Case Management

Overview of Cost Reporting Tool

January 27-28, 2009

Cost Report Principles

Purpose of the Cost Report

• The purpose of a cost report is to define the cost of each service and determine a rate per unit for the fiscal period (i.e. cost report period).

• The cost report period should cover the twelve month period of the provider’s fiscal year.

• Submitted using Form 470-0664, Financial and Statistical Report for Purchase of Service Contracts.

• The cost report allows for reporting of financial (cost) and statistical (units) data.

Cost Report Submission

• Actual cost reports for the current fiscal year are due no later than September 30th of each year.

• Projected cost reports are due no later than July 1st of each year. We encourage you to return them by June 1st. – This allows cost reports to be reviewed and

rates entered in the system for authorization and billing starting July 1.

Reasonable Costs

• Only reasonable and allowable cost should be reported on the cost report.

• Reasonable cost principles are set forth in the following: Federal Register – 42 CFR Part 413 Office of Management and Budget (OMB) Circular

A-87, Attachment B CMS Publication 15-I

Other Cost Report Principles

• The cost report must be completed on an accrual basis of accounting and in accordance with Generally Accepted Accounting Principles (GAAP).

• Accrual accounting is defined as the recognition of cost or expenses when incurred.

• For example, when expenses are incurred in the last month of a cost reporting period but are paid in the first month of the following cost reporting period, include them in the cost report period in which they are incurred, and not the cost report period in which they are paid.

Accrual Accounting

• If another basis for accounting is used (e.g. cash-basis), expense amounts should be adjusted to the accrual basis for cost reporting purposes.

• This is necessary to obtain information that is comparable among facilities.

Cost Report

Information Sources

• Information to complete the cost report may come from various sources depending on each provider’s method of tracking costs.

• Personnel, payroll, provider expense records, activity logs, mileage logs, time studies, and billable unit report are examples of tools that may be used to compile information to complete the cost report.

What to Send and Where

• Form 470-0664 is available on the IME website at http://www.ime.state.ia.us/Providers/Forms.html

• Email completed cost reports and documentation to: costaudit@dhs.state.ia.us (Preferred Method)

• Mail paper copies to Provider Cost Audit & Rate Setting Unit, PO Box 36450, Des Moines, IA 50315

• A signed copy of the Certification Page must be mailed, with original signatures, through US Mail, FedEx, etc. Fax or email is not acceptable.

Supporting Financial Records• Per IAC 441 Chapter 79.3: “A provider of a service that is

charged to the medical assistance program shall maintain complete and legible records as required in this rule. Failure to maintain records or failure to make records available to the department or to its authorized representative timely upon request may result in claim denial or recoupment.

• Per IAC 441 Chapter 79.3(1): “A provider of service shall maintain records as necessary to:– (1) Support the determination of the provider’s reimbursement rate

under the medical assistance program; and– (2) Support each item of service for which a charge is made to the

medical assistance program. These records include financial records and other records as may be necessary for reporting and accountability.”

Components of the Cost Report

Provider Identification Page Provider Info/Rate Summary

Certification Page Statistics/Demographics

Schedule B FTEs and Wages

Schedule C Depreciation

Schedule D Expenses

Schedule E Balance Sheet

Schedule F Allocation Methodology

Provider Identification Page• Provider Information

– The provider number is your assigned NPI/Taxonomy number – the full number should be used (NPI-Taxonomy-Zip9). In the absence of an NPI/Taxonomy number, the Medicaid provider number (legacy number) should be used.

– Provider Name (will automatically populate)– City (will automatically populate)– Report Type – Actual or Projected– FYE – Fiscal Year End

• Unit Cost Summary– This data is pulled from Schedule D. No input is required.– If you have a BI Waiver or Habilitation provider number, please

ensure provider number is included on this page. If NPI was entered above, these provider numbers should automatically populate.

NPI

AGENCY NAME

CITY

REPORT TYPE (ACTUAL/PROJECTED)

FYE

RATE REFLECTED -

W0578 $ 0.00

W0574 $ 0.00

W0579 $ 0.00

W0580 $ 0.00

W1330 $ 0.00 Provider #

W1409 $ 0.00 Provider #

W1410 $ 0.00

Case Management (CMI)

Children's Mental Health Waiver

Elderly Waiver Case Management

CASE MANAGEMENT PROVIDER IDENTIFICATION PAGE

Habilitation Services

Brain Injury Waiver

Case Management (MR/DD)

Case Management For Children (MR/DD)

Certification Page

• The purpose of the certification page is to report agency statistical information and record the signature of the authorized officer of the agency.

• Certification page should be signed to attest that the information is true and correct to the best of your knowledge.

• Must receive a signed Certification Page to consider the cost report complete.

Certification Page

• Name of Person to Contact with Questions– We will generally try to communicate with your

specific contact person; however, some circumstances may require us to direct questions to the Medicaid provider instead of a contracted preparer.

• Statistical Data for Period of Report– Total number of units of service provided

• Includes all units of service provided regardless of whether or not payment has been received (includes denied claims, claims not yet submitted to IME, pending claims, etc.)

• Report units by procedure code with MBC and 100% County units reported separately in their designated columns.

Iowa Department of Human Services

FINANCIAL AND STATISTICAL REPORT FOR PURCHASE OF SERVICE CONTRACTS

CERT IFICAT ION P AGE

AGENCY NAME IRS ID#

ADDRESS PROVIDER NO. 0

CITY, STATE, ZIP CODE

PERIOD OF REPORT: From To DATE OF FISCAL YEAR END 01/00/00

ADMINISTRATOR NAME TELEPHONE NO. NAM E OF PERSON TO CONTACT IF

QUESTIONS ABOUT REPORT TELEPHONE NO.

Does agency have an independent audit? Yes, for year ending No

Has a copy of the latest independent audit been submitted? Yes No

A. Type of Control : GOVERNMENT NON-P ROFIT ORGANIZAT ION P ROP RIET ARY

B. Accounting Basis : ACCRUAL MODIFIED CASH CASH

C. Statis tical Data For Period of Report :MEDICAID (TITLE XIX) UNITS

Service Code W0578 W0574 W1409 W1330 W0579 W0580Elderly Waiver MBC

100% County

1. Total number of units of service provided

D. Form of Certification by Officer or Adminis trator of Provider Agency: I CERTIFY that I have examined the accompanying schedules of revenues and expenses and the calculations of cost of service prepared for this agency and that to the best of my knowledge and belief they are true and correct. I also certify these schedules were prepared from the books and records of the facility in accordance with instructions contained in this report, and allowable cost of care excludes expenses that were not necessary to provide this care.

SIGNED (Officer or Adminis trator of Facility)

(Title) (Date)

E. Statement of Preparer (If Other Than Agency) I have prepared this report and to the best of my knowledge and belief, it represents true and accurate data of the agency s tated above.

(Signed) (Date)

F. Statement of Project Manager I have reviewed this report prior to submitting it to the State (Dept. of Human Services , Bureau of Purchased Services , Purchase of Service Unit.)

(Signed) (Date)

SS-1703-0 (Rev. 1/92) 470-0664

Schedule BGross Salaries & Staff Numbers

• The purpose of Schedule B, “Staff Numbers and Wages,” is to report full-time equivalent numbers of staff and wages by job title.

• 1.0 FTE is considered to be 2,080 paid hours. For example, a person that was paid for 1,040 hours would be considered 0.5 FTE.

• The wages reported on Sch. B should tie to the amounts reported on Sch. D, Column 1.

• Detail the job titles under each each classification with the applicable number of staff, FTEs and Wage information.

Schedule B

• Completing this schedule monitors staffing levels by job classification.

• Details the amount of FTEs that are required to maintain service levels at the agency.

Title:

ADMINISTRATIVE TOTAL - NO. 2110 0 0 0.00

Title:

PROFESSIONAL TOTAL - NO. 2120 0 0 0.00

Title:

DIRECT CLIENT CARE TOTAL - NO. 2130 0 0 0.00

Title:

CLERICAL TOTAL - NO. 2150 0 0 0.00

Title:

OTHER STAFF TOTAL - NO. 2190 0 0 0.00

$ 0TOTAL SALARIES & STAFF NUMBERS 0 0 0.00

CLERICAL - NO. 2150

JOB CLASSIFICATIONS:

FTE'sPart TimeFull Time

$ 0

ADMINISTRATIVE - NO. 2110

PROFESSIONAL - NO. 2120

DIRECT CLIENT CARE - NO. 2130

OTHER STAFF - NO. 2190

$ 0

$ 0

$ 0

$ 0

SCHEDULE B - STAFF GROSS SALARIES AND STAFF NUMBERS

Gross Salaries and WagesNUMBER OF STAFF

Schedule C

• The purpose of Schedule C, “Property and Equipment Depreciation and Related Party Cost,” is to report information related to depreciable assets.

• If your agency has a straight-line depreciation schedule, this may be submitted in lieu of Schedule C. This must include subtotals and reconcile to Schedule D.

• Schedule C includes the original acquisition costs, capital improvements, and depreciation on buildings and equipment owned by the provider.

Schedule C

• The total depreciation amounts reported on Sch. C must tie to the amounts reported on Sch. D., column 1, lines 4410, 4420, and 4480.

• Depreciation expense must be calculated using a the straight-line method.

Schedule C

• To determine the estimated useful life on new assets, the American Hospital Association (AHA) guidelines should be followed.

• If a depreciable asset at the time of its acquisition has an estimated useful life of at least two years and a historical cost of at least $5,000, the cost must be capitalized and depreciated over the estimated useful life.

• On Sch. C, the estimated useful life is reported as a percentage (e.g. an asset with an estimated useful life of 5 years would be reported at 20%).

Schedule C

• When items are purchased as an integrated system, all items must be considered as a single asset when applying the capitalization threshold. Items that have a stand-alone functional capability may be considered on an item-by-item basis.– For example, an integrated system of office furniture with

interlocking panels and desktops that are supported by locking panels must be considered as a single asset.

– Stand-alone office furniture such as a chair may be considered on an item-by-item basis.

Schedule C – Change of Ownership

• If a change of ownership occurs, the historical cost of the assets acquired will be the historical cost less depreciation allowed to the previous owner (book value).

Acct. No. (Sch D)

Year Acquired

Original Cost

Deprec Recorded

Prior Year

Deprec Method

Annual Rate

Recorded Depreciation

Expense

44201. SL $ 02. SL $ 03. SL $ 0

4420 $ 0T o Sch D line 4420 $ 0

Acct. No. (Sch D)

Year Acquired

Original Cost

Deprec Recorded

Prior Year

Deprec Method

Annual Rate

Recorded Depreciation

Expense

44101. SL $ 02. SL $ 03. SL $ 0

4410 $ 0T o Sch D line 4410 $ 0

Acct. No. (Sch D)

Year Acquired

Original Cost

Deprec Recorded

Prior Year

Deprec Method

Annual Rate

Recorded Depreciation

Expense

44801. SL $ 02. SL $ 03. SL $ 0

4480 $ 0T o Sch D line 4480 $ 0

4400 $ 0T o Sch D line 4400 $ 0

TOTAL BUILDINGS & LEASEHOLDS

TOTAL EQUIPMENT & BUILDINGS

BUILDINGS

SUBTOTAL VEHICLES

BUILDINGS:

EQUIPMENT:

MOTOR VEHICLES:

SUBTOTAL EQUIPMENT

BUILDING EQUIPMENT

SCHEDULE C - DEPRECIATION AND AMORTIZATION EXPENSE

Schedule C – Related Party

• If property is being leased from a related party, information regarding the lessor’s costs must be submitted on Schedule C.

• Related to the provider means that the provider to a significant extent is associated or affiliated with, or has control of, or is controlled by, the organization furnishing the services, facilities, or supplies.

• Related party property cost is limited to the lessor’s cost.

RELATED PARTY PROPERTY COSTS

1. Is any property being leased from a party "related to provider" us ing the definitions in the contract and the Provider Handbook? Yes No

2. SCHEDULE OF LESSOR'S COSTS : If answer to number 1 is yes , provide lessor's costs in the space below.

Depreciation on property

Property taxes

Mortgage interes t on property

Insurance

Other (describe)

TOTAL $0

Schedule D

• The purpose of Schedule D, “Expense Report,” is to report total agency expenses and allocate those expenses to the various services provided by an agency.

• The allocation of costs per service includes all costs for the agency and should be consistent with the costs included on the general ledger.

Schedule D

• Direct Cost includes expenses that are identifiable to a specific service. Direct cost could include, but is not limited to:– All direct personnel & immediate supervisors involved in a

service (salary, benefits and payroll tax)

– Mileage costs for travel necessary in the provision of service

– Time spent documenting services provided

– Time spent in staff meetings related to a specific service

– Occupancy expenses related to space dedicated to a specific service

Schedule D

• Indirect Cost includes expenses that are not identifiable to any specific service. This includes expenses incurred to benefit all functions of the agency.– Indirect Cost will be allocated across all programs.

Therefore, all expenses included in Indirect Cost must be allowable under all programs.

– Indirect Costs can include, but are not limited to:• Overhead expenses from the County• Administrative and Clerical staff• Office supplies• Occupancy Expense related to general use areas• Property or liability insurance

Schedule DExpense Report

• Gross Total - Column 1: Report total operating costs of the agency. Total expenses should be supported by a general ledger, working trial balance or other schedule.

• Revenue Adjustments - Column 2: Use this column to offset expense with any related revenues.

Schedule DExpense Report

• Excluded Costs - Col. 3: Use this column to remove expense that is not reimbursable under the Medicaid program. This column should not be used to report Other Program expense.– Excluded Cost may include, but is not limited to the following:

• Fundraising• Bad Debt• Fines and Penalties• Lobbying (includes the portion of certain organization dues

apportioned for lobbying)• Promotional advertising/marketing• Mileage expense in excess of the State Reimbursement Rate• Other expenses unallowable per OMB Circular A-87, Att. B.

Schedule DExpense Report

• Excluded Cost – Mileage Limit: Mileage cost is limited to the DHS employee reimbursement rate. Any reimbursement paid to employees in excess of the limit should be excluded in Column 3.– The current mileage rate can be found at the Department of

Administrative Services website: http://www.das.iowa.gov

– The policy is located under the “Fleet and Mail Services” menu

• 7/1/05 – 12/31/07 $0.34

• 1/1/08 – Current $0.39

Schedule DExpense Report

• Adjusted Cost – Column 4: This column shows costs that are allowable and allocable to Case Management, Elderly Waiver, Other Programs and Indirect Expense (Gross Cost - Revenue Deductions - Excluded Cost = Adjusted Cost).

• Case Management Direct Service Cost – Column 5 to 7: Use these column to report costs and units directly associated with case management services. – Column 5: Include costs and units associated with W0574/W0578

MR/DD, W1330 Habilitation and W1409 BI consumers to calculate a blended rate. If the same rate is applicable for W0579 CMI and MBC (Magellan) consumers, include those costs and units in this column.

– Column 6: Include costs and units associated with W0579 CMI and MBC (Magellan) consumers if a separate rate is needed.

– Column 7: Include costs and units associated with W0580 Children’s Mental Health Waiver.

Schedule DExpense Report

• Elderly Waiver Direct Service Cost – Column 8: Use this column to report costs and units directly associated with W1410 Elderly Waiver services.

• Other Programs Direct Cost – Column 9: Use this column to report cost directly associated with any program other than Case Management or Elderly Waiver.

• Total Facility Indirect Cost – Column 10: This column includes costs that benefit all functions of the agency and cannot be directly related to any specific service or program.– These costs will be allocated to all programs on Schedule D.

– All line items may be used to report indirect expense in Column 10.

– Case management indirect overhead expenses from the County should be included on Line 5000, Column 10.

Schedule DExpense Report

• Total Facility Indirect Cost – Continued:

– Each agency is responsible for developing an acceptable method of distributing indirect cost to the various programs and supporting its rationale.

– The standard method is based on the total accumulated direct costs for each program before the indirect cost allocation.

– If an agency believes that another allocation method is more appropriate, it may be used. However, the agency must submit documentation to support and justify the alternate allocation basis used.

Schedule DExpense Report

• Unit Cost Calculation – Last Page of Sch D:– Total Direct + Total Allocated Indirect = Total

Expense for each service– Units: Total Expense after Deductions is

divided by Total Units for each Service• Must include all units of service provided,

regardless of whether or not payment has been made

Schedule D

• A definition of each of the cost centers on Sch. D is located in the “Purchase of Services” Handbook.

• The handbook can be found at the following website:

http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Documents/Master/comm61.pdf

AGENCY NAME: FYE: 01/00/00

PROVIDER NO.: 00-00000 REPORT TYPE: 0

SCHEDULE D - EXPENSE REPORTTARGETED CASE MANAGEMENT SERVICES

W0578/W0573W1330/W1409 W1410 Indirect

Gross Revenue Excluded Adjusted MR/DD W0579 W0580 Elderly Other ServiceNO. ACCOUNT TITLE Total Adjust Costs Costs Hab Svc/BI CMI CMHW Waiver Programs Costs2110 Adminis trative $ 0 $ 0 $ 02120 Professional Staff - Direct $ 0 $ 0 $ 02130 Other - Direct $ 0 $ 0 $ 02150 Clerical $ 0 $ 0 $ 02190 Other Staff $ 0 $ 0 $ 02100 TOTAL SALARIES $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

2210 Health Benefits $ 0 $ 0 $ 02220 Retirement Plan $ 0 $ 0 $ 02290 Other Benefits $ 0 $ 0 $ 02200 TOTAL BENEFITS $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

2310 FICA Expense $ 0 $ 0 $ 02320 Unemployment $ 0 $ 0 $ 02350 Workmen's Compensation $ 0 $ 0 $ 02300 TOTAL PAYROLL TAXES $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

2450 Medical & Psych Services Purchased $ 0 $ 0 $ 02470 Accounting and Auditing $ 0 $ 0 $ 02480 Attorney's Fees $ 0 $ 0 $ 02490 Other Non-Medical $ 0 $ 0 $ 02400 TOTAL PROFESSIONAL FEES $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

2510 Office Supplies $ 0 $ 0 $ 02530 Medical Supplies $ 0 $ 0 $ 02540 Recreation & Craft Supplies $ 0 $ 0 $ 02550 Food $ 0 $ 0 $ 02590 Other Supplies $ 0 $ 0 $ 02500 TOTAL SUPPLIES $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

2600 TELEPHONE & INTERNET $ 0 $ 0 $ 0

2700 POSTAGE & SHIPPING $ 0 $ 0 $ 0 $ 0

2810 $ 0 $ 0 $ 02820 Building & Grounds Supplies $ 0 $ 0 $ 02830 Utilities $ 0 $ 0 $ 02840 Care of Buildings & Grounds $ 0 $ 0 $ 02870 Interest Expense $ 0 $ 0 $ 02880 Insurance & Property Taxes $ 0 $ 0 $ 02890 Other Occupancy Expense $ 0 $ 0 $ 02800 TOTAL OCCUPANCY EXPENSE $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

Rent of Space

3100 OUTSIDE PRTG - ART WORK $ 0 $ 0 $ 0

3210 Mileage & Auto Rental $ 0 $ 0 $ 03250 Agency Vehicles Expense $ 0 $ 0 $ 03280 Automobile Insurance $ 0 $ 0 $ 03290 Other Related Transportation $ 0 $ 0 $ 0

3200 TOTAL LOCAL TRANS. $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

3310 Staff Development & Training $ 0 $ 0 $ 03320 Annual Meetings & Bus. Conference $ 0 $ 0 $ 0

3300 TOTAL CONF. & CONVENTIONS $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

3400 SUBSCRIPTIONS/PUBLICS. $ 0 $ 0 $ 0

3510 Clothing & Personal Needs $ 0 $ 0 $ 03520 Other $ 0 $ 0 $ 0

3500 TOTAL ASSISTANCE $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

4100 ORGANIZATION DUES $ 0 $ 0 $ 0

4200 AWARDS & DUES $ 0 $ 0 $ 0

4310 Agency Vehicle Repair $ 0 $ 0 $ 04320 Other Equipment Repair or Purchase $ 0 $ 0 $ 0

4300 REPAIRS & EXPENDABLE EQ UIP. $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

4410 Agency Vehicles $ 0 $ 0 $ 04420 Equipment $ 0 $ 0 $ 04480 Buildings and Leaseholds $ 0 $ 0 $ 04400 TOTAL DEPRECIATION $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

4910 Moving & Recruitment $ 0 $ 0 $ 04920 Liability Insurance $ 0 $ 0 $ 04930 Miscellaneous $ 0 $ 0 $ 0

4900 TOTAL MISCELLANEOUS $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

5000 INDIRECT SERVICE COST $ 0 $ 0 $ 0 $ 0

TOTAL EXPENSES $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0

ALLOCATION OF INDIRECT PROGRAM SERVICE COSTS $ 0 $ 0 $ 0 $ 0 $ 0

TOTAL SERVICE COSTS AFTER INDIRECT COST $ 0 $ 0 $ 0 $ 0 UNITS OF SERVICE 0 0 0 0 UNIT COST $ 0.00 $ 0.00 $ 0.00 $ 0.00

Schedule F

• The purpose of Schedule F, “Cost Allocation Procedures,” is to report other supplemental information related to agency operations and accounting procedures.

• Complete Schedule F when your agency provides more than one service or service component.

Schedule F

• Cost allocations are required for direct costs benefiting more than one service or service component and for the provider’s indirect costs.

• “Direct Costs” are defined as those which are directly identifiable to services or components.

• “Indirect Costs” are defined as those which are not readily identifiable with each service or service component.

Schedule F

• The schedule provides questions regarding methods used in allocating expenses which benefit more than one service or service component.

• The provider should send supporting documentation for the allocation basis of these costs.

SCHEDULE F - COST ALLOCATION PROCEDURES(To be completed by Providers which offer more than one service)

Cost are allocable to a particular service, such as a grant, project, or other activity, in accordance with the relative benefits received. A cost is allocable to a service if it is treated consis tently with other costs incurred for the purpose in like circumstances , and if it (1) is incurred specifically for the service, (2) benefits the service and can be dis tributed in reasonable proportion to the benefits received and (3) is necessary to the overall operation of the organization, although a direct relationship to a particular service cannot be shown.

Any cost allocable to a particular service under the above principles may not be shifted to other services to overcome funding deficiencies , or to avoid other res trictions imposed by law or terms of an award.

Direct Costs : YES NO1. Do you have a cost allocation plan which describes the methods you

use in dis tributing joint costs to services or activities?

2. If you do not have a cost allocation plan describing the methodsfollowed, do you have accounting workpapers available to support joint direct cost allocations?

3. Is your method of allocating joint service costs consis tentlyfollowed from year to year?

4. Are costs allocated to services in reasonable proportion to benefitsreceived?

5. Are service income deductions allocated in a manner which is consis tentwith the costs incurred in generating the income?

6. Additional comments regarding allocation of joint service costs :

Indirect Costs :1. Are the indirect costs dis tributed on a bas is of total direct service

or costs?

2. If indirect costs are not allocated on the basis of total direct servicecosts , what was the basis used?

3. Is the bas is for dis tributing indirect cost the same as that used in the previous year?

SS-1703-0 (Rev. 1/92) 470-0664

Rates andCost Settlement

Determination of Payment RatesProjected Rates

• Case Management providers will be paid at their projected rate for claims billed during the fiscal year.

• You will not be able to get prior authorization in ISIS until a projected rate has been entered effective July 1st of each fiscal year.

• Elderly Waiver providers are capped at $70 per month per member.

Determination of Payment RatesFinalized Rates

• The finalized payment rates will be established retrospectively after review of the Actual and Allowable Cost per Unit from the actual cost report.– Retrospective – the finalized rate becomes

effective the first day of the cost report period

Determination of Cost Settlement Amount

• Cost Settlement is performed by adjusting each individual paid claim.– Paid claims for procedure codes W1330 Habilitation

and W1409 BI Waiver are not currently cost settled

• For each claim, payments made at the interim rate are taken back and new payments are made at the finalized rate.– This is evidenced by negative amounts on your

remittance advice followed by a positive amount for each claim.

Determination of Cost Settlement Amount

• The Settlement Amount is the net of all the negative and positive claims paid for all services.

• Shown on the last page of the Remittance Advice.• Amounts Due Provider will be paid through the

usual process.• Amounts Due IME will be recouped as new

Original Claims are billed.

Related WebsitesCost Report Template http://www.ime.state.ia.us/Providers/Forms

Training Materials http://www.ime.state.ia.us/Providers/TrainingSchedule

Provider Manuals http://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/MedProvider

Iowa Administrative Code

http://www.dhs.state.ia.us/policyanalysis/RulesPages/RulesChap

OMB Circular A-87 http://clinton2.nara.gov/OMB/circulars/a087/a087-all

Iowa Medicaid Enterprise

http://www.ime.state.ia.us

Department of Human Services

http://www.dhs.state.ia.us

CMS Publication 15-I http://www.cms.hhs.gov/manuals/pBm/list

Contact Information

Provider Cost Audit and Rate Setting Unit

Iowa Medicaid Enterprise

P.O. Box 36450

Des Moines, IA 50315

515-725-1108 (Local)

866-863-8610 (Toll-Free)

E-Mail: costaudit@dhs.state.ia.us