Mental Health Financial Issues

							   Mental Health
Financial Issues
 CMHDA Small Counties
      Conference Call
   November 16, 2009
Mental Health Financial Issues
   Short Doyle II
   Medi-Medi Update
   Waiver and SPA
   ARRA Reporting
   Payments
   Cost Report Delay
   Cost Report Study
   MHSA Audit Questions
   MHSA FY10/11 Annual Update
   MHP Contract Language
   EPSDT Question
                                 1
Short Doyle II
   DHCS provided a status update
   DHCS indicated MEDS is reason for 5,000 CLM limit
   DHCS requested counties not change their
    implementation wave
       DHCS subsequently issued memo that modified the cutoff
        for Wave 1 to be concurrent with Wave 2
         Link under Breaking News on CMHDA website
       Production data test period for Wave 2 is 12/10 – 12/23




                                                                  2
Medi-Medi Update
   DHCS stated the current policy of CMS is claim
    must be denied from Medicare in order to bill Medi-
    Cal for Medi-Medi services
   CMHDA developed specific list of services that
    should be exempt
   DHCS requesting flexibility from CMS for
    exemptions
   Good cause should be automatically granted for
    Medi-Medi claims that exceed 6 month timeframe
   Request that DMH conform to CMS claim timelines
    (12 months) and not 6 months
                                                          3
Waiver and SPA
   Current 1915 Medi-Cal Specialty Mental Health Waiver was
    renewed for one year pending resolution of coverage issues
     DHCS hopes to submit documentation in the next couple of
       weeks addressing CMS’s concerns
   CMS wants comprehensive SPA that addresses all
    reimbursement issues
     Negotiated rates
     Supplemental Payments
     Description of payment process
   SPA will be retroactive to 1/1/09
   Supplemental payments for six months of FY 08/09 probably
    won’t be distributed until FY11/12


                                                                 4
ARRA Reporting
   Governor Schwarzenegger issued a letter on
    September 28, 2009 specifying that ARRA
    recipients receiving ARRA funds from a state
    agency should report to that state agency
   DMH has verbally stated DHCS is responsible for
    reporting on the use of Medi-Cal ARRA funds and
    counties are not required to report to DMH or DHCS
    on these funds
   DMH indicated a letter was forthcoming from either
    DMH or DHCS indicating counties are not required
    to report on ARRA funds
                                                         5
Payments
   DMH provided approach for allocating
    FY09/10 AB3632 funds
       Link under FSC Handouts on CMHDA website
   DMH indicated managed care allocation not a
    proportionate reduction for each county
       DMH to provide calculations to CMHDA




                                                   6
Cost Report Delay
   DMH Information Notice 09-18 informed counties of DMH’s
    intention not to enforce the statutorily required due date of the
    SD/MC cost report until February 26, 2010
   DMH is hosting cost report webinar on November 30th from 9:00
    – 2:00
     Link under Breaking News on CMHDA website
   CMHDA has requested DMH delay MHSA Revenue and
    Expenditure Report to coincide with the cost report
     Also requested 25% be released without submission of Revenue
       and Expenditure Report
   Counties still have to complete SB90 claims for AB3632 services
    by February 15th or face a 10% penalty


                                                                        7
Cost Report Study
   Budget trailer bill language requires DMH to conduct
    a cost report study of a sample of counties and
    providers that exceed SMAs in FY 09/10
       Selected counties would have to submit data by 10/31/10
   DMH identified 12 counties selected for study
       Link under FSC Handouts on CMHDA website
   DMH methodology for selection has some flaws but
    overall selection appears fine
   CMHDA will request to change submission date to
    correspond with normal cost report submission date
                                                                  8
MHSA Audit Questions
   CMHDA developed list of questions for DMH
    auditors to respond in writing
       Link under Breaking News on CMHDA website
   DMH auditors to attend December FSC
    meeting to discuss




                                                    9
MHSA FY10/11 Annual Update
   DMH trying to issue FY10/11 Annual Update
    Guidelines by end of November
   DMH confirmed that counties will have
    access to MHSA prudent reserve as part of
    FY10/11 Annual Update
   The 50% prudent reserve requirement will not
    be applied in FY10/11
       50% becomes a limit and not a requirement

                                                    10
MHP Contract Language
   CMHDA working with DMH on MHP contract
    language
   CMHDA proposed several changes
       EPSDT quarterly advances
       No withhold of managed care allocation
       Timeframe for FFP payments
       Elimination of Auditor-Controller signature from
        cost report

                                                           11
EPSDT Question
   Counties still unsure of where Phase II amount is
    derived
   DMH Information Notices 98-03 and 98-12 describe
    and provide amounts of Phase II baseline
   Phase II amount represents share of managed care
    allocation attributable to EPSDT services
       DMH increases county baseline by this amount so DMH
        doesn’t pay twice for services
       Phase II amount should be modified based on changes to
        the managed care allocation

                                                                 12