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Third level
Fourth level
Fifth level
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1
Substance Abuse
Prevention and Control
www.publichealth.laco= unty.gov/sapc
DRUG MEDI-CAL
Prevention and Control
www.publichealth.laco= unty.gov/sapc
DRUG MEDI-CAL
1000 S. Fremont Avenue
Building A-9 East, 3rd Floor,
North Wing Unit 34
Alhambra, CA 91803
7/01/2012
•
•
•Welcome
to
•SAPC
•Cost
Report Orientation
•for
Fiscal Year 2011-12
2
3
Topics of Discussion
1.Type of Forms/Worksheets
2.Instructions for Completing the Forms
3.Common Errors
4.Deadline
7/01/2012
Types of Cost Report Forms
ØDrug Medi-Cal
(Non-NTP)
D=
ata
Entry Sheet for –
1)2)3)4)ØNarcotic Treatment Pro=
gram
(NTP)
1)7990NTP-AD (or Program Cost Summary) is required =
for ALL Narcotic Treatment
Programs.
Ø
=
2)Worksheet <=
i>7895NTP-AD (or Report of Expenditure
and Revenue) <=
span
style=3D'position:absolute;top:81.25%;left:18.53%;width:81.46%;height:4.0%=
'>is required ONLY<=
/u> when the program has both
NNA and DMC
4
7/01/2012
5
Drug Medi-Cal Data Ent=
ry
Sheet<=
br>
ODF – Group Counseling =
211;
Alcohol/Drug
&#=
13;
ØSignature Sheet
<=
/i>Enter the
Contract Agency Name, Facility Address, Contract Number, Provider
4-digit DMC Number, Authorized Signature, and
Contact Information.
7/01/2012
6
D=
rug
Medi-Cal Data Entry Sheet
ØData Entry Sheet
Ø
A. Heading
=
All information are automatically linked from signatu=
re
page.
B. Cost Information
=
Column(1-3=
):
for each line expense, enter the total cost for
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=
; &n=
bsp;
each applicable cost center.
Please note that the entry for column 3 is only requi=
red
when
you provide NNA/DMC services at the same site/locatio=
n.
This
cost must agree with your NNA cost report.
7/01/2012
7
Drug Medi-Cal Data Ent=
ry
Sheet<=
br>
ØData Entry Sheet
C. Fees and
Insurance
=
Column (4-6): Enter the participants fe=
es,
insurance, column.
v Please note, this excludes County=
<=
span
style=3D'mso-spacerun:yes'>
Reimbursement
7/01/2012
8
Drug Medi-Cal Data Ent=
ry
Sheet<=
br>
ØData
Entry Sheet (cont.)=
<=
span
style=3D'mso-tab-count:1;width:6.26%'> D. Unit Information
Box (7-8)
Enter Group Face to Face Visits information, if applicable
=
;
(Private/NNA Public Funded).
Box (9-11) Enter Group Sessions provided within a yea=
r,
if applicable
=
;
(Private Pay, DMC and NNA/Public Funded).
vBox (8) and (11) are
required only if you provide NNA/DMC service at the same site and location
=
•Note – If you reported cost for any cost center,
then you
7/01/2012
9
Drug Medi-Cal Data Ent=
ry
Sheet<=
br>
ØUnit Information
(Continue)
ØGroup Face-to-Face
Visitsattending the group
counseling session.
ØGroup Sessions<=
/b> are the number of
sessions held for providing group counseling. Group counseling shall be conduct=
ed
with <=
u>no
less than four (4) and no more than ten (10) clients<=
/b> at the same time.
=
;
Ø
=
ØStaff Hours=
are direct treatment
service hours (Counseling Hours).
ØGroup
Counseling - 90 minutes per
session
ØIndividu=
al
Counseling - 50 minutes per
session
ØØIndividual Face-to-=
Face
Visitsthe individual counsel=
ing
session.
7/01/2012
10
Drug Medi-Cal Data Ent=
ry
Sheet<=
br>
ØData Entry Sheet (cont.)
E. Drug Medi-Cal
Reconciliation of Claims (Units)
&n=
bsp;
Colu=
mn
(12 to14): Enter the Total Submitted,
Denied and Adjusted
Units of
Service by reporting period.
&n=
bsp;
ü=
Please note, the Total Submitted U=
nits
should agree with PDR
which information was originally from your monthly billings. If
there is discrepancy, please contact us immediately.
7/01/2012
11
Drug Medi-Cal Data Ent=
ry
Sheet<=
br>
Ø
<=
u>F. Revenue From Drug
Medi-Cal Units of Service
Colu=
mn
(15): These cells are formula driven. No entry
=
; &n=
bsp;
required.
7/01/2012
12
![](3D"slide0049_image003.gif")
13
Drug Medi-Cal Data Ent=
ry
Sheet
<=
span
style=3D'font-family:Arial;font-size:63%;color:#666699'>ØOD=
F-INDIVIDUAL,
DCR AND RESIDENTIAL
Inst=
ructions
for completing data entry sheet for all other modalities are the same =
as ODF-Group except for the Units of
Service information.
7/01/2012
![](3D"slide0010_image005.gif")
14
Drug Medi-Cal Data Ent=
ry
Sheet
Instructions for completing the Perinat=
al
forms for
the above modalities are the same as for
Alcohol
and Drug except for the unit of service
rates.
Customarily, th=
e unit
rate for Perinatal is higher
than Alcohol &a=
mp;
Drug. (Please see instructions for
Drug
Medi-Cal-A&D).
7/01/2012
15
N=
TP
Forms Instructions
ØSignature Page&#=
13;
Enter the
Contract Agency name, Facility Address, Contract Number, Provider
4-digit DMC Number, Authorized Signature, and Contact
Information.
7/01/2012
16
N=
TP
Forms Instructions
Form 7990NTP-A=
D
<=
span
style=3D'font-family:Arial;text-shadow:auto'>ØCost Summary Page
=
Heading<=
/span>
All information are
automatically linked from
signature page.
=
7/01/2012
17
NTP Forms
Instructions
Ø<=
/span>Form 79=
90NTP-AD (cont.)
Units of Service
Column (1-4)
Enter the total submitted/Denied/Adjusted Units of Service and
Minor
=
; &n=
bsp;
Consent Non-Title XIX for each service provided (e.g. Methadone,=
3;
=
; &n=
bsp;
Individual Counseling, and Group Counseling).
Column (5) Final UOS
– This reflects the total of column 1 through 4. This is
=
; &n=
bsp;
formula driven. No en=
try
required.
Column (6) Enter the=
total
approved/final units of service for the time period July
=
; &n=
bsp;
through September in the appropriate column for each service
provided.
Column (7) Enter the=
total
approved/final units of service for the time period October
=
; &n=
bsp;
through June in the appropriate column for each service provided.&#=
13;
Column (8) Minor Con=
sent
Non-Title XIX – Data is carried from column 4.
=
; &n=
bsp;
No direct entry is required.
Column (9) Check Tot=
al
– This reflects the total of column 6 to 8. This total must
=
; &n=
bsp;
equal column 5.
Column (10) This is the check fig=
ure
for columns 5 and 9. If
“Okay” appears in this
=
; &n=
bsp;
column, no correction is needed.&n=
bsp;
7/01/2012
18
NTP Forms
Instructions
=
<=
span
style=3D'font-family:Arial;font-size:6%;visibility:hidden'>Ø
<=
/span>
Line (11) Total Program Units
=
=
; &n=
bsp; =
;
Enter the total number of Methadone Units issued during the fiscal year for the entire
=
; &n=
bsp; =
;
program (NNA, DMC, and Private Pay).
=
=
; &n=
bsp;
=
; &n=
bsp; =
;
Enter total revenue such as Share of Cost, Insurance amounts, Medic=
are
and
=
=
=
“Some Medi-Cal beneficiaries must meet a specified SOC for
medical expenses
=
=
;
before Medi-Cal will pay claims for services provided in that month. The SOC
=
=
;
amount is determined by the county Welfare Department and is based =
on
the
=
=
;
beneficiary’s family’s income and living arrangement. &=
#13;
=
=
;
The monthly SOC may change at any time if the individual’s or
family’s income
=
=
;
increases or decreases, or the family’s living arrangement
changes”
=
=
;
(ADP Bulletin 99-39).
7/01/2012
19
NTP Forms
Instructions
Drug Medi-Cal Fiscal Detail
Drug Medi-Cal Fiscal Detail
ØForm 7895NTP-AD
v(Use this
form only if you provide DMC/NNA service at sa=
me
site/location)
=
v
=
;
This
form has 2 parts, Detail and Summary.
DETAIL –
Heading - All information are
automatically linked from signature page.
Expenses
Column
(1) =
It
reflects the total of Column (2) through (5). This is formulated. No entry
required. =
3;
Column =
(2-5) For each line expense, enter the total cost for each
applicable cost center (Detox,
=
; &n=
bsp;
Private Pay, Drug Medi-Cal and/or NNA Public Funded).
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Column
(6) =
It
reflects the total of column (4) and (5), no entry required.
<=
/div>
Column
(7) =
It
reflects the total of column (3) and (6), no entry required.
=
<=
span
style=3D'font-family:Arial;font-size:57%;visibility:hidden'>Ø
7/01/2012
20
NTP Forms
Instructions
Drug Medi-Cal Fiscal Detail
Drug Medi-Cal Fiscal Detail
Heading – .
Gross Cost=
–
Columns
A-G: Data are automatically
carried from DETAIL PAGE
Revenue –
Lines H=
and
I: For each line, enter the
revenue applicable to each cost
center
(Detox, Private Pay, Medi-Cal and/or NNA/Public). These exclude
County
reimbursement.
=
Units of Services –
Lines M1
through M6: Enter the units =
of
service in the applicable column.
Please =
note
that the uos entered in column D must match the Final UOS in
column 5
(Form 7990 NTP-AD).
7/01/2012
21
Perin=
atal Narco=
tic
Treatment Program
Form 7=
990NTP-P
& 7895NTP-P
Treatment Program Perinatal forms are the&#=
13;
same as for NTP-Alcoh=
ol and
Drug except for =
;
the unit of service r=
ates.
Customarily, the unit
<=
/span>
rate for Perinatal is
higher than Alcohol & Drug.
(Please see instructi=
ons
for NTP-AD).
7/01/2012
22
Common Errors
We usually found these common errors when
auditing your cost report as follows -
1.
=
1 - Signature
Page
&n=
bsp;
(1) 4-dig=
it DMC
number does not match with facility address.
(2) Contr=
act
numbers are incorrect.
(3) Signa=
ture
page is not signed.
(4) Missi=
ng
contact information.
üPlease make sure the Signature Page is filled out
completely The contact infor=
mation
is very important in case we have questions concerning the cost report.
7/01/2012
23
Common Errors (cont.)<=
/b>
2.Cost Information=
3;
2.
ØThe NNA Cost information is required for
agency who provide =
both
NNA/DMC services at same site & location are left blank.
üPlease ensure the NNA cost data are completely fill-out for both Data Entry Sheet and =
NTP
7895 forms when
required.
7/01/2012
24
Common Errors (cont.)<=
/b>
3.Unit Information
Ø Units of service do not match with bill=
ings
(PDR) or # of group
sessions are left blank on both Data Entry Sheet and NTP forms.
=
üPlease ensure units of service agree wi=
th
PDR and group
sessions are posted to the appropriate sheets and columns.
7/01/2012
25
Common Errors (cont.)<=
/b>
4.Reven=
ue /
Fees (Share of Costs)
5.
=
ØCounty reimbursement is being
reported under Share =
of
Cost.
=
üThis amount
should exclude County
r=
eimbursement.
7/01/2012
26
Cost Report Forms and Instructions can be
downloaded at Substance Abuse Prevention and Control
website:
www.publichealth.lacounty.gov/sapc
7/01/2012
27
Deadline
1. FIRST E-MAIL COST REPORT FOR
REVIEW.
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SUBMIT FY 2011-12 COST RE=
PORT
BY
AUGUST 1=
5,
2012
=
;
2.<=
span
style=3D'mso-spacerun:yes'> MAIL ORIGINAL COST REPORT AND ONE
COPY
3.
ATTACH CARE CERTIFICATION
=
;
4. ATTACH COST REPORT
CERTIFICATION
7/01/2012
TO:
COUNTY OF LOS ANGELES&=
#13;
DEPARTMENT OF PUBLIC
HEALTH
SUBSTANCE ABUSE PREVEN=
TION
AND CONTROL
1000 S. FREMONT AVE. B=
LDG.
A-9 EAST
3RD FLOOR NORTH =
WING
UNIT 34
ALHAMBRA, CA 91803
=
;
28
COST REPORTING UNIT
L=
isa
Lee (626) 299-4165 lislee@ph.lacounty.gov
Ø
A=
lex
Domond (626) 299-4156<=
span
style=3D'mso-tab-count:2;width:17.35%'> adomond@ph.lacounty.gov
=
;
Ø
H=
anna
Battung (626) 299-4179=
hbattung@ph.lacounty.gov
Ø
Z=
enaida
Arenas (626) 299-4584<=
span
style=3D'mso-spacerun:yes'> zarenas@ph.lacounty.gov
Ø
Ø
NOTE: FOR DMC INQUIRIES
PLEASE CONTACT:
L=
orena
Craig =
; &n=
bsp;
(626) 299-3226 &n=
bsp; =
; &n=
bsp;
lcraig@ph.lacounty.gov
E=
mily
Chan =
;
(626) 299-4173<=
span
style=3D'mso-spacerun:yes'> =
; &n=
bsp;
emchan@ph.lacounty.gov
<=
span
style=3D'mso-spacerun:yes'> =
; &n=
bsp;
J=
un
Yan (626) 299-4194 junyan@ph.lacounty.gov
Ø
M=
edi-Cal
Eligibility Website: =
www.medi-cal.ca.gov/Eligibility/login.asp
Ø
7/01/2012
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