Mental Health Financial Issues - PowerPoint Presentation

Mental Health Financial Issues California Institute for Behavioral Health Solutions (CIBHS) Small County Fiscal Technical AssistanceApril 26, 2019

Mental Health Financial Issues Quarterly Federal Financial Management Report (QFFMR)DHCS Information NoticesOther Fiscal Issues1

Quarterly Federal Financial Management Report The reporting of costs for the Substance Abuse Block Grant (SABG) changed as of January 1, 2019SABG is now retrospective reimbursement rather than advance allocationDHCS changed the QFFMR forms to reflect reimbursementThird Quarter (1/1/19-3/31/19) Summary form and detail General Ledger form that supports information on SummaryReport unused SABG funds in top section of Summary form Most counties received State FY Q1 payments but State does not have authority to release SFY Q2 payments yet DHCS has proposed hosting a webinar to address county questions https://www.dhcs.ca.gov/provgovpart/Pages/SUD_Forms.aspx 2

DHCS Information Notices 19-020 – CSI Assessment Record19-019 – MHSA Program Review Implementation19-018 – DMC-ODS Provider Selection Review Process19-017 – MHSA Implementation of W&I Sections 5892 and 5892.119-016 – Revisions to ODS Interim Rates19-015 – Establishing a FY19/20 County Contract Rate in SD/MC Claiming System 19-014 – Approval of CAADE as DMC Certifying Organization 19-013 – ICD 10 Revisions to SD/MC Claiming System 3

MHSA Program Review Implementation DHCS Information Notice 19-019 notifies counties that DHCS will conduct program reviews of performance contracts to determine complianceFocus is on compliance with the performance contractNot a fiscal auditSeventeen counties chosen for calendar year 2019Performance contract key elementsSubmission of MHSA Annual Revenue and Expenditure Report by December 31 st MHSA funds used to expand services Non-Supplant of existing resources Distribution of MHSA Funds 4

MHSA Fiscal Changes SB 192 added W&I Code Sections 5892 and 5892.1Required plan to spend the fundsPrudent Reserve LimitAllocation of InterestPlans to spend the fundsCounties were required to submit to the OAC by January 1, 2019 a plan on how they intend to spend all reverted and reallocated funds Counties that did not submit a plan to the OAC must remit the reverted funds to DHCS 5

MHSA Fiscal Changes Prudent Reserve Funding LimitCounties are required to establish a prudent reserve that does not exceed 33 percent of the average CSS revenue received in the local MHS Fund in the preceding five yearsFive fiscal years (FY13/14 through FY17/18)Sum of total distributions from July 2013 through June 2018 multiplied by 76 percent divided by 5 multiplied by 33 percentCounties must complete the calculations and certify form DHCS 1819 Counties that exceed the limit have until June 30, 2020 to move the funds from the prudent reserve to CSS and PEI (if applicable) Include transfer(s) in FY19/20 MHSA Annual Update Report transfer(s) on FY19/20 MHSA Annual Revenue and Expenditure Report Allocation of Interest Counties must allocate interest based on the amount of interest earned by each component during the fiscal year Applies to interest earned in FY18/19 and subsequent FY 6

Revisions to DMC-ODS Rates Counties have ability to request updated DMC-ODS ratesMust submit revisions to DHCS by February 1st prior to start of the fiscal yearFiscal Plan templateJustification for the rate changeCertified Public Expenditure data Revised projections for units of service and beneficiaries Basically two year lag between actual data and interim rates 7

SD/MC Contract Rates County Mental Health Plans (MHPs) have the ability to limit interim rates paid to contract providers using the County Contract Rate formOnly necessary if the interim rates for contractors are higher than what the MHP wants to pay the contractorMHPs can establish one set of contract rates for all contractorsDHCS will pay the lower of the contract rate or the amount claimedIn general, MHPs claim at interims rate equal to the rates paid to contractors Form is not necessary Contract rates are interim rates subject to cost settlement through the normal cost report process 8

Other Fiscal Issues Allocation of MHSA Revenue and InterestCBHDA Prudent Reserve RecommendationsCo-Practitioner ClaimingCANS and PSC-35 State General Fund allocation methodologyCBHDA MEDSLITE RecommendationDHCS auditors interpretation of indirect costsRedirection of future MHSA funding for WET Five Year Plan 15% of revenues in excess of $1.9 billion after accounting for NPLH, limited to $300 million in aggregate Allocation of OIG recoupments between funding sources 2020 Waiver 9

Other Fiscal Issues AB43 – Open MeetingsNetwork AdequacyCalculation of MHSA FSP PercentageMHSA Annual Adjustment$443.6 million to be posted 7/1/19DHCS ReorganizationAudit Treatment of Units of Service 10