FISCAL OFFICERS TRAINING MANUAL

Transcription

1 FISCAL OFFICERS TRAINING MANUAL INTRODUCTION WELCOME TO THE FISCAL OFFICERS TRAINING MANUAL! The Fiscal Officers Training Manual serves as a guiding document on various aspects of Mental Hygiene funding. It is designed to provide new and current fiscal officers direction and instruction on how to perform their fiscal responsibilities of oversight and management of Mental Health, Alcohol and Substance Abuse, and Developmental Disabilities services within their county. The manual is divided into three sections: introduction, table of contents, and procedures. It is a dynamic document and is intended for reference purposes only. The policies and procedures are not all inclusive and should not be misconstrued as such. Sincere gratitude to the following members of the Fiscal Officers Manual Workgroup who contributed their time and expertise to the development of this Business Process document: Peg LaWare Jim Monfort Jill Tibbett Laurie Durham Sean Ganter Rob Carey Karolyn Sayles Jason Kuby Angelica Torres NYS OMH Central Office CCSI Central NYS OMH Field Office Clinton County Essex County Greene County Madison County Monroe County Suffolk County The manual is maintained by a Fiscal Officers Manual Workgroup comprised of county Fiscal Officers and NYS Field Office staff and membership may change annually. Please send any comments and/or suggestions to Mary Coppola MC@clmhd.org and they will be directed to the appropriate workgroup members. The purpose of the Fiscal Officers Manual Workgroup is not meant to support Fiscal Officers, but to provide written direction and instruction. If you have any questions or need assistance with any of the procedures, please call your appropriate Local Field Office for assistance.

2 FISCAL OFFICER TRAINING MANUAL TABLE OF CONTENTS I. Overview A. Introduction B. Calendar Cycle Overview 1. Calendar Year 2. Fiscal Year II. State Aid Funding (Net Deficit) A. NYS State Aid Funding Letter B. NYS State Advance Payments III. Other Revenue Sources (if applicable) A. Medicaid B. Comprehensive Outpatient Program Services (COPS) C. Community Support Program Services (CSP) D. Disproportionate Share Income (DSH) E. Federal Medicaid Salary Sharing (FSS) IV. County Reports and Deliverables A. County Budget Process V. NYS Agency Reporting Requirements A. NYS Deliverables and Sanctions 1. OMH 2. OASAS [under construction] 3. OPWDD B. Preliminary Allocation Summary (PAS) (OMH - discontinued 2011) C. County Allocation Tracker (CAT) [under construction] (OMH) D. Budget Submission Process (CBR) (OMH, OPWDD, OASAS) 9/30/2011

3 CALENDAR YEAR CYCLE STATE DELIVERABLES Legend: Calendar Fiscal Cycles Prior Year: (-1) Jan (-1) to Dec (-1) State: April 1 March 31 Current Year: (0) Jan (0) to Dec (0) OMH/OAS/OPW Community Budget: July 1 June 30 Next Year: (+1) Jan (+1) to Dec (+1) Upstate / Downstate Counties: January 1 December 31 NYC: July 1 June 30 Direct State Contracts: Varies Jan 1/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 4 for Year (-1) Feb 2/15 OPW Budgets and Contract for Year 0 Mar 3/1 OMH MHPD updates for Year 0 Apr 4/1 OMH Preliminary Allocation Summary (PAS) for Year 0 4/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 1 for Year 0 May 5/1 OAS Estimated Claim Due for Year (-1) 5/1 Pre-Approved 30 Day Extension Request Due (OMH, OASAS, OPWDD) 5/1 CFR s Due w/o 30-Day Extension (OMH/OPW/OAS) for Year (-1) Jun 6/1 County Budget Process Begins for Year +1 (varies) 6/1 CFR s Due with 30-Day Extension for Year (-1) 6/15 Final Claims Due (OMH/OPW/OAS) for Year (-1) (with 30-day extension) Jul 7/1 County - Provider Claims / Payment Reconciliations for Year (-1) 7/15 NYS Closeout packages begin being received for Year (-1) 7/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 2 for Year 0 Aug 8/15 OAS Mid-Year Claims due for Year 0 Sep 9/30 Federal Single Audits due for Year (-1) Oct 10/1 OAS CBR s due for Year +1 (with work scope) 10/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 3 for Year 0 Nov 11/1 OMH CBR s due for Year 0 11/1 County Provider Contracts processed for Year +1 (varies) Dec 12/1 Final Equipment Requests due to NYS FO for Year 0 12/15 Federal Certifications Due for Year +1 Updated: May 1, 2011

4 E. Program Budget Change Request (PBCR) (OASAS) 1. PBCR Form (OASAS) F. Consolidated Quarterly Report (CQR) Submission (OASAS) G. Consolidated Fiscal Report (CFR) (OMH, OPWDD, OASAS) H. Final Year End Claim Submission (OMH, OPWDD, OASAS) VI. Closeouts / Reconciliations A. NYS Closeout Review 1. OMH 2. OASAS 3. OPWDD B. Provider Reconciliations and Recovery Process VII. Other NYS Requirements and Reports A. Equipment Purchases Approval by Field Office 1. OMH 2. OASAS 3. OPWDD [under construction] B. Federal Funds Certifications and Assurances (OMH) C. Single Audit (A133) (OMH, OPWDD, OASAS) D. Uncompensated Care Report (OMH) VIII. Programs and Program Fiscal Models A. Case Management Fiscal Models (OMH) B. Case Management Service Dollars (OMH) C. Personalized Recovery Oriented Services (PROS) (OMH) D. Child and Family Clinic Plus (OMH) E. Clinic Restructuring Overview (OMH, OASAS) IX. Applications / Websites A. Aid to Localities Fiscal System (ALFS) Access (OMH) 9/30/2011

5 B. Mental Health Provider Database (MHPD) (OMH) C. State Aid Budget & Reporting System (SABRS) [under construction] (OASAS) X. Additional Resources A. Acronyms B. CBR & Claiming Manual C. CFR Manual D. Aid to Localities Spending Plan Guidelines E. NYS OMH / OMR / OAS Websites 1. CFRS mailing list F. Fiscal Officer Meetings G. NYS Field Offices H. What is? 1. Form AC NPI 3. Patient Characteristics I. Program Changes What do you do? 1. PAR 2. MHPD J. OMH Statistics and Reports 9/30/2011

6 FISCAL YEAR CYCLE (NYC) STATE DELIVERABLES Legend: Calendar Fiscal Cycles Prior Year: (-1) Jan (-1) to Dec (-1) State: April 1 March 31 Current Year: (0) Jan (0) to Dec (0) OMH/OAS/OPW Community Budget: July 1 June 30 Next Year: (+1) Jan (+1) to Dec (+1) Upstate / Downstate Counties: January 1 December 31 NYC: July 1 June 30 Direct State Contracts: Varies Jan 1/1 County - Provider Claims / Payment Reconciliations for Year (-1) 1/15 NYS Closeout packages begin being received for Year (-1) 1/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 2 for Year (-1) Feb 2/15 OAS Mid-Year Claims due for Year 0 Mar 3/1 OAS CBR s due for Year +1 (with work scope) 3/31 Federal Single Audits due for Year (-1) Apr 4/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 3 for Year (-1) May 5/1 County Provider Contracts processed for Year +1 (varies) Jun 6/1 Final Equipment Requests due to NYS FO for Year 0 6/15 Federal Certifications Due for Year +1 6/31 OPW Budgets and Contract for Year +1 July 7/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 4 for Year (-1) Aug Sep 9/1 OMH MHPD updates for Year 0 Oct 10/1 OMH CBR s due for Year 0 10/1 OMH Preliminary Allocation Summary (PAS) for Year 0 10/21 OMH Federal Medicaid Salary Sharing (FSS) Quarter 1 for Year 0 Nov 11/1 OAS Estimated Claims Due for Year (-1) 11/1 Pre-Approved 30 Day Extension Request Due for Year (-1) (OMH, OASAS, OPWDD) 11/1 CFR s Due w/o 30-Day Extension (OMH/OPW/OAS) for Year (-1) Dec 12/1 CFR s Due with 30-Day Extension for Year (-1) 12/15 Final Claims Due (OMH/OPW/OAS) for Year (-1) 12/31 OPW Budgets and Contract for Year 0 12/1 County Budget Process Begins for Year +1 (varies) Updated: May 1, 2011

7 Business Process: (what is it?) FISCAL OFFICER TRAINING MANUAL NYS STATE AID FUNDING LETTER State Aid funding for Local Governmental Units (LGU s), county operated programs and county contracted service providers are communicated via State Aid Funding Letter process. State Aid Funding Letters are issued to LGU s by each of the applicable Department of Mental Hygiene (DMH) State Agencies (the Office of Mental Health OMH, the Office of Alcoholism and Substance Abuse Services-OASAS, and the Office for People With Developmental Disabilities OPWDD) for a specified fiscal reporting period. Brief Description of Process: (how does it work?) State Aid Funding Letters are usually issued to the LGUs by the applicable DMH State Agency (OMH/OASAS/OPWDD) prior to start of the fiscal period covered. Each DMH State Agency displays their State Aid allocations in different formats. OMH: Funding Letters are issued by funding source code and are not service provider specific. OMH funding is allocated through the LGU to subcontracted not-for-profit service providers and county operated programs (if applicable as not all counties directly operate services). OASAS: Funding Letters are service provider, program, and funding source specific. OPWDD: Funding Letters are agency and funding source specific. It is the responsibility of the LGU to identify any changes in funding from previous funding letters and facilitate the allocation of the correct funding amounts to the service providers. Local services contracts between the LGU and subcontract agencies are developed to reflect the funding being allocated and the service/program expectations. Direct State Contracts are contracts between NYS and a provider agency that does not include the County. The funding flow direct from NYS to the provider and is not included on the County State Aid Funding Letter. Frequency: Initial funding letters from each DMH State Agency are generally issued prior to or close to the beginning of the fiscal period that they cover. There can be many revisions of these letters throughout the fiscal period that reflect additions, reductions or shifts in funding that may occur as a result of fiscal changes at the State level. OMH State Aid Funding Letters are issued quarterly and as needed on a county-specific basis. Instructions: The OMH State Aid Funding letters are not agency specific and funds must be allocated and approved by the LGU. OMH State Aid Funding Letters are transmitted to the LGU through the Aid to Localities Financial System (ALFS). OMH State Aid Funding Letter also includes; 1) a cover letter with instructions/important updates, 2) number of funding slots/beds/managers in modeled programs, 3) county Case Management models, and 4) where applicable, DSH thresholds. The OASAS State Aid Funding letter is both agency and program specific. Note: Each State Aid Funding Authorization must be signed by the Director of Community Services and returned to NYS OASAS. OASAS State Aid Funding Letters are mailed to the County Director of Community Services or designee on file. The OPWDD State Aid Funding letter is agency specific. OPWDD State Aid Funding Letters are mailed to the County Director of Community Services or designee on file. The LGU is responsible for the verification of approved funding levels and contracting for all State Aid funding allocations for their County. Changes to funding may result in Contract amendments for subcontracted provider agencies. Providers should be notified of any funding changes that may affect them.

8 It is the responsibility of the LGU to ensure that correct funding codes, funding code indexes, site codes, and funding amounts, including calculations of funding increases or reductions, for the current fiscal period are relayed to the service providers. This may result in contract amendments at the county level. Direct Contracts are service contracts between NYS and a provider agency. LGU s are not responsible for any actions related to the contracts including: reviewing, informing, auditing, reporting, etc. of any Direct Contracts. Direct Contracts can usually be identified on the CFRS submissions with Contract # s starting with C###### or T#######. Direct Contracts include all of the reporting requirements as Local Contracts (funding flowing through the County State Aid Funding letter), but all submission requirements are sent directly to the state. Resources: 1. NYS Consolidated Budget & Claiming Manual, Local Governmental Unit (LGU) Responsibilities 2. NYS Consolidating Fiscal Reporting Manual, Introduction to State Aid Claiming in the CFRS sections. The manuals can be accessed at 3. Aid to Localities Spending Plan Guidelines: Date: May 1, 2011 OMH Review: 8/27/10 OASAS Review: 2/9/11 OPWDD Review: (none)

9 Business Process: (what is it?) FISCAL OFFICER TRAINING MANUAL NYS STATE ADVANCE PAYMENTS Each disability, Office of Mental Health (OMH), Office of Alcoholism & Substance Abuse Services (OASAS), and Office of People with Developmental Disabilities (OPWDD), send payments for local service contracts to County s Local Governing Units. The basis for the payments is the County s State Aid Funding Letter for that disability. Brief Description of Process: (how does it work?) Each state disability will process payments based upon their determined frequency, month, or under special instructions. The county will receive the payments as either an ACH wire transfer to their County accounts or as a check mailed to the county. Note: Counties differ in the payment procedures, Counties may make payments to providers (which may include themselves as a provider of services) based upon contracts, provider vouchers, or state advances received (money received is paid out to providers). Frequency: Each state disability has its own advance payment frequency as described: OMH makes 4 quarterly payments with additional supplemental as needed, OASAS makes 4 quarterly payments for State funding and 12 monthly payments for Federal funding with additional supplemental as needed, OPWDD makes 4 quarterly payments with a 10% withhold until final payment upon closeout. Final Closeouts: Upon receipt of final prior year closeout, NYS disabilities will make any final corrections for overpayments/ underpayments in a future State Advance payment to the county. Instructions: Notifications that payments have been received, ACH wire transfer or check, are usually sent to the Director of Community Services, the County Fiscal Officer, and/or Treasurer s Office. After receiving notification/ receipt, the Fiscal Officer will follow the county procedures for processing the State Advances and depositing the payments into the proper accounts. Note: This process may initiate the Provider payment process. A tracking log should be setup to reconcile current State Aid Letter allocations and payments received for a given year. It should allow for prior year recoupments / recoveries to be identified. This document will assist in identifying balances, payment errors, and/or future payments. Note: OPWDD withholds 10% of the State Aid allocations from their payments and makes final payment upon closeout of the final county provider claims. It is the LGU s responsibility to notify providers of any delay in anticipated payments. Providers may need to turn to other options (i.e. lines of credit, restricted funding, etc) in the interim. For NYS closeouts that result in a recovery of state dollars, the recovery is taken out of a future state advance payment to a county. Any closeout recoveries are reflected in the State Advance Payment Remittance letter, which reflects the expected advance payment minus the prior year recovery and the total state advance payment paid to the county. Note: OPWDD State Advance Payments Remittance letters do not provide as much detail, so it may be necessary to contact NYS staff for additional information. Resources:

10 1. To Sign up for Electronic Payments Track a payment: NYS Comptroller Office Payment Information Inquiry - Date: May 1, 2010 OMH Review: 1/4/11 OASAS Review: (none) OPWDD Review: (none)

11 Business Process: (what is it?) FISCAL OFFICER TRAINING MANUAL MEDICAID Medicaid is a federal health insurance program for low income individuals and families. Medicaid is administered at the state level and managed at the county level in NYS. Eligibility is based on federal poverty guidelines. Covered benefits include minimum federal requirements and optional benefits identified in state medicaid plans. In NYS, Medicaid is funded by federal, state and local shares. Medicaid is largest share of revenues for Behavioral Health services. In NYS, Medicaid is paid directly to licensed service providers on a fee-for-service basis and through the Medicaid managed care program. Most individuals in NYS participate in managed care (HMO styled plans) on a mandatory basis. However, many behavioral health services are provided outside the managed care benefit plan. Rules defining Medicaid covered services, payment rates and billing guidelines are set forth in NYS regulations (add link). Brief Description of Process: (how does it work?)medicaid regulations outline the minimum requirements which must be met in order for a licensed provider to be able to bill Medicaid for a covered service to a Medicaid eligible individual. The Billing section summarizes the basic billing rules and limitations. The Documentation section summarizes the requirements which, when met, provide supporting documentation that the eligibility and billing requirements have been met. Even when there is not a specific documentation requirement included in the regulations, providers are advised to ensure that they have sufficient documentation to verify compliance with other standards. Medicaid claims are auditable by federal and state agencies. (See NYS Office of Medicaid Inspector General website below) Frequency: Medicaid covered services are billed according to rules set forth in regulation. For example, the frequency could be pervisit, hour, day of service or month of service. Medicaid covered services and payment rates are periodically updates in NYS regulations. Significant changes may require federal approval of Medicaid state plans. Instructions: Medicaid has various components; please refer to the websites listed below for additional subject matter. Resources: 1. Medicaid Program General Information: 2. Administrative Practices and Medicaid Requirements: 3. Medicaid Compliance Program: 4. Medicaid Self-Disclosure Guidance: 5. Use of Electronic Records by Medicaid Providers: 6. EMedNY electronic claiming:

12 7. NYS Department of Health Medicaid Updates: 8. NYS Office of the Medicaid Inspector General (OMIG): Date: May 1, 2011 OMH Review: (none) OASAS Review: (none) OPWDD Review: (none)

13 Business Process (what is it?) FISCAL OFFICER TRAINING MANUAL COMPREHENSIVE OUTPATIENT PROGRAM SERVICES (COPS) Level I Comprehensive Outpatient Program Services (Level I COPS) is a program which enables a provider of licensed mental health outpatient services to be eligible to receive supplemental medical assistance reimbursement (Level I COPS Medicaid revenue or simply Level I COPS) in exchange for the provision of enhanced outpatient services in accordance with 14 New York Codes, Rules and Regulations (NYCRR) Part 592 (the Level I COPS regulations). The Local Governmental Unit (LGU) is responsible for ensuring the Level I COPS providers under its jurisdiction provide the enhanced outpatient services consistent with Level I COPS regulations, including a written agreement with designated providers, as required by 14 NYCRR Part and Brief Description of Process: (how does it work?) Level I COPS is paid to providers through the Medicaid payment system. Specifically, by Computer Sciences Corporation (CSC) the State s Medicaid paying agent, through the Medicaid Management Information System (MMIS), by way of a provider and program-specific Level I COPS Medicaid rate add-on (the Level I COPS rate). Level I COPS payments are covered 50% by federal Medicaid and 50% by the State share of Medicaid. Historically, OMH has recognized state savings by converting State Aid for outpatient mental health programs to Medicaid as part of COPS funding. Frequency: Level I COPS rates are recalculated for each provider every year based on an updated three year average of Medicaid paid claims. Rate sheets delineating rate, funding and thresholds are sent to the provider with a notification letter. A copy of the notification letter is sent to the County Mental Health Director. Instructions: 1. Level 1 COPS Rates: a. The specifics of each provider s Level I COPS program are contained in their Level I COPS rate sheet, which is maintained by the Office of Mental Health Comprehensive Outpatient Program Services/Community Support Program (OMH COPS/CSP) Rate Setting Unit. b. The Level I COPS rate is calculated by OMH, and is equal to the total Level I COPS funding as determined by the LGU (see Part 592.8(c)) for that particular outpatient program, divided by the product of (1) the three year average of paid Medicaid claims, from the three most recent fiscal years for which data is available (Data Source: MMIS), (2) 90.9% (the Level I COPS constant a vacancy factor to increase the rate), and (3) the provider and program-specific Medicare/Medicaid crossover (crossover) percentage. c. This Level I COPS rate is then added to the Medicaid rates already in effect for that provider, for that program. However, for Article 28 general hospitals, Level I COPS is not added to the clinic collateral or group collateral rate codes, or the CDT collateral or group collateral rate codes. d. Additional detail on the components of COPS rates is available at the first link below in Resources. 2. Level 1 COPS Threshold: a. The amount of Level I COPS a provider can retain in any local fiscal year, for a particular Level I COPS program, is equal to that program s Level I COPS threshold. The Level I COPS threshold is a provider and program-specific amount, and is equal to no more than the full annual amount of the Level I COPS base supplement funding for that program, plus 10%. b. Level I COPS Thresholds for current and prior years are populated in ALFS. The LGU should ensure its subcontracted providers have the correct Level I COPS threshold for budgeting purposes. c. All Clinic services rendered on or after July 1, 2008 will no longer be subject to the Level I COPS Reconciliation process. All other programs are subject to the Level I COPS Reconciliation process. 3. Level 1 COPS Revenue Reconciliation: a. Level I COPS received in a local fiscal year in excess of that year s Level I COPS threshold will be recouped by the State through MMIS (see Part 592.4(f)). The LGU or its providers are responsible

14 for the accounting/tracking of the amount of COPS received. Level I COPS payment report will be sent to each provider detailing the amount of Level I COPS that OMH has determined the provider received, as compared to their threshold for the program for the fiscal year, during the reconciliation process. Providers will have an opportunity to verify the data used to calculate the recovery amount by the OMH before implementation of the recovery by MMIS. Included in any notice of recovery of overpayment will be a description of the recovery process, as well as the date the request for recovery would be sent to MMIS. b. Any Level I COPS revenue received in excess of the Level I COPS threshold must be kept in a reserve account for future recovery by the OMH. c. An LGU or provider may appeal the COPS recovery amount by following the instructions on the reconciliation notification letter that is sent with the Level I COPS payment report. NOTE: If an overpayment occurs, the recovery process can be a one-time reduction to the first Medicaid payment processed and paid after OMH notifies DOH, a check payable to NYSDOH for the full amount or a series of 10% reductions (or larger if you request a percentage increase) of future Medicaid checks. Keep in mind that interest will be charge equal to prime-plus 2% on any unpaid balance beginning 90 days after the date that DOH is notified by OMH. 4. Level 1 COPS Reporting and Claiming: a. Article 31 and D&TC providers should account for Level I COPS on the Level I COPS cash basis. According to this accounting basis, Level I COPS is considered paid consistent with the date on the Medicaid check, and assumes that any retroactive Level I COPS rate changes are repatriated to their original payment date by the provider. b. Article 28 general hospitals should account for Level I COPS on the Level I COPS accrual basis. According to this accounting basis, Level I COPS is considered paid consistent with the description provided above for Article 31 and D&TC providers. c. Additional detail and examples of Level 1 COPS Reporting and Claiming is available at the first link below in Resources. d. Please see Appendix DD of the Consolidated Budget Report (CBR) and Consolidated Fiscal Reports (CFR) manuals for budgeting and claiming guidelines. See link to Appendix DD below in Resources. 5. Level 1 COPS Reallocations and Program Closure: a. The LGU may reallocate a portion of a Level I COPS provider s allocation to one or more of their other Level I COPS providers, limited to the level of Level I COPS underachievement experienced by all providers in the county. b. If the program associated with the Level I COPS closes, the LGU can request that the Level I COPS allocation be reallocated to another provider operating a Level I COPS qualifying program or that the Level I COPS funding be converted to State Aid for $.50 on the dollar. Resources: 1. COPS Level 1 Description (OMH Website) CBR/CCR Manual Appendix DD NYS OMH Regulations Part 592 Comprehensive Outpatient Programs - link not available 4. NYS OMH Regulations Part 599 Clinic Treatment Programs (supersedes Part 592 for Clinic Treatment Programs) 5. NYS Conference of Local Mental Hygiene Directors Fiscal Brief COPS - (bit outdated now ) Date: May 1, 2011 OMH Review: (none)

15 Business Process (what is it?) FISCAL OFFICER TRAINING MANUAL COMMUNITY SUPPORT PROGRAM SERVICES (CSP) Community Support Program (CSP) Medicaid is a NYS Office of Mental Health initiative for certain community-based mental health programs. Office of Mental Health (OMH) maintains the responsibility for CSP Medicaid rate setting, as described in 14 New York Codes, Rules and Regulations (NYCRR) Part Brief Description of Process: (how does it work?) CSP Medicaid is paid to providers by the Medicaid payment system (MMIS) as an add-on to certain outpatient rates (Clinic, Continuing Day Treatment (CDT), or Day Treatment) on a program specific basis. Therefore, each Medicaid visit to an outpatient program may include the base Medicaid payment, plus the CSP Medicaid payment (and some providers may also receive a Comprehensive Outpatient Program Services (COPS) Medicaid payment or a Level II COPS fee supplement Medicaid payment). The CSP Medicaid revenue generated in the outpatient program is then used by the agency in the designated CSP programs. Frequency: CSP Medicaid rates are recalculated annually based on an updated three-year average of the number of Medicaid paid claims. Instructions: 1. CSP Medicaid Rates: a. The OMH maintains rate sheets to document CSP Medicaid rate calculations on a provider specific basis. b. The CSP Medicaid rate is calculated by OMH, and is equal to the CSP base supplement funding for all CSP programs eligible for CSP Medicaid, divided by the product of (1) the estimated annual number of Medicaid paid claims that will generate CSP payments (this estimate represents the threeyear average of the Medicaid paid claims for the specific program that the CSP rate will be added to, for the three most recent fiscal years for which data is available) and (2) the CSP constant of 89%. The constant represents a vacancy factor built into the rate calculation methodology. c. The calculated CSP Medicaid rate is added to the standard base Medicaid rate that is already in effect for the provider and the program. However, for Article 28 general hospitals, the CSP Medicaid rate is not added to Clinic or CDT collateral or group collateral type visits. d. Additional detail on the components of CSP rates is available at the first link below in Resources. 2. CSP Medicaid Threshold: a. The maximum amount of CSP Medicaid revenue that a provider can retain on an annual basis is equal to that provider s CSP Medicaid threshold. The CSP Medicaid threshold is equal to the full annual amount of provider s CSP base supplement funding. b. The CSP threshold can be found in the COPS/CSP Table in ALFS. The table reflects the annual CSP threshold by provider as well as a breakout of the anticipated CSP revenue by CSP program. 3. CSP Revenue Reconciliation: a. CSP received in a local fiscal year in excess of that year s CSP threshold will be recouped by the State through MMIS (see Part (f)). A CSP payment report will be sent to each provider detailing the amount of CSP that OMH has determined the provider received during the reconciliation process. Providers will have an opportunity to verify the data used to calculate the recovery amount by the OMH before implementation of the recovery by MMIS. Included in any notice of recovery of overpayment will be a description of the recovery process, as well as the date the request for recovery would be sent to MMIS b. Any CSP revenue received in excess of the CSP threshold must be kept in a reserve account for future recovery by the OMH (CSP Liability).

16 c. When a provider s CSP revenue is less than their threshold for a fiscal year, and a rate amendment will not ensure maintenance of funding, the underachievement amount will be paid to the provider through a state aid payment (see Part (g)). d. NOTE: If an overpayment occurs, the recovery process can be a one-time reduction to the first Medicaid payment processed and paid after OMH notifies DOH, a check payable to NYSDOH for the full amount or a series of 10% reductions (or larger if you request a percentage increase) of future Medicaid checks. Keep in mind that interest will be charge equal to prime-plus 2% on any unpaid balance beginning 90 days after the date that DOH is notified by OMH. 4. CSP Reporting and Claiming: a. CSP Medicaid accounting for Article 31 providers is conducted on a cash basis while CSP Medicaid accounting for Article 28 general hospitals is on an accrual basis. OMH payment reports fully explain the accounting rules supporting both methodologies. b. CSP Medicaid accounting also results in determination of the amount of CSP Medicaid paid for the year, and amounts in excess of the threshold, that will be recovered through the MMIS. If the CSP Medicaid amount paid through MMIS in a local fiscal year falls below the CSP Medicaid threshold, OMH will either recalculate the CSP rate, using actual paid claims for the specific rate period, or will make a State Aid payment in an amount equal to the CSP Medicaid revenue shortfall. c. Additional detail and examples of CSP Reporting and Claiming, as well as a list of CSP eligible programs is available at the first link below in Resources. d. Providers are required to budget and claim CSP Medicaid on the Consolidated Budget Report (CBR), the Consolidated Claiming Report (CCR), and the Consolidated Fiscal Report (CFR) -- consistent with Appendix DD of the CBR and CFR manuals. See link to Appendix DD below in Resources. 5. Closure of a Program: a. The LGU should contact the Field Office and COPS/CSP Rate Setting Unit prior to the closure of a program that generates a CSP rate add-on or is funded by CSP. Where possible, an alternate eligible program can be utilized. Such actions require both OMH and the Division of Budget (DOB) approval. b. Closure of a program with a CSP rate add-on i. When a Medicaid-eligible program with a CSP rate add-on closes but the program that receives the CSP funding continues, the LGU should request that the rate add-on be recalculated and attached to another CSP eligible Medicaid Program. ii. If the provider does not operate another eligible program, the LGU should request that the CSP funding be restored as State Aid. In such cases the State Aid is restored to the State Aid Approval Letter at 100%. c. Closure of a program that receives CSP funding i. When a CSP funded program closes or the LGU terminates funding for a CSP program, the LGU can request that an alternate program(s), eligible to receive CSP funding, be awarded the CSP funding from the closed program. 1. The LGU should identify the CSP eligible program(s) to receive the funding from the closing program and request that the COPS/CSP Unit estimate the Total Funding that is eligible to be transferred. 2. The OMH will verify that there is sufficient room under the CSP Rate Cap to allow the transferring of funding. ii. Alternatively, the LGU may allocate the CSP Medicaid funds to a DSH-eligible article 28 provider. 1. The LGU should identify the DSH eligible program(s) to receive the funding from the closing program and request that the COPS/CSP Unit estimate the Total Funding that is eligible to be transferred. 2. The OMH will verify that there is sufficient room under the DSH Cap to allow the addition of funding. 3. Upon OMH and DOB approval of the request, an amended DSH MOU will be issued to the LGU reflecting the increased funding. The LGU must approve the revised MOU. iii. If there is no ability to move the funding associated with the closed program to another CSP eligible or DSH eligible provider, funding will be restored as State Aid. In such cases, the CSP regulations only allow the OMH to restore an amount equal to the State Share of Medicaid (50%) to the LGU as State Aid. This will result in the loss of Federal funds that had previously supported the services.

17 Resources: 1. CSP Description (OMH Website) CBR/CCR Manual Appendix DD NYS OMH Regulations Part 587 Operation of Outpatient Programs - Part 587 Regulations Operation of Outpatient Program 4. NYS OMH Regulations Part 588 Medical Assistance for Outpatient Programs - Part 588 Regulations Medical Assistance for Outpatient Programs 5. Clinic Restructuring Implementation Plan - Clinic Restructuring Implementation Plan 6. NYS Conference of Local Mental Hygiene Directors Fiscal Brief CSP - (bit outdated now ) Date: May 1, 2011 OMH Review: (none)

18 FISCAL OFFICER TRAINING MANUAL DISPROPORTIONATE SHARE INCOME (DSH) Business Process (what is it?) In accordance with Legislation signed by the Governor on June 19, 1997, (Bill No A), a Budget initiative will replace Office of Mental Health (OMH) and Office of Alcohol and Substance Abuse Services (OASAS) net deficit financing with Disproportionate Share funding (DSH) in some Article 28 voluntary hospitals. Brief Description of Process: (how does it work?) Beginning April 1, 1997 and for annual periods beginning April 1st thereafter, additional Disproportionate Share payments shall be paid to voluntary non-profit general hospitals. Payments shall not exceed such general hospital's cost of providing services to uninsured and Medicaid patients after taking into consideration all other Medical Assistance received, including Disproportionate Share payments made to such general hospital and payments from and on behalf of such uninsured patients and shall also not exceed the amount of State aid and local aid grants for which the hospital or its successor would have been eligible pursuant to Articles 25 and 41 of the Mental Hygiene Law for fiscal year Payments beginning April 1, 1998 and thereafter will be related to the hospital's willingness to continue to provide services previously funded by State Aid grants. Frequency: The Commissioners of OMH and OASAS, in consultation with county directors of community services, will annually designate to the Department of Health those general hospitals eligible for the additional disproportionate share payment, and the amount thereof. Instructions: 1. Memorandum of Understanding (MOU): a. Chapter 119 of the Laws of 1997 requires the Commissioner of OMH, in consultation with the county director of community services, to annually certify those hospitals which will receive these additional DSH payments. b. This annual certification is accomplished through use of a memorandum of understanding (MOU). Annually, the MOU and DSH Appendix A, which details annual amounts of DSH by provider, by program, will be mailed to the county director of community services. This MOU is to be executed by signature of the county director of community services, return to NYS OMH, and subsequent signature by Commissioner of OMH or agent thereof. 2. Payments: a. DSH payments are to be made on a quarterly basis. The payment process begins with OMH, by generation of a payment request package. This package contains hospital and program specific detail of amounts to be paid. The payment package is then forwarded to the New York State Department of Health (NYS DOH). NYS DOH then processes the payments and remits checks for, where applicable, transmits funds through electronic transfer, for the quarterly DSH payment. 3. Approval of DSH Payments by DOH a. As there exist Statewide DSH caps for each hospital that receives DSH, in accordance with the NYS fiscal year (April 1 March 31), the OMH must provide the NYS Department of Health (NYS DOH) with estimated DSH payment, by hospital, for the upcoming fiscal year. NYS DOH compares the total of all estimated DSH payments (from all agencies) to each hospital s DSH cap. b. At times, the OMH may be notified that OMH DSH will cause a hospital to reach or exceed its DSH cap. In such an instance, the OMH may temporarily pay an amount equal to the amount in excess of the hospital s DSH cap to the hospital in State Aid, via a voucher payment. Providers will be notified of such payments, and such notification will include details of the amount of the payment that is attributed to each program. c. In some instances, a hospital may perpetually be at its DSH cap. In such instances, the OMH may convert such a hospital s DSH funding back to State Aid. 4. Maintenance of Effort

19 a. Hospitals receiving DSH funds are still subject to all contracting, fiscal and programmatic reporting requirements and guidelines, e.g., for model programs the Full Time Equivalent (FTE) requirements must be maintained. For all programs, gross cost and service levels must be maintained at a level consistent with the program's recent history under state aid funding. Therefore, beginning April 1, 1997 and for annual periods thereafter, if effort is not maintained in both gross expenditures and non- DSH revenues, DSH overpayments shall be calculated and recovered. 5. DSH Fiscal Policy Control Points a. Hospitals must continue to include programs designated to receive DSH funds on schedules DMH-2, DMH-3 and Consolidated Budget Report (CBR)-4 of the CBR. b. For OMH programs funding streams with a fiscal model (e.g. Intensive Case Management (ICM), Supportive Case Management (SCM), Assertive Community Treatment (ACT), Community Residence (CR)), providers continue to be subject to all programmatic and fiscal requirements. c. If a provider is designated as a DSH provider, the DSH revenue is to be reported on DMH-1, line 30 (Other Revenue see specific detail line) and DMH-2, line 29 (Other Revenue - see specific detail line). The reported DSH revenue must equal the full annual DSH amount by county, provider and program as maintained by OMH. d. Actual gross expenditures must be at least the same as budgeted gross expenditures and actual non- DSH "other" income must be at least the same as budgeted non-dsh other income. Actual reported DSH must be the same as budgeted DSH. e. Providers must report any voucher payments made in lieu of DSH on DMH-1, line 30 (other revenue), and on DMH-2, line 29. In each case, the provider shall report such payments as "OMH Voucher Payment". The DSH payments a provider receives shall be reported in these lines as well, using the specific detail line. f. A DSH profit exists if claimed expenses are less that reported DSH for that program. If a DSH profit exists, the Closeout process will check for State Aid in the same program. If State Aid exists in that program, recovery will be made against the State Aid. If State Aid does not exist in that program, the DSH profit amount will then be moved to an internal funding code and marked for recovery. Recovery will be made either through reduction in an equal amount to future DSH payments, or through the request of remittance from the hospital should no future DSH payments exist. Resources: 1. DSH Description (OMH Website) NYS Conference of Local Mental Hygiene Directors Fiscal Brief CSP - Date: May 1, 2011 OMH Review: (none)

20 Business Process: (what is it?): FISCAL OFFICER TRAINING MANUAL FEDERAL MEDICAID SALARY SHARING (FSS) Federal Salary Sharing (FSS) is a program enabling States and Counties to receive federal reimbursement for a portion of expenditures related to the administration of Medicaid programs. FSS is a revenue stream which a County Local Governmental Unit (LGU) may choose to participate in. Brief Description of Process: (how does it work?) OMH: To participate, the LGU must submit electronic quarterly claims to the Office of Mental Health (OMH) for OMH related County administration costs through the ALFS-Web application. OMH submits the LGU s FSS claims to the Department of Health, who then submits them to the federal government (CMS), consistent with federal Medicaid policy. Currently, OMH receives and retains the funds until the LGU requests them i. OPWDD: LGU s complete a FSS survey and Payroll Summary on an annual basis, submits paper claims to the Bureau of Community Funding Administration and Revenue Support. OPWDD summarizes the data by county and submits one claim to DOH. The funds are kept by OPWDD to offset the state aid paid to the Counties for Administration. OASAS: The cost allocation methodology identifies OASAS and Local government expenses that are reimbursable under the Federal Medicaid grant for the administration of the Federal Medicaid grant program. After identification of these expenses, federal reimbursement is calculated at fifty-percent of these costs. Information is extracted from OASAS s Statewide Data Collection System to identify the percentage of clients enrolled in the federal Medicaid program by County. With these percentages, eligible expenses and the amount of funding made available to OASAS for reimbursement to Local governments determine the amount of each County reimbursement. Frequency: For OMH, claims are submitted quarterly and request for payments from the reserve can be made on an as needed basis. Claims can be submitted retroactively for two years, but it is recommended Counties claim as timely as possible in order to be fully reimbursed. Note: The balance may be held for up to 4 years. OMH s ability to pay against old year accounts (4+ years) is dependent upon their ability to access Federal funds. For OPWDD, claims are requested by OPWDD annually and there are no payments from OPWDD. For OASAS, no specific claims are submitted and a single payment by OASAS is made annually. Instructions: OMH Process: A TOKEN MUST BE REQUESTED TO PARTICIPATE IN THE OMH PROCESS. If you do not already have a token for the Aid to Localities Financial System (ALFS), complete an ALFS Security Agreement Authorization Form and a Request for Access Aid to Localities Financial System (ALFS) for non-omh employees and submit to these forms and the signed letter from the County Director of Community Services (DCS) on County letterhead that requests permission for their use of ALFS to: Peg LaWare or Shweta Gupta, Director of Administrative Services, NYS OMH Community Budget and Financial Management, 44 Holland Ave., Albany, NY It is important to submit this documentation as soon as possible as it generally takes up to 2 weeks to receive the taken after materials are received by OMH. Once the token is received, the process begins by accessing the following website: Note: Do not use the OMH Bridges website to access ALFS Web

21 The very first time you log into ALFS Web you must create a Personal Identification Number (PIN) at the salute login box. Type in your user ID in lower case in the user field. Type in the 6 digit number displayed on your token in the token field and click login. The Enter A New PIN box will pop up. Type in a 4 digit number in the new PIN field; re-type it and click ok. A new Salute login box will be displayed. Use your User ID, your PIN followed by your token number to sign in. 1. The ALFS Web home page will be on your screen. Click on Budget in the toolbar and then select Federal Salary Sharing. 2. There are two options to select from Claim Summary and Payment Summary. a. Under the claim summary, click on the quarter you need to work on. It contains the employee summary. You can view/edit each employee listed. You can add an employee. Employee details such as name, salary, employee type and a specific employee ID are assigned in the screen along with function/job tasks and % time allocated to Medicaid and %NON-Medicaid. Click the save button. You must include an aggregated fringe percentage. Once your claim is complete, click the Generate Appendix D button. You must print this form and obtain the County Mental Health Director or designee signature to mail or fax it to the claim administrator, Brad Titus at the NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229; fax You can also print and export the individual employee worksheets and computation report for your records. b. The other option is Payment Summary. You can perform the following tasks in this field: view payment summary; add a request amount; edit a comment and view comment history by clicking on the appropriate button on this screen. Federal Salary Sharing funds are to be reported on line 29 on the CFR, and also to be clearly identified in the required detailed backup document for line 29. Funds may be utilized as an offset for one or more OMH programs for expenses associated with the provision of services to the county s mentally ill population. The Catalog of Federal Domestic Assistance (CFDA) number for Federal Salary Sharing program is Note: There is no cap placed on FSS amounts claimed by counties, but counties are entirely responsible for the accuracy of the claims, which are subject to state and federal audits. OPWDD Process: Counties complete a FSS survey and Payroll Summary on an annual basis. 1. The Local Government Federal Salary Sharing Survey determines the percentage of time spent on: Providing technical assistance to community-based DD Medicaid programs and services (specifically intermediate care facilities, certified clinics and day treatment and Home and Community Based Services Program under the Waiver) for persons with developmental disabilities to ensure compliance with Federal Medicaid regulations. Planning for, coordinating and overseeing the community-based DD Medicaid service system in your county. 2. Completion of the following forms for each individual who qualifies: Part I Staff Information Part II & III Staff Percentage of time and certification Appendix C Work Functions Survey 3. Completion of the Annual Payroll summary

22 4. Return Parts I, II, III and the Annual Payroll Summary to: Christine Doherty, Bureau of Community Funding Administration and Revenue Support, New York State Office of People with Developmental Disabilities, 44 Holland Avenue, Albany, NY (518) or Christine.Doherty@opwdd.ny.gov Retain Appendix C and a copy of all materials for your records. Counties should periodically review and update the documentation of employee functions and time spent on Medicaid activities. OASAS Process: (None) Resources: 1. Aid to Localities Financial System (ALFS) Web User Manual (contact field office for copy) 2. helpdesk@omh.state.ny.us - Help desk Phone Numbers: OR OPWDD Local Government Federal Salary Sharing Manual (contact Christine Doherty or Bureau of Community Funding Administration and Revenue Support) Date: May 1, 2011 OMH Review: 8/18/10 OASAS Review: (none) OPWDD Review: (none)

23 Business Process (what is it?) FISCAL OFFICER TRAINING MANUAL COUNTY BUDGET PROCESS The County budget is a process that estimates the expenses and revenues of County operations and contract service providers for the following fiscal year (where applicable). Brief Description of Process: (how does it work?) The county budget process varies from county to county. The county Local Governmental Unit (LGU) receives a budget packet from the county budget officer for the upcoming year that includes instructions, forms, and deadlines. The LGU then distributes materials and instructions to county operations and contract service providers (if applicable). LGU then collects the budget information from all service providers, prepares and submits the completed package by the County budget deadline. Frequency: County budgets are prepared on an annual basis. Instructions: 1) Receive instructions, forms, and deadlines from the County Budget Officer(s). 2) Prepare budget in accordance with instructions. All expenses and revenue sources must be taken into account. The Budget Officer will likely provide some expense figures such as salaries and health insurance. Expense estimates should take into account past spending levels along with current needs. Revenue estimates should be based on current known information and trending. 3) Review the budgets of contract service providers (if applicable). Careful attention should be paid to conformity with State Aid Funding levels. 4) Presentation of budget package to Legislative committee, if applicable. 5) Submit the budget(s) to the County Budget Officer(s). 6) A hearing may be scheduled to discuss the budget(s) with the Budget Officer(s) and other interested parties. 7) The Budget Officer(s) will make adjustments to suit the County tax levy. There may or may not be an opportunity for negotiations regarding these adjustments. 8) Present budget package to Finance Ways and Means committee, if applicable. 9) As part of the County Annual session, the county budget is presented to the public for comment. 10) The County legislative body will consider the budgets and adopt them with any final adjustments by the end of the fiscal year. 11) Any budget amendments throughout the year are submitted to the Budget Officer(s) for approval, if applicable. Date: May 1, 20111