LEC/LGA: Cla Time Survey Week/Month/Year: Year and Quarte Location of Visit: Site Visit Checklist Time Survey Comments

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1 LEC/LGA: Time Survey Week/Month/Year: Ye Location of Visit: Administrative Claiming Operations Unit State Field Visit Tool Site Visit Checklist General 1. Does claiming unit perform both MAA and TCM? a. If yes, What safeguards are in place to ensure that staff costs are not duplicated in MAA Invoices and TCM Cost Reports? (List safeguards in comments. Describe how you identified the 2. Are all activities that are being invoiced reflected in the duty statements of job classes? 3. Are all activities that are being invoiced reflected on the grid? 4. When providing "Direct Medical Services" were they coded as Code 2, Direct Medical Services? 5. Are the documents that are listed on the "Audit File Checklist" maintained? Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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4 LEC/LGA: Cla Time Survey Week/Month/Year: Year and Quarte Location of Visit: Site Visit Checklist Time Survey 1. Did the LEA/LEC/LGA survey in the designated week/month? a. If not, did they survey in a time period approved by DHS? 2. Are original Time Surveys available for inspection? 3. Do the activities time surveyed agree with the MAA Operational Plan? a. If not, was non-approved activity classified as "School/Education Activities" on the Invoice? b. If not, was recommendation made to the claiming unit for updating the operational plan grid in the future? 4. From the Tally of Time Surveys are the Time Surveys completed correctly? a. Samples were appropriate to the code to which they were recorded? 5. Is there evidence that participating staff was trained and/or oriented to the MAA Program and Ti S P d? 6. If individual staff claim more than one activity, did they time survey? 7. Are the activities surveyed supported by the operational plan/audit file? Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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7 LEC/LGA: Claiming Un Time Survey Week/Month/Year: Year and Quar Location of Visit: Site Visit Checklist Code 4 (Initial Medi-Cal Outreach) 1. Is the Claiming Unit performing this activity? (Reviewer: If no, proceed to next section.) 2. Does the Operational Plan indicate that printed material is/will be developed? Are Do the the flyers, announcements and other materials pertain available to MAA? for use at the location(s) listed in the Operational Plan?. a. List in Comments section the location(s) that were confirmed. Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

8 LEC/LGA: Claimi Time Survey Week/Month/Year: Year and Qua Location of Visit: Site Visit Checklist Code 6 (Facilitating Medi-Cal Application) 1. Is the Claiming Unit performing this activity? (Reviewer: If no, proceed to next section.) 2. When assisting an individual or family, how does the claiming unit staff ensure their time is related to accessing and/or understanding Medi-Cal? Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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10 LEC/LGA: Claimin Time Survey Week/Month/Year: Year and Quarter R Location of Visit: Site Visit Checklist Code 8 (Ongoing Referral, Coordination and Monitoring of Medi-Cal Covered Services) 1. Is the Claiming Unit performing this activity? (Reviewer: If no, proceed to next section.) 2. Did the school staff use this code when making referrals, coordinating and/or monitoring the delivery of Medi-Cal Services? 3. Did the school staff use this code to record activities related to services in an IEP? 4. Were any activities that are a part of direct services recorded to this activity? 5. Did any Case Managers participating in the LEA Billing Option code any time to this activity? (Case Managers are not allowed to code to Code 8, instead, they should code to Code 2, Direct Medical Services.) Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

11 LEC/LGA: Claiming Time Survey Week/Month/Year: Year and Quarter Revie Location of Visit: Site Visit Checklist Code 10 (Transportation) 1. Is the Claiming Unit performing this activity? (Reviewer: If no, proceed to next section.) (Transportation questions are also referenced/addressed in Sub-Contracts and Invoice S 2. When the ) school staff assisted an individual or family so that they could obtain transportation to Medi-Cal covered services was it coded to this activity? Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

12 3. Did any Case Managers participating in the LEA Billing Option for IEP-driven arranging and providing specialized transportation code any time to this activity? (Case Managers are not allowed to code to Code 10, instead, they should code to Code 2, Direct Medical Services.) 4. If providing transportation, does the Individual Education Program/Plan (IEP) list transportation as a service? 5. If providing transportation, did the child receive Medi-Cal covered services at school on the day(s) that transportation was charged? (Only applicable if home to school transportation is listed in the operational plan ) Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

13 LEC/LGA: Claiming Time Survey Week/Month/Year: Year and Quarter Reviewed Location of Visit: Site Visit Checklist Code 12 (Translation) 1. Is the Claiming Unit performing this activity? (Reviewer: If no, proceed to next section.) 2. Did school staff provide translation services that were not included and paid for as part of a 3. di Did the l translation i t service i? that was coded facilitate access to Medi-Cal covered services? If a. Was it coded under Code 2, Direct Medical Services? 4. Did the school staff that arranged for or provided the translation services assist the individual and/or family so they were able to access and understand necessary care or treatment covered 5. Did any Case Managers participating in the LEA Billing Option code any time to this activity? (Case Managers are not allowed to code to Code 12, instead, they should code their time to Code 2 Direct Medical Services) Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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17 LEC/LGA: Claiming Unit: Time Survey Week/Month/Year: Year and Quarter Revi Location of Visit: Site Visit Checklist Code 14 (Program Planning and Policy Development and Interagency Coordination Related to Medi- Cal Services) 1. Is the Claiming Unit performing this activity? (Reviewer: If no, proceed to next section.) 2. Are employees that do not have this activity listed in their position description coding to this activity? 3. Are the staff performing this activity employed less than 100% in a "Direct Medi-Cal-billable services setting? If yes: a. Does the employee's time survey indicate time spent in a "Direct Medi-Cal-billable services" setting is coded to Code 2? 4. If resource directories are listed in the time survey as being developed, was one developed? (Evidence by copy available for review). 5. Is the Claiming Unit a non-governmental entity? a. Is there a contract available for review? If not, why? b. Is there evidence that public funds are available as local share for this claiming unit? c. Do the contracts clearly describe the MAA being claimed? 6. Are there subcontractors listed in the Operational Plan? b. Is there a contract available for review? c. Do the contracts/mous clearly describe the MAA being claimed? Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

18 7. Do the subcontractors show the method used for determining direct charge claimed in the operational plan and/or the dollar amount to be paid to the contractor? Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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20 LEC/LGA: Claiming Unit Time Survey Week/Month/Year: Year and Quarter R Location of Visit: Site Visit Checklist Code 15 (Medi-Cal Claims Administration, Coordination and Training) 1. Is the Claiming Unit performing this activity? (Questions are referenced/addressed in General, Time Surveys, and Invoice Sections.) 2. Does the staff perform MAA/TCM Claims Administration part-time in addition to other duties? 3. If performing this activity 100% of the time, are the employees direct charging? 4. If staff coded time to this activity, is the employee(s) directly related to Medi-Cal claims administration, coordination, and training activities? Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

21 LEC/LGA: Claiming Unit Time Survey Week/Month/Year: Year and Quarter R Location of Visit: Site Visit Checklist Code 16 (General Administration/Paid Time Off) 1. Is the Claiming Unit performing this activity? 2. Is all time that is coded paid time? If not: a. What type of time was it? (List in comments) 3. Is the time that was coded to this activity allowable? a. Is there adequate documentation supporting the time claimed? Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

22 Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

23 LEC/LGA: Claiming Unit: Time Survey Week/Month/Year: Year and Quarter R Location of Visit: Site Visit Checklist Invoices 1. Do the staff's salaries that are included in the MAA Claiming Invoice appear reasonable for the number of staff that time surveyed? 2. When a mixed population (Medi-Cal and Non-Medi-Cal) is involved was the appropriate Medi- Cal discount applied? 3. Is any staff direct charging? If yes: a. Is there an adequate method for tracking time/cost? 4. If a Claiming Unit is a non-governmental entity are its claiming activities resevered for governmental entities, such as Program Planning & Policy Development? 5. Were the invoice documents/documentation maintained in the audit file? Comments Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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26 Cl Year and Quarte YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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29 aiming Unit er Reviewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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32 nit rter Reviewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

33 ing Unit arter Reviewed YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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35 ng Unit Reviewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

36 g Unit ewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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38 g Unit d: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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42 iewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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45 t Reviewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

46 it Reviewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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48 Reviewed: YES NO Prepared by DHS-ACOU.wpj.9/29/2004 Effective Date: 10/2004

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