FEDERAL FINANCIAL PARTICIPATION (FFP)

Comprehensive Perinatal Services Program (CPSP)Annual Meeting

November 7, 2012

Jonathan Alspektor, BSBAState of California

Contract Manager

Objectives for this Presentation

FFP Definition and Objectives

FFP RequirementsFFP ReimbursementFFP Decision TreeFFP Secondary Documentation

Federal Financial Participation (FFP) is a Title XIX (Medicaid) program that allows states to receive partial reimbursement for activities that meet FFP objectives.

WHAT IS FFP?

FFP has two programs:1.) Targeted Case Management – TCM2.) Medi-Cal Administrative Activities – MAA

MAA FFP reimburses for activities that primarily involve linking clients to Medi-Cal services and/or coverage.

MCAH FFP is a MAA program.

WHAT IS FFP?

Qualified Perinatal Services Coordinator (PSC) must: Be a Skilled Professional Medical

Personnel (SPMP) and must meet Federal SPMP requirements not State or County.

Complete SPMP Questionnaire Complete activities that meet at least

one of the two FFP Objectives .

FFP REQUIREMENTS

Qualified Perinatal Services Coordinator (PSC) must: Time Study Adhere to current MCAH Policy &

Procedure position requirements

FFP REQUIREMENTS

There are two FFP personnel classifications:

1.) Skilled Professional Medical Personnel (SPMP) Education and training at the professional level

Nurses, physicians, Registered Dieticians, etc.

2.) Non-Skilled Professional Medical Personnel (Non-SPMP) All other personnel

FFP PERSONNEL

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All SPMPs must complete the SPMP Questionnaire Determines SPMP or Non-SPMP Complete once and keep on file for

audit purposes.

SPMP REQUIREMENTS

1.) To assist individuals eligible for Medi-Cal to enroll in the Medi-Cal program

and/or2.) To assist individuals on Medi-Cal to

access Medi-Cal providers, care and services.

FFP OBJECTIVES

Staff claiming FFP reimbursement must keep record of 100% of their time and activities for all programs (including non-MCAH programs) for a minimum of one month each quarter.

The “start and stop” time of all activities are required on each time study at a maximum of 30 minute increments. Double-click

image to show full screen example

FFP TIME STUDY

50/50 Non-Enhanced Matching (Non-SPMP)$1 spent = .50 cents reimbursed

75/25 Enhanced Matching (SPMP)$1 spent = .75 cents reimbursed

FFP REIMBURSEMENT

Medi-Cal Factor (MCF%)- Medi-Cal paid births as a percentage of live births in each county.

Comprehensive Perinatal Services Program (CPSP) is a Medi-Cal program serving only Medi-Cal providers and clients.

PSCs can claim up to 95% of their matchable activities.

FFP REIMBURSEMENT

Determines if an activity can be matched

Determines the codes than can be claimed for an activity

FFP DECISION TREE

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SPMP FFP CODES

Enhanced (75/25 Matching)2: Administrative Medical Case Management

(Short Term Only)3: SPMP Intra/Interagency Coordination,

Collaboration and Administration6: SPMP Training8: Program Planning and Policy Development9: Quality Management

NON-SPMP FFP CODES

Non-Enhanced (50/50 Matching)1: Outreach4: Intra/Interagency Collaboration and

Coordination 5: Program Specific Administration7: Non-SPMP Training

OTHER FFP CODES

10: Non-Program Specific General Administration

11: Other MCAH Scope of Work Activities that are not matched

12: Paid Time Off

FUNCTION CODE 1 Outreach

Examples:

Informing potential client about the services offered by a CPSP provider

Describing range of services, how to access them, and the benefits of preventative health care.

FUNCTION CODE EXAMPLES

FUNCTION CODE 2 (SPMP)SPMP Administration Medical Case Management

Examples:

Consulting with a Medi-Cal provider in regards to the client’s or the infant’s health needs.

Assisting Medi-Cal client in contacting their physician for clarification on a specific medical condition such as gestational diabetes and its effect on her pregnancy.

FUNCTION CODE EXAMPLES

FUNCTION CODE 3 (SPMP)SPMP Intra/Interagency Coordination,

Collaboration, & Administration

Examples:

Meeting with Dental providers to develop strategies to increase access to dental services for pregnant women.

Community Action and Planning strategy meetings

FUNCTION CODE EXAMPLES

FUNCTION CODE 4Non-SPMP Intra/Interagency

Collaborationand Coordination

Examples:

PSC provides assistance to a CPSP Provider with a technical question related to the program i.e. Billing for services to Medi-Cal.

FUNCTION CODE EXAMPLES

FUNCTION CODE 5Program Specific Administration

Examples:

Reviewing reports, documents, and/or legislation for potential impacts to the CPSP programs.

Coordinate logistics for outreach services from various programs to prevent duplication of services and encourage optimal use of resources for Medi-Cal clients.

FUNCTION CODE EXAMPLES

FUNCTION CODE 6 (SPMP)SPMP Training

Examples:

Develop, conduct, or participate in training for CPSP physicians, nurse practitioners, and office nurses to increase access to Medi-Cal services.

Using skilled medical expertise to deliver professional training to health care providers that will improve quality of care.

FUNCTION CODE EXAMPLES

FUNCTION CODE 7NON-SPMP Training

Examples:

Participate in training on data sources, data management and preparation for analysis to improve access to care for Medi-Cal clients.

Attending an FFP training

FUNCTION CODE EXAMPLES

FUNCTION CODE 8 (SPMP)SPMP Program Planning and Policy

Development

Examples:

Identify, recruit, and provide program support for new providers to expand access for CPSP clients.

Assisting providers with CPSP clinical requirements and implementation.

FUNCTION CODE EXAMPLES

FUNCTION CODE 9 (SPMP)Quality Management by

Skilled Professional Medical Personnel

Examples:

Developing training materials for CPSP providers for quality assurance monitoring.

Reviewing CPSP provider arrangements to assure continuous provision of required consultant services.

FUNCTION CODE EXAMPLES

FUNCTION CODE 10Non-Program Specific General

Administration

Examples:

Agency related activities, such as, fire drills.

Staff attend agency meetings and non-program related trainings such as HIPAA, Safety Training, Sexual Harassment.

FUNCTION CODE EXAMPLES

FUNCTION CODE 11 Other Activities (Included in MCAH SOW)

Examples:

Attending Child Abuse Prevention Council meetings.

Smoking cessation training.

FUNCTION CODE EXAMPLES

FUNCTION CODE 12 Paid Time Off

Examples:

Paid time off for a Holiday, sick leave, vacation, or jury duty

FUNCTION CODE EXAMPLES

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATION

Purpose: The information and data that

substantiates and supports reimbursable activities claimed on the Time Study.

Ensures Program Integrity Informs Auditor

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATION

Documentation Requirements: Requirement of All FFP Staff Evidence of FFP Activities Performed Provides Audit Trail Accessible and Available Records Must Be Retained

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATIONExample – SPMP Program Planning And Policy Development – Function Code 8Good

5/21/09 from 12:00-2:00 (when) – Attended the South Bay Prenatal Access Task Group meeting (where). The membership, doctors and nurses (who), discussed and made plans (what) to increase access to prenatal care clinics (why).

Other relevant details might include the meeting agenda and participant list

PoorMet with the South Bay Prenatal Access Task Group about access to prenatal care clinics

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATIONSupporting Documents:

Job specifications Duty statements Organizational chart Scope of Work

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATIONGuidelines and Suggestions:

No standardized form but must provide evidence

Notes should be detailed and specific Attach other types of documentation,

such as, agendas, day planner, flyers, client notes, etc.

Secondary Documentation can be anything an agency chooses, but it should include the following elements:

Date Time Spent Activity Program

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATION

Secondary Documentation can be anything an agency chooses, but it should include the following elements:

Identify the client/Program/Event for which the activity was performed

Function Code

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATION

FEDERAL FINANCIAL PARTICIPATION (FFP)

SECONDARY DOCUMENTATIONREMEMBER

Secondary documentation must

support time study

If not supported, FFP activities cannot be reimbursed

MCAH Business Partnershttp://www.cdph.ca.gov/services/funding/mcah/Pages/default.aspx

RESOURCES

QUESTIONS?