texas health and human services commission rate analysis...analysis due to a cost report review. c....
TRANSCRIPT
Texas Health and Human Services Commission Rate Analysis
Time and Financial Information (TAFI)
Instructions for Preparation of the Cost Report for MR Service Coordination, MH Targeted Case Management and Rehabilitative
Services for Persons with Mental Illness and
Manual for the Completion of the Medicaid Administrative Claim
FOR TAFI USERS ONLY
October 2008
TAFI Manual
Table of Contents General Instructions and Information Due Date 1 Amended TAFI Cost Reports 1 Desk Review 1 Access 1 General Operations Search Staff 3 Staff Information 5 Copy Staff Information 7 Contractor Information 8 Data Entry Quarterly Cost Data Unstudied Staff (and Programs) 9 SPMP Staff 11 Non-SPMP Staff 12 Cost Pool 4 Dollars 13 Unallowable Costs 14 Time Study Data Non-SPMP Staff 15 SPMP Staff 16 Contractors 18 Service Data TCM/Service Coordination 20 Rehabilitative Services 21 Revenues Unrecognized 22 Recognized 22 Reports 24 Appendix A – Pro Forma Logs 25 Appendix B – Reconciling the TAFI to the General Ledger 28 Appendix C – Frequently Asked Questions 29 Appendix D – Requesting Authorization to Reopen a Quarter and
Resubmitting the Reopened TAFI 32 Appendix E – Desk Review Form 33
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General Instructions and Information
A. Due Date
The TAFI Cost Report is due by 5 p.m. on the 15th of the month following 45 days after the end of the Federal Fiscal Quarter. If the 15th falls on a weekend or a holiday, then the due date is 5 p.m. on the next working day. A TAFI Cost Report that has not been received by 5 p.m. on the due date automatically defers the MAC claim. Acceptable receipt is defined as:
• Certification Pages signed by CEO and TAFI preparer • TAFI Training Certificate; • Signed, original QSI on letterhead; • Direct Charge Detail;
B. Amended TAFI Cost Reports
The procedures to follow in order to amend a TAFI Cost Report are set out in Appendix D.
Approved amendments to TAFI Cost Reports will be accepted through the dates listed below. Revised MAC Claims required due to cost report amendments will be submitted for payment/collection with the 1st and 3rd Quarter TAFI Claims. Centers are only allowed to request re-opening of a quarter for revisions up to 60 days after the due date. The only revisions allowed after that will be at the direction of the MAC Team due to a review, OIG Audit, or HHSC Rate Analysis due to a cost report review.
C. Desk Review
1 TAC §355.106 “HHSC conducts desk reviews of all provider cost reports to ensure that the financial and statistical information submitted in the cost reports conforms to all applicable rules and instructions.” Cost report preparers should refer to 1 TAC §355.101 through §355.113 as well as the OMB A-87 for guidelines regarding allowable costs, reporting requirements, and reimbursement rules. Appendix E contains a copy of the current form for desk review by Acute Care Section, HHSC. Variance from the established norms may cause the deferral of a MAC claim and require an explanation or correction. If that explanation/correction is not received by the due date in the written correspondence, the claim will be deferred until the next resubmission period (1st and 3rd quarters), and administrative penalties may be levied until an acceptance cost report is received.
D. ACCESS
Initial TAFI LOGIN screen. User names and initial passwords must be obtained from MIS Security. Dial 1-888-952-4357 for help. The TAFI login screen can be found at the following web address (for quarters beginning September 2006 forward): http://mhmrweb02.mhmr.state.tx.us/TAFI2007/Security/Forms/frm_Login.asp
TAFI 2007 Login User Name
Password
Login
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TAFI Manual
After you login, this screen will appear. Tafi - Set Base Quarter (frm_SetBaseQtr.asp)
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User Name:
General Information for the Quarter
AFTER SELECTING THE FACILITY INFORMATION PLEASE WAIT FOR THE YEAR-QUARTER INFORMATION TO LOAD
BEFORE PROCEEDING
THIS MAY TAKE A COUPLE OF MINUTES !!!
010-MHMR-BETTY HARDWICK CTR (Abilene Regional)Facility Id:
2007-1-CLOSEDFiscal Year-Quarter:
Facility ID No. The number used to identify the facility, the Component Code (CARE Identification Number).
Federal Fiscal Year and Quarter Note that the Federal fiscal year begins
October 1st and ends September 30th.
This screen informs the TAFI system which quarter you wish to open and make entries. Choose the Facility from the drop down menu by clicking on it. Wait for the Fiscal Year-Quarter area to “jump”, then select the Year-Quarter you want to work in. The year-quarter area is color-coded: RED is a previously worked, submitted and closed quarter BLUE open quarter YELLOW re-opened quarter, usually for corrections GREEN never opened quarter, available for creating a new quarter After selecting your year-quarter press the “Set Quarter” button. The following should appear with a blank screen, the options bar and the information bar. TAFI 2007: PRODUCTION WEBSERVER 02
Data Entry
General Operatio
Reports
Close Out
Utilities
Logout
User: Facility: 010-MHMR-BETTY HARDWICK CTR (Abilene Regional) Facility Type: MHMR Fiscal Year-Quarter: 2007-1 Quarter Status: Closed TV: 20
TAFI Manual
General Operations
On the drop down menu for General Operations there are six options: A. Search Staff B. Staff Information C. Copy Staff Information D. Contractor Information E. Set Base Quarter/Facility F. Change Password A. Search staff is a query used to find the data for time studied staff. You can search by employee
number (EMP No) or first and last name. Once you have entered your search data, press search. If neither EMP No or first and last name are known, just press search and all names will appear. A screen will appear showing the staff member’s EMP NO, first name, last name and service type (SPMP, Non-SPMP, Contractor). To access the data, place your cursor over the “document” to the left of the line number and click. The staff member’s name and job title will appear on a new screen along with the dates of time studies. Click on the date(s) you want. The following new screen will appear with the timestudy data for the period you requested:
NON-SPMP Staffing Time Study (frm_Time_Non_SPMP.ASP)
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EMP No 01010101
Position No 0101
Position Title hand w iper
Employee Name Unit Code Mary Doe 100
Starting
4/1/2004
Ending 4/1/2004
Total Units From Worksheet135
Total Units Entered Proforma
135
Code Description Value
1 Facilitating Medicaid Elig (All Staff) 2 Facilitating Non-Medicaid Elig (All Staff) 4 Medicaid Outreach (All Staff) 5 Non-Medicaid Outreach (All Staff) 6 Ref, Coord, and Mtr Medicaid Svcs (All Staff) 8 Ref, Coord, and Mtr Non-Medicaid Svcs (All Staff) 9 Medicaid Transportation & Translation (All Staff) 10 Medicaid Provider Relations (All Staff) 11 Prg Plan, Dev and Interagency Coord (All Staff) 13 Direct Medical Services (All Staff) 14 Non-Medicaid, Other Educ and Soc Svcs (All Staff)
1015 General Administration (All Staff) 16 Service Coordination 50
16-A MR - Adult And Child 2516-B MH - Routine - Adult
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16-C 25MH - Routine - Child/Adolescent 16-D MH - Intensive - Child/Adolescent 17 Rehabilitation Services(Medicaid-Covered Services) 75
17-A 25Day Program for Acute Needs 17-B Crisis Intervention Services 17-C Med Training and Support - Individual
2517-D Med Training and Support - Group - Adult 17-E Med Training and Support - Group - Child/Adolescent 17-F Psychosocial Rehabilitative Services - Individual 17-G Psychosocial Rehabilitative Services - Group 17-J Skills Training and Development - Individual 17-K Skills Training and Development - Adult Group 17-L Skills Training and Development - Child Group
2518 Home and Community Services (HCS) 21 Intermediate Care Facilty - MR (ICF-MR)
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B. Staff Information is another query. When you click on “staff information”, the following appears (In content this resembles what shows on the web):
Staff Information (frm_StaffInfo.asp) [Add New ]Humpty DumptyLittle Jack HornerLittle Miss MuffetOld King Cole
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FTE Unit Code
Staff ID
Position Number
Service Type SPMP
First Name
Middle
Last
Position Title
Salary
+
Benefits
Total =
Save Delete
Cancel
Select the staff person by clicking on their name.
TAFI Manual
The following will appear:
Staff Information (frm_StaffInfo.asp) [Add New ]Humpty DumptyLittle Jack HornerLittle Miss MuffetOld King Cole
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FTE Unit Code
1 572
Staff ID 463795138
Position Number 125
Service Type SPMP
First Name
Humpty
Middle
Last Dumpty
Position Title
Short Order Cook
Salary 500
+
Benefits Total 100 600=
Save Delete
Cancel
FTE Budgeted FTE for the person in the position. May be less than 1 for non-regular staff (relief, PRN, etc.)
Unit Code For your facility’s internal use.
Staff ID Employee’s assigned number. DO NOT USE the
employee’s full social security number.
Position No. The employee’s listed facility position number.
Service Type Select either SPMP or Non-SPMP.
Name May be in any order, caps or lowercase, but must be consistent.
Position Title The facility’s title for the position.
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Salary and Benefits Salary includes all expenses for work performed or for benefit leave taken or paid out. Benefits include all expenses incurred by the facility for payroll taxes, insurance
premiums, and miscellaneous employee benefits.
• If an employee occupies only one position during the quarter:
Salary and Fringe includes all salary and fringe benefit expense for the employee in that position for the quarter.
• If an employee occupies more than one position during the quarter:
Enter the Salary and Fringe expense for the quarter for each position separately. One of these positions generally has a pro forma log.
Example: Pos. 2789 John Svc Coordinator 4/1/xx - 5/16/xx $2,250
Time-studied in this position
Pos. 5294 John Caseworker II 5/17/xx - 6/30/xx $3,000 Pro forma log being created
C. Copy Staff Information Once you have created a new quarter at the “TAFI – Set Base Quarter” screen, you can use Copy Staff Information screen to copy existing staff from the previous quarter into the new quarter. This is how the screen looks initially with the addition of two buttons, “Copy Staff Records” and “Cancel”. Enter the required data and click on the copy button. A smaller warning screen appears asking you if you really want to proceed. Click on “yes”. If the operation is successful, a white colored bar will appear above the original “Copy Staff Records” with a confirmation in red letters: Staff records have been copied!
Copy Staff Records (frm_CopyStaff.asp) This procedure will copy Staff records from the quarter immediately preceding the Quarter you are logged into
Please verify the following information
before copying
Facility Id: 010-MHMR-BETTY HARDWICK CTR (Abilene Regional) Fiscal Year-
Quarter: 2006-4
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D.
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Contractor Information Contractors can be time studied (not recommended) or you can convert their logs to timestudy units. Contractors must be created here first before you can load a timestudy for them. Click “[ADD NEW]”.
Contractor ID Must be numerical and have 9 digits Position Number Employer assigned Name The name must be entered in both the “First” and
“Last” name blocks Position Title Employer assigned Amount Expensed The amount expensed or payable booked
Contractor Information (frm_ContractorInfo.ASP)
Contractor ID
Position Number
First Name Middle
Last Name
Position Title
Amount Expensed for Quarter
[Add New ]Castle Corp. The Big
SAVE DELETE CANCEL
Contractor Information (frm_ContractorInfo.ASP)
Contractor ID 944444444
Position Number 94
First Name
The BigMiddle
Last Name Castle Corp.
Position Title
IP Amount Expensed for Quarter
1000
[Add New ]Castle Corp. The Big
SAVE DELETE CANCEL
TAFI Manual
DATA ENTRY On the drop down menu for Data Entry there are four options:
A. Quarterly Data B. Time Study Data C. Units of Service D. Revenues
QUARTERLY COST DATA - Unstudied Programs and Staff (frm_Qtr_Unstudied_Staff.asp)
Note: COST entered is for the ENTIRE QUARTER not just time study period.
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Unstudied Direct Operating Cost Totals
Salary/ Benefits
Travel/ Training
Depreciation Mortgage/ Interest
Other Operating
Total DO TotalCosts Code
13-Medical Services 138419.59 128.19 4199.43
10440.27
14-Other Educ, Non Med, Soc Services 329613.45 12156.29 36031.91
78876.3
16-TCM/Serv Coord
17-Rehab
18-HCS 304909.57 2293.02 23064.01
194836.92
21-ICF-MR
SAVE CANCEL RECALC
A. Quarterly Cost Data
1. Unstudied Staff (and Programs)
All expenses of positions and programs which were not time-studied (other than General Administrative and Program Direct Support of time-studied personnel) are placed here. Positions which were supposed to time study but did not are handled by other means unless they fall in Appendix A, Pro Forma Logs.
a. Code 13 Med. Svcs Unstudied Direct Medical personnel, those programs which
are directly billable as Medicaid card services, pharmacy, drug costs, lab fees (not covered under a Medicaid program), non-TDMHMR Medicaid programs (e.g., ECI), substance abuse programs, etc.
b. Code 14 Other Educ, Vocational, residential (including room and board), client
NonMed, Soc Svcs personal items (not covered by a Medicaid program), HB1154, etc.
c. Code 16 TCM/SC Use only for expenses that fall in Appendix A, Pro Forma
Logs, Section C.2., Category IV and expenses that are pulled out as Targeted Case Management or Service Coordination (e.g., Service Coordination forms, etc.).
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d. Code 17 Rehab Use only for expenses that fall in Appendix A, Pro Forma Logs, Section C.2., Category IV and expenses that are pulled out as purely Rehab (e.g. supplies for a Group Session or Day Treatment that cannot be used for other purposes, including MAC activities, etc.).
e. Code 18 HCS Costs for HCS program, including all 100% HCS staff.
f. Code 19 HCS/O No longer utilized.
g. Code 20 No longer utilized.
h. Code 21 ICF/MR Costs for ICF/MR program, including all 100% ICF/MR staff.
After all data is entered, click the “save button” (one of 3 buttons: save, cancel and recalc) at the bottom of the screen. If you modify the data later, click on “recalc button” and then the “save button”.
NOTE: Depreciation, Mortgage Interest and Other Operating costs are listed
separately for all categories. These expenses must be reported separately and not grouped together. ICF/MR and HCS/TXHml/HCS-O (code 18) costs must be reported separately.
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QUARTERLY COST DATA - SPMP Quarter (frm_Qtr_SPMP.asp)
Note: COSTS entered are for the ENTIRE QUARTER not just the time study period.
Direct Program Support Costs for SPMP Staff
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Salary and Benefits 0.00
Travel and Training 0.00
Total Direct Program Support Costs 0.00
Direct Operating Costs for SPMP Staff Depreciation 0.00
Mortgage Interest ( Interest Only ) 0.00
Other Operating Costs 0.00
Total Direct Operating Costs 0.00
Total Cost SPMP Staff 0.00
Edit Close
2. SPMP Staff
Enter all costs specifically related to SPMP staff positions required to time-study and which do not fall under Appendix A, Pro Forma Logs, Section C., 2., Category IV here. This includes:
a. Clerical Salary/Benefits (CSB) - salaries and benefits of
1) clerical support staff who are evaluated as qualifying as SPMP Clerical Support (see Texas Medicaid Administrative Claiming Implementation Guide for MHMR Programs for specific guidelines on these positions);
2) SPMP staff who fall under Appendix A, Pro Forma Logs, Section C., 2., Category III.
b. Travel/Training - travel and training costs directly attributable to SPMP time-studied staff and all staff included under salaries and benefits in a. above, including local mileage reimbursements. Mileage documentation must be maintained, in writing, per the MAC Operating Manual. These costs may not be allocated. Exclude costs that are not specific to the SPMP staff (e.g. a $500 seminar for all staff, including SPMPs).
c. Depreciation - depreciation related to all SPMP time-studied staff and positions in a) above. These costs may be allocated.
d. Mortgage Interest - mortgage interest related to all SPMP time-studied staff and positions in a) above. These costs may be allocated.
e. Other Operating Costs - rent, utilities, maintenance, supplies, payments for contract clerical temporaries [supporting staff such as in a. above], and other costs related to all SPMP time-studied staff and positions in a. above. These costs may be allocated.
TAFI Manual
QUARTERLY COST DATA - Non-SPMP Quarter (frm_Qtr_Non_SPMP.asp)
Note: COSTS entered are for the ENTIRE QUARTER not just the time study period.
Direct Program Support Costs for Non-SPMP Staff
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Salary and Benefits 34,960.49
Travel and Training 4,360.91
Total Direct Program Support Costs 39,321.40
Direct Operating Costs for Non-SPMP Staff Depreciation 36,432.22
Mortgage Interest ( Interest Only ) 0.00
Other Operating Costs 93,644.47
Total Direct Operating Costs 130,076.69
Total Cost Non-SPMP Staff 169,398.09
EDIT CLOSE
3. Non-SPMP Staff
Enter all costs related to non-SPMP staff positions which are required to time study and which do not fall under Appendix A, Pro Forma Logs, Section C., 2., Category IV here. (This does not include the actual salary and benefits of the time-studied personnel, which are captured through Staff Information). These costs include:
a. Program Direct Support Salary/Benefits (CSB) - salaries and benefits of staff who:
1) directly support only non-SPMPs; 2) directly support both SPMPs and Non- SPMPs (but no other staff); 3) directly support both studied and unstudied staff, but only the portion
allocable to the studied staff; 4) fall under Appendix A, Pro Forma Logs, Section C.,2., Category III. 5) supervise first-line supervisors, but are not themselves time-studied, and who
are supervising only time-studied staff (and their clerical support), but who are not center wide administrative staff.
b. Travel/Training - travel and training costs of: 1) all non-SPMP time-studied staff; 2) all staff included under salaries and benefits in a. above; 3) travel related to SPMP and non-SPMP staff that cannot be directly attributed
to SPMP staff, including local mileage reimbursements. c. Depreciation - depreciation related to all non-SPMP time-studied staff and positions in a.
above. May be allocated. d. Mortgage Interest - mortgage interest related to all non-SPMP time-studied staff and
positions in a. above. May be allocated.
TAFI Manual
e. Other Operating Costs - rent, utilities, maintenance, supplies, payments for contract clerical temporaries [supporting staff such as in a. above], and other allowable costs related to all non-SPMP time-studied staff and positions in a. above. May be allocated.
QUARTERLY COST DATA - Cost Pool 4 (frm_Qtr_Cost_Pool4.asp) Note: COSTS entered are for the ENTIRE QUARTER
not just the time study period.
Direct Program Support Costs for Cost Pool 4
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Salary and Benefits 0.00
Travel and Training 0.00
Total Direct Program Support Costs 0.00
Direct Operating Costs for Cost Pool 4 Depreciation 0.00
Mortgage Interest ( Interest Only ) 0.00
Other Operating Costs 0.00
Total Direct Operating Costs 0.00
Total Cost Pool 4 Costs 0.00
EDIT CLOSE
4. Cost Pool 4
Enter salary, fringe benefit, travel and operating costs here for staff that are administrators
and support the entire organization. This includes the Executive Director’s Office, Business Office, Human Resources, Billing, MIS, Legal, Client Rights and MR and MH Directors (unless these staff carry a regular caseload), and any other general administrative units. In some organizations this may include Quality Assurance and Building Services, if these are maintained at the general level. Also include staff costs for direct support of these positions here.
a. Salary/Benefits - personnel costs for all cost centers/positions (professional,
technical, and support) which are designated in this cost area. b. Travel/Training - these costs for all cost centers/positions in a. above. c. Depreciation - depreciation for all cost centers/positions included in a. above. d. Mortgage Interest - mortgage interest for all cost centers/positions included in a.
above. e. Other Operating Costs - rent, utilities, maintenance, supplies, payments for contract
clerical temporaries [supporting staff such as in a. above], and other costs related to the cost centers/positions in a. above. These costs may be allocated. Also included here are any costs that are neither identifiable nor applicable to any other cost area
TAFI Manual
(Unstudied, non-SPMP or SPMP), but can be identified as allowable in nature.
QUARTERLY COST DATA - Unallowable Costs (frm_Qtr_Unallowable.asp) Note: COSTS entered are for the ENTIRE QUARTER
not just the time study period.
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Unallowable Costs 0.00
EDIT CLOSE
5. Unallowable Costs
Enter all quarterly costs deemed unallowable according to Circular OMB A-87 (revised) or as referenced and modified in 1 TAC §355, Subchapter A. Do not include those costs which are unallowable costs of a specific Medicaid program due to the nature of the program (e.g., residential costs in a non-residential program or costs which are covered under a separate Medicaid program), but which are otherwise allowable costs. Such programmatic unallowables are entered in Unstudied Staff (and Programs) under the appropriate code as discussed in Data Entry A.1.
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B.
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Time Study Data
Time Studies will be conducted in accordance with Texas Medicaid Administrative Claiming Implementation Guide for MHMR Programs.
A time study must be entered in order for the salary and benefits from Staff Information to be captured in the TAFI. A time study cannot be entered for a person who has not been set-up through Staff Information.
1. Timestudy data entry
a. Select SPMP from the list of SPMP, Non-SPMP and Contractor. Data for SPMP must be enter first before Non-SPMP or Contractor.
b. Then select your first staff person for timestudy data entry. When the entry screen appears, EMP No., Position No., Position Title, Employee Name, and Unit Code fields should all be filled with the data from the Staff Information file.
c. Dates will appear in “starting” and “ending”. Change these to the dates for your Center’s timestudy period. Then enter the total timestudy units.
d. Check the Proforma block if it is a Proforma timestudy. e. Then enter each of the individual Timestudy Codes units. Click on save
when complete. If an error appears, check the total of your individual entries, make corrections and click on save again.
f. This process applies for the Non-SPMP and Contractor Timestudy screens.
g. Note the SPMP codes 3, 7, and 12 will only appear on the SPMP screen.
NON-SPMP Staffing Time Study (frm_Time_Non_SPMP.ASP) EMP No
31574137
Position No 781
Position Title Merry soul
Employee Name Unit Code Old King Cole 474
Starting
10/1/2000
Ending 10/1/2000
Total Units From Worksheet400
Total Units Entered Proforma 400
LIST SAVE DELETE CANCEL
Code Description Value 51 Facilitating Medicaid Elig (All Staff)
2 Facilitating Non-Medicaid Elig (All Staff) 4 Medicaid Outreach (All Staff) 5 Non-Medicaid Outreach (All Staff)
806 Ref, Coord, and Mtr Medicaid Svcs (All Staff) 8 Ref, Coord, and Mtr Non-Medicaid Svcs (All Staff)
89 Medicaid Transportation & Translation (All Staff) 10 Medicaid Provider Relations (All Staff) 11 Prg Plan, Dev and Interagency Coord (All Staff) 13 Direct Medical Services (All Staff) 14 Non-Medicaid, Other Educ and Soc Svcs (All Staff)
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15 General Administration (All Staff) 76
16 Service Coordination 0
16-A MR - Adult And Child 16-B MH - Routine - Adult 16-C MH - Routine - Child/Adolescent 16-D MH - Intensive - Child/Adolescent 17 Rehabilitation Services(Medicaid-Covered Services) 23
17-A Day Program for Acute Needs 17-B Crisis Intervention Services 17-C Med Training and Support - Individual 17-D Med Training and Support - Group - Adult 17-E Med Training and Support - Group - Child/Adolescnt
2317-F Psychosocial Rehabilitative Services - Individual 17-G Psychosocial Rehabilitative Services - Group 17-J Skills Training and Development - Individual 17-K Skills Training and Development - Adult Group 17-L Skills Training and Development - Child Group 18 Home and Community Services (HCS) 21 Intermediate Care Facilty - MR (ICF-MR)
SPMP Staffing Time Study (frm_Time_SPMP.asp)
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EMP No 96573983
Position No 1285
Position Title Pie Eater
Employee Name Unit Code Little orne Jack H r 101
Starting
10/1/2000
Ending 10/1/2000
Total Units From Worksheet270
Total Units Entered Proforma 270
LIST SAVE DELETE CANCEL
Code Description Value
1 Facilitating Medicaid Elig (All Staff) 2 Facilitating Non-Medicaid Elig (All Staff) 3 Medicaid Outreach (SPMP) 4 Medicaid Outreach (All Staff) 5 Non-Medicaid Outreach (All Staff) 6 Ref, Coord, and Mtr Medicaid Svcs (All Staff) 7 Ref, Coord, and Mtr Medicaid Svcs (SPMP) 8 Ref, Coord, and Mtr Non-Medicaid Svcs (All Staff) 9 Medicaid Transportation & Translation (All Staff) 10 Medicaid Provider Relations (All Staff) 11 Prg Plan, Dev and Interagency Coord (All Staff) 12 Prg Plan, Dev and Interagency Coord (SPMP) 13 Direct Medical Services (All Staff) 14 Non-Medicaid, Other Educ and Soc Svcs (All Staff)
4015 General Administration (All Staff) 16 Service Coordination 230
16-A MR - Adult And Child 16-B MH - Routine - Adult
2316-C MH - Routine - Child/Adolescent 16-D MH - Intensive - Child/Adolescent 17 Rehabilitation Services(Medicaid-Covered Services) 0
17-A Day Program for Acute Needs 17-B Crisis Intervention Services 17-C Med Training and Support - Individual 17-D Med Training and Support - Group - Adult 17-E Med Training and Support - Group - Child/Adolescnt 17-F Psychosocial Rehabilitative Services - Individual 17-G Psychosocial Rehabilitative Services - Group 17-J Skills Training and Development - Individual
TAFI Manual
17-K Skills Training and Development - Adult Group 17-L Skills Training and Development - Child Group 18 Home and Community Services (HCS) 21 Intermediate Care Facilty - MR (ICF-MR)
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2. Contractors are not required to time study.
If they do so, then the timestudy and costs must be entered here exactly as you would those of time studied staff. However, if they provide services for programs for which a timestudy is required (Rehabilitative services), then their costs must also be allocated through this process. A timestudy cannot be entered for a contractor who has not been setup in Contractor Information.
For Contractors who DO NOT timestudy:
a. Take the service log data for the entire quarter and translate the services into timestudy codes from 13-21. No MAC codes 1-12 and no TCM codes 16 may be used for these contractors.
b. Enter the Timestudy Period dates c. Enter the total number of units to be entered. d. Enter the units by Code. If only one Code is to be used, then a unit of “1”
may be entered. If more than one code is to be used, actual timestudy or converted units must be used.
Contractor Time Study (frm_Time_Contractor.asp)
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EMP No 94444444
Position No 94
Position Title IP
Contractor Name Unit Code The Big Castle Co
Starting
10/1/2000
Ending 10/1/2000
Total Units From Worksheet160
Total Units Entered Proforma 160
LIST SAVE DELETE CANCEL
Code Description Value
1 Facilitating Medicaid Elig (All Staff) 2 Facilitating Non-Medicaid Elig (All Staff) 4 Medicaid Outreach (All Staff) 5 Non-Medicaid Outreach (All Staff) 6 Ref, Coord, and Mtr Medicaid Svcs (All Staff) 8 Ref, Coord, and Mtr Non-Medicaid Svcs (All Staff) 9 Medicaid Transportation & Translation (All Staff) 10 Medicaid Provider Relations (All Staff) 11 Prg Plan, Dev and Interagency Coord (All Staff) 13 Direct Medical Services (All Staff) 14 Non-Medicaid, Other Educ and Soc Svcs (All Staff) 15 General Administration (All Staff) 17 Rehabilitation Services(Medicaid-Covered Services) 160
17-A Day Program for Acute Needs 17-B Crisis Intervention Services
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17-C Med Training and Support - Individual 17-D Med Training and Support - Group - Adult 17-E Med Training and Support - Group - Child/Adolescent 17-F Psychosocial Rehabilitative Services - Individual 160
17-G Psychosocial Rehabilitative Services - Group 17-J Skills Training and Development - Individual 17-K Skills Training and Development - Adult Group 17-L Skills Training and Development - Child Group 18 Home and Community Services (HCS) 21 Intermediate Care Facilty - MR (ICF-MR)
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C.
21
Service Data
Service data is a required component of the TAFI cost report Covered A unit of service that is included in the definition of the particular
Medicaid program. It may or may not be billable for various reasons, but it is covered under the program service definition and is being performed by a person authorized to provide the service to a person authorized to receive the service. These units are the total units of service entered under DATA ENTRY on the TAFI.
Unit of service The designated period of service for that Medicaid program (e.g.,
45-60 minutes, a contact, 15 minutes, etc.).
1. Service Coordination
a. Enter an unduplicated count by month, for each type of service, of all clients receiving TCM/Service Coordination.
b. Then, enter an unduplicated count of those clients reported in the Total section who were Medicaid-eligible for the month.
2. Targeted Case Management
a. Report data for the entire Federal fiscal quarter and include all services
performed during the quarter whether they are billable or not billable on the second line for each service.
b. On the first line enter those units which were Medicaid for the quarter.
3. Rehabilitative Services
a. Unit of service definitions for Rehabilitative Services vary by service, so be careful that accurate units are reported for each service.
b. Report data for the entire Federal fiscal quarter and include all services whether or not the service was billable on the second line for each service.
c. On the first line enter those units which are Medicaid for each service. d. Click on save when all data is entered. e. If data needs to be corrected at a later, click on “recalc”, then save.
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Units of Service (frm_UnitsOfService.asp) Note: UNITS entered are for the ENTIRE QUARTER not just time study period. Cod
e Code Description Unit Month 1 Month 2 Month 3 TOTAL
16 Service Coordination 16-A: MR Total Unduplicated Clients Served 160 154
157
471
16-A: MR Unduplicated Medicaid Eligble 127 123
125
375
16 Targeted Case Management 16-B: TCM-R-Adult Medicaid 321
16-B: TCM-R-Adult Total Units 908
16-C: TCM-R-Child Medicaid 700
16-C: TCM-R-Child Total Units 921
16-D: TCM-I-Child Medicaid 390
16-D: TCM-I-Child Total Units 506
17 Rehabilitation Services 17-A: Day Program-Acute Care Adult Medicaid
17-A: Day Program-Acute Care Adult Total Units
17-B: Crisis Intervention Medicaid 59
17-B: Crisis Intervention Total Units 1945
17-C: MTS-Individual Medicaid 612
17-C: MTS-Individual Total Units 918
17-D: MTS-Grp-Adult Medicaid
17-D: MTS-Grp-Adult Total Units
17-E: MTS-Grp-Child Medicaid
17-E: MTS-Grp-Child Total Units
17-F: Psychosocial Rehab-Ind Medicaid 7140
17-F: Psychosocial Rehab-Ind Total Units 9066
17-G: Psychosocial Rehab-Grp Medicaid 344
17-G: Psychosocial Rehab-Grp Total Units 394
17-J: Skills Training & Developmnt-Ind Medicaid 2504
17-J: Skills Training & Developmnt-Ind Total Units 3861
17-K: Skills Training & Developmnt-Grp Medicaid 200
17-K: Skills Training & Developmnt-Grp Total Units
333
17-L: Skills Trng & Dev - Grp Child Medicaid
17-L: Skills Trng & Dev-Grp Child Total Units
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D.
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Revenues
A general rule for determining placement of revenue is that revenue must follow the activity by which it is earned or the expense for which it is a reimbursement.
1. Unrecognized
These revenues have no effect on the calculation of the claim but are included for
purposes of audit and full reporting.
a. Medicaid Administrative Reimbursement b. Other State Funds - General Revenue c. Local Government Funds d. Donations to public agencies - usually legislatively-mandated agencies. e. Federal Emergency Assistance Reimbursement (Title IV-A) or FEMA funds. f. Federal Title IV-E Reimbursement
2. Recognized
These are income sources that must be adjusted (offset) against the costs of the agency. They are collected in either Cost Pool #3 or Cost Pool #4, based on an analysis of the revenue source.
a. Medicaid Fees + Match - Includes all Title XIX reimbursements and, as
required, the state matching funds b. Federal Grants + Match - A Federal grant may pass through one or more state
agencies, but it remains Federal funds. If a grant funds the entire salary of a timestudy participant, then at least the portion of the grant pertaining to the expenses of that participant must be placed in Cost Pool #4 in order to allocate it over all the Cost Pools, as those expenditures do. If the expenditures covered by the grant are collected in Cost Pool #3, then place the grant in Cost Pool #3 as well. If the grant funds a percentage of a staff member and will cover any of their activities, including activities which would fall under MAC Codes 1-12 ( e.g., MH Block Grant or PATH), then that portion of the grant which is not absolutely tied to expenditures which were directly placed in Cost Pool #3 (e.g., medication purchases or housing supplements which were funded by an auditable means with those grants) must be placed in Cost Pool #4
c. Medicare – Direct service related and placed in Cost Pool #3. d. Insurance - Usually placed in Cost Pool #3, except for casualty insurance that
exceeds replacement/repair cost, which is placed in Cost Pool #4. e. Fees - Usually paid by or on behalf of clients for direct service and placed in
Cost Pool #3. f. Donation to Contractor - Used only by private entities g. Other Revenue - Place all revenue sources not previously mentioned here.
Most will go into Cost Pool #3, but some are specifically placed in Cost Pool #4. Place Miscellaneous revenues, those which were one-time or unusual or not readily identifiable, in Cost Pool #4, along with Interest income, Other Business Income, Fundraising income not specifically designated for a specific Cost Pool #3 activity, and any other purely “administrative” income. Cost Pool #3 Other Revenues include revenues for vocational production; from clients, families or other sources covering residential costs; and grants from private foundations.
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Revenues (frm_Revenue.asp) Note: UNITS entered are for the ENTIRE QUARTER not just time study period. UNRECOGNIZED REVENUES: COST POOL #4 Medicaid Admin Reimb 150327
Other State Funds 120000
Local Government Funds 12000
Donation to Public Agency
Federal Emer. Ass't Reimb.
Federal IV-E Reimb.
TOTAL UNRECOGNIZED REVENUES: COST POOL #4 282327
RECOGNIZED REVENUES: COST POOL #3
Medicaid Fees + Match 658000
Federal Grants + Match 45000
Medicare 10000
Insurance 500
Fees
Donations to Contractor
Other Revenue
TOTAL RECOGNIZED REVENUES: COST POOL #3 713500
RECOGNIZED REVENUES: COST POOL #4
Medicaid Fees + Match
Federal Grants + Match 5555555
Medicare
Insurance
Fees 28000
Donations to Contractor
Other Revenue 1000000
TOTAL RECOGNIZED REVENUES: COST POOL #4 6583555
GRAND TOTAL OF ALL REVENUES
TOTAL of Recognized/Unrecognized Cost Pool #3 713500
TOTAL of Recognized/Unrecognized Cost Pool #4 6865882
GRAND TOTAL OF ALL REVENUES 7579382
MEDICAID % AND FEDERAL SHARES
Medicaid Percent (Enter % like 70.25) 58
Federal Direct Charge (Adj): 2500
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REPORTS Under the Reports Tab there are 8 types of reports that can be run.
A. The first 5 report titles are fairly self explanatory. B. Under the Rehab/Case Mgmt. Reports are the 4 reports dealing with Codes 16 and 17. These are
the reports used for Rate Setting and Settle-up. Two reports provide units of service per sub code and two reports provide costs per sub code (16-A, 17-A, etc). These reports must equal by service. If the Code 16 Units of Service report shows units for 16-A then there should be costs for 16-A on the Code 16 FROS (full report of service) report. And vice versa.
C. Under Detailed Report of Time Log Entries are 5 reports built for the MAC staff for MAC reviews. They list time studies by job title.
D. This is the Final TAFI Report. This report is used to complete your Quarterly Summary Invoice after you have reconciled it to your General Ledger.
E. Close your quarter online before mailing your TAFI Certification pages to HHSC/Rate Setting. Any Certification Pages received with the quarter still open online will be deemed unacceptable. New Certification Pages will have to be submitted once you have closed your quarter online. If the second set is received after the due date, the report will be considered late. A report is not complete until the quarter is closed (TAC 355.105(b)(3)-(4)).
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Appendix A - Pro Forma Logs Sometimes there is not a valid timestudy for a position, which is required to timestudy. These positions, however, must be accounted for in the TAFI. The questions in Section A below will assist you in determining the proper treatment for these positions, personnel, and costs. Section B details how to calculate a pro forma log. A. When do you create a pro forma log?
1. Are there costs for that position during the quarter? a. No. You need do nothing further. b. Yes. Move to Question 2.
2. Was there a timestudy for the position?
a. Yes, but it failed Quality Control check (see definitions) and could not be corrected. Place the cost in Unstudied costs for the program.
b. Yes, but it was not for the full timestudy period. If it was for at least one week (160 units/5 working days) of the period, then it may be used as is. If it was for less than one week of the period, create a Category II pro forma log. Exception: If it is due to lost or uncompleted time study logs, then go to question 4.b.
c. Yes, but it was for another person. If there was turnover in the position during the quarter, a valid time study for the position may be used to create a Category I pro forma log for all persons who occupied that position during the quarter.
d. No. Continue with the next question.
3. Was the position vacant during the time study period? a. Yes. A Category II or III pro forma log may be created for quarterly costs in the
position before and/or after the time study period b. No. Continue with the next question.
4. Was the person filling the position too new (that is, was not employed by the facility in
a time study eligible position during that quarter’s initial/refresher training) to have been trained for the time study?
a. Yes. Treat the position as vacant and create a Category II or III pro forma log. b. No. These costs must be placed in Unstudied costs under the correct code.
(Category IV pro forma.)
Please note that if a time study staff person is out on leave during the time study, they are not eligible for a pro forma log. The staff person’s time study logs should show only Code 15 for the time study period.
B. How do you create and document a pro forma log?
Calculate a pro forma log by adding the grand totals of the logs for all “substantially similar” positions in the organization, then dividing the resulting figures by the number of positions included. There must be at least 2 substantially similar positions in order to create a pro forma log. If there are not, see section 2, Category III.
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1. Theory and Definitions
“Substantially similar” means that the job duties (not the job titles) of the position are mostly equivalent to those of the position that requires a pro forma log. A facility may have the general title of “MHMR Aide”, but the duties of a person in this position in a MR facility may differ greatly from those of a person with the same position title in a MH Day Treatment program. The duties of a Caseworker I in an outpatient clinic in an urban area may be very different from those of a Caseworker I in a rural outpatient clinic. In order to determine substantially similar positions, seek the assistance of department managers and/or supervisors. Once determined, however, these substantially similar positions should only change with the addition of new positions or major program changes or reductions.
Most importantly, a pro forma log must look like the log for that position if it had been time-studied for the quarter. This, then, determines whether two positions are substantially similar (albeit, not identical). For example, perhaps Mary performs Medicaid eligibility assistance once in a while (a 1-2% occurrence over an entire year), but other than that, she does the same duties as all the other Caseworker Assistants at her Center. That occasional activity, because it is rare or unusual, would not exclude her from the calculation of a pro forma log for a Caseworker Assistant position.
Should a position be included that is part-time or was time-studied for less than the full time study period? YES, as long as the duties of the position are substantially similar to the position requiring the pro forma. The calculations rely on the distribution percentage of the time study units, not on the number of log units.
2. Calculations
Category I pro forma log A pro forma log is prepared for one person based directly on a time study completed by another person in that position. It is an exact duplicate of the log totals for the person who was actually studied in the position.
Category II pro forma log Add together the time study total of the logs of the substantially similar positions. The resulting figures are then divided by the number of substantially similar positions being used to create the average.
Example: 6 logs added together yield a total of 89 units in Code 1, 138 units in Code 6,
43 units in Code 9, 1103 units in Code 15, 890 in Code 17-F, and 457 in Code 17-G. Divide each of these totals by 6 to produce a pro forma log with these totals:
Code 1 15 Code 6 23 Code 9 7 Code 15 184 Code 17-F 148 Code 17-G 76
Category III pro forma log If there are not at least 2 substantially similar positions, the costs of the position, which would ordinarily fall into Category II, may be placed in Quarterly Cost Data, Clerical Salary and Benefits, for the correct staff type (SPMP or NON-SPMP).
Category IV pro forma log While the situations described in A.4.b. rarely occur, place the costs in Unstudied Staff with the program that categorizes the employee. This unusual situation always raises a desk audit flag if the costs appear in Unstudied Codes 16 or 17. This is not a true pro forma log, since no log is prepared. Place the actual Salary and Benefit costs, along with
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Travel and Operating Costs pertaining or allocated to that staff member, in the Unstudied area. If the costs are placed in Codes 16 or 17, send written documentation with the Certification Pages detailing the employee’s name, the employee’s salary and benefits and other costs for the quarter, and the reason they were placed in Unstudied Code 16 or 17.
3. Documentation
Documentation for a pro forma log must include the pro forma log itself, names and position title and number of the persons used to create the pro forma, a statement regarding why a pro forma for that person was needed, and back-up information such that a reviewer can readily determine if the process results in an accurate pro forma log.
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Appendix B - Reconciling the TAFI to the General Ledger Step A. First, go to Final TAFI Report - Summary of Pools. In Summary of Pools, go to the “Total” column
between Operating Costs and Allocated Cost Pool #4. The total in that column must reconcile to the total adjusted expenditures from the General Ledger.
Step B. If these totals do not match, locate the problem through a process of elimination. Step C. Review total operating costs. On the Final TAFI Report – Summary of Pools, go to Operating Costs.
Take the OC (Operating Costs) total minus CP4 Salaries and Benefits (SB) and Travel and training (TT) (from Final TAFI Report – Cost Pool 4(CP4) Dollars) and reconciled to the total adjusted operating costs from the General Ledger. If these figures reconcile, the problem occurred elsewhere. If these figures do not reconcile, the difference may reflect the discrepancy in the reconciliation. If so, make the necessary adjustments, rerun the TAFI, and begin at Step A. If not, continue with Step D.
Step D. Next, review total travel and training costs. On the Final TAFI Report – Summary of Pools, go to TT and
add CP4 TT (from Final TAFI Report – Cost Pool 4 Dollars). The sum of these two numbers should reconcile to the total adjusted travel/training costs from the General Ledger. If these figures reconcile, the problem occurred elsewhere. If these figures do not reconcile, the difference may reflect the discrepancy in the reconciliation. If so, make the necessary adjustments, rerun the TAFI, and begin at Step A. If not, continue with Step E.
Step E. Next, review total salaries and benefits. NOTE: This is the most common location of errors. Go to
Final TAFI Report - Cost Pool 4 Dollars, under the “SB” column. Take the SB (Salary and Benefits) total and add it to the total Salary/Benefits in Summary of Pools. The sum of these two numbers must reconcile to the total adjusted salary/benefits from the General Ledger. If these figures reconcile, the problem occurred elsewhere. If these figures do not reconcile, the difference may reflect the discrepancy in the reconciliation. If so, make the necessary adjustments, rerun the TAFI, and begin at Step A. If not, continue with Step F.
Step F. Review total SPMP Staff Salary and Benefits. On the SPMP Summary of Pools page, under the “ Total”
column, take the SB number and reconcile it to the total adjusted salary/benefits for SPMP staff from the General Ledger. If these figures reconcile, the problem generally will have occurred in the NON-SPMP staff salaries and benefits. If not, check to make sure that all the SPMP staff that were supposed to be time-studied were time-studied, that there are time study logs for those individuals, and that all of the information was entered into the TAFI. If any time study information was inadvertently overlooked, enter the information into the TAFI, rerun it, and begin with step A.
Step G. Review total NON-SPMP Staff Salary and Benefits. On the NON-SPMP Summary of Pools page, under
the “Total” column, take the total Salary/Benefits and reconcile it to the total adjusted salary/benefits for NON-SPMP staff from the General Ledger. If these figures reconcile, yet the overall discrepancy remains review the entire reconciliation process to determine the exact nature of the error. Ensure that all the NON-SPMP staff that was supposed to be time-studied were time-studied, that there are time study logs for those individuals and that all of the information was entered correctly into the TAFI. If any time study information was omitted, enter the information into the TAFI, rerun it, and begin with Step A.
Step H. NOTE: Remember to check all data that is “hard-keyed”, or entered directly, into the TAFI. Check
data entry in these important areas:
1. Cost Pool 4 dollars; 2. Unstudied Staff dollars; 3. SPMP CSB, staff travel/training and operating costs; 4. Non-SPMP CSB, staff travel/training and operating costs; 5. Unallowable Costs; 6. Failing to enter data from pro forma logs; 7. Incorrectly entered data or typographical errors.
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Appendix C - Frequently Asked Questions (FAQs)
1. Where should I put this cost? Or, I have this unique situation…
Many costs are either unallowable at any time for Federal fund expenditures per OMB A-87 or are unallowable under specific Medicaid programs for various programmatic and waiver reasons.
Place OMB A-87 costs in the Unallowable Costs entry section of the TAFI.
Analyze other costs to determine under which program they may fall.
A. Food and Residential Costs (e.g., client housing, utilities, etc.)
Room and board costs are allowable under ICF/MR, which is a residential program and includes that type of expense.
Room and board costs are not allowable in non-residential programs such as Rehabilitative Services, and Service Coordination. Those are residential costs and must be reported under Unstudied Staff and Programs, Code 14.
B. Vocational Costs (e.g., client wages, workshop/production supplies, etc.)
Do not include vocational costs with the costs of time-studied staff.
Captured these costs in Unstudied Staff and Programs, Code 14.
C. Drugs
Covered by another Medicaid program, thus, they are not allowable parts of the Rehabilitative Services or Service Coordination.
These costs should be included in Unstudied Staff and Programs, Code 13.
D. Client Assistance Costs
This type of cost is normally incurred in the process of helping consumers, but is not included in Medicaid programs and may not be paid for by Medicaid dollars.
These costs are more correctly classified as Social Services and included in Unstudied Staff and Programs, Code 14.
E. Salaries and Benefits
How should On-call Pay be handled?
On-call pay is included with regular Salary and Fringe.
Are travel reimbursements included here? Include travel reimbursements here only if they are paid through payroll and are subject to payroll taxes.
Do I have to input my entire staff here?
No, enter only time-studied staff.
Do I have to input this data each quarter? No. A function of the TAFI system allows you to copy over the staff data from the previous quarter as you create a new quarter. Then make only needed adjustments to
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the salary and fringe benefit data and add any new employees.
Do I have to delete employees who are no longer with the agency in the new quarter? No. Former employees may be left in the Staff Information section because the costs for an employee become part of the TAFI Cost Report only if there is a time study for that person
2. What are the 4 Sections and what costs and revenues are collected in each?
A. SPMP (formerly Cost Pool # 1)
Includes costs compiled by the TAFI for those activity codes performed by designated SPMP personnel which are reimbursable at the enhanced rate. This includes Code 3 (which is not discounted by the Medicaid percentage) and Code 7 and Code 12 (which are discounted by the Medicaid percentage).
B. Non-SPMP Timestudied (formerly Cost Pool # 2)
Includes costs derived from activities performed by SPMPs and non-SPMPs using Code 1, Code 4, and Code 10 (which are not discounted by the Medicaid percentage) and Code 6, Code 9 and Code 11 (which are discounted by the Medicaid percentage).
C. Unstudied (formerly Cost Pool # 3)
Several types of costs are collected in this Section. For time study participants, costs derive from activities coded by both SPMPs and non-SPMPs which are either non-Medicaid related (Code 2, Code 5 and Code 8) and those which are direct service activities (Code 13, Code 14 and Code 16 and above). Also include in this Section are the costs for those staff who were not in the time study and who will be entered in the Unstudied Staff section.
D. Cost Pool # 4
This Section contains costs for General Administrative services (HR, accounting, CEO, etc) including any expenditure that cannot be allocated in a more accurate fashion.
3. Other?
A. I have contract providers and client workers. Do I put their costs in the salary line? Contractors must be placed in the Other Operating expense line item. If you give the person a 1099 at the end of the year rather than a W-2, then he/she is a contractor. This includes client workers.
B. I know that some costs that are allowable under OMB A-87 are not allowable under certain
Medicaid programs. How do I know what kinds of costs are allowable for each program? Cost rules can be found at 1 TAC§355, subchapter A that relate to the allowable activities. If the program is a residential one, then it is reasonable that costs for room and board would be allowable (e.g., ICF-MR). If the program is NOT residential, then those costs would not be covered under the program (e.g., Service Coordination, Rehabilitative Services).
C. How do I handle costs when part of the cost center is time-studied and part of it is unstudied?
Where possible, it is easier to either study or not study entire cost centers. If the whole cost center is non-SPMP staff and staff who fall in a. above, then all allowable costs of the cost center may be placed in this cost area. If some of the staff are SPMP and/or Unstudied, then the costs must be allocated among the various groups. The primary
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allocation method for the TAFI is by percentage of salary and benefits.
D. If I am unsure of where to place a cost, may I place it in Cost Pool #4 without lots of research? Place costs that can be attributed or allocated to one of the other cost areas (Unstudied, non-SPMP or SPMP) that cost area. Use Cost Pool 4 only as a last resort for non-General Administrative costs.
E. What if I have a person with more than one position number for the quarter?
Be careful that you enter the correct timestudy with the correct position number. This will often occur when you have a pro forma situation arising from a transfer.
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Appendix D Procedure for Requesting Authorization to Reopen a Quarter and Resubmitting the Reopened TAFI – RA-677.
1. Fill out the top part of Form RA-677 and include your fax number.
TAFI Mailbox2. Email form (preferred method) to and include “Reopen Quarter” in the subject line of the email message or fax the form to HHSC Rate Analysis, Acute Care Section (512) 491-1998.
3. Rate Analysis will fax the form back to you with an approval or denial and a due
date. Center Initiated re-opens will not be accepted 61 or more days beyond the due date.
4. When the revision is completed, fill out the bottom portion of the form, and fax it
back to Rate Analysis, Acute Care Section, Attn: “whoever approved the request”, informing the Approver what the revision includes: what changes were made, what you are sending (new data, QSI, or both) and when you will e-mail, mail or transmit it.
5. The RA-677 (Request to Reopen Previously Opened Quarters) form can be found
at the Acute Care Rate Analysis website address below: http://www.hhsc.state.tx.us/Medicaid/programs/rad/AcuteCare/Eci/2008EciCrInfo.html
Any resubmitted TAFI data or MAC Claim received in the Rate Analysis or Medicaid Administration offices without prior approval through the use of Form RA-677 will result in the deferral of the revised quarter and current quarter being deferred.
This procedure is necessary to assure that: • the data in the field is not changed without prior written authorization; • Rate Analysis and Medicaid Administration staff know what is being changed,
making the resubmission review process more efficient.
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Appendix E – Desk Review Form Time and Financial Information (TAFI)
Desk Review of TAFI Report
Center Code: ______ Center Name:___________________________________ Qtr_____ FFY_____ Reviewed By:_________________________ Date Reviewed:_________________ Check off (answer yes or no): ________ 1. Was the Cost Report Certification page submitted by the due date? ________ 2. Was the Methodology Certification page submitted by the due date? ________ 3. Are all certification pages properly signed and notarized? ________ 4. Are the Total Expenses for this quarter within +/- 10% of prior quarter? ____ Qtr.,FFY_____ ________$ current quarter Variance=______ ____ Qtr.,FFY_____ ________$ prior quarter ________ 5. Are the Cost Pool 4 Expenses for this quarter within +/- 10% of prior quarter? _____Qtr.,FFY_____ ________$ current quarter Variance=______ _____Qtr.,FFY_____ ________$ prior quarter _______ 6. Is the amount in Clerical Salaries & Benefits (CSB) reasonable compared to the salaries (Tot) for the same
category? (>10%,<50%) CSB=_____________ Variance = _________ SAL TOT=_____________
________ 7. Is the amount in SPMP and Non-SPMP Operating Costs (OC) reasonable compared to the (Tot) for the same
category? (<25%) OC=_____________ Variance = _________ TOT=_____________
________ 8. Are there unallowable costs reported? Amount $________
9. Code 16 Units of Service (UOS) Report ____a) Do the UOS match those on the Code 16 FROS expense summary report? ____b) For each UOS type, is the total for “Medicaid Eligible” less than “Clients Service?
10. Code 17 Units of Service (UOS) Report ____a) Do the UOS match those on the Code 17 FROS expense summary report? ____b) For each UOS type, is the total for “Medicaid Eligible” less than “Clients Service?
11. Is Unstudied Code 16 (TCM) empty?___ Unstudied Code 17 (Rehab)_____
Notes:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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