of page MAA 5-4. For example A=Medi-Cal Outreach, B=Medi-Cal Eligibility Intake, etc. Next to the MAA letter place the number of the document. For example if three documents are submitted to support the activity Medi-Cal Outreach, separately number the documents as A-1, A-2, and A-3

2. Position descriptions and/or duty statements for each staff performing the MAA identified in the claiming plan. The position descriptions and/or duty statements must clearly show the performance of the MAA identified in the claiming plan as being part or all of the employees' duties. The MAA duties described on the position descriptions and/or duty statements must be clearly identified. To clearly identify the MAA duty, place next to each MAA duty the letter assigned to the MAA. The letters assigned to the MAA are listed at the bottom of page MAA 5-4. For example A=Medi-Cal Outreach, B=Medi-Cal Eligibility Intake, etc.



(A) MEDI-CAL OUTREACH NOT DISCOUNTED

(MODE 55, SFC 01-03)(Attach additional pages if needed. See description and instructions on reverse side.)

Claiming Unit: Submittal Date:

Local Governmental Agency:

DMH USE ONLY




(A) MEDI-CAL OUTREACH – NOT DISCOUNTED

(MODE 55, SFC 01-03)

DESCRIPTION

1. Informing Medi-Cal eligibles or potential Medi-Cal eligibles about Medi-Cal services, including Short-Doyle/Medi-Cal services.2. Assisting at-risk Medi-Cal eligibles or potential Medi-Cal eligibles to understand the need for mental health services covered by

Medi-Cal.3. Actively encouraging reluctant and difficult Medi-Cal eligibles or potential Medi-Cal eligibles to accept needed mental health

and health services.

NOTE:

Public health campaigns that contain a discrete segment targeted only to bringing Medi-Cal eligibles into Medi-Cal covered services may be claimed as Outreach only for the targeted segment.

Information and referral activity that involves referring Medi-Cal eligibles to Medi-Cal providers, or referring potential Medi-Cal eligibles exclusively to Medi-Cal eligibility workers are allowable as Outreach.

SUBCONTRACTING

The local governmental agency (LGA) may subcontract with nongovernmental agencies or programs to conduct Outreach. If the LGA chooses to direct charge the Outreach performed by subcontractors, the contracts must clearly describe the Outreach to be performed, the method used for determining direct charge claiming, and the dollar amount to be paid to the subcontractor.

INSTRUCTIONS FOR PREPARING THE MEDI-CAL OUTREACH CLAIMING PLAN

For each campaign, program, or ongoing outreach, provide the following information. Identify the information by using the same numbering sequence as shown below:

1. Identify the type of Outreach performed. (Select from 1, 2 and/or 3 shown above).2. Provide a clear description of how each Outreach activity will be performed to achieve the objective.3. Identify the population targeted.4. Provide the length of time of the Outreach, i.e. days and/or hours.5. Provide the location(s) where the Outreach will be conducted.6. Provide the number of times Outreach will be conducted during the fiscal year or indicate if Outreach is an ongoing activity.7. If using other than actual reported staff time to Mode 55, describe how the costs of Outreach will be developed and

documented.8. Provide the name(s) of the subcontractor(s), if applicable.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA.2. Flyers, announcements, or any materials that describe the Outreach campaigns. If materials are unavailable when the claiming

plan is submitted to the DMH, provide a statement that gives the location of where materials will be maintained for future DMH, DHS and CMS review.

3. A list of subcontractors, if direct-charge invoices will be submitted.4. Copies of those sections of contracts that clearly describe the Outreach to be performed, how the time spent performing

Outreach will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining direct-charge claiming (including application of the Medi-Cal percentage discount) and the dollar amount to be paid to the contractor.



(A) MEDI-CAL OUTREACH DISCOUNTED

(MODE 55, SFC 17-19)(Attach additional pages if needed. See description and instructions on reverse.)



Methodology Approved for Calculating the Medi-Cal Discount:: (Place checkmark next to methodology to be used.)

_____Client Count ______Countywide Medi-Cal Average _____Check here if submitting unapproved methodology. Explain methodology below.

DMH USE ONLY




(A) MEDI-CAL OUTREACH DISCOUNTED

(MODE 55, SFC 17-19)

DESCRIPTION

1. Informing at-risk populations about the need for and availability of Medi-Cal and non-Medi-Cal mental health services.2. Telephone, walk-in, or drop-in services for referring persons to Medi-Cal and non-Medi-Cal mental health programs.

The approved methods to calculate the discount are (1) county-wide average, and (2) Medi-Cal actual client count. The Department of Health Services (DHS) and the Centers for Medicare and Medicaid Services (CMS) will review the methods during the review of the claiming plan.

SUBCONTRACTING

The LGA may subcontract with nongovernmental agencies or programs to conduct Outreach. If the LGA chooses to direct charge the Outreach performed by subcontractors, the contracts must clearly describe the Outreach to be performed, the method used for determining direct charge claiming, and the dollar amount to be paid to the subcontractor .

INSTRUCTIONS FOR PREPARING THE MEDI-CAL OUTREACH CLAIMING PLAN

For each campaign, program, or ongoing Outreach, provide the following information in the order requested. Identify the information by using the same numbering sequence as shown below:

1. Identify the type of Outreach performed. (Select from 1 and/or 2 shown above.)2. Provide a clear description of how each Outreach activity will be performed to achieve the objective.3. Identify the population targeted.4. Provide the method for calculating the Medi-Cal discount.5. Provide the length of time of the Outreach, i.e. days and/or hours.6. Provide the location(s) where the Outreach will be conducted.7. Provide the number of times the Outreach will be conducted during the fiscal year or indicate if Outreach is an ongoing activity.8. If using other than actual reported staff time to Mode 55, describe how the costs of Outreach will be developed and

documented.9. Provide the name(s) of the subcontractor(s), if applicable.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing MAA.2. Flyers, announcements, or any materials that describe the Outreach campaigns. If materials are unavailable when the claiming

plan is submitted to the DMH, provide a statement that gives the location of where materials will be maintained for future DMH, DHS and CMS review.

3. A list of subcontractors, if direct-charge invoices will be submitted.

4. Copies of those sections of contracts that clearly describe the Outreach to be performed, how the time spent performing Outreach will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining direct-charge claiming (including application of the Medi-Cal percentage discount) and the dollar amount to be paid to the contractor.



(B) MEDI-CAL ELIGIBILITY INTAKENOT DISCOUNTED




DMH USE ONLY




(B) MEDI-CAL ELIGIBILITY INTAKENOT DISCOUNTED

(Mode 55, SFC 04-06)

DESCRIPTION

Screening and assisting applicants for mental health services with the application for Medi-Cal benefits.

NOTE:

This activity does not include the eligibility determination itself.

SUBCONTRACTING

The local governmental agency (LGA) may subcontract with non-governmental agencies or programs to conduct Eligibility Intake. If the LGA chooses to direct charge the Eligibility Intake performed by subcontractors, the contracts must clearly describe the Eligibility Intake to be performed, the method used for determining direct charge claiming, and the dollar amount to be paid to the subcontractor.

The LGA may subcontract with nongovernmental agencies or programs to conduct eligibility intake activities.

________________________________________________________________________________________________________

INSTRUCTIONS FOR PREPARING THE MEDI-CAL ELIGIBILITY INTAKE CLAIMING PLAN

Provide the information listed below. Identify the information by using the same numbering sequence as shown below:

1. Identify the Eligibility Intake objective.2. Provide a clear description of how the Eligibility Intake activity will be performed to achieve the objective. For example,

identify the staff performing the activity, describe what is performed, indicate when and where it is performed, and explain the purpose of performing it.

3. Indicate whether the Eligibility Intake is performed by the LGA's subcontractors or by claiming unit staff.4. Provide the name(s) and address(es) of the subcontractor(s), if applicable.5. If using other than actual reported staff time to Mode 55, describe how the costs of the Eligibility Intake will be developed and

documented.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA.2. Copies of any materials unique to or designed by the claiming unit for use in conjunction with this activity.3. A list of subcontractors, if direct-charge invoices will be submitted.4. Copies of those sections of contracts that clearly describe the Eligibility Intake to be performed, how the time spent performing

the Eligibility Intake will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining direct-charge claiming and the dollar amount to be paid to the contractor.





(C) REFERRAL IN CRISIS SITUATIONS FOR NON-OPEN CASESDISCOUNTED

(MODE, SFC 11-13)(Attach additional pages if needed. See description and instructions on reverse.)



Methodology Approved for Calculating the Medi-Cal Discount: (Place checkmark next to methodology to be used.)

____Client Count ___Countywide Medi-Cal Average ___Check here if submitting unapproved Methodology. Explain methodology Below.

DMH USE ONLY




(C) REFERRAL IN CRISIS SITUATIONS FOR NON-OPEN CASESDISCOUNTED

(MODE 55, SFC 11-13)

DESCRIPTION

Intervening in a crisis situation by referring to mental health services

INSTRUCTIONS FOR PREPARING THE REFERRAL IN CRISIS SITUATIONS FOR NON-OPEN CASES CLAIMING PLAN

For each type of crisis intervention performed, provide the following information: Identify the information by using the same numbering sequence as shown below.

1. Individually list and clearly describe each allowable type of activity.2. Provide a clear and specific description of how each type of activity will be performed to achieve the objective.3. Provide the name(s) of the subcontractor(s) performing the activity, if applicable.4. Provide the method used to determine time, if other than actual reported staff time to Mode 55,and costs when the activity is

performed by claiming unit staff or by subcontractors, and how the cost is calculated.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA.2. Copies of those sections of contracts that clearly describe the activity to be performed; how the time spent performing the

activity will be documented; how the rate is calculated; and that show the effective date of the contract.



(D) MEDI-CAL / MENTAL HEALTH SERVICES CONTRACT ADMINISTRATION(MODE 55, SFC 07-08 (NOT DISCOUNTED) & SFC 14-16 (DISCOUNTED)

(Attach additional pages if needed. See description and instructions on reverse.)




___Client Count ___Countywide Medi-Cal Average ____Check here if submitting unapproved methodology. Explain methodology below.

DMH USE ONLY

CP Reference No. _____________ Original Approval Date: Amendment Approval Date:



(D) MEDI-CAL/MENTAL HEALTH SERVICES CONTRACT ADMINISTRATIONNOT DISCOUNTED IF PERFORMED FOR 100% MEDI-CAL POPULATION; OTHERWISE

(MODE 55, SFC 07-08 (NOT DISCOUNTED) & SFC 14-16 (DISCOUNTED)

DESCRIPTION

Medi-Cal contract administration (100% Medi-Cal) - includes: (Mode 55 - SFC - 07-08) NOT DISCOUNTED- Identifying and recruiting community agencies as Medi-Cal contract providers.

- Developing and negotiating Medi-Cal provider contracts.- Monitoring Medi-Cal provider contracts.- Providing technical assistance to Medi-Cal contract agencies regarding County, State and Federal regulations.

Mental Health services contract administration - includes: (Mode 55 - SFC 14-16) DISCOUNTED- Identifying and recruiting community agencies as mental health service contract providers serving Medi-Cal and non-Medi-Cal

clients.- Developing and negotiating mental health service contracts serving Medi-Cal and non-Medi-Cal clients.- Monitoring mental health service contract providers serving Medi-Cal and non-Medi-Cal clients.- Providing technical assistance to mental health service contract agencies regarding County, State and Federal regulations.

NOTE: Local governmental agencies (LGAs) have the option of claiming the costs of contract administration for allowable MAA, such as Outreach, under that activity or the costs may be claimed under Contract Administration. Under no circumstances are the costs of contract administration for allowable MAA to be claimed under both Contract Administration and the activity, such as Outreach. Contracting for Medi-Cal Services may only be claimed under Contract Administration.

Contracting for Medi-Cal Services under activity "D" when the administration of those contracts meets all of the following criteria:

1. The contract administration is performed by an identifiable unit of one or more employees, whose tasks officially involve contract administration, according to their job position descriptions, or by individual LGA staff at the clinic level participating in MAA.

2. The contract administration involves contractors that provide Medi-Cal services and/or MAA.3. The contract administration is directed to one or more of the following goals:

a. Identifying, recruiting, and contracting with community agencies as Medi-Cal services and/or MAA contract providers.b. Providing technical assistance to Medi-Cal subcontractors regarding county, state, and federal regulations.c. Monitoring provider agency capacity and availability.d. Ensuring compliance with the terms of the contract.

DISCOUNTED COSTSThe contracts being administered must be for Medi-Cal services and/or MAA and may involve Medi-Cal populations only or may involve Medi-Cal and other indigent, non-Medi-Cal populations. When the contract involves a Medi-Cal and non-Medi-Cal population, the costs of contract administration will be discounted by the Medi-Cal percentage. In addition, another reasonable basis may be used by LGAs for apportioning the time of employees who administer contracts involving Medi-Cal and non-Medi-Cal activities and services.

DIRECT CHARGE If employees perform contract administration 100 percent of their time, the activity should be claimed on the direct-charge portion of the invoice.

NOT CLAIMABLE UNDER – MAA

LGA subcontractors cannot claim contract administration. Contract administration must be a LGA function.

INSTRUCTIONS FOR PREPARING THE MENTAL HEALTH SERVICES CONTRACT

1. Individually list each type of contract administered by the claiming unit and describe how staff perform contract administration for each contract listed.

2. For each contract, indicate whether the contract is for Medi-Cal populations only or for a combination of Medi-Cal and non-Medi-Cal populations.

3. For those contracts that combine both Medi-Cal and non-Medi-Cal populations, indicate the Medi-Cal population served by each contract and the methodology used for determining the Medi-Cal percentage.

4. For each contract, explain the method for allocating time spent by employees between Medi-Cal and non-Medi-Cal contract functions, if this method of discounting will be used.

5. For Mental Health Services Contract Administration, describe each type of claimable activity performed by staff at the clinic level.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA.2. Copies of a sample of the contracts being administered.3. Descriptions of activities being claimed.



(E) PROGRAM PLANNING AND POLICY DEVELOPMENTDISCOUNTED

(MODE 55, SFC 24-26 & SFC 35-39) (Attach additional pages if needed. See description and instructions on reverse.)




___Client Count ____Countywide Medi-Cal Average ___Check here if submitting unapproved methodology. Explain methodology below.

DMH USE ONLY

CP Referenc No.____________ Original Approval Date: Amendment Approved Date:



(E) PROGRAM PLANNING AND POLICY DEVELOPMENTDISCOUNTED

(MODE 55, SFC 24-26 & SFC 35-39)

DESCRIPTION

SPMP Program planning and development - includes: (Mode 55 - SFC 24-26)Developing strategies to increase system capacity and to close service gaps.Interagency coordination to improve delivery of mental health services to seriously mentally ill adults or seriously emotionally disturbed children or adolescents.

Non-SPMP Program planning and development - includes: (Mode 55 - SFC 35-39)Developing strategies to increase system capacity and to close service gaps.Interagency coordination to improve delivery of mental health services to seriously mentally ill adults or seriously emotionally disturbed children or adolescents.

Under the conditions specified above, the following tasks are allowable as MAA:

1. Developing strategies to increase Medi-Cal system capacity and close Medi-Cal service gaps. This includes analyzing Medi-Cal data related to a specific program or specific group.

2. Interagency coordination to improve delivery of Medi-Cal services.3. Developing resource directories of Medi-Cal services/providers.

NOT ALLOWABLE

Program planning and policy development activities are not allowable MAA when performed by LGA subcontractors.

INSTRUCTIONS FOR PREPARING THE PROGRAM PLANNING AND POLICY DEVELOPMENT CLAIMING PLAN

1. Individually list each type of allowable Program Planning and Policy Development performed.2. Provide the location(s) where the activity is performed.3. If the activity is performed in the LGA's mental health department, identify the programs involved.4. Explain how the Medi-Cal percentage will be determined.5. Explain the method for determining time and costs.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA2. Resource directories, if available, and a list of service providers that are involved with tasks 1, 2, and 3 above developing

strategies, interagency coordination, and developing resource directories.



(F) CASE MANAGEMENT OF NON-OPEN CASES DISCOUNTED

(MODE 55, SFC 21-23 & SFC 31-34)(Attach additional pages if needed. See description and instructions on reverse.)




___Client Count ___Countywide Medi-Cal Average __Check here if submitting unapproved methodology. Explain methodology below.

DMH USE ONLY

CP Reference No.____________ Original Approval Date: Amendment Approved Date:



(F) CASE MANAGEMENT OF NON-OPEN CASESDISCOUNTED

(MODE 55, SFC 21-23 & SFC 31-34)

DESCRIPTION

SPMP Case management of non-open cases – includes: (Mode 55 - SFC 21-23)Gathering information about an individual’s health and mental health needs, when performed by SPMP staff.Assisting individuals to access Medi-Cal covered physical health and mental health services by providing referrals, followup, and arranging transportation for health care, when performed by SPMP staff.

Non-SPMP Case management of non-open cases – includes: (Mode 55 - SFC 31-34)Gathering information about an individual’s health and mental health needs.Assisting individuals to access Medi-Cal covered physical health and mental health services by providing referrals, follow-up, and arranging transportation for health care.

This activity is performed by either SPMP or non-SPMP staff. Qualified, documented SPMP staff time is reimbursable at the enhanced 75% federal rate. Non-SPMP time is reimbursable at the 50% federal rate. Contractor staff cannot be reimbursed at the enhanced SPMP rate.

SUBCONTRACTING

The LGA may subcontract with non-governmental agencies or programs to conduct Case Management of Non-Open Cases. If the LGA chooses to direct charge this activity when performed by subcontractors, the contracts must clearly describe the activity to be performed, the method for determining direct charge claiming, and the dollar amount to be paid to the subcontractor.

INSTRUCTIONS FOR PREPARING THE CASE MANAGEMENT OF NON-OPEN CASES CLAIMING PLAN

1. Individually list each type of allowable activity performed and describe how staff performs this activity.2. Indicate whether MAA perform this activity part-time in addition to other duties.3. Describe the method that will be used for claiming, i.e., direct charge or actual staff time reported to Mode 55.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA.2. Attach copies of any contracts entered into for the performance of Case Management of non-Open Cases.



(G) TRAININGDISCOUNTED





___Client Count ____Countywide Medi-Cal Average ____Check here if submitting unapproved methodology. Explain methodology below.

DMH USE ONLY

CP Reference No.____________ Original Approval Date: Amendment Approved Date:



(G) TRAINING DISCOUNTED

(MODE 55, SFC 27-29)

DESCRIPTION

SPMP training, given or received, which improves the skill levels of SPMP staff members in performing allowable SPMP enhanced Medi-Cal Administrative Activities, specifically SPMP program planning and development and SPMP case management of non-open cases.

The only skilled professional medical personnel (SPMP) administrative training activities that are allowable at the 75 percent federal financial participation (FFP) rate are those that directly relate to the SPMP’s performance of his or her allowable SPMP administrative activities. Reimbursement cannot be claimed for medical or health-related training provided to or conducted by an SPMP. Training for SPMPs and Non-SPMPs that is directly related to MAA that are nonenhanced is matched at the 50 percent FFP rate and should be included in the MAA service functions to which the training relates.

INSTRUCTIONS FOR PREPARING THE TRAINING CLAIMING PLAN

1. Individually list (by course title, if applicable) and clearly describe each allowable type of training activity and how it relates to the MAA.

2. The frequency of the training.3. The approximate number of staff who, as a part of their job, perform the training. (Position descriptions/duty statements must

list training as one of their duties.)4. Indicate for each training course, the approximate number of staff expected to attend the training course during the fiscal year.5. Describe the method of determining time and costs for this activity when it is performed in-house or by subcontractors.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for the staff performing the MAA.2. A list of subcontractors, if direct-charge invoices will be submitted. 3. Copies of those sections of the contracts that clearly describe the Training to be performed, how the time spent performing the

Training will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining the direct-charge claiming, i.e. the amount charged per student or session.



(H) MAA COORDINATION AND CLAIMS ADMINISTRATIONNOT DISCOUNTED

(MODE 55, SFC 09)(Attach additional pages if needed. See description and instructions on reverse.)



DMH USE ONLY

CP Reference No. _____________ Original Approval Date: Amendment Approval Date:



(H) MAA COORDINATION AND CLAIMS ADMINISTRATIONNOT DISCOUNTED(MODE 55, SFC 09)

DESCRIPTION

1. Drafting, revising, and submitting MAA claiming plans2. Serving as liaison with claiming programs within the LGA and with the state and federal governments on MAA. Monitoring the

performance of claiming programs.3. Administering LGA claiming, including overseeing, preparing, compiling, revising, and submitting MAA claims to the state.4. Attending training sessions, meetings, and conferences involving MAA.5. Training LGA program and subcontractor staff on state, federal, and local requirements for MAA claiming.6. Ensuring that MAA claims do not duplicate Medi-Cal claims for the same activities from other providers.

INSTRUCTIONS FOR PREPARING THE MAA COORDINATION AND CLAIMS ADMINSTRATION

Claiming plan individually lists each type of coordination/claims administration and describes how staff performed this activity.

1. Claiming plan indicates whether staff performs this activity part-time in addition to other duties.2. Claiming plan indicates the method that will be used for claiming this activity, i.e. direct charge or actual staff time.3. Claiming plan indicates whether any claims preparation activity are being performed by contractors or consultants.

DOCUMENTS REQUIRED

1. Position descriptions/duty statements for each of the staff performing the activity.2. Copies of any contracts entered into for the performance of LGA claims administration.



DOCUMENTS REQUIRED FOR EACHMEDI-CAL ADMINISTRATIVE ACTIVITY

A – Medi-Cal Outreach (Mode 55, SFC 01-03 Not Discounted and

SFC17-19 Discounted)

Position descriptions/duty statements for the staff performing the MAA

Flyers, announcements, or any materials that describe the Outreach campaigns. If materials are unavailable at the time of submission of the claiming plan, provide a statement that gives the location of where materials will be maintained for future DMH, DHS and CMS review.

A list of subcontractors, if direct-charge invoices will be submitted.

Copies of those sections of the contract that clearly describe the Outreach to be performed, how the time spent performing the Outreach will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining direct-charge claiming (including application of the Medi-Cal percentage discount) and the dollar amount to be paid to the contractor.

B – Medi-Cal Eligibility Intake (Mode 55, SFC 04-06 Not Discounted)

Position descriptions/duty statements for the staff performing the MAA.

Copies of any materials unique to or designed by the claiming unit for use in conjunction with this activity.

A list of subcontractors, if direct-charge invoices will be submitted.

Copies of those sections of contracts that clearly describe the Eligibility Intake to be performed, how the time spent performing the Eligibility Intake will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining direct-charge claiming (including application of the Medi-Cal percentage discount) and the dollar amount to be paid to the contractor.

C- Referral in Crisis Situations for Non Open Cases

(Mode 55, SFC 11-13 Discounted)


Copies of those sections of contracts that clearly describe the activity to be performed; how the time spent performing the activity will be documented; how the rate is calculated; and that show the effective date of the contract.

D –Medi-Cal Mental Health Services Contract Administration

(Mode 55, SFC 07-08 Not Discounted and SFC14-16 Discounted)


Copies of a sample of the contracts being administered.

California Department of Mental Health, County Financial Program Support MAA-5-24


E – Program Planning and Policy Development(Mode 55, SFC 24-26 and 35-39 Discounted)


Resource directories, if available, and a list of service providers that are involved with developing strategies, interagency coordination, and developing resource directories.

F – Case Management of Non-Open Cases(Mode 55, SFC 21-23 and 31-34 Discounted)


Copies of any contracts entered into for the performance of Case Management of Non-Open Cases.

G – Training(Mode 55, SFC 27-29 Discounted)


A list of subcontractors if direct charge invoices will be submitted.

Copies of those sections of the contracts that clearly describe the Training to be performed, how the time spent performing the Training will be documented, and that show the effective date of the contract. If direct charging, the contract must clearly show the method used for determining the direct-charge claiming, i.e. the amount charged per student or session.

H – MAA Coordination and Claims Administration(Mode 55, SFC 09 Not Discounted)


Copies of any contracts entered into for the performance of LGA claims administration.



Mental Health MAA Claiming Plan Preparation Check-List

The goal of this checklist is to ensure your MH MAA Claiming Plan is complete and complies with the standard format. Careful attention to the items listed below will enable State staff to perform their reviews of the claiming plan and will prevent many of the omissions that would otherwise result in requests for revisions, thereby speeding the approval of the claiming plan and your invoices for reimbursement. Consider the use of index pages, section tabs, and the like, to enhance the ability of reviewers to find all materials you have included.

Experience has shown that the secret to preparing a MAA claiming plan that will be approved is basically following the instructions. This checklist is designed to help you do just that.

I. General Instructions -

A. Submit three copies of the claiming plan.

B. Read and follow the instructions contained in the claiming plan itself.

C. For EACH claiming unit, prepare and submit all appropriate detailedinformation using the respective pages of the MH MAA Claiming Plan.

D. If a section of the plan does not fit onto one page, use additional copies of the MH MAA form for that section and write “continued” at the top of each page.

E. Use the letters on the grid, which correspond to the allowable activities, to identify MAA activities. Some documents may be labeled with more than one letter.

F. If the claiming unit does not perform a certain MAA function, omit that page.

II. Certification Statement –

A. Statement is complete and signed by the MAA Coordinator.

B. All sections have been completed as required and legible.



III. Table of Contents –

A. All pages of the MH MAA Claiming Plan are numbered.

B. Confirm all page references and numbers are accurate. Clearly label all required documents according to the instructions.

C. County/Chartered City organization chart showing all departments, programs, and subcontractors participating in MH MAA is included.

D. Attachments are clearly and correctly identified, numbered, and included.

IV. Staff List for EACH Claiming Unit – Note that your Department may represent a single claiming unit, if there is no variance in the purpose/activity of the different clinic sites. (For example, your Department operates 8 clinics, and all are open from 7:30am – 5:00pm - five days a week, and provide the same range of outpatient services.) However, if a particular unit is a 24-hour unit, or is staffed to perform a different function – such as emergency psychiatric response – it should be represented as a separate claiming unit.

A. List the number of staff in each staff job classification for each claiming unit. Include the actual staff count, not FTE count. Names are not required.

B. Provide Staff Job Descriptions and/or Duty Statements that reflect the MH MAA activities being claimed as Attachments.

C. List provider sites and addresses.

D. The number of staff includes all staff employed in the claiming unit.Section #10 of the same page includes only staff who are providing and claiming MAA activities. The total for section #10 must be less than Box #3.

E. Provide specificity to avoid using the terms “ongoing and occasionally.”

V. Activity Descriptions for Each Claiming Unit – The Job Descriptions and/or Duty Statements must include the MAA that will be performed and claimed for persons in the positions as indicated in the grid. If the official jurisdiction Job Descriptions are generic and do not include specific duties such as MAA, attach a more descriptive Duty Statement that does include MAA. The Duty Statements should list actual duties and must state more than “performs Medi-Cal Outreach”, “performs Medi-Cal Eligibility Intake”, etc. Be sure to label the specific MAA duties using the letter assigned to each activity on the grid.



A. Medi-Cal Outreach (Mode 55, SFC 01-03 & SFC 17-19)

Use the same numbering sequence to identify the information for preparing the Medi-Cal Outreach Claiming Plan. Include the following:

Clearly describe how this activity will be performed to achieve the objective. (Do not editorialize or provide non-responsive information. Short, precise responses are the best. Focus on providing the requested information in an easy to read and review format. A list is frequently clearer than a lengthy paragraph.)

It is generally advisable to use words used in the MH MAA claiming plan instructions to describe outreach activities. Avoid words CMS may not interpret to be outreach. (Example; use “inform” rather than “educate” or “teach”. Avoid vague words such as “occasionally”.)

Define the target population. If this truly is a broad category of persons, such as low income, state this. When possible and appropriate, be more specific, such as children, homeless individuals, older adults, etc.

Length of time Medi-Cal Outreach will be provided in days and/or hours. If this is an ongoing, daily activity, state eight hours per day, five days per week. List actual times whenever possible.

Location Medi-Cal Outreach will be conducted. This may be at all locations; however, “throughout the county” is not an adequate response. List the locations and give street addresses.

Number of times Medi-Cal Outreach programs will be conducted during the fiscal year. (If the activity will be performed on a regular basis, clearly identify the frequency or indicate this is an ongoing activity.)

If using other than actual reported staff time to Mode 55, describe how the costs of Outreach will be developed and documented.

List any subcontractors, if applicable. Include sections of contracts that clearly describe the Media-Cal Outreach how staff time will be documented, and the contract effective date.

Attach any flyers, announcements or materials that describe the Medi-Cal Outreach. State the title of each outreach campaign and respond to each of the numbered requests for information for each campaign separately. Do the same for each program or ongoing outreach.

For ease of review, type “Documents Required” on the form and respond to the numbered requests. Write “See Attached” if you are attaching materials and clearly mark the attached materials so they can be easily reviewed. If you are not attaching outreach materials listed as items #1 and #3, state the address where copies of the materials will be maintained.

If direct charging, ensure the contract clearly states the method for direct claiming, and the dollar amount to be paid to the contractor.

Discounted Mental Health Outreach (Mode 55, SFC 17-19). Use the same numbering sequence to identify the information for preparing the Medi-Cal Outreach Discounted Claiming Plan. Include the following: The general requirements are the same, however, you are required to also include the discounting methodology your jurisdiction will use to determine the Medi-Cal percentage.

Include all required documents.

B. Medi-Cal Eligibility Intake (Mode 55, SFC 04-06)

Use the same numbering sequence to identify the information for preparing the Medi-Cal Eligibility Intake Claiming Plan. Include the following:

Clearly describe how this activity will be performed to achieve the objective. Indicate whether Eligibility Intake is performed by the LGA’s subcontractors or by claiming unit staff. List the names and addresses of any subcontractors. If using other than actual reported staff time to Mode 55, describe how the costs of the Eligibility Intake will be

developed and documented. Refer to “A” above for other general instructions. Include any required documents.



C. Referral in Crisis Situations for Non-Open Cases (Mode 55, SFC 11-13)

Use the same numbering sequence to identify the information for preparing the Referral in Crisis Situations for Non-Open Cases Claiming Plan. Include the following:

Describe briefly and clearly each allowable type of activity being claimed. Provide a clear and specific description of how the activity will be performed to achieve the objective. List names of any subcontractors performing the activity. Provide the method used to determine time (if other than actual reported direct staff time to Mode 55) and cost

calculation methodology. Include any required documents.

D. Mental Health Services Contract Administration (Mode 55, SFC 07-08and SFC 14-16)

Use the same numbering sequence to identify the information for preparing the Mental Health Services Contract Administration Claiming Plan. Include the following:

Describe briefly and clearly each allowable type of activity being claimed. Provide a clear and specific description of how the activity will be performed to achieve the objective. Method used to determine time (if other than actual reported direct staff time to Mode 55) and cost calculation

methodology. Ensure that the activities meet the criteria listed on the MH MAA Claim Plan. If employees perform this activity 100% of their time, it must be claimed on the direct-charge portion of the

invoice. Subcontractors cannot claim this activity. Respond fully to items numbered 1-5 of the claim plan instructions for Activity D.

1. Identify the MAA activity performed (i.e., identifying and recruiting…, developing and negotiating…, monitor…, providing technical assistance…) for each contract.

2. Indicate whether the contract is Medi-Cal only or mixed with non-Medi-Cal.3. Include the discount methodology your jurisdiction will use to determine the Medi-Cal percentage.4. Describe how activities for SFC 07-09 (Medi-Cal contract admin) are identified to ensure these activities are

not more appropriately reimbursed as SFC 14-16 (Mental Health services contract admin).5. Describe each type of activity performed by staff at the clinic level.

Include all required documents.

E. Program Planning and Development (Mode 55, SFC 24-26 and SFC 35-39)

Use the same numbering sequence to identify the information for preparing the Program Planning and Development Claiming Plan. Include the following:

Describe briefly and clearly each allowable type of activity being claimed. Provide locations were activity(ies) is performed. Identify the programs involved in performing this activity. Subcontractors cannot claim this activity. If employees perform this activity 100% of their time, it should be claimed on the direct-charge portion of

the invoice. Include the discount methodology your jurisdiction will use to determine the Medi-Cal percentage.



Indicate the method used to determine time (if other than actual reported direct staff time to Mode 55) and cost calculation methodology.

Include any required documents.

F. Case Management of Non-Open Cases (Mode 55, SFC 21-23 {SPMP} and SFC 31-34 {non-SPMP})

Use the same numbering sequence to identify the information for preparing the Case Management of non-Open Cases Claiming Plan. Include the following:

Describe briefly and clearly each allowable type of activity being claimed, and how staff will perform this activity. Indicate whether this activity is performed part-time in addition to other duties. Indicate the method used to determine time (if other than actual reported direct staff time to Mode 55) and cost

calculation methodology. Indicate if being direct-charged. Contractor staff may perform this activity, but cannot be reimbursed at the SPMP rate. Include any required documents.

G. SPMP MAA Related Training (Mode 55, SFC 27-29)

Use the same numbering sequence to identify the information for preparing the SPMP MAA Related Training Claiming Plan. Include the following:

This activity can only be claimed by SPMP staff providing or receiving training that is directly related to the SPMP’s performance of allowable SPMP MAA activities.

Individually list and describe each allowable training activity and how it relates to MAA (by course title, if applicable), the frequency of the training, and the approximate number of staff who, as part of their job, perform the training. Also, indicate the number of staff expected to attend each training course during the fiscal year.

Describe the method of determining time and costs for this activity when it is performed in-house or by sub-contractors.

Include any required documents.

H. MAA Coordination and Claims Administration

Use the same numbering sequence to identify the information for preparing the MAA Coordination and Claims Administration Claiming Plan. Include the following:

Describe briefly and clearly each allowable type of activity being claimed. Provide a clear and specific description of how the activity will be performed to achieve the objective. Indicate whether staff performs this activity part-time in addition to other duties. Indicate the method that will be used for claiming this activity (direct charge or actual staff time). Indicate whether any claims preparation activity is being performed by contractors or consultants. Include any required documents.



MENTAL HEALTH MAACLAIMING PLAN AMENDMENT CHECK-LIST

CHANGES THAT MAY OR MAY NOT REQUIRE AN AMENDMENT TO EXISTING MAA CLAIMING PLANS COULD CONSIST OF THE FOLLOWING:County: Name of Claiming Unit: Submittal Date:

Need To Submit Amendment To Your MAA Claiming Plan?

1 Change in the originally submitted ORGANIZATION CHART.ORGANIZATION CHART. No

2 Change in A ADDRESSDDRESS, P, PHONEHONE NUMBERNUMBER, , OROR MAA C MAA COORDINATOROORDINATOR for a Claiming Unit. No

3 Addition of new CLAIMING UNITCLAIMING UNIT. YES

4 Inactivity (i.e., non-claiming) of an approved CLAIMINGCLAIMING UNITUNIT. No *

5 Deletion of previously approved CLAIMINGCLAIMING UNITUNIT. No *

6 Change in the DESCRIPTIONDESCRIPTION of the specific CLAIMINGCLAIMING UNITUNIT functions performed by the Claiming Unit, as described in box #8, on page 4, of the Claiming Plan Instructions.

No

7 Change in the NAMENAME of the CLAIMINGCLAIMING UNITUNIT (which affects the claims / invoicing). Yes

8 Designation of activities as either OUTREACH OUTREACH (Discounted/Non Discounted) (Discounted/Non Discounted) (Note: Amend GRID.)

Yes

9 Addition of new MAA MAA CATEGORYCATEGORY to an existing Claiming Unit; e.g., adding PP&PD. (Note: Amend GRID.)

Yes

10 Addition of new, CAMPAIGN, PROGRAM, OR ACTIVITYCAMPAIGN, PROGRAM, OR ACTIVITY that is substantially different from those approved for Outreach (Discounted/Non Discounted) to an existing Claiming Unit..

Yes

11 Inactivity (i.e., non-claiming) of an approved MAA MAA CATEGORYCATEGORY for an existing Claiming Unit.

No *

12 Deletion of previously approved MAA MAA CATEGORYCATEGORY for a Claiming Unit, e.g., deleting PP&PD.

No *

13 Addition of new STAFF JOB CLASSIFICATIONSTAFF JOB CLASSIFICATION performing MAA, as described in box #9, on page 4 of the Claiming Plan Instructions. (Note: Amend GRID and submit position descriptions/duty statements.)

No

14 Deletion of a classification from the S STAFFTAFF J JOBOB C CLASSIFICATIONLASSIFICATION GRID GRID, as described in box #10, on page 4 of the Claiming Plan Instructions.

No



15 Change in existing POSITION DESCRIPTION/DUTY STATEMENT. No

16 Change in the total NUMBERNUMBER OFOF STAFFSTAFF for which MAA will be claimed -- increase or decrease of 25% or more than the number in the approved Claiming Plan. (Note: Amend GRID and submit additional duty statements).

Yes

17Change in the number of staff who are SPMPSPMP or NONNON-SPMP-SPMP, as described in box #11, on page 4 of the Claiming Plan Instructions. No

18 Addition of a new SUBCONTRACTORSUBCONTRACTOR to an existing Claiming Unit. (Note: Submit copies of those sections of contract that describe the activity to be performed.)

Yes

19 Change in the types of CONTRACTSCONTRACTS for which “Contracting for Medi-Cal Services and MAA” is performed.

No

20 Inactivity (i.e., non-claiming) of an approved SUBCONTRACTORSUBCONTRACTOR for an existing Claiming Unit.

No *

21 Deletion of previously approved SUBCONTRACTORSUBCONTRACTOR from an existing Claiming Unit. No *

22 Change in the METHODOLOGYMETHODOLOGY used in calculating the Medi-Cal discount percentage for MAA.

Yes

23 Change in the METHODOLOGYMETHODOLOGY used for determining how the time and costs for MAA will be developed and documented.

Yes

24 Change in the TARGETEDTARGETED POPULATIONPOPULATION((SS)), e.g., addition of homeless teens who need assistance.

No

25Change in the LOCATIONLOCATION((SS)) where an approved MAA will be performed; e.g., changing the location from the “Main School Clinic” in Martinez, to the “Central School Clinic” in Pittsburgh.

No

26Change in the NUMBERNUMBER OFOF TIMESTIMES outreach campaigns, programs, or activities will be conducted; e.g., changing from weekly to bi-weekly.

No

27 OTHER:OTHER:

* Even though amendments are not required for these inactive and/or deletions, if the local governmental agency (LGA) resumes claiming for these categories, please be sure the previously approved Claiming Plan is still applicable.

It is required that this Check-list accompany the MAA Claiming Plan amendment, along with a cover letter from the LGA and a new Certification Statement containing a new date and signature. This Check-list is not an all-inclusive listing of Claiming Plan amendment situations. If a circumstance arises that is not listed on this Check-list, please explain the situation under #27 above, or attach additional explanation. Also, be sure that the Table of Contents is resubmitted to reflect any changes. ONLY the pages of the existing MAA Claiming Plan, that are changing, need to be amended and submitted to the Department of Mental Health (DMH). Please DO NOT resubmit the entire MAA Claiming Plan. The MAA Claiming Plan Amendment package must be submitted in triplicate.

NOTE: If none of the items checked on the MAA Claiming Plan Amendment Check-list require an amendment, do not submit the Check-list to DMH.



LIST OF EXAMPLES FOR MAA CODING

MAAClaimable Mode SFC

EXAMPLE 1:You are assessing a new client’s mental health needs, and developing a treatment plan. You discover the client does not have Medi-Cal and has not been screened for potential Medi-Cal eligibility. You take the client to see the staff person responsible for financial screening. Yes 55 04-06

EXAMPLE 2:You are assessing a new client’s mental health needs, and developing a treatment plan (therefore, an open case). The client may or may not be Medi-Cal eligible. No ------- -----------------

EXAMPLE 3:You provide referral service to a client with an open case. No ------- -----------------

EXAMPLE 4:During a visit to a residential living facility, you encounter a resident with an emergency physical health problem. You refer that client to a Medi-Cal health provider and arrange transportation. Client has open case: Client does not have open case:

No Yes

------- 55

-----------------21-23/31-34

EXAMPLE 5:You refer a client to an Institution for Mental Diseases (IMD) facility, and assist him in the process by arranging transportation. No ------- -----------------

EXAMPLE 6:You refer a client to a residential living facility, and assist him in the process by arranging transportation. No ------- -----------------

EXAMPLE 7:A contract provider contacts you with questions about a new Federal Medi-Cal program. Yes 55 07-09/14-16

EXAMPLE 8:You interview and screen clients for financial data. Whenever a client does not have Medi-Cal, you spend time determining whether they may be eligible. When a client appears to be potentially eligible, you refer them to the agency in your county that handles Medi-Cal applications. Yes 55 04-06

EXAMPLE 9:Same as above, but for Supplemental Security Income (SSI) Yes 55 04-06

EXAMPLE 10:Same as above, but for food stamps. No ------- -----------------





EXAMPLE 11:You attend training regarding new procedures to follow when intervening in a crisis situation. The training includes referral information, emphasizing the importance of linking the client to the appropriate level of treatment. Yes 55 11-13

EXAMPLE 12:You attend training where Medi-Cal Administrative Activities (MAA) is explained to you, and you are instructed in the use of the new form to claim your MAA activity time. Yes 55 01-09

EXAMPLE 13:You work with a youth population where many are eligible for Sensitive Services Medi-Cal. You ensure that as many of them as possible are enrolled in Sensitive Services Medi-Cal by referring them for Medi-Cal applications whenever appropriate. Yes 55 04-06

EXAMPLE 14:Your facility treats a homeless population. You find that many are resistant to enrollment in treatment programs, Medi-Cal, SSI, or any of the other services you try to link them up to. You spend time with these clients discussing the benefits to them and encouraging them to enroll. Yes 55 01-03

EXAMPLE 15:You believe you have identified the need for a Day Treatment program in your facility. At a staff meeting you bring the issue up for discussion. All agree it is a good idea. No action is taken. No ------- -----------------

EXAMPLE 16:You believe you have identified the need for a Day Treatment program in yourFacility. You recommend to your program manager that one should be started. No ------- -----------------

EXAMPLE 17:You believe you have identified the need for a Day Treatment program in yourFacility. You list the clients who need the program, do a cost-to-benefitAnalysis, and submit a written proposal to your program manager. Yes 55 24-26/35-39





EXAMPLE 18:Your Director has approved your proposal for a new Day Treatment program. Funding and staffing are made available, and you are assigned to coordinate it. You identify space, enroll clients, develop the program curriculum, train staff, etc. Some of this work is done during unscheduled, unpaid hours. Paid Time: Unpaid Time:

Yes No

55-------

24-26/35-39-----------------

EXAMPLE 19:You assist in developing a cold weather program designed to bring the homeless out of winter weather. No ------- -----------------

EXAMPLE 20:You pick up a phone call from a woman about her husband’s behavior. Recently he has begun acting oddly and she’s becoming concerned that she can’t handle him. Your discussion of his actions leads you to suggest she bring him to a mental health clinic near her home. You give her the phone number and address, and possibly a contact person at the facility. Yes 55 01-03/17-19

EXAMPLE 21:Same factual situation, except your facility is convenient and you schedule an appointment for her husband. Yes 55 01-03/17-19

EXAMPLE 22:Same woman and husband, except that you receive the call from the police, who have been called out because the husband appeared violent. You roll as part of your Psychiatric Emergency Response Team. Once on site, you are able to stabilize the man, arrange transportation to an inpatient Medi-Cal facility, and determine that they has no medical coverage, and he has not received any mental health care:

(a) The husband does not have an open case.(b) The husband has an open case.

Yes No

55-------

11-13-----------------



CHAPTER 6

Determining the Medi-Cal Percentage

Table of Contents

Subject PageOverview MAA 6-1MAA That May Require Discounting by the Medi-Cal Percentage

MAA 6-1

Definition of the Medi-Cal Percentage MAA 6-1Approval of Methodologies for Determining Medi-Cal Percentages

MAA 6-2

Actual Head Count MAA 6-3Using Actual Head Count for Determining the Medi-Cal Percentage

MAA 6-4

Countywide Average Percentage MAA 6-4



Determining the Medi-Cal Percentage

Overview The portion of costs that can be claimed as allowable for some Medi-Cal Administrative Activities (MAA) is based on the Medi-Cal percentage. Costs may be reduced or “discounted” by the Medi-Cal percentage when the activity benefits or involves both Medi-Cal and non-Medi-Cal populations. Methods for determining the applicable Medi-Cal percentage may vary for each MAA. The Medi-Cal percentage is multiplied against other factors to determine the amount of reimbursement. The Medi-Cal percentage must be determined each quarter and the method used to determine the percentage must be consistent with the methods identified in the MAA Claiming Plan.

MAA That May Require Medi-Cal Outreach (Discounted): This activity mustDiscounting by the Medi-Cal always be discounted by county-wide Medi-Cal average orPercentage any other method approved by DHS. Please refer to DHS

website for policy and procedure letters: http:/www.dhs.ca.gov/mcs/mcpd/mbb/acss/ppl_index.htm.

Contracting for Medi-Cal Services and Medi-Cal Administrative Activities: If the contracts administered under this activity provide services to both Medi-Cal and non-Medi-Cal populations, then it must be discounted by the appropriate Medi-Cal percentage.

Program Planning and Policy Development: If the Programs for which planning and policy development are performed serve both medi-Cal and non-Medi-Cal populations; this activity must be discounted by the appropriate Mdi-Cal percentage.

Definition of the The Medi-Cal percentage is the fraction of persons whoMedi-Cal Percentage are actual recipients of the Medi-Cal program. The

numerator is the number of the Medi-Cal recipients and the denominator is the total number of persons.

A person who would be Medi-Cal eligible but has neither applied nor has been determined to be enrolled in Medi-Cal, or whose status is “pending,” is not to be counted in the numerator of the calculation to determine the Medi-Cal percentage. The term “enrolled” means



that the individual has gone through a formal eligibility determination process and that the county social services



agency has determined him/her to be eligible and currently able to receive Medi-Cal services. “Share of cost” clients are “spend down” clients, and may or may not be Medi-Cal enrolled at any given point in time. Clients for whom the “share of cost” obligation has not been met are not considered Medi-Cal eligible for this purpose and are not to be included in the numerator of the calculation.

Approval of Methodologies State and federal guidelines require that the methodologyFor Determining used to determine the Medi-Cal percentage beMedi-Cal Percentages “statistically valid". Currently the two approved

methodologies are based on “actual head count” and “countywide average Medi-Cal percentage.” These two methodologies are described below. A number of methods for determining the Medi-Cal percentage are possible. However, the acceptance of other proposed methodologies will ultimately be based on State and federal review and approval.

The procedure for securing approval is to include the proposed methodology in the MAA Claiming Plan. If the proposed methodology is not approved, any claims that used this methodology will be returned to the LGA unpaid so that the Medi-Cal percentage can be re-calculated using an approved methodology.

LGA’s should expect disapproval of a methodology if "staff judgement" or "management determinations" are the basis for calculating the Medi-Cal percentage. The Medi-Cal percentage must be current with the quarter being claimed and must be updated with each invoice submitted to DMH before December 31st of the fiscal year for which a claim is being submitted. Please note that all claims must be submitted to DMH prior to, or at the time of, the submission of the fiscal year cost report.

Each claiming unit within the LGA may use a different methodology. Decisions on which methodology to use to calculate the Medi-Cal percentage must be based on the nature of the claiming unit and by the kind of data that is collected on the client population. Following state and federal approval of the methodology, the claiming unit must use the approved methodology from quarter to quarter so that the Medi-Cal percentage is current with



the period of costs reflected on the MAA Invoice. Should a claiming unit elect to change methodologies, e.g., from



actual count to countywide average, a MAA Claiming Plan Amendment must be filed no later than the end of the quarter in which the claiming unit wishes to use the new methodology.

Actual Head Count A Medi-Cal percentage that is based upon the actual “head count” is determined from the total number of Medi-Cal recipients and the total number of all individuals served by the claiming unit. The total number of all individuals served by the claiming unit is defined in the claiming plan as the target population. The Medi-Cal percentage is the fraction of a claiming unit’s target population whom are actual recipients of the Medi-Cal program. To use this methodology, the claiming unit must define the population “served” and identify the Medi-Cal status of each person. Although a true actual head count would be done on an ongoing basis, a head count that is done for one full month during each quarter for which claims will be made is acceptable. A sampling taken once per year will not suffice to document the Medi-Cal percentage.

To document the Medi-Cal status of clients, staff must record the Medi-Cal number of each person served. This information can be documented on an information collection form or in the client’s case record. Another strategy is to compare identifying information that the entity collects on the population with data on the Medi-Cal population kept by the local social services agency. This comparison must be done through electronic tape matches to ensure statistical validity and accuracy.

It should also be noted that county social services agencies may not include information on Supplemental Security Income (SSI) recipients who have Medi-Cal cards. Thus, this population, as well as children in foster care, may not be reflected in any tape match that is done by the LGA. It is also important to remember that the tape match is possible only when the LGA needing the data provides the social services agency with a list of its population and includes the agreed upon identifying information. The social services agency's response will be a single number, the percentage of the defined population who matched the Medi-Cal population.





Using Actual Head Count For multiple Outreach (Discounted) campaignsFor Determining The Medi-Cal accurate data must be collected on the Medi-Cal statusPercentage of each person reached for each outreach campaign.

Two methods, 1) Client Count and 2) Countywide Average Percentage may be used to calculate the combined Medi-Cal percentage for all Outreach (Discounted) campaigns.

For Mental Health Services Contract Administration and Program Planning and Development more than one contract or program may be involved. The Medi-Cal percentage may vary by the contract being administered or the program for which planning and policy development is being performed

Countywide Average Claiming units may find that the collection of informationPercentage about a population's Medi-Cal status may be intrusive or

inefficient. In these cases, the claiming unit may use the percentage of the LGA’s total population which have Medi-Cal cards for its own Medi-Cal percentage. A list of these percentages, by county is available from DHS. Please refer to DHS website for policy and procedure letters: http://www.dhs.ca.gov/mcs/mcpd/mbb/acss/ppl_index.htm.



CHAPTER 7

Medi-Cal Administrative Activities (MAA)SD/MC Quarterly Claims

Table of Contents

Subject PageMH1982D (Short-Doyle/Medi-Cal Quarterly Claim) MAA 7-1Instructions and Form MH 1982D MAA 7-2



California Department of Mental Health, County Financial Program Support MAA 7-1


INSTRUCTIONS FOR COMPLETING MH 1982D

A. HEADING INSTRUCTIONS

1. Complete the identifying information in the headingB. COLUMN INSTRUCTIONS

1. Column "A" is for activities reimbursed at the 50% FFP rate with no eligibility factor applied. Please indicate the specific service function codes. These services function should match the information in the county’s approved Mental Health MAA Claiming Plan.

Complete only the yellow shaded areas on the MH 1982 D form. The system will automated calculate the other fields.

These activities include service functions:01-03 Medi-Cal Outreach04-06 Medi-Cal Eligibility Intake07-09 Mental Health Services Contract Administration

(Note: Service function 09 may be used for MAA claims and claiming plan preparation and implementation training.)

2. Column "B" is for activities reimbursed at the 50% FFP rate with the eligibility factor applied. These activities include service functions:

11-13 Referral in Crisis Situation for Non-Open Cases14-16 Discounted Medi-Cal Mental Health Services Contract Administration17-19 Discounted Medi-Cal Outreach31-34 Non-SPMP Case Management of Non-Open Cases35-39 Non-SPMP Program Planning and Policy Development

3. Column "C" is for subtotals of columns "A" and "B"

4. Column "D" is for activities reimbursed at the 75% FFP rate with the eligibility factor applied These activities include service functions:

21-23 SPMP Case Management of Non-Open Cases24-26 SPMP Program Planning and Policy Development27-29 SPMP MAA Training

5. Column "E" is the total of columns "C" and "D"

C. LINE INSTRUCTIONSService function codes: Enter a single code from each of the ranges approved in the claiming plan(e.g. if approved for 01-03 Medi-Cal Outreach, enter an "01", "02" or "03")Line 1: Enter the total amount of staff time for the activities (expressed as minutes)Line 2: Enter the provision unit of service (per minute) claiming rateLine 3: Multiple Line 1 by Line 2Line 4: Enter the Medi-Cal eligibility discount factor calculated in accordance with the approved MAA claiming planLine 5: Multiple Line 3 by Line 4Line 6: Enter any offsetting revenues attributable to MAALine 7: Subtract Line 6 from Line 5Line 8: Multiple Line 7 in column "A" and "B" by 0.5Line 9: Multiple Line 7 in column "D" by 0.75



Line 10: Subtract Line 8 from Line 7 in columns "A" and "B". Subtract Line 9 from Line 7 in column "D"Line 11: Add the amount on Line 8 in column "C" to the amount on Line 9 in column "D"Line 12: Add the amount on Line 10 in column "C" and "D"Line 13: If applicable, enter the amount of any direct claimLine 14: Enter the amount of any revenue offsetting the direct claim amountLine 15: Subtract Line 14 from Line 13Line 16: Add the amounts on Lines 11 and 15

D. CERTIFICATION INSTRUCTIONS1. Complete the name, date and title information and sign the claim.

E. CLAIM SUBMISSION1. Submit the claim to: Department of Mental Health

Medi-Cal Liaison Unit1600 Ninth Street, Room 120Sacramento, CA 95814Attention: Antoinette Reed



CHAPTER 8

Medi-Cal Administrative Activities (MAA)Guides and Examples

Table of Contents

Subject PageSkilled Professional Medical Personnel MAA 8-1Guidelines for Securing Enhanced FFP MAA 8-2



MAA Guides and Examples

SKILLED PROFESSIONAL MEDICAL PERSONNEL

In 1986, CMS implemented regulations at section 432.50 of 42 CFR with defined professional education and training as:

…the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession. This is demonstrated by possession of a medical licensee, certificate, or other document issued by a recognized National and State medical licensure or certifying organization or a degree in a medical field issued by a college or university certified by a professional medical organization. Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in the field of medical Care.

The Code of Federal Regulations goes on to say that to receive 75 (%) percent FFP for the allowable costs of these staff:

…The skilled professional medical personnel are in positions that have duties and responsibilities that require those professional medical knowledge and skills.

In regard to 75 (%) percent FFP for clerical staff who provide direct support to Skilled Professional Medical Personnel.

…The directly supporting staffs are secretarial, stenographic, and copying personnel and file and records clerks who provide clerical services that are directly necessary for the completion of the skilled professional medical responsibilities and functions of the skilled professional medical staff. The skilled professional medical staff must directly supervise the supporting staff and the performance of the supporting staff’s work.



GUIDELINES FOR SECURING ENHANCED FEDERAL FINANCIAL PARTICIPATION

Stipulations for Enhanced Funding: Seventy-five percent (Enhanced) federal matching rate can be claimed for salaries, benefits, travel and training of skilled professional medical personnel (SPMP) and their directly supporting clerical staff who are in an employee-employer relationship with the Contractor and are involved in activities that are necessary for proper and efficient Medi-Cal administration. Fifty percent (non-enhanced) federal matching can be claimed for SPMP and directly supporting clerical staff performing related activities that are non-enhanced.

SPMP costs may be matched at the 75 percent rate in proportion to the time worked by SPMP in performing those duties that require professional medical knowledge and skills, as evidenced by position descriptions, job announcements or job classifications and when qualified functions are performed such as:

. Liaison on clinical aspects of the program with providers of services and other agencies that provide clinical care,

. Furnishing expert clinical opinions,

. Reviewing complex clinical billings,

. Participating in clinical review, or

. Assessing the necessity for and adequacy of mental health care and services.



Directly supporting staff costs may be matched at the 75 percent rate in proportion to the time worked by clerical staff in performing those clerical job responsibilities that directly support skilled professional medical personnel (Part 423.2, 42 CFR). The directly supporting staff must provide clerical services that are directly necessary for carrying out the professional medical responsibilities and functions of the SPMP. The SPMP must be immediately responsible for the work performed by the clerical staff and must directly supervise (immediate first-level supervision) the supporting staff and the performance of the supporting staff’s work.

Classifications Eligible for It is the legal entity’s responsibility to substantiateEnhanced Funding: claiming based on SPMP status. The legal entity’s

job specification must stipulate that the incumbent be from one of the below classifications and the program duty statement must reflect enhanced and non-enhanced activities.

A. Skilled professional medical personnel (SPMP) per the Title 42, Code of Federal Regulations (CFR), Charger IV, and the Federal Register.

1. Physician,

2. Registered Nurse,

3. Physician Assistant,

4. Medical Social Worker- with a Master’s degree in Social Work (M.S.W.) with a specialty in a medical setting,

5. Health Educator- with a Master’s degree in Public or community Health Education and graduated from a institution accredited by the American Public Association or the Council on Education for Public Health,





6. Licensed Vocational Nurse- who have graduated from a two-year program, and

B. SPMP per the U.S. Department of Health and Human Services Departmental Appeal Board decisions:

1. Licensed Clinical Psychologist- with a Ph.D. in psychology.

C. SPMP per State Department of Health Services policy:

1. Licensed Audiologist- certified by the American Speech and Hearing Association,

2. Licensed Physical Therapist,

3. Licensed Occupational Therapist- registered by the National Registry of American’ Occupational Therapy Association,

4. Licensed Speech Pathologist, and

5. Licensed Marriage, Family and Child Counselors.

D. Directly supporting staff:

Clerical Staff - who is in direct support of and supervised by skilled professional medical personnel,

The employer’s job specification must require clerical skills,

The program duty statement must reflect clerical functions in support of skilled professional medical personnel.





SPMP includes only professionals in the field of medical care. SPMP does not include non-health professionals such as public administrators, medical budget directors or analysis, lobbyists, or senior managers of public assistance or Medicaid programs.

Direct support staff means clerical staff who:

Is a secretarial, stenographic, copy file, or record clerk that provides direct support to the skilled professional medical personnel,

Provides clerical services directly necessary for carrying out the professional medical responsibilities and functions of the skilled professional medical personnel, and

Has documentation such as a job description, that the services provided for the skilled professional medical personnel are directly related and necessary to the election of the SPMP responsibilities.

Professional Education and Training Skilled professional medical personnel are required to have education and training at a professional level in the field of medical care or appropriate medical practice before FFP can be claimed at 75 percent “Education and training at professional level” means the completion of two year or longer program leading to an academic degree or certificate in a medically related profession. Completion of a program may be demonstrated by possession of a medical license or certificate issued by a recognized national or staff medical licenser or certifying organization or a degree in a medical field issued by a



college or university certified by a professional medical organization. Experience in the administration, direction, or implementation of the Medicaid program will not be considered the equivalent of professional training in a field of medical care.
