Cal. Code Regs. Tit. 22, § 51535.7 - Targeted Case Management Services Reimbursement
(a) Each targeted case management provider of
service pursuant to Welfare and Institutions Code, Section
14132.44,
shall complete and submit to the department, by November 1 of each year, a cost
report of the prior year costs of each local program providing targeted case
management services in a format specified by the department. Only one cost
report shall be submitted for targeted case management services provided to
target populations specified in subsections
50262.7(a)(1);
50262.7(a)(2); 50262.7(a)(3)(A); 50262.7(a)(3)(B), (C) or (D); or
50262.7(a)(3)(E).
(b) The cost
report shall certify all of the following:
(1)
The availability and expenditure of one-hundred (100) percent of the nonfederal
share of the cost of providing targeted case management services from the
provider's general fund or from any other federally approved source.
(2) The amount of funds expended on allowable
targeted case management services.
(3) Targeted case management program
expenditures represent costs that are eligible for federal financial
participation.
(4) The costs
reflected in the annual cost reports used to determine targeted case management
rates are developed pursuant to Welfare and Institutions Code, Section
14132.44(f)(1)(D).
(5) That targeted case management services
provided in accordance with Section
1396 n(g) of Title 42 of the
United States Code will not duplicate case management services provided under
any home- and community-based services waiver.
(6) That claims for providing case management
services pursuant to Welfare and Institutions Code, Section
14132.44
will not duplicate claims made to public agencies or private entitles under
other program authorities for the same purposes.
(7) That the provider has complied with all
the requirements of Section
51271.
(c) The cost report shall reflect only the
allowable direct and indirect costs of providing targeted case management
services. Allowable costs include the following:
(1) Salaries and benefits;
(2) Services and supplies, including costs of
contracted targeted case management services;
(3) Operating expenses including leases, bond
servicing costs and county (city)-wide overhead costs as reflected in the
approved cost allocation plan;
(4)
Amortized capital expenditures;
(5)
Documented cost increases, such as contractual increases for salaries, benefits
or operating costs.
(d)
The information in the cost report shall be used to determine the annual,
program specific, per encounter reimbursement rate for the current fiscal year
using actual allowable costs and encounter data from the prior fiscal
year.
(e) Effective July 1, 1996,
and each year thereafter, the reimbursement rate shall be calculated by
dividing the allowable case management costs of providing targeted case
management services by the total number of all encounters in the prior fiscal
year, including encounters with persons who are not Medi-Cal
beneficiaries.
(f) Effective July
1, 1996, and each year thereafter, the total dollar amount that may be claimed
in the current year by the local governmental agency for targeted case
management services provided pursuant to this section shall not exceed the
product of:
(1) The projected number of
Medicaid encounters for the current year, times the current year billable rate
per encounter.
(g) Any
costs associated with providing targeted case management services in the
current year in excess of the total dollar amount specified in subsection (f),
shall be recognized in the annual cost report and become part of the
calculation to determine the billable rate per encounter for the subsequent
year.
(h) All claims scheduled for
payment for targeted case management services provided prior to July 1, 1995,
are not subject to revision unless the department requests a revised claim from
the local governmental agency.
Notes
2. New section refiled 10-29-96 as an emergency; operative 10-29-96 (Register 96, No. 44). Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995. A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency language will be repealed by operation of law on the following day.
3. Editorial correction of HISTORY 2 (Register 97, No. 15).
4. Repealed by operation of Government Code section 11346.1(g) (Register 97, No. 15).
5. New section filed 4-10-97; operative 4-10-97 pursuant to Government Code section 11343.4(d) (Register 97, No. 15).
Note: Authority cited: Sections 14105, 14124.5 and 14132.44, Welfare and Institutions Code. Reference: Section 14132.44, Welfare and Institutions Code.
2. New section refiled 10-29-96 as an emergency; operative 10-29-96 (Register 96, No. 44). Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995. A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency language will be repealed by operation of law on the following day.
3. Editorial correction of History 2 (Register 97, No. 15).
4. Repealed by operation of Government Code section 11346.1(g) (Register 97, No. 15).
5. New section filed 4-10-97; operative 4-10-97 pursuant to Government Code section 11343.4(d) (Register 97, No. 15).
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