TITLE
Recommendation to authorize repayment of funds for FY 2011 Targeted Case Management Program activities to the State of California Department of Health Care Services for overpayment in the amount of $81,472, plus interest. (Citywide)
DISCUSSION
The State Department of Health Care Services (DHCS) administers the County Based MediCal Administrative Activities (MAA) and Targeted Case Management (TCM) Program. The MAA portion of the program allows reimbursement of costs for the performance of administrative activities that directly support efforts to identify and enroll potential eligible individuals into MediCal. The TCM program provides reimbursement for case management services to: MediCal beneficiaries under the age of 21; the medically fragile; and individuals at risk of institutionalization, communicable diseases or negative health or psycho-social outcomes. The City of Long Beach Department of Health & Human Services (DHHS) has participated in these programs since the early 1990s and has received over $7 million for these activities.
In FY 2009, Local Government Agencies (LGA) were instructed by the DHCS to use an interim one-month time study methodology in the preparation of cost reports for invoice reimbursement for the MAA and TCM programs until a permanent time study methodology was approved.
In July 2013, a new permanent Perpetual Time Study (PTS) methodology was developed by the DHCS, and approved by the Center for Medicare and Medicaid Services, to determine eligible activities and billable hours for reimbursement. The PTS methodology resulted in a decrease in eligible activities, and staffing reductions that occurred after FY 2009 further decreased the reimbursement claim.
On August 12, 2015, the DHCS Audit and Investigation Branch used the results of the 2013 PTS methodology to reconcile reimbursable activities in the FY 2011 TCM Cost Report. As a result of this audit, the DHCS determined that the DHHS was overpaid $81,472 for TCM acti...
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