wisconsin medicaid cost reporting (wimcr) instruction manual...2014/09/03 · basic county...

Wisconsin Medicaid Cost Reporting (WIMCR)

Instruction Manual

Cost Reporting Year 2013

WIMCR Support • [email protected] • (866) 803-8698 1

mailto:[email protected]

SECTION I – INTRODUCTION TO 2013 WIMCR COST REPORTING

A. WIMCR Program Overview B. Purpose of the WIMCR Cost Report C. Introduction to WIMCR Cost Report Tool (CRT)

SECTION II – NAVIGATING THE COST REPORT TOOL (CRT)

A. Accessing the WIMCR CRT • New User Email • Username • Password • Forgot Password

B. Navigating the Dashboard

• Progress Bar • Agency Overview • Resources • Important Dates • Guide to Cost Reporting • Accessing Cost Report and Desk Review • User Management

SECTION III – COMPLETING THE WIMCR COST REPORT

A. General Cost Report Functionality • Import/Export • Printing • Pop-Up Explanation • Save & Close vs. Save & Continue • Navigating Between Cost Report Pages • Report List Functionality • Program and Category Summary Data • Desk Reviews

B. Cost Report Pages

• County Agency Overview • WIMCR Direct Service Checklist • Direct Service Data by Professional Type • Direct Service Non – Personnel Cost • WIMCR Direct Support • Supplemental Direct Service Information • Overhead • Federal Funds and Reductions • Summary and Certification

C. Desk Review

• Goals of Updated WIMCR Desk Review • Desk Review Structure and Process • PCG Response • Provider Response • Desk Review Email Notifications

SECTION IV – MANAGEMENT REPORTS

A. Provider Summary Reports (PSRs) • PSR Overview • PSR Data and Navigation

B. County Treasurer Reports (CTRs) • CTR Overview • CTR Data and Navigation



SECTION I – INTRODUCTION TO 2013 WIMCR COST REPORTING Why Implement an Updated WIMCR Reporting Process?

In order to improve overall compliance with the federal oversight agency, the Centers for Medicare and Medicaid Services (CMS), the Wisconsin Department of Health Services (DHS) has initiated an updated WIMCR reporting process effective for dates of service on or after January 1, 2013. Updates to the WIMCR program are a common theme which is addressed throughout the guide to Wisconsin Medicaid Cost Reporting (WIMCR). The graphic below is used within the WIMCR Program Overview section of the Guide to WIMCR Cost Reporting to highlight items and policies which have changed as part of the updated WIMCR reporting process.

In the past, county agencies have completed an individual WIMCR report for each unique WIMCR program and provider ID combination under which services were provided and claims were submitted to Medicaid. This process limited the availability of detailed information regarding individual program costs. One of the goals of the updated WIMCR reporting process is to address the disadvantages of the reporting process which has been completed in the past, outlined below: Challenge: Duplicative reporting – if an agency billed a single program under multiple provider IDs, they were required to submit two identical WIMCR cost reports. Resolution: Each agency will complete a single WIMCR report which will include all WIMCR program costs. Challenge: Difficulty reconciling reported values with total agency cost – in order to comply with past WIMCR reporting requirements, agency cost was reported in aggregate by category for individual programs. Resolution: The costs reported by category on the WIMCR report will include adequate detail to tie back to agency financial reports. Clinician costs will be reported at the individual clinician level. Challenge: Lack of statewide uniformity in the WIMCR reporting process – to identify how much cost should be reported within each report, each agency implemented their own allocation methodology. Resolution: All costs will be included on a single report which will ensure that all allowable costs are accurately allocated to each WIMCR program using an allowable methodology which is implemented on a statewide basis. The allocation formulas will be applied automatically within the WIMCR webtool. Challenge: Cumbersome review process – Individual reviews were completed for each report and system generated edits frequently overlapped with desk review edits. Resolution: The WIMCR review process will be completed entirely within the updated WIMCR webtool. Additionally, the consolidation of WIMCR reporting to a single report will limit the review process to a single report. WIMCR Program Overview

The Wisconsin Medicaid Cost Reporting (WIMCR) program, is a cost-based payment system for counties certified as Medicaid providers of community-based services. WIMCR is administered by the Division of Health Care Access and Accountability (DHCAA) in the Wisconsin Department of Health Services (DHS). County providers participating in WIMCR receive a Medicaid payment from DHS based on actual costs incurred, as reported on annual cost reports.

WIMCR payments are funded by General Purpose Revenue (GPR) and federal Medicaid matching funds. Each county’s Community Aids Basic County Allocation (BCA) will be:

• Readjusted to reflect Medicaid cost reporting payments.

• Increased by maintenance of effort (MOE) amounts. Total statewide MOE of $19.25 Million is allocated to each county by a two tiered calculation based on a 2002 look back and remaining Medicaid deficit.

WIMCR includes services provided by county agencies for calendar year dates of service. These services include:

• Targeted case management services (the non-federal share of this service is provided by the county)

• Child/adolescent day treatment services

• Community support program services (the non-federal share of this service is provided by the county)

• Crisis intervention services, hourly (the non-federal share of this service is provided by the county)

Update to WIMCR Cost Reporting



• Crisis Stabilization per diem services (the non-federal share of this service is provided by the county)

• Home health services

• Adult mental health day treatment services

• Outpatient mental health and substance abuse services, including evaluation, psychotherapy, substance abuse counseling, and intensive in-home mental health services for children under HealthCheck

• Outpatient mental health and substance abuse services provided in the home and community (the non-federal share of this service is provided by the county)

• Personal care services

• Prenatal care coordination services

• Substance abuse day treatment

Centers for Medicare and Medicaid Services (CMS) require that federal payments are based on actual allowable and documented costs calculated using an assured cost-based accounting methodology. Consequently, county agencies are required to submit a cost report which reflects all WIMCR services that are provided by Medicaid certified providers.

Each county agency providing one or more WIMCR service programs paid for by Medicaid and listed above is required to complete an annual WIMCR cost report. Cost reports are not required for any service program for which Medicaid payments were not received for the applicable time period.

In order for a county to receive its proper share of the payments, each county agency’s cost report must reflect all of their cost associated with all applicable WIMCR programs. Medicaid payments to counties may be withheld or recouped if a complete cost report is not submitted in a timely manner. DHS has a mechanism in place to follow-up on missing cost reports.

As county agencies navigate through the WIMCR cost report, the report will trigger edits following the completion of each cost report section. These edits are designed to ensure the appropriateness and accuracy of the information reported. The state, the WIMCR coordinator, and/or single county or state auditors may also follow-up with county agencies with cost reports that result in unusually low or high rates compared to other county agencies. Additionally, the WIMCR coordinator

will monitor all significant year to year changes in WIMCR cost reported by each county agency. Agencies that receive funding for Wisconsin Medicaid Cost Reporting programs directly from the Department of Health Services are subject to audit. The audit guidelines are posted within Section 3.6 of the “Appendix to the State Single Audit Guidelines for Programs from the Department of Health and Services,” and are used in conjunction with the “State Single Audit Guidelines Main Document,” other parts of the appendix, and appendices from other departments. All of these documents are online at www.ssag.state.wi.us.

Auditors can also confirm an agency’s participation in WIMCR, and the programs covered by WIMCR, the amounts claimed, and the amounts (or estimated amounts) paid by contacting the 2013 WIMCR Coordinator at [email protected] or at (866) 803-8698.

This manual serves to guide providers through the completion of the WIMCR cost reports. The following addresses the purpose of the cost reports, how to submit reports into the system, what a reporting system user should expect when submitting reports, and additional features of the system. If additional assistance is needed, please contact the WIMCR Coordinator by calling the WIMCR toll-free hotline at (866) 803-8698 or via email at [email protected].

Purpose of the Report

The purpose of the cost report is to identify your total cost per unit of service. The cost per unit includes WIMCR Direct Costs and General Overhead Costs for all program clients (not just for Medicaid clients).

Once your dollar cost per unit of service is identified, your Medicaid reimbursement for those services is determined by analyzing the Medicaid claims submitted by your agency for the reporting year.

Update to WIMCR Cost Reporting: The requirement that each county agency will submit only one report with consolidated data for all applicable WIMCR services was implemented for dates of service on or after January 2013. In the past, all county providers were required to submit a unique cost report for each Medicaid provider ID for every WIMCR service program paid for by Medicaid.

Update to WIMCR Cost Reporting: The updated desk review process takes place entirely within the WIMCR webtool. Most of the desk review will be completed at the time a report is submitted!



http://www.ssag.state.wi.us/



Please note that, according to DHS 106.02(9)(d), Wis. Admin. Code, providers are required to retain all evidence of billing and cost reporting information necessary to support the truthfulness, accuracy and completeness of the reports.

Web-based cost reports must be completed for each applicable service. Reported costs must be consistent with the Department of Health and Family Services’ allowable cost policy as described in the Allowable Cost Policy Manual and OMB Circular A-87. A link to this manual is provided on the WIMCR dashboard page.

1. Agency Wide Costs Agency wide FTE count and cost information is a required component of the WIMCR cost report. Information relating to total agency cost and FTEs will be used to appropriately allocate Overhead cost to each WIMCR program. Additionally, agency wide information will be play a critical role in desk review edit checks. Total cost applied to each WIMCR program will be compared to each category of total agency wide cost to ensure reasonability.

2. WIMCR Direct Costs

Allocation of direct care staff to a program (e.g., Substance Abuse Day Treatment, Child/Adolescent day treatment, etc.) must be consistent with the way in which Medicaid defines the program. Therefore, if a staff person is providing services to different programs, and those programs are billed to Medicaid, the portion of the staff person’s time spent and the associated costs in each program must be allocated separately. In order to properly allocate cost associated with an individual clinician, each clinician’s total paid hours must be recorded within the WIMCR cost report and distributed between all applicable WIMCR programs and other, non – WIMCR activities.

3. General Overhead

The overhead personnel time and cost and overhead non personnel cost must reflect the total agency-wide overhead cost. Allocation of the non-direct service staff time and overhead to service areas within the program is determined by the FTE allocation method and automatically factored into each agency’s cost reports.

4. WIMCR Procedure Codes

A list of the procedure codes and descriptions used to bill Medicaid for the services covered under each program has been identified in Appendix II: Eligible WIMCR Services and Procedure Codes. Please refer to this appendix to identify direct care staff and to determine who should be reported under each program. In some cases, you may allocate staff to a program even though they may not provide Medicaid-covered services (i.e., a bachelor’s level staff person in an outpatient clinic). It is still necessary to identify these staff members on the report since it affects allocation of non-direct costs (part of the non- direct costs support these staff members)

Introduction to the WIMCR Cost Report Tool

Update to WIMCR Cost Reporting: Agency wide information is a new addition to the WIMCR cost report.

WIMCR Direct Cost: Includes cost that supports direct program operation of one or more specific WIMCR programs. WIMCR Direct

represents direct program staffing, client services and program support. Also included are direct program non-personnel.

General Overhead: Commonly reflects central services related to overall agency operations that are allocable to all agency programs, including WIMCR. General overhead includes general support and general non

personnel.



The WIMCR Cost Report Tool was developed by Public Consulting Group (PCG) under contract with the Wisconsin Department of Health Services (DHS) for the purpose of supporting the WIMCR program. The WIMCR Cost Report Tool has been designed to serve as a comprehensive resource for county agencies participating in WIMCR. The WIMCR Cost Report Tool will primarily function as the web-based cost reporting tool for the county agencies as they complete their WIMCR cost reports on an annual basis. It will also function as a repository of useful information for the county agencies, including a dynamic dashboard with historical WIMCR data, summary claims data, helpful WIMCR resources, important dates for WIMCR, and upcoming training schedules. County agencies will also be able to view important WIMCR reports such as the Provider Summary Report (PSR) and the County Treasury Report (CTR) as well as generate ad-hoc management reports. The following sections of this guide provide additional details about the specific components and functionality within the WIMCR Cost Report Tool.



SECTION II – NAVIGATING THE COST REPORT TOOL (CRT)

A. Accessing the WIMCR CRT For first time users, a system generated email will be sent to you when you are granted access to the system. This email will include your username and temporary password. In the login box on the right hand side of the page, you will enter your username in the first box. Your username is the email address you provided when requesting access to the system. Your temporary password should be entered in the next box. You will then be prompted to change your password. In the event that you have forgotten your password, click on the blue “Forgot Your Password?” link under the “Sign In” button. An email will be sent to this address with a temporary password. Upon logging into the system with this temporary password, you will be required to change your password. Below is a screenshot from the WIMCR webtool login function from the WIMCR webtool login page:

B. Navigating the Dashboard Once in the WIMCR Cost Report Tool, the user will be taken to the Dashboard page of the system. The Dashboard page serves as the home screen for the entire system. From the Dashboard page, the user can access the cost report and the management reports or perform administrative functions such as creating new users, managing user notifications and resetting user passwords.

a. Accessing Cost Report and Desk Review

There are two ways to access the WIMCR cost report from the Dashboard page. Users can access the cost report by selecting the “View Cost Report” button which is included within the WIMCR Dashboard progress bar screen.

Alternately, a user can select the “WIMCR” tab from the top of any screen within the WIMCR cost report.

Once a cost report is submitted and certified, and a desk review is initiated by a PCG reviewer, the desk review can be accessed from the Report List page of the WIMCR cost report. In other words, the desk review can be accessed by visiting the main cost report screen and selecting “WIMCR Desk Review” from the bottom of the report list.

b. Progress Bar At the top of the Dashboard page, the user will see a Progress Bar that identifies the status of their WIMCR cost report for the current period. The Progress Bar will indicate where the county agency is in the cost reporting process relative to five key checkpoints within the cost report and desk review processes; Cost Report Started, Cost Report Certified, Desk Review - PCG Review, Desk Review - Provider Response, and Desk Review - Complete. Once a county has completed the work associated with each checkpoint along the Progress Bar, the circle for that item will turn green with an arrow indicating the status of the next task prior to the next checkpoint. For example, once a county agency has begun their cost report, the ‘Cost Report Started’ circle will turn green with the arrow pointing



towards the ‘Cost Report Certified’ circle activated. The arrow between these two checkpoints will remain yellow, indicating that the cost report is in process. Once the cost report has been certified, the line between the two checkpoints as well as the ‘Cost Report Certified’ circle turn blue to reflect completion of those tasks. In addition to indicating the status, the Progress Bar will also include the date of the last activity for each checkpoint. Once a cost report is certified, the Progress Bar will indicate the date the certification was completed below the ‘Cost Report Certified’ checkpoint.

c. Agency Overview Within the Agency Overview section on the Dashboard page, the user will be able to access two sets of information regarding their county agency’s WIMCR program; historical data and paid claims data. These two items will provide further details on the county agency’s WIMCR program. Users will be able to access this information by clicking on the respective button under the Agency Overview section of the Dashboard page. i. Historical Data

The Historical Data will provide an overview of the county agency’s historical performance in the WIMCR program. The data will display the WIMCR payments, the MOE amounts, and the Act 318 Adjustments for the most recently completed three years.

ii. Paid Claims Data The Paid Claims data will provide a summary of the claiming activity of the county agency by WIMCR program. This will include data for the current WIMCR year.

d. Resources The Resources section of the Dashboard page will provide quick access for users to some of the important documents and links to important pages for WIMCR. This section of the Dashboard page will house recent training materials, frequently asked questions documents, and links to external sites such as the Access Wisconsin Portal.

e. Important Dates The Important Dates section of the Dashboard page will be used to communicate important dates related to WIMCR ranging from important deadlines, such as that for the submission of the cost reports to desk review completion dates and the availability of WIMCR reports. The important dates will also include up-to-date information about upcoming WIMCR training opportunities.

f. Guide to Cost Reporting The most updated version of this Guide to Cost Reporting will be accessible through the Dashboard page of the WIMCR webtool. The Guide provides a comprehensive description of navigating the system, the system functionality, and completing the cost report. It is also accessible at the top of the WIMCR cost report screen. Additionally, a link to the Guide to Cost Reporting will be posted at the top of the WIMCR cost report. Each user will have the option of minimizing the link to the guide to free up additional space on their screen by clicking the “hide” button of the image as seen below:



C. User Management and WIMCR Notifications

a. Creating a User Account

An account can be created by contacting any individual with “County Level Administrator” status. Alternately, an account can be created by contacting PCG at [email protected] or (866) 803-8698. In order to create an account for WIMCR webtool users, the following information is required: • First Name • Last Name • County • County Agency • Email • Phone • User Level – see user level information below. • Notification status

b. User Levels

Each county agency must identify those individuals that will have access to the WIMCR webtool and at what level. The following descriptions outline the ability of each of the three levels of access to the WIMCR webtool:

County Level Administrator: Required to “manage” the county agency’s contacts and notifications (or web-based system users), and the only level with the ability to certify costs. County Level Administrator includes the role of Report Editor. Report Editor: Can add, delete, or edit information in the WIMCR cost reporting system prior to certification by the County Level Administrator. Report Viewer: Can only view information entered by a designated county agency into the WIMCR cost reporting system and cannot add, delete, or edit information.

County Level Administrators are the only user with the ability to certify (submit) a WIMCR cost report. Consequently, each agency completing a WIMCR cost report must designate at least one individual as a “County Level Administrator”. The role of “report editor” is recommended for agency employees who will be entering cost information, but will not be certifying cost. The role of “viewer” is recommended for agency administrators and county auditors who will need access to the information entered into the agency’s WIMCR report, but will not be responsible for entering data.




c. Purpose of Notifications

WIMCR notifications are designed to provide recipients with information about the WIMCR cost reporting process, and updates on their agency’s WIMCR cost report status. The WIMCR webtool will automatically generate notifications in each of the following scenarios:

Notification Name Certified Cost Report Cost Report is open for completion Provider Summary Reports are Viewable County Treasurer Reports are Viewable Cost Report Deadline Reminder Cost Report Past Due Reminder Desk Review Complete Initial Desk Review Response Required User Account Created User Password Reset

In addition to the automated notifications outlined above, notifications will also be used to provide general WIMCR program updates and information on an ad hoc basis.

d. Notification Management

Upon creation of a new WIMCR user account, each individual must be designated as a notification recipient or they must opt out of receiving notifications. There are two possible options for each user’s notification status - “yes” or “no”. Those with a notification status of “yes” will receive regular updates via email related to their agency’s WIMCR report as well as general WIMCR notifications. Those with a notification status of “no” will receive an email with their WIMCR webtool login credentials when an account is created; however, they will not receive subsequent WIMCR emails unless their notifications status is changed. In order to update a webtool user’s notification status, contact the County Level Administrator or PCG ([email protected], (866) 803-8698).




SECTION III – COMPLETING THE WIMCR COST REPORT General Cost Report Functionality

A. Report List Functionality

The WIMCR cost report follows a logical progression which first calls for the reporting of agency-wide information, followed by direct cost information (including Direct Service Non-Personnel cost and Direct Support), supplemental direct cost information, overhead and federal funds. There are many instances throughout the WIMCR cost report where data entered on a screen impacts components of one or more subsequent screens. As a result, there is a predetermined order in which the various components of the cost report must be completed. The report list is designed to indicate which components of the WIMCR cost report are available for completion and which components are unavailable. The report list page is the central screen of the WIMCR report, which connects the provider to each page of the cost report. Additionally, the report list serves as a guide which directs each user through the cost report. Each item on the report list screen is a link to a portion of the WIMCR cost report. Completed

The report list will indicate when a screen has been completed with a circle and a checkmark similar to the example below. Completed screens can still be viewed and updated; however, no additional information is required.

Available for Completion

When a screen is available for completion the report list will reflect a circle which is completely shaded in blue similar to the example below. At any given time, one report link will be in process. All preceding links will be completed per the example above, and all subsequent links will be unavailable per the example of a locked screen below. A screen will display on the report list as available for completion if the provider has not yet accessed the screen, or the screen is partially completed.

Locked

When a screen is unavailable until a preceding component of the cost report is complete, the report list will reflect a circle with a lock and faded text similar to the example below. In order to unlock the screen and access the corresponding component of the WIMCR cost report, one or more preceding screens must be completed.

Report List Subsections

Many components of the WIMCR cost report reflected on the report list page will have additional subsections which must be completed. A provider will be able to access subsections by clicking on the link of the corresponding cost report component. If a component has applicable subsections (such as Direct Service and Support below), the link to the cost report component will open up the subsections for viewing. Once a subsection has been completed a small blue sphere will appear next to that subsection.

B. Navigating Between Cost Report Pages



The WIMCR cost report must be completed sequentially. The cost report list will guide each provider through the navigation process by restricting access to each page until all required predecessors have been completed. The report list is designed to help each user navigate through the WIMCR cost report.

C. Save & Close vs. Save & Continue

Each screen requiring data entry will be displayed as a pop-up in front of the report list page. As a provider navigates to each page, they will have the option of clicking the “save & close” button, to save all data that’s been entered and return to the report list page. The “save & continue” button will allow each user to save previously entered data and continue to the next applicable screen of their WIMCR cost report.

D. Import/Export

Throughout the cost report, the provider can enter the requested cost information directly into the web-based system by clicking the “Add New Row” button.

Alternately, the provider can download (export) an Excel spreadsheet, enter the requested information into excel, and upload (import) into the web-based system.

The “export” button will automatically open an Excel spreadsheet with a header for each column on the corresponding professional type Basic Information, Cost, Hours and Direct Time Allocation screens, along with any data which has been entered into the cost report by the provider. In order to import the Excel spreadsheet into the WIMCR webtool, the provider should save the import spreadsheet, select the “Browse” button, find the previously saved import spreadsheet and select the “Import” button. If there are any issues with the formatting of the import spreadsheet, the system will display an error message at the top of the page notifying the user of the location and type of issue. Once a file is imported into the WIMCR webtool, the import spreadsheet will replace all data previously entered into the webtool. It is critical that each user saves all relevant data outside of the WIMCR webtool or includes all data in the cost report in the import spreadsheet in order to avoid losing data when the import process occurs. Using the Import/Export feature is optional to each provider. The Import/Export feature provides an optional solution for providers with many lines of data or any who are looking to expedite the data entry process.

E. Printing To print, select the Print button on the final page of the cost report (Summary and Certification). In order to print pages throughout the cost report completion process, use your browser’s print function. To access your browser’s print function, right click anywhere on the screen and select “print”. Alternately, selecting “print preview” instead of “print” will allow the user to format the page for printing prior to printing.

F. Pop-Up Explanation

Throughout the cost report, column and row headers within each screen are equipped with pop-up explanations which provide clarifying information. Pop-up explanations may include definitions, examples and instructions relating to open data fields on each screen. The purpose of the pop-up explanation is to preempt many of the frequently asked questions from providers to assist in the seamless navigation of the WIMCR webtool and the WIMCR cost report.

G. Program, Professional Type and Category Summary Data

Upon completion of each section of the WIMCR cost report, summary data will be displayed. All links to summary data will have the word “summary” in the title in order to differentiate them from screens where data entry is required. Providers have the option of viewing



summary data which will show how much cost for each category (i.e. direct service professional type, direct support, direct service non-personnel, overhead) has been allocated to each WIMCR program by clicking on the corresponding summary link. There is no requirement that a provider access summary reports; however, they are available as an optional resource. Each summary report will become available once all required cost information impacting the corresponding cost report component has been entered. The example below shows a link to a Masters Degree Level summary data which is displayed following the completion of all Masters Degree Level cost information.

As soon as all required sections of the WIMCR cost report have been completed, a “Summary and Certification” page will become available which will display all information previously entered into the WIMCR cost report. A “County Level Admin” user must access the summary and certification page and certify the allocation of all reported cost to each WIMCR program reported on the agency’s WIMCR cost report. From the “summary and certification” page, the user will be able to navigate to all other summary information by clicking on the corresponding column and row headers. Column headers displayed along the top of the screen will provide links to program level summary data, row headers displayed vertically on the left hand side of the screen will provide links to summary data by cost category.

H. Desk Reviews The WIMCR webtool is designed to process desk reviews during the cost report completion process. As soon as data is entered into a screen within the WIMCR webtool, all applicable desk review edits will be triggered immediately. By incorporating the desk review process throughout the process of cost report completion, the system is able to address all potential audit risks as soon as all relevant information has been entered into the cost report. This method will expedite the WIMCR desk review process while simultaneously helping to avoid errors which may impact subsequent sections of the cost report. There are two types of WIMCR desk review edits – Level 1 edits which indicate an error has been made which required resolution, and Level 2 edits which indicate that the data entered by the provider falls outside of the expected range and an explanation or adjustment is required. Level 1 Edit Resolution

Level 1 edits can only be resolved by returning to a prior cost report screen and updating the data entered into the WIMCR cost report. If the data is correct, a PCG WIMCR reviewer can override a Level 1 edit. In order to contact a PCG reviewer, call (866) 803-8698 or email [email protected]. An example of a Level 1 edit is a required field which has been left blank.

Level 2 Edit Resolution

Level 2 edits occur when a data element or the relationship between multiple data elements falls outside of the usual or expected range. Level 2 edits are a part of the WIMCR cost reporting process. If a level 2 edit is triggered and the data entered into the cost report is accurate, a provider can proceed to a subsequent section of the WIMCR cost report by providing a reasonable explanation. An example of a Level 2 edit would be an individual clinician’s salary exceeding the expected value.




Desk Review Next Steps – Level 2 Edits Each explanation entered in response to a Level 2 edit will be reviewed by a PCG reviewer during the Desk Review process following the certification of each agency’s cost report. Detailed explanations which specifically address the desk review edit will be approved. If the PCG reviewer believes that additional clarification is needed, the provider will receive an email notifying them that a follow up response is required. The example below shows an individual clinician with benefits outside of the expected threshold. In order to resolve the edit, the provider must enter an explanation into the “Desk Review User Override” column.

Example provider responses: A. Michael’s Benefit costs are accurate B. Michael opts for a higher prices insurance plan to include better vision coverage hence why his benefits are unusually high C. Michael’s insurance plan includes the cost of coverage for four of his family members. This results in a higher than normal insurance

rate.

Response A may result in a PCG reviewer following up during the desk review process with a request for additional clarification. Responses B and C provide a reasonable and detailed explanation which adequately address Michael’s unusually high benefit cost.



Cost Report Pages One cost report will be completed for each WIMCR provider agency regardless of the number of separate WIMCR programs and provider IDs provided by that agency. This is an update to the WIMCR cost reporting process designed to avoid unnecessary duplicative reporting. Additionally, it is expected that in many instances clinicians and resources are shared between multiple WIMCR programs within a single county agency or provider agency. The updated WIMCR reporting methodology which consolidates all WIMCR programs into a single WIMCR cost report allows each provider to ensure that all clinician time and cost is appropriately allocated among all WIMCR programs.

A. County Agency Overview The county agency overview page is a new component of the WIMCR cost report as of the 2014 WIMCR reporting period corresponding to dates of service in Calendar Year 2013. The county agency overview page is a key component of the WIMCR desk review process which allows the WIMCR webtool to compare all cost which will be allocated to various WIMCR programs provided by an individual agency to the total agency wide cost for that agency. It is expected that total agency wide cost will exceed total WIMCR cost for each agency. In some instances, information entered into the county agency overview screen will impact the cost allocation on subsequent sections of the cost report. The FTE information entered into the county agency overview page will impact the allocation of reported overhead cost. Total FTEs providing WIMCR program services will be compared to total agency wide FTEs for overhead allocation purposes. Additionally, the interdepartmental charges entered into the county agency overview screen will be added to “Overhead Non-Personnel cost” and factored into the total agency wide overhead to be allocated.

• Total Agency Employed FTEs (mandatory field) Total FTEs reflected on agency wide payroll. Includes FTEs with limited or no involvement in WIMCR programs. 1 FTE is equal to 40 hours per week and 2,080 hours per year.

Example: Part time (20 hrs per week) employee = .5 FTE Full time (40 hrs per week) employee = 1 FTE

• Total Agency Contracted FTEs to which agency allocates overhead (optional field)

Total FTEs providing services per a contractual agreement to whom agency allocates overhead cost. Includes FTEs with limited or no involvement in WIMCR programs. If your agency does not allocate overhead cost to contracted staff, this field should be left blank.

Example: Agency has 20 total contractors. Agency does not allocate overhead cost to contractors. Total Contracted FTEs to which agency allocates overhead = 0. Agency has 20 total contractors. 10 of the agency's contractors are factored into the agency's overhead allocation methodology. Total Contracted FTEs to which agency allocates overhead = 10.

• Total Annual Agency Personnel Expenditures (mandatory field)

Gross agency wide salary and benefit cost. Total payroll expenditures related to Total Agency Employed FTEs.

• Total Annual Agency Operation Expenditures (mandatory field) All non-personnel cost relating to day-to-day agency operations including contract cost, building cost and materials and supplies.

County Agency Overview - Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include:

Required Field Left Blank

If no value has been entered for "Total Annual Agency Personnel Expenditures”, “Total Annual Agency Operations Expenditures" or "Interdepartmental Charges”, the WIMCR webtool will trigger an edit requiring an explanation. Multi-county agencies will not see an edit relating to “interdepartmental charges”.

Total cost per FTE is unusually low

Total agency wide cost divided by total reported FTEs falls below the expected threshold.



• Interdepartmental Charges (mandatory field for all county agencies – optional field for multi-county agencies)

A lump sum portion of county wide overhead cost allocated to a particular county agency.

B. WIMCR Direct Service Checklist The WIMCR Direct Service Checklist screen is the driver which determines which WIMCR programs and professional types will be reflected on a particular agency’s WIMCR cost report. Selections made on the WIMCR Direct Service Checklist will define the structure of the WIMCR cost report. It is critical that the WIMCR programs and professional types reflected on the Direct Service Checklist are accurate and comprehensive.

• WIMCR Programs Based on Medicaid Paid Claims WIMCR Programs Based on Medicaid Paid Claims field is a locked field which is not editable to the provider. This field is prepopulated with the provider IDs and program names of all known Provider IDs associated with a particular agency under which Medicaid claims have been submitted at the time in which cost report completion initially opens. These programs are prepopulated based on Medicaid claiming activity. If a program or provider ID is listed in error, please contact a PCG WIMCR coordinator at [email protected] or (866) 803-8698 to remove the provider ID. Note: Cost reports are completed in the year following each Calendar Year of WIMCR service provision. There is a 12 month claiming window within which a WIMCR provider can bill Medicaid. Consequently, provider agencies may continue to submit claims simultaneously with cost report completion. It is possible that a provider ID/WIMCR program combination is missing from this list because claims have not yet been submitted.

• Additional WIMCR Programs (check all that apply) The additional WIMCR programs checklist allows the provider to indicate any additional WIMCR programs and provider IDs which were not included in the Medicaid Programs Based on Paid Claims list. The checklist includes the name of each additional WIMCR program as well as a multi-select dropdown list which includes all provider IDs associated with a particular provider. If a program is selected from the checklist, it is mandatory that one or more provider IDs under which claims are submitted for that program is also selected. If a provider ID under which claims are submitted is missing from the dropdown list, please contact a PCG WIMCR coordinator at [email protected] or (866) 803-8698 to register an additional provider ID.

• WIMCR Professional Types (check all that apply) In addition to the identification of WIMCR programs provided by each agency, the direct service checklist page is designed to capture a comprehensive list of professional types providing WIMCR services. The professional types of all clinicians providing one or more WIMCR services should be selected from the WIMCR professional type checklist. Subsequent WIMCR cost report data must be completed at the professional type level for each professional type selected from the WIMCR direct services checklist (see Direct Service Data by Professional Type). For many WIMCR programs, when claims are submitted to Medicaid, a modifier is included which indicates the professional type of the individual providing the service. In instances where a claim has been submitted by a provider agency identifying a specific professional type as the provider of a WIMCR service, the name of that WIMCR service has been prepopulated in the “WIMCR Services Based on Medicaid Claims” field next to the corresponding professional type. The purpose of this feature is to alert the provider that their agency has

Direct Service Checklist - Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include:

Missing Provider ID

Please enter a provider ID corresponding to each WIMCR service selected from the WIMCR Programs Checklist

Professional Type With Corresponding Paid Claims Not Selected

If there is paid claims data associated with a particular professional type and agency, that agency is required to enter cost data associated with the professional type. For example, if claims were submitted for OPMHSA services provided by Bachelors Level staff, Bachelors Level should be selected from the WIMCR direct service checklist and cost information should be reported for Bachelors Level staff.





billed Medicaid for services provided by a particular professional type and they should enter corresponding cost information for that professional type. Many WIMCR programs are billed to Medicaid as an “average” professional type (AMHDT, SADT, CADT, PNCC and TCM). These programs will be excluded from the “WIMCR Services Based on Medicaid Claims” field, because there is no way to determine which professional type provided a service based on paid claims. This is important to note because there may be professional types with no “WIMCR Services Based on Medicaid Claims” that should be selected from the WIMCR Professional Type Checklist. Professional type naming conventions vary among different WIMCR programs. See below for a crosswalk of the professional type names used in the WIMCR webtool, and the various names and descriptions used for each professional type

Professional Type Clinicians Included Advanced Practice Nurse Practitioner Advanced Practice Nurse Practitioner

Bachelors Degree Level Bachelors Degree Level; Bachelors Degree Level RN; Substance Abuse Counselor/Bachelors

Masters Degree Level Masters Degree Level; Masters Degree Level RN; Masters Level with 3000 Hours; Substance Abuse Counselor/Masters

Psychiatrist/MD Psychiatrist; MD Less than Bachelors Degree Level

Less than bachelor degree level; Mental Health Tech; Paraprofessional; Personal Care Worker; Home Health Aide

Occupational Therapist Occupational Therapist PhD Psychologist/Doctoral Level PhD Psychologist; Doctoral Level Physical Therapist Physical Therapist Physician Assistant Physician Assistant Registered Nurse/Licensed Practical Nurse Registered Nurse; Licensed Practical Nurse Speech Pathologist Speech Pathologist Qualified Treatment Trainees Qualified Treatment Trainees (QTT)

C. Direct Service Data by Professional Type

The Direct Service Data by Professional Type pages of the cost report allow for the reporting of all personnel (salary, benefit, or contract) costs for the direct service clinicians employed by or under contract with the county agency. A separate page will be available for each professional type identified on the Professional Type Checklist within the WIMCR Direct Service Checklist page. For example, if a county agency has selected Masters Degree Level, Psychiatrist/MD, and Registered Nurse/Licensed Practical Nurse on the Professional Type Checklist of the WIMCR Direct Service Checklist page, these would be the only three professional types available to report data for on the Direct Service Data by Professional Type page. The user is able to begin entering data for a specific professional type by selecting that professional type from the list shown on the Direct Service by Professional Type page. For each professional type, the user will need to navigate through four (4) separate screens to provide the necessary data and complete the reporting for that professional type. The four (4) pages are: a. Professional Type Basic Information b. Professional Type Cost c. Professional Type Hours d. Professional Type Direct Service Time Allocation Statistics

In completing the Direct Service by Professional Type pages, users will be required to complete the four screens in the defined order. Once a user has completed a screen, they may go back to edit that screen however a user cannot complete the Professional Type Hours screen before they have completed the Professional Type Cost screen. There will be a progress bar at the top of each of the four WIMCR direct service professional type screens which will indicate the status of the WIMCR cost report for each direct service professional type. Once a section has been completed, the corresponding component will be highlighted in dark blue on the WIMCR progress bar (see the “Basic Information” component in the example below). Completed sections of the



cost report can be accessed by clicking on the corresponding component from the WIMCR progress bar. An item which is currently in process, will be highlighted in bright blue (see the “Cost” component below). Lastly, components which are not yet completed will be highlighted in light blue (see “Hours” and “Direct Time Allocation” components below).

Professional Type Basic Information Screen The Professional Type Basic Information Screen is used to capture the basic information needed to identify the direct service staff for whom the county agency will be reporting costs and allocating expense to the WIMCR program for. The data captured within this screen includes the First Name and Last Name of the direct service staff, county job title, National Provider ID (NPI), employment status, and allocation of overhead costs. Users will have the ability to add as many rows as necessary to include all of the staff for the professional type. The information provided on the Professional Type Basic Information Screen will establish the structure for the subsequent screens for that professional type. Users will only be able to provide cost, hour, and allocation information for the professionals they have included on the Basic Information Screen. Users will be able to navigate back to this screen to add or remove staff as necessary however they will not be able to begin entering cost information until they have completed the Basic Information Screen.

• First Name (Mandatory Field) The user will report the first name of the staff member they are adding to the cost report. The name used for the staff should match the name included on the county agency’s supporting documentation. For example, if a staff member is identified in the county agency’s payroll as Steven, the First Name included in the cost report should be Steven and not Steve in order to avoid any discrepancies in the event of an audit.



• Last Name (Mandatory Field) The user will report the last name of the staff member they are adding to the cost report.

• County Job Title (Optional Field)

The user can use this field to provide the staff member’s job title according to county agency records. For example, the county agency may identify the staff they include on the MD Professional Type page as Physician, MD, or Psychiatrist.

• Provider NPI (Optional Field)

The user can use this field to report the unique 10-digit NPI number assigned to each individual clinician.

• Status (Mandatory Field)

The user will use this field to identify the employment status of each clinician reported. The user will identify whether each clinician is directly employed by the agency (Agency Employee) or provides services per a contractual agreement (Contractor).

• Allocate Overhead Cost (Mandatory Field)

The user will use this field to identify whether overhead cost is allocated to each contracted clinician. This field has been defaulted to "yes" for agency employed clinicians.

Professional Type Cost Screen After completing the Professional Type Basic Information Screen, the county agency user will then be able to navigate to the Professional Type Cost Screen. Users will be able to report the salary and benefit costs for any staff that were identified as an Agency Employee or contract costs for any staff that were identified as a Contractor.

• First Name This field will be prepopulated based on the information provided on the Professional Type Basic Information Screen.

• Last Name This field will be prepopulated based on the information provided on the Professional Type Basic Information Screen.

• Salary The user will report the gross salary amounts paid to any staff identified as an Agency Employee. The amount reported in this field should be inclusive of all cost from which payroll taxes are deducted, including Regular wages or extra pay, Paid time off (e.g., sick or annual leave), Overtime, Bonuses or longevity, Stipends, and Cash Bonuses and/or cash incentives.

Professional Type Basic Information Screen - Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include:

First or last name missing

Please enter a first and last name for all professionals.

Duplicate Entry The name of an individual clinician appears twice in your cost report. Please confirm that there are no duplicative staff entries.



Do not include any reimbursements for expenses such as mileage or other travel reimbursements.

• Benefits

Benefits include employer-paid health/medical, life, disability, or dental insurance premiums, as well as employer-paid child day care for children of employees paid as employee benefits on behalf of your staff, retirement contributions, and worker’s compensation costs. Report the expended amounts paid by the county agency which are directly associated with each staff member by type of employee benefit.

The following employee benefits can be captured:

Employee Insurance- Amounts for the employer’s share of any insurance plans, such as life, health, dental, and accident insurance. Social Security Contributions- Employer’s share of amounts paid by the district for social security. This can include Social Security- OASDI and Medicare-Hospital Insurance. State Retirement System Contributions- Employer’s share of amounts paid by the district for retirement and long-term disability contributions. Tuition Reimbursement- Amounts reimbursed by the county agency to any employee qualifying for tuition reimbursement on the basis of county agency policy. Unemployment Insurance- Amounts paid by the county agency to provide unemployment insurance for its employees. Workers’ Compensation- Amounts paid by the county agency to provide workers’ compensation insurance for its employees. Other Health Benefits (Employer Paid) - Amounts paid by the county agency to provide health benefits, other than insurance, for its current or former employees. Other Employee Benefits (Employer Paid) - Employee benefits other than those classified above, including fringe benefits such as automobile allowances, housing or related supplements, moving expenses, and paid parking.

• Contract

The user will use this field to report any costs incurred for the purchase of professional services provided by staff identified as a Contractor. Contracted staff costs include compensation paid for services contracted by the county agency with any outside agency or individual (such as an independent clinician). The reported costs should be the total costs for the agency or individual as paid by the county agency for the reporting period.

• Gross The Gross field is calculated by the system. For staff that are identified as an Agency Employee, this field represents the sum of the amounts reported in the Salary and Benefit fields. For staff that are identified as a Contractor, this field represents the amount reported in the Contract field.



Professional Type Hours Screen After completing the Professional Type Cost Screen, the county agency user will then be able to navigate to the Professional Type Hours Screen. Users will be able to report the paid hours for all staff identified on the Basic Information Screen. Hours can be broken out between WIMCR Direct Hours, WIMCR Direct Support Hours, Paid Time Off (PTO), and Other Non WIMCR Hours. The Professional Type Hours Screen will not be available for data entry until the user has completed the Basic Information Screen and Cost Screen.

• First Name

This field will be prepopulated based on the information provided on the Professional Type Basic Information Screen.


• WIMCR Direct Hours

Professional Type Cost Screen - Desk Review Checks

In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include:

Salary is unusually high

Salaries listed for an individual clinician exceed the expected threshold.

Benefits are unusually high Benefits costs listed for an individual clinician exceed the expected threshold.

Contract cost is unusually high Contract costs listed for an individual clinician exceed the expected threshold.

Benefit to salary ratio is unusually high Benefits for an individual clinician are more than an established percentage of salary cost, which is unusually high.

Salary or contract cost missing Please enter a [contract/salary] cost for an individual clinician.

Salary with no benefits No benefit cost reported for an individual clinician.



The user will input the hours providing direct medical WIMCR services in this field. Direct services are those that would be billable to Medicaid if all recipients were Medicaid eligible. WIMCR Direct Hours include:

• Face to face medical services • Medicaid allowable activities included in the relevant ForwardHealth Handbook

• WIMCR Direct Support Hours

WIMCR Direct Support hours should include all time spent on a WIMCR program aside from WIMCR Direct Hours (providing face-to-face medical services).

Direct Support Services include: • WIMCR Program Supervision • WIMCR Planning and Coordination • WIMCR Administration • WIMCR Clerical support • Paid Time Off (PTO) Paid Time Off (PTO) includes sick time, vacation time, and personal time used by the employee during the reporting period. • Other Non WIMCR Hours Other Non WIMCR Hours includes all other paid hours supporting any program or activity outside of WIMCR. Other non-WIMCR hours includes time spent on CRS and CCS programs. • Total Paid Hours Total Paid Hours is a system generated field based on the sum of the hours reported in the WIMCR Direct Hours, WIMCR Direct Support Hours, PTO, and Other Non WIMCR fields.

• Paid Hours Net of PTO Paid Hours Net of PTO is a system generated field based on the values of Total Paid Hours field less the PTO field. Professional Type Direct Time Allocation

Statistics Screen After completing the Professional Type Hours Screen, the county agency user will then be able to navigate to the Professional Type Direct Time Allocation Statistics Screen. Users will be able to report the WIMCR Direct Services hours for all staff identified on the Basic Information Screen. Hours should be broken out across the WIMCR programs for which the professional type can provide services. The WIMCR programs will be limited to only those programs that were selected on the WIMCR Direct Services Checklist screen. The Professional Type Direct Time Allocation Statistics Screen will not be available for data entry until the user has completed the Basic Information Screen, Cost Screen, and Hours Screen.

Professional Type Hours Screen - Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: No WIMCR Direct Hours Reported

No hours are allocated to WIMCR direct service for an individual clinician. If any clinician does not provide direct medical WIMCR services, their information should be reported under "WIMCR Direct Support"

Hours reported for all personnel are unusually low

The total paid hours reported for all [professional type] staff are unusually low.

WIMCR Direct hours are unusually high

The ratio of WIMCR Direct Hours to Total Paid Hours exceeds the established threshold.

Total paid hours unusually high

The total paid hours reported for an individual clinician are unusually high.

Cost per paid hour is unusually high/low Total cost divided by total paid hours for an individual clinician is

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https://www.forwardhealth.wi.gov/WIPortal/Online%20Handbooks/Display/tabid/152/Default.aspx

• First Name

This field will be prepopulated based on the information provided on the Professional Type Basic Information Screen.


• WIMCR Direct Hours

This field will be prepopulated based on the WIMCR Direct Hours reported on the Professional Type Hours Screen. Users will only be able to allocate hours to the WIMCR programs up to the total WIMCR Direct Hours reported for a clinician on the Professional Type Hours Screen.

• WIMCR Program Fields The user will have the ability to enter the total WIMCR Direct Hours for each program available for the professional type based on the WIMCR programs selected on the WIMCR Direct Service Checklist. For example, when completing the Direct Service allocations for the MD professional type, the user would only be able to report WIMCR Direct Hours for CSP, OPMHSA, and TCM if those were the only services selected on the WIMCR Direct Service Checklist that were applicable to the MD professional type. In order to report WIMCR Direct Hours to other programs for an MD, the user would need to return to the WIMCR Direct Services Checklist to select the applicable WIMCR program(s).

The user will only be able to report Direct Hours across the applicable WIMCR programs up to the WIMCR Direct Hours reported for each clinician on the Professional Type Hours Screen.

Professional Type Summary Screen Once a user has completed the four screens for a professional type, they will be able to view a summary for that professional type. The Professional Type Summary Screen will show how the cost and hours have been allocated across the WIMCR programs based on the information provided in the Professional Type Cost, Professional Type Hours, and Professional Type Direct Time Allocation Statistics Screens.

Professional Type Direct Time Allocation Statistics Screen - Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: Paid Hours allocated does not equal WIMCR direct hours

All reported WIMCR direct hours must be allocated among WIMCR programs for each clinician.

Medicaid paid claims exceed WIMCR direct hours

Medicaid paid claims (converted to hours) exceed WIMCR direct hours for a [professional type (if applicable)] staff providing [WIMCR program] services.

Cost per paid hour is unusually high/low

Total cost divided by total paid hours for an individual clinician is unusually high or low.



Each professional type summary screen is a locked screen which can be accessed for informational purposes. No data can be entered directly into the professional type summary screen. D. Direct Service Non – Personnel Cost The Direct Service Non-Personnel Cost page of the cost report will allow the county user to report all of the non-personnel costs associated with the Direct Service clinicians included on the various Professional Type pages of the cost report. Allowable costs on this page are limited to three non-personnel cost categories:

• Clinician Travel

Expenses reported under the Clinician Travel category are those expenses that are incurred by the county agency for a clinician to travel to and from a location for the provision of a direct service. This may include mileage expenses, tolls, meals, lodging, and other similar expenses.

• Clinician Training Expenses reported under the Clinician Training category are those expenses that are incurred by the county agency related to the training of direct service clinicians. This may include expenses for conference attendance, continuing education needed to maintain licensure.

• Direct Medical Service Materials Expenses reported under the Direct Medical Service Materials category are those expenses that are incurred by the county agency for the purchase of materials and supplies that are used in the provision of a Direct WIMCR service.

Users will report the total cost for each of these categories by WIMCR program. The WIMCR programs will be defined based on the programs selected on the WIMCR Direct Service Checklist. Users will also be able to report the Direct Service Non Personnel expenses for non WIMCR programs in the Non WIMCR field. Users will report a lump sum value for each category of non personnel expenses. Non personnel costs will not be allocated to each individual clinician. However, providers are reminded that the expenses reported on this page should be inclusive of the expenses incurred for only those staff that were included on the Direct Service Data by Professional Type pages. In other words, if a clinician is not a provider of a direct medical WIMCR service, the cost of travel, training and Direct Medical Service Materials associated with that clinician should not be included. The Direct Service Non Personnel Category field includes the three categories of allowable direct service non personnel expenses. These fields will be prepopulated in the system. • Total Cost

The user will enter the total cost associated with each of the direct service non personnel expense categories. This cost will be allocated to the defined WIMCR programs and Non WIMCR fields based on the distribution of the WIMCR direct service program hours and Other Non WIMCR hours as reported on the Direct Service Data by Professional Type pages.

• WIMCR Program and Non WIMCR Fields

The expenses will be allocated to each of the defined WIMCR program and Non WIMCR fields based on the distribution of the WIMCR direct service program and Other Non WIMCR hours as reported on the Direct Service Data by Professional Type pages.

E. WIMCR Direct Support In addition to WIMCR direct service clinicians, many agencies employee staff who are focused specifically on providing Direct Support services to the WIMCR program; however, they do not provide a WIMCR Direct Service at any point. WIMCR Direct Support hours should include all time spent on a WIMCR program aside from WIMCR Direct Hours (providing face-to-face medical services).

Direct Service Non-Personnel – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: Non personnel cost to salary & benefit or contract cost ratio is unusually high

The ratio of direct service non personnel cost to personnel cost is unusually high.



Direct Support Services include: • WIMCR Program Supervision • WIMCR Planning and Coordination • WIMCR Administration • WIMCR Clerical support

In order to qualify as a WIMCR Direct Support provider, an individual must meet the following 2 criteria:

1. Do not provide a WIMCR Direct face-to-face service – individual clinicians who provide a direct service in addition to direct support should be reported under the appropriate direct service professional type.

2. Spend at least 25% of their time providing WIMCR direct support activities – general agency support staff that spend fewer than 25% of their paid hours supporting the WIMCR program should be reported within Overhead Personnel.

WIMCR Direct Support providers meeting the above criteria are reported individually. The cost reporting process for direct support providers mirrors the reporting process for direct service clinicians outlined above.

F. WIMCR Supplemental Reports Due to the unique structure of each individual WIMCR program, there is a need for supplemental information relating to several WIMCR programs. Each agency will only see the supplemental report screens associated with WIMCR programs that they are providing. It is possible for an agency to not have access to any supplemental reports. Group Services (Optional) Any provider agency providing PNCC, OPMHSA, OPMHSA-HC or CSP services are required to report group services hours and total group services participants if they are providing any WIMCR services in a group setting. If the provider does not provide WIMCR services in a group setting, they are not required to report WIMCR group services data.

The following fields are reflected for each unique program/professional type combination applicable to a particular agency on the group services supplemental screens. • WIMCR Direct Hours (Prepopulated) Hours providing direct medical WIMCR services. WIMCR Direct Hours are inclusive of Group and Individual services • Group Services Hours (Open Field – Data Entered by Provider if Applicable) Total number of hours corresponding to each WIMCR Program and Professional Type providing a WIMCR medical service to a group of clients (as opposed to an individual client) • Individual Services Hours (Prepopulated) Total number of hours corresponding to each WIMCR Program and Professional Type providing a WIMCR medical service to an individual client.

Direct Support – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: All Professional Type Basic Information, Cost and Hours desk review checks.

Direct support reporting mirrors direct service reporting, consequently the same edit checks are applicable.

Ratio of WIMCR Direct Support Hours to total paid hours is below required threshold

In order to qualify as a direct support provider, an individual must spend at least 25% of their paid hours on WIMCR direct support activities.

Group Services – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: Group service hours exceeds WIMCR direct hours

Group service hours exceeds WIMCR direct hours for a specific professional type.

Paid claims exceeds WIMCR group services hours reported

Medicaid paid claims (converted to hours) exceed WIMCR direct hours for a [professional type (if applicable)] staff providing [WIMCR program] group services.

Average participants per unit less than 2

By definition, group services require a minimum of two participants. Services provided to a single individual cannot be billed as a group service.



Individual Services Hours are prepopulated based on the following formula: Individual Services Hours = Total WIMCR Direct Hours - Group Services Hours

• Billable Units (Prepopulated) Increments in which Medicaid is billed (i.e. 1 hour unit, 15 minute increment, etc.)

• Group Services Units (Prepopulated) Prepopulated conversion from total hours reported to total number of units of service provided based on Billable Units.

• Duplicated Participant Count (Open Field – Data Entered by Provider if Applicable) Total duplicated number of participants attending all Group Services Units. For example: For 2 group sessions, 1 session has 11 participants and the second session has 15 participants, for a total of 26 participants. Even if 4 participants attend both sessions, the total duplicated count is 26 participants.

• Average Participants Per Unit (Prepopulated) Duplicated Participant Count ÷ Group Services Units

Prenatal Care Coordination, Personal Care Nurses, Home Health (Mandatory)

In the case of PNCC, PC provided by nursing staff and HH services, one or more procedure codes are billed as a “Visit”. Consequently, the previously reported hours allocated to direct service providers working on each program is not adequate information to determine how many units of service (or visits) were provided. Consequently, a supplemental sheet is necessary in order to appropriately calculate a cost per unit of service provided for each program. The following fields will be available on the supplemental reports for Prenatal Care Coordination, Personal Care Nurses and Home Health:

• Hours (Prepopulated)

Previously reported - hours providing direct medical WIMCR services.

• Visits (Open Field) Total number of units of service (measured in individual visits) provided to PNCC/PC/HH clients during previously reported PNCC/PC/HH hours.

• Conversion Factor (Prepopulated) Hours ÷ Visits The conversion factor measures the average amount of time it takes to provide a single visit. The conversion factor will be automatically applied to the cost per hour for each associated service in order to calculate the cost of providing one visit.

Crisis Intervention (Stabilization Per Diem) Crisis Stabilization is the only WIMCR program which falls completely outside of the WIMCR reporting process which allocates clinician cost and agency overhead to various WIMCR programs. All cost associated with WIMCR Crisis Stabilization will be reported on the crisis stabilization supplemental form which mirrors the format of the Crisis Stabilization WIMCR form used prior to 2013 WIMCR reporting. The following fields will be captured on the Crisis Stabilization WIMCR supplemental form:

Prenatal Care Coordination, Personal Care Nurses, Home – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: (PNCC only) Hours reported for PNCC visits exceed total PNCC hours

Total hours allocated to specific PNCC services exceeds WIMCR direct PNCC hours.

(PC, PNCC, HH) Paid claims exceeds WIMCR program hours reported

Medicaid paid claims (converted to hours) exceed WIMCR direct hours for a staff providing [WIMCR program] group services.

(PC, PNCC, HH) Conversion factor is outside of expected range

The ratio of hours to visits is outside of the expected range. This occurs when an average visit lasts less than half an hour or more than two hours.



• Name of Facility

Report the name of each facility where Crisis Stabilization services are provided

• Residential Staff Cost Gross residential facility salary and benefit cost.

• Operating Cost All non-personnel cost relating to day-to-day facility operations including contract cost and materials and supplies.

• Space Cost

Total cost of residential facility space including building maintenance and utilities.

• Total Cost Residential Staff Cost + Operating Cost + Space Cost

• Total Participant Days

Total days of service provided at each residential facility during the reporting period.

• Total Cost Per Diem Total Cost ÷ Total Participant Days

G. WIMCR Overhead

In order to appropriately allocate a portion of each agency’s overhead cost to the WIMCR program, each agency should report their entire agency-wide overhead cost which will then be allocated among the various WIMCR programs based on the FTE allocation methodology.

Overhead Personnel Providers of central services related to overall agency operations that are allocable to all agency programs, including WIMCR. The following fields are related to overhead personnel reporting.

• Overhead Personnel Cost Category (Dropdown Menu)

See the chart below for possible overhead personnel cost categories

Overhead Personnel Accounting Administrative Assistant Billing Clerical Emergency Services Financial Human Resources Legal Plant Maintenance Program Administrator Program Director Other - Please Describe

• FTE Count

FTEs Count Total FTEs applicable to each Overhead service. 1 FTE is equal to 40 hours per week and 2,080 hours per year.

Crisis Intervention (Stabilization Per Diem) – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: Total cost per diem unusually high/low

The average cost per diem for Crisis Stabilization services falls outside of the usual range.

Medicaid paid claims exceed total participant days reported

Medicaid paid claims for Crisis Stabilization services exceed total participant days per the WIMCR cost report.



Example: Part time (20 hours per week) employee = .5 FTE Full time (40 hours per week) employee = 1 FTE

• Salary, Benefits, Contract Cost and Gross See direct service professional type for a definition of salary, benefits, contract cost and gross. All cost data should be reported in aggregate for all FTEs reflected in the FTE count within each overhead personnel cost category.

Overhead – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: Total direct service plus direct support plus overhead personnel salary and benefit cost exceeds agency wide Personnel Expenditures

Agency wide personnel expenditures is meant to capture all personnel cost; consequently, cumulative personnel expenditures should not exceed agency wide personnel.

Total OH Non Personnel minus Intergovernmental Charges greater than agency wide operation expenditures

Agency wide operation expenditures is meant to capture all operation cost; consequently, cumulative non-personnel expenditures should not exceed agency wide operation cost.

Total cost per FTE unusually high/low

Total cost per FTE falls outside of the expected range. Ratio of total overhead cost (personnel plus non personnel) allocated to WIMCR divided by all WIMCR cost exceeds expected threshold (above expected but below unallowable).

Overhead amounting to greater than 40% of total direct service (personnel and non-personnel) and direct support cost. This edit will require an explanation.

Ratio of total overhead cost (personnel plus non personnel) allocated to WIMCR divided by all WIMCR cost exceeds unallowable threshold

This edit will trigger in addition to the edit above is overhead amounts to greater than 50% of total direct service (personnel and non-personnel) and direct support cost. NOTE: This edit is the only edit with the potential to automatically change cost report values. It will automatically limit total WIMCR overhead cost to 50% of all other WIMCR cost.



Overhead Non Personnel Non personnel cost applicable to overall agency operations that are allocable to all agency programs, including WIMCR.

• Overhead Non-Personnel Cost Category (Dropdown Menu)

See the chart below for possible overhead Non-personnel cost categories

Overhead Non-Personnel Lease and Rental Office Supplies Professional Liability Insurance Utilities Other - Please Describe

• Interdepartmental Charges

Previously reported on County Agency Overview Page. A lump sum portion of county wide overhead cost allocated to a particular county agency.

• Cost See the chart below for possible overhead Non-personnel cost categories

• Overhead Cost Allocation

Overhead cost has been automatically allocated to each WIMCR program and non-WIMCR based on the FTE method. If your agency has a preferred overhead allocation methodology, please see the overhead cost override information below.

Overhead Cost Allocation Methodology (FTE Method)

1) Agency Reports total agency employed FTEs and total contracted FTEs to whom the agency allocates overhead.

2) Agency identifies which WIMCR clinicians are appropriate for overhead allocation on an individual clinician basis. When a clinician is entered by a county agency, the agency will identify contractors and agency employees. Overhead cost will automatically be allocated to agency employees. For all clinicians who are identified as contractors, the agency will be required to identify whether or not overhead should be applied based on agency accounting practices.

WIMCR Clinician

Contractor

Allocate Overhead

No Overhead AllocationOH is included in

contract cost

Agency Employee

Allocate Overhead



3) Computing total overhead cost per FTE. This step determines the average share of overhead per FTE based on total overhead cost reported divided by total agency wide FTEs. Agency wide FTEs includes all FTEs that are directly employed by the agency and contractors that to whom overhead is allocated.

Step 1 Example Cost Reported Total Agency Wide FTEs Average Overhead per FTE

Overhead Personnel & Non Personnel

$200,000 ÷ 40 = $5,000

4) Applying the average overhead per FTE to WIMCR FTEs per program. This step determines the portion of overhead cost which can be attributed to a particular WIMCR program.

Step 2 Example Average Overhead per FTE CSP FTEs Total WIMCR Overhead

Overhead Personnel & Non Personnel

$5,000 x 3.5 = $17,500.00

Alternative to FTE Method (Override)

1) Comprehensive overhead proposal is submitted to PCG and DHS. If an agency contends that there is a more appropriate and accurate overhead allocation methodology based on the structure of the agency, PCG will collect detailed information regarding the proposed method of overhead allocation.

2) PCG and DHS will collect all override requests and determine an appropriate review process. Once the cost reporting period has ended and PCG has compiled all requests to override the prepopulated overhead cost allocation, PCG and DHS will determine an appropriate method for reviewing and approving or denying override requests.

3) If approved, PCG will allow the agency to override data on WIMCR overhead allocation page. If a determination is made that the overhead allocation methodology proposed by the agency is both reasonable and appropriate, the agency will be able to update the values reflected on their overhead allocation page.

4) PCG will review all data manually entered by the agency and confirm that it is consistent with what was reflected in the override request documentation. Once PCG has approved the updated overhead allocation as reflected in the WIMCR webtool, the agency will be able to recertify their report.

5) All approved override requests will be considered for year two webtool updates. If a county agency proposes an allowable method of overhead cost allocation, their method will be evaluated and potentially incorporated into the WIMCR webtool going forward.



H. Federal Funds WIMCR providers are required to report the receipt of federal grant funding which is used to offset the cost of a WIMCR program. The following are data fields on the Federal Funds screen of the WIMCR Cost Report:

• Total Allocated Cost Total Allocated Cost includes previously reported direct service cost, direct support cost and overhead cost which has been allocated to each individual WIMCR program. Full time (40 hours per week) employee = 1 FTE

• Federal Funds and Reductions Please use this space to identify any federal grant dollars applied to offset the cost of your agency's WIMCR programs.

Federal dollars include, but are not limited to: - Substance Abuse Block Grant - Mental Health Block Grant - Social Services Block Grant

• Net Cost Total Allocated Cost - Federal Funds and Reductions

WIMCR Desk Review

A. Goals of Updated WIMCR Desk Review The WIMCR desk review process has been integrated throughout the cost report to ensure that providers completing WIMCR cost reports are aware of all potential audit risks. Following the completion of each screen within the WIMCR cost report, the provider will submit clarification on each applicable audit risk.

B. Desk Review Structure and Process The WIMCR webtool is designed to process desk reviews during the cost report completion process. As soon as data is entered into a screen within the WIMCR webtool, all applicable desk review edits will be triggered immediately. By incorporating the desk review process throughout the process of cost report completion, the system is able to address all potential audit risks as soon as all relevant information has been entered into the cost report. This method will expedite the WIMCR desk review process while simultaneously helping to avoid errors which may impact subsequent sections of the cost report. Following the certification of a WIMCR cost report, all desk review edits that appeared throughout the report will be summarized on a single “desk review” page for PCG review. Once the desk review process is initiated following the closing of the WIMCR cost reporting period, the provider will be able to view all desk review explanations provided during the completion of the WIMCR cost report. As soon as a WIMCR coordinator has reviewed all desk review edits, an email will be sent to the provider notifying them that their initial desk review has occurred and informing them whether additional clarification is required or the desk review is complete and no further action is required.

C. PCG Response

The WIMCR Coordinator will review the desk review summary screen including provider explanations for all audit risks. The WIMCR Coordinator will indicate within the WIMCR webtool if there is a need for clarifications and revisions to the cost report. It is crucial that you update your contact information stored within the WIMCR webtool each year, because the WIMCR Coordinator will contact the user associated with each cost report via e-mail and telephone. Cost reports with pending reviews may be delayed from final settlement payment, until each report’s review is completed by the WIMCR Coordinator and revisions are verified by the user.

Crisis Intervention (Stabilization Per Diem) – Desk Review Checks In order for a user to navigate to the next section of the cost report, they will need to ensure that any desk review checks associated with the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered based on the data entered on this screen include: Federal funds exceed total program costs

The total value of federal funds used toward a specific WIMCR program cannot be greater than the cost of the entire WIMCR program.



A PCG user will respond individually to each audit risk that arises. If the explanation entered by the provider during the cost reporting period adequately addresses the associated audit risk, a PCG reviewer will simply approve the provider’s explanation and no further action will be required. When this occurs, the PCG reviewer will enter an explanation similar to the review below:

A PCG Desk Reviewer has reviewed your explanation and no further action is required.

If the PCG desk reviewer completes a desk review and no further action is required, the provider will receive a “desk review complete” email notification. If one or more items require additional clarification, the PCG reviewer will request follow up from the provider.

D. Provider Response When a provider response is required following an initial PCG desk review, the provider has two options.

a. If all data entered into the WIMCR cost report is accurate and verified, the provider will respond with an additional clarifying explanation. Additionally, (if requested by a PCG reviewer), the provider may be required to email supporting documentation to PCG at [email protected].

b. If an error was made during the completion of a WIMCR cost report. The provider can roll back their cost report certification and update their cost data.

E. Desk Review Email Notifications

Following each review of the WIMCR desk review by a PCG reviewer, one of the below emails will be automatically sent to each notification recipient within a particular agency. If there are still pending desk review edits which require additional clarification, the “2013 Desk Review Action Required” email will be sent. If all desk review audit risks have been appropriately resolved, the agency’s designated notification recipients will receive a desk review complete email. The receipt of a desk review complete email serves as confirmation that the agency has completed their desk review process and no further action is required.

Notification - 2013 Desk Review Action Required

Recipient: Your agency’s WIMCR report has been reviewed by PCG, and one or more items require additional clarification. To resolve pending items, please logon to the WIMCR webtool and visit the desk review page prior deadline. Please contact PCG at (866) 803-8698 or [email protected] with any questions regarding your WIMCR desk review. Sincerely, Public Consulting Group [email protected] (866) 803-8698

Notification - 2013 Desk Review Complete

Recipient: Your agency’s WIMCR report has been reviewed by PCG, and no further action is required. Please note that, as a Wisconsin Medicaid provider, your agency must maintain documentation of all reported costs submitted in the WIMCR Cost Report in the event the reports are to be reviewed or audited in the future. Please contact PCG at (866) 803-8698 or [email protected] with any questions regarding your WIMCR report. Sincerely, Public Consulting Group [email protected] (866) 803-8698






SECTION IV – MANAGEMENT REPORTS

What Happens Next? Once all submitted cost reports have been reviewed and finalized, the cost report data is downloaded from the web tool. In order to calculate the Medicaid costs eligible for settlement, the reported cost per unit from the cost report is applied to the number of Medicaid paid units with dates of service in Calendar Year 2012. The cost for Medicaid services is then compared to the Medicaid claim payments for dates of services in Calendar Year 2012. This is a comparison of "revenue vs. costs" for each program for which a cost report is submitted. This comparison identifies your operating deficit and WIMCR payment amount. A "Provider Summary Report" is then created. This report is the "Revenue vs. Cost" analysis that evaluates whether the particular WIMCR program is eligible for additional funds (e.g. costs exceeded revenue) or whether revenue exceeded costs. Important points to note regarding this report:

• The Provider Summary Report reflects paid units of service for the Medicaid-eligible population only.

• The Provider Summary Report displays units of service for those programs that were claimed for dates of services in Calendar Year 2012, regardless of payment date.

• A notification that the Provider Summary Report has been shared within the WIMCR webtool is e-mailed to all designated WIMCR notification recipients. To ensure all important emails continue to reach your inbox, please add the WIMCR Coordinator’s email address ([email protected]) to your address book.

Federal regulations require Medicaid payments to be made to only Medicaid-certified providers. The WIMCR checks will be made payable to the Medicaid provider, but they will be mailed to the county treasurer by the Medicaid Claims Administrator and will be accompanied by the county treasurer reports (also known as Wisconsin Medicaid Cost Reporting (WIMCR) and Community Aids Adjustment Financial Report). The Medicaid providers will be sent electronic copies of both the county treasurer reports and the provider summary reports.

Evaluating the provider summary report can be beneficial to check the reasonability of the cost report you have submitted. The reported costs on the provider summary report should match the cost per unit from the cost report. The payment on the provider summary report should match the WIMCR payment on the county treasurer report.



wisconsin medicaid cost reporting (wimcr) instruction manual...2014/09/03 · basic county...

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