DSL MEMO SERIES 2001-20

REPLACES DSL MEMO 95-38

October 16, 2001

STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living

To:
Area Administrators/Assistant Area Administrators
Bureau /Office Directors
County COP Coordinators
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Tribal/Aging Directors

From:
Sinikka McCabe, Administrator
Division of Supportive Living

Re: Use and Reporting of Wisconsin Medicaid Case Management Revenue

Certification of counties as providers of Wisconsin’s Medicaid targeted case management services became effective October 1, 1987. This memo clarifies requirements regarding the reporting, use and reconciliation of Medicaid case management expenses and revenues.

For technical assistance on Medicaid billing, policy, or adding and deleting eligible target populations for targeted case management, please refer to the Wisconsin Medical Assistance Provider Handbook, Part U, on Case Management. Each provider agency, at the time of certification, receives from the Division of Health Care Financing, a provider handbook and all regular updates.

Reporting of Targeted Case Management Expenditures
When targeted case management is provided, report 100 percent of the actual costs as a Community Options Program (COP) or community aids expense on the appropriate line of the CARS (600) report. The appropriate line corresponds to the source of (match) funding for case management. In effect, COP or community aids will pay the case management "up front" while the county is waiting for processing of the federal claim.

Reporting of Targeted Case Management Revenues
Revenues received from Medicaid for targeted case management funded initially by COP must be reported as revenue on the COP line of the CARS (600) report. Revenues received for case management initially funded from other sources must be reported on the CARS line corresponding to how the funds will be expended. The amount reported should be only the amount received that month, not the cumulative total received for the calendar year. Counties will receive a remittance report from Medicaid which lists, by recipient, the amounts paid that billing cycle. Counties will also receive a quarterly summary (for both COP and non-COP programs) of the amount paid each month by target group and procedure code (assessment, case plan, ongoing monitoring) as well as the overall amount paid.

Use of Targeted Case Management Revenues
All revenues received from Medicaid for targeted case management, which partially replace dollars that were originally billed to COP (i.e., COP supplied the match) must be returned to the COP budget. If the initial billing was for assessments and plans, the revenues must be credited back into the COP assessment and plan portion of the budget. If the revenue was for ongoing monitoring, it is credited to the COP services portion of the budget. All revenues which are returned to the COP budget are subject to the same requirements as regular COP funds as described in the COP Guidelines and Procedures.

When billing Medicaid the county must indicate on the claim form whether or not the person is a COP participant. However, if COP is not being billed for any case management costs, then the person should not be coded as a COP participant (e.g., use an "A" code). The federal case management revenues should be reported on the community aids CARS line corresponding to the program from which the local match was provided (e.g., supportive home care, nonfederal CSP program, etc.)

The criterion for determining whether Medicaid case management revenue must be spent in COP is whether COP is used as the funding match source for any of the monthly case management that generated the revenue. For example, if COP performs an assessment and case plan but ongoing case management will not be billed to COP, then the person must be coded as a COP recipient on the claim form when the assessment and case plan is submitted, even if ongoing monitoring is provided in the same month. In subsequent months, since the ongoing case management is not being billed to COP, the person would not be coded as a COP recipient on the Medicaid claim form. If COP match paid for any of the case management activities for the month, the person must be coded as a COP recipient (by using a "B" target code) on the Medicaid claim form and all federal revenue received for that month for that recipient must be returned to the COP budget.

End-of-Year Budget Reconciliation
All Medicaid payments received for case management will be treated as program revenue in the year they are received. Case management revenues will increase the county’s budget for the program (i.e., CARS line) to which the revenues are applied. Revenues received for case management matched by other sources increase the budget of the program (i.e., CARS line) chosen by the county for use of the funds. Any unspent funds will lapse to the state except as the law allows for funds to be carried over.

Billing Medicaid for COP assessments, case plans and ongoing monitoring does not change the way fiscal reconciliation occurs, except that all revenues received from Medicaid during the year for COP funded targeted case management will be credited against total COP expenses. Your COP budget is considered to be increased by an amount equal to Medicaid case management revenues received. The revenues must be credited to the activity billed and may be used for additional assessments, case plans or services (including but not limited to case management). As indicated, Medicaid case management revenue generated through COP is subject to the same requirements as other COP funds.

While reporting on the HSRS system will govern final budget reconciliation for COP, reporting on the CARS (600) system determines monthly advances and should be consistent with the directions for reporting targeted case management expenses and revenues outlined above.

At the end of the year, all Medicaid case management revenue reviews for COP recipients or applicants (when such services were charged to the COP budget) will be treated as COP revenue and subtracted from COP expenditures. For this reason, it is important to accurately keep track of all revenues received during the course of the year in order to know how much additional COP funding is actually available.

MA Case Management and Fiscal Management in COP
Billing Medicaid for assessments, case plans and ongoing case monitoring for Medicaid eligible COP participants does not change the way those activities are reimbursed. A county will be reimbursed
100 percent of its COP assessment rate for each assessment conducted, regardless of whether that assessment is billed to Medicaid. Likewise, a county will be reimbursed the full rate (currently $184) from sub-allocation A for each COP case plan completed. In most circumstances, it will be worthwhile for the county to bill Medicaid for all assessments and plans provided to Medicaid eligible COP recipients. Counties will receive the COP assessment and plan rates plus the federal percentage of allowable charges billed to Medicaid, which are approximately 60 percent of the contracted rate. (For CY 02 the actual federal percentage is 58.57% and the contracted rate is 41.93%.)

It is important to note that when billing Medicaid for assessments and plans, a county should bill the number of actual service hours provided multiplied by its full customary hourly cost. Reimbursement will be the federal percentage of the customary charge up to the federal maximum of $24.56 an hour (as of October 1, 2001). On going monitoring (case management) costs should be billed to COP and to Medicaid based on the agency customary hourly cost.

A certified county agency, which is not the COP lead agency, but which is providing case management for COP recipients could collect the federal revenues as long as the lead agency is not billing Medicaid for case management at the same time. We recognize, however, that for some COP recipients, case management is incurred by both the lead and non-lead agencies. Medicaid will reimburse only one agency for ongoing case management costs. Local agencies must reach an agreement as part of their COP inter-agency agreement as to which agency’s ongoing case management costs will be billed and reimbursed under Medicaid targeted case management. If any case management costs are billed to COP and Medicaid (regardless of which agencies are involved), the person must be coded as a COP recipient on the claim form for that month and revenues received for that month must be reported on the CARS line for the COP.

Medicaid targeted case management cannot be billed for ongoing case management provided to Medicaid Home and Community Based Waiver (CIP 1A, CIP 1B, CIP II, COP-W or BIW) participants by any agency. The assessment and plan provided to a Medicaid eligible individual who later becomes a waiver participant, however, can be billed to Medicaid targeted case management. Case management provided to Medicaid Community Support Program (CSP) participants is reimbursed through the CSP program and cannot be billed to targeted case management. 

Italics indicates most current rate change.

Regional Office Contact:
Area Administrator

Central Office Contact:
Sue Liegel
Bureau of Aging and Long Term Care Resources
P. O. Box 7851
Madison, WI 53707-7851
Phone: (608) 266-9755
Fax: (608) 267-3203
Email: Liegesk@wisconsin.gov

cc:
Area Agencies on Aging Directors
Independent Living Centers
Program Office Directors/Section Chiefs
Tribal Chairpersons/Human Services Facilitators

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