Financial Management Guidebook Overview

[Pages:87]Financial Management Guidebook

Financial Management Guidebook Overview

HCSIS Financial Management (FM) is designed specifically to support individual plans and a budget for each individual served in the Office of Developmental Programs (ODP) Mental Retardation (MR) program. The FM module allows county users to monitor the financial status of each individual and of all individuals with services funded by the county. HCSIS is integrated with PROMISeTM, the Department of Public Welfare's (DPW's) claims processing system, to approve claims authorized in an individual's plan and to keep track of payments made on behalf of the individual.

The HCSIS Financial Management (FM) Guidebook is a reference manual for counties and the ODP providers using HCSIS FM and PROMISeTM claims processing. You will find the information contained in the guidebook useful throughout initial implementation, for the months after go-live, and at fiscal year end to prepare for opening the upcoming fiscal year. The most up-to-date version of the guidebook is available by accessing the Learning Management System (LMS) website. Click the HCSIS Information link on the LMS Home Page and download the most recent version of the FM Guidebook.

10/24/2015

HCSIS v7.13

1

Financial Management Guidebook

Table of Contents

WHAT'S NEW FOR ODP FM FOR FY 2010-2011 .................................................................................... 3 DEFINITION OF FINANCIAL MANAGEMENT (FM) TERMS ........................................................................... 5 FINANCIAL MANAGEMENT ROLES AND RESPONSIBILITIES...................................................................... 14 THE PROMISETM/CIS/HCSIS RELATIONSHIP...................................................................................... 15 LIFE OF AN ODP CLAIM ...................................................................................................................... 17 STEPS FOR PROVIDERS USING HCSIS FINANCIAL MANAGEMENT.......................................................... 20 STEPS FOR COUNTIES USING HCSIS FINANCIAL MANAGEMENT............................................................ 26 APPENDIX A: SERVICE LOCATION AND SITE TIP SHEET ........................................................................ A1 APPENDIX B: FINANCIAL MANAGEMENT ACRONYMS............................................................................. B1 APPENDIX C: HCSIS FINANCIAL MANAGEMENT ROLE TEMPLATES ........................................................C1 APPENDIX D: STEPS FOR OFFICE OF DEVELOPMENTAL PROGRAMS (ODP) PROVIDER ENROLLMENT......D1 APPENDIX E: IMPORTANT CONTACT INFORMATION .............................................................................. E1 APPENDIX F: FINANCIAL MANAGEMENT CHECKLISTS ............................................................................ F1 APPENDIX G: HELPFUL MATERIALS AND BOOKMARKS..........................................................................G1 APPENDIX H: PROVIDER PAYMENT FILE LAYOUT AND INSTRUCTIONS....................................................H1 APPENDIX I: COUNTY PAYMENT FILE LAYOUT AND INSTRUCTIONS ......................................................... I1 APPENDIX J: PROVIDERS: RETRIEVE, DOWNLOAD AND IMPORT PAYMENT FILE...................................... J1 APPENDIX K: COUNTY: RETRIEVE, DOWNLOAD AND IMPORT PAYMENT FILE .......................................... K1 APPENDIX L: SET UP YOUR PAYMENT FILE ACCOUNT (PROVIDER) ....................................................... L1 APPENDIX M: SET UP YOUR PAYMENT FILE ACCOUNT (COUNTY) ........................................................ M1

10/24/2015

HCSIS v7.13

2

Financial Management Guidebook

What's New for ODP FM for FY 2010-2011

In FY 2009-2010, ODP began operating under a Waiver Capacity Management model. Beginning with FY 2009-2010, ODP provided (and will continue to provide every fiscal year) each AE with notification of the number of waiver participants the AE can enroll in each waiver at any given time during the fiscal year. AEs are expected to track enrollments against the number of participants provided in their Waiver Capacity Commitment Letter, while ODP will track expenditures against the statewide legislative appropriations.

HCSIS functionality had been modified to support Waiver Capacity Management at the end of July 2009. Additional enhancements were added in September, followed by the Enterprise Rate Service (ERS) added in April 2010. The highlights are noted in the table below.

Functional Area

Service Authorization

Projected Plan Budget Amount Master contracts and service contracts

New reports

New Functionality

When plans are approved, funding streams are pre-populated based on waiver eligibility of individual.

When waiver plans are approved, the ISP Approval role will authorized the services at the same time on the Authorize Services screen Plan > Plan Admin > Pending Approval/Review.

Only base funding streams are available to fund services on the Authorize Service screen Financial > Individual > Authorize Service.

Funding streams can be changed by a simple edit on the Authorize Service screen.

There is no comparison of the Plan Budget Total and Projected Plan Budget Amount when approving waiver-funded plans.

Waiver master and service contracts are created by HCSIS automatically, based on rates derived from provider cost reports and entered into PROMISeTM. Contracts will not be created unless: o The provider is qualified o The provider's service location is enrolled in PROMISeTM o The provider has updated service offerings in their SSD

Base-only master contracts and service contracts are created by the County Contract Administrator role when a rate has been negotiated and recorded in HCSIS.

Waiver Capacity Allocation Information Report Waiver Funding Level Report Individuals in Queue Report Waiver Enrollment Report Enrollment Indicators Report (General) Enrollment Indicators with Details Report Provider Service Details Report

10/24/2015

HCSIS v7.13

3

Financial Management Guidebook

Functional Area

Introduction of Enterprise Rate Service (ERS) Enhanced Mass Rate Change (MRC) Tool

End Date ODP Service Offering Tool Addition of a FY Parameter on Add Services screen

New Functionality

Contract Creation Exception Report

Rates for waiver and base services are stored in PROMISeTM and contract information is maintained in HCSIS.

During the contract creation process, information is shared between HCSIS and PROMISeTM, meaning that some PROMISeTM validations must pass before certain actions can be completed in HCSIS; e.g., if a provider service location is not enrolled in PROMISeTM, a contract will not be created in HCSIS.

When a waiver-funded rate is updated in PROMISeTM, the MRC tool gives ODP the ability to update the rate on the service contract in HCSIS.

Counties may use the MRC tool to update baseonly service rates in HCSIS.

As part of the MRC process, all impacted plans will be updated automatically with the new rate of the service contract.

The new tool has additional enhancements to increase automation and flexibility, such as the ability to update a service contract at any point in time and to freeze plans when a mass rate change is in progress.

The new tool allows retroactive rate changes, midyear rate changes, and includes an automated process to split units on the plans affected by the MRC.

Counties will be notified via alerts when waiver MRCs affecting their county are initiated by ODP and will have the opportunity to update plans associated with this change.

The process allows ODP to end-date provider service offerings, service contracts, and services on plans.

This action, performed in conjunction with a county, provides a streamlined method for end-dating offerings and contracts when a provider moves, closes a service location, or goes out of business.

Regional and county users can use this functionality to view all contracts, ISPs, and submitted claims associated with a service location.

A fiscal year option has been added on the Services screen in Provider Access to assist providers in selecting the correct service when adding services to their SSD.

10/24/2015

HCSIS v7.13

4

Financial Management Guidebook

Definition of Financial Management (FM) Terms

The Definition of Terms section defines some of the terms used throughout the Financial Management Guidebook. For a more complete list of FM terms, please refer to the FM Glossary of Terms available on the Learning Management System (LMS) website.

Allocation

Allocation is the term used by ODP to represent the financial resources designated to each county/joinder to fund a specific base funding stream within a specific fiscal year. County overbooking, another financial resource, can supplement the allocation.

Allocation Upload Utility

The Allocation Upload Utility is the computer application that uploads and finalizes base financial information in HCSIS. In the process of both uploading and finalizing the information, a File Upload Log is created to document any errors that occurred. During an upload, the Allocation Upload Utility converts the financial information in the HCSIS Upload Excel File and copies it into a temporary section of HCSIS. During the finalize process, the information is copied from the temporary section of HCSIS and saved in HCSIS as real data. The finalized information remains in the temporary section of HCSIS until another upload of the same type overwrites it. For example, if the tentative/primary allocation was finalized and, subsequently, a re-budget was uploaded, there will be two uploads in the temporary section of HCSIS: one with the uploaded re-budget and another with the finalized tentative/primary allocation.

Appropriation

Appropriation is the term used by ODP to represent the financial resources designated to each AE to fund a specific waiver funding stream within a specific fiscal year.

Authorized Service

An authorized service is one that has been authorized for payment. Funds are encumbered when services are authorized. The ISP Financial Support or County Financial Manager role can authorize services for the current fiscal year only. Services for the upcoming fiscal year can be pre-authorized, but not authorized. As the upcoming fiscal year approaches, performing the R2E process successfully converts the pre-authorized services to authorized services.

Claims

Claims are provider payment requests based on services rendered to individuals. PROMISeTM is the system providers use to submit claims for payment. PROMISeTM interfaces with HCSIS to confirm the following service information on a claim: the individual, service, units, rate, service dates, etc.

Consumer Funding Stream Planning Report

Consumer Funding Stream Planning Report lists all funding streams that exceed the current year's allocation and shows the breakdown of financial commitments for all individuals within each funding stream (base-only).

Note: The current year's overbooking and non-service encumbrance will not be taken into account on the Future Funding Stream Exception and Consumer Funding Stream Planning reports. As a reminder,

10/24/2015

HCSIS v7.13

5

Financial Management Guidebook

when comparing the reserves to an allocation, these reports use the current fiscal year allocation, because next year's allocation has not been uploaded.

Contracts: Real and Provisional On-hold

Contracts are what HCSIS uses to record the provider's services and rates that can be added to an individual's plan in HCSIS. A provisional on-hold contract is created automatically when an individual's fiscal year renewal plan is created for the next fiscal year. The provisional on-hold contract is for planning purposes, and uses the previous year's rate as a placeholder. Services with provisional on-hold contracts can be added to plans, but cannot be authorized.

When a Fiscal Year (FY) Renewal plan is initiated, provisional on-hold contracts will be created automatically in HCSIS for all services included on the plan that are valid for the next FY. The provisional on-hold contracts will use the previous FY rate as a placeholder.

A real contract must exist for a service to be authorized on a plan and for claims to be paid. The real contract exists at the assigned rate for the service.

For base-only services, the County Contract Administrator can convert provisional on-hold contracts to real contracts through the Manage Service Contracts screen in HCSIS (Financial > Providers > Manage Service Contracts).

For waiver services, HCSIS will create real contracts automatically for service offerings with no contract or with a provisional on-hold contract when all of the following conditions are met:

Service offering is listed in the provider's Services & Supports Directory (SSD).

Provider is qualified for the specialty associated with the service.

Rate is available in PROMISeTM for the service (requires pre-requisite PROMISeTM

enrollment).

Note: Vendor, FMS, and individualized services do not follow the real/provisional on-hold definitions listed above. Individualized services do have contracts that will be real or provisional on-hold, however, an individualized service rate can be changed directly in an individual's plan.

County Funding Level Report

This report contains the same information as on the Funding Level screen; however the benefit is the report shows all base funding streams. The report is organized by funding stream and is available as on off-line report.

County Match

County Match is the service cost that the county/joinder must pay directly when certain services are funded by specific base-level funding streams. For these services, the county pays 10% and the State pays 90%. The amount that the county/joinder owes is calculated automatically based on the funds encumbered (services authorized) using these specific base-level funding streams. The 10% county match is a financial resource because it does not reduce the funding stream's allocation since the county/joinder must pay the 10% county match.

County Match Report

County Match Report lists the funding streams for which the county must match funds for a specific fiscal year because of the 90/10 rule.

10/24/2015

HCSIS v7.13

6

Financial Management Guidebook

County Overbooking County overbooking is a financial resource that the county uses to exceed (i.e., overbook) the state allocation. County overbooking is a separate line of funding that is used to encumber funds above the allocation amount.

Eligibility The term Eligibility, as it relates to Financial Management, refers to the eligibility status of a funding stream. If a funding stream is marked as eligible, it means that the services are eligible for Federal Financial Participation (FFP).

Encumbrance An encumbrance is the amount of funds set aside for authorized services within a funding stream. Before the fiscal year begins, funds have to be encumbered for all services so that claims can be paid for those services in the next fiscal year.

Enterprise Rate Service (ERS) This initiative established PROMISeTM as the central Enterprise Rate Repository. Waiver service rates are entered into PROMISeTM by each program office. Base-only service rates continue to be entered into HCSIS by the County Contract Administrator, and HCSIS sends the rates to PROMISeTM.

Financial Management (FM) Financial Management is the HCSIS process used to establish ODP's funding structure, analyze financial information, encumber funds, track utilization, and validate provider claims for all funding streams supported by HCSIS.

Fiscal Year ODP determines funding on a fiscal year basis. A fiscal year runs from 7/1 to 6/30. All financial resources (allocations, overbooking, revenue adjustments) and financial commitments (encumbrance, pre-encumbrance, non-service encumbrance, reserves, expensed/billed services) are tracked on a fiscal year basis.

Funding Stream The term funding stream is used in HCSIS to identify the source by which services are funded. For ODP, the funding streams are the categoricals for waivers and programs by county/joinder. Countylevel revenue adjustments are recorded in HCSIS as funding streams (bank interest, donations, for example). A county/joinder's financial resources and financial commitments are tracked at the funding stream level.

Future Funding Stream Exception Report Future Funding Stream Exception Report summarizes only the funding streams that have a negative available dollar amount for the upcoming fiscal year (base-only).

Non-Service Encumbrance Non-service encumbrance amounts are financial commitments made by the county that decrease available dollars within the corresponding funding stream. A non-service encumbrance is an amount

10/24/2015

HCSIS v7.13

7

Financial Management Guidebook

encumbered from a funding stream during the current fiscal year for non-service related costs. These funds will be unavailable for service related costs.

Overbooking Overbooking is a financial resource that the County Financial Manager uses to exceed (i.e., overbook) the state allocation. However, there are no funds in place to cover the overbooking unless revenue adjustments are designated to reduce an overbooking.

Pending Service

A pending service is the default status of a new service added to a plan. Additionally, if an authorized or pre-authorized service is changed on a plan, the service's status will revert to pending. Pending services have no financial impact until their status changes to authorized or pre-authorized.

Provider claims filed against pending services will be rejected because a service authorization decision has not been made.

Plan Approval or ISP Approval

Plan Approval (or ISP Approval) is the process of reviewing and approving the information in an individual's plan. The ISP Approval role performs this task in HCSIS. Plan approval triggers the service authorization process for waiver funded plans, including the association of the appropriate waiver funding stream with the service. For base-funded plans, the ISP Financial Support or County Financial Manager must authorize services via the Authorize Service screen after verification of available funds.

Any pending services that were changed via a critical revision to either decrease service units or change service dates will revert to their previous status (authorized or pre-authorized) after plan approval. In other words, the service authorization process is not necessary. Claims submitted against previously authorized services while the ISP is in draft form will be processed against the service as if the plan was in approved status.

Plan Budget A plan budget is the sum total of all services on an individual's plan. For base-only services, to complete the approval process successfully in HCSIS, the plan budget cannot exceed the individual's projected plan budget amount. This validation is not required for waiver funded services.

Plan Year A plan year is the timeframe that an individual's plan is valid. It can be up to 365 days. A plan for an individual served under a waiver or program administered by ODP may cross fiscal years.

Pre-Authorized Service

A pre-authorized service is one that the ISP Financial Support or County Financial Manager role approved via the service authorization process, but the service dates are in the next fiscal year. Funds will not be encumbered for pre-authorized services until R2E is performed for that fiscal year. Provider claims submitted for pre-authorized services will be denied.

10/24/2015

HCSIS v7.13

8

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download