Project Manager for a DMH FFS/MC Psychiatric Inpatient Data Analysis project. We compiled data on Short-Doyle/Medi-Cal (SD/MC) and Fee-for-Service/Medi-Cal (FFS/MC) psychiatric inpatient rates of treatment and payments for the California Department of Mental Health (DMH). Data was compiled based on different variables, including age, gender, Medi-Cal aid code group, and ethnicity. Charts were then prepared based on the compiled data and distributed to various stakeholders.
Project manager on an engagement to assist the Department with the consolidation of Fee-for-Service/Medi-Cal (FFS/MC) funding and Short-Doyle/Medi-Cal (SD/MC) funding for acute psychiatric inpatient services. The main objectives of this project were to: (1) determine total FFS/MC funding for acute psychiatric inpatient services, (2) determine the amount of State General Funds (SGF) to be transferred from the Department of Health Services (DHS) to the DMH for FFS/MC psychiatric inpatient services, (3) identify and evaluate alternative allocation methodologies for distributing the SGF amount to the counties, and (4) identify cost saving to the DHS as a result of psychiatric inpatient funding consolidation.
Lead consultant on an engagement to provide technical assistance on cost reporting/data collection system deficiencies in the Short-Doyle/Medi-Cal program. The Short-Doyle/Medi-Cal program receives over $800 million annually in federal financial participation for providing mental health services to Medi-Cal eligible persons. In 1987, the Short-Doyle/Medi-Cal Cost Reporting/Data Collection system was found to be deficient by federal Medicaid cost reporting standards. The objectives of this study were to (1) develop an understanding of the current Short-Doyle/Medi-Cal cost reporting environment, (2) address deficiencies identified in the Cost Reporting/Data Collection system, and (3) develop a revised Short-Doyle/Medi-Cal cost reporting system to meet federal Medicaid and Medicaid standards. Activities performed under Phase II of this engagement included (1) developing automated spreadsheets to facilitate completion of the new cost reporting system, (2) providing on-site training to all 58 counties in California on how to complete the new cost reports, and (3) providing on-call technical assistance for any questions relating to the new cost reporting system.
Project manager on an engagement to assist the Department of Mental Health (DMH) in development and implementation of a new rate setting methodology for the Short-Doyle/Medi-Cal (SD/MC) program. Phase I of this project involved (1) analysis of alternative rate setting methodologies and (2) development of a proposed rate setting methodology based on this analysis. Alternative rate setting methodologies considered for the SD/MC program included prospective payment systems, cost-based reimbursement systems, and fee-for-service reimbursement systems. The second phase of this project included implementation of the proposed rate setting methodology. As part of this phase, the estimated impact of the proposed rate setting methodology on SD/MC reimbursement was computed. Also, reimbursement rates under the proposed rate setting methodology were compared to current SD/MC reimbursement rates. Finally, the SD/MC cost report system was modified to conform to the cost reporting requirements of the proposed rate setting methodology.
Project manager on an engagement to assist the Department with the consolidation of three cost reports: the State Cost Reporting/Data Collection (CR/DC) cost report, the Short-Doyle/Medi-Cal (SD/MC) cost report, and the Medicare partial hospitalization cost report. Previously, counties were required to complete all three cost reports in order to obtain federal and state funding. The objectives of this project were to develop a single cost reporting system that met federal and state regulations and minimized the workload to counties.
Project manager to conduct the evaluation of two federal Medicaid Freedom of Choice Waivers in California (e.g., Medi-Cal Psychiatric Inpatient Hospital Services Consolidation Waiver and Medi-Cal Mental Health Care Field Test-San Mateo County Waiver). The scope of this project involved evaluating Medi-Cal beneficiary access to services, quality of services, and cost effectiveness of services under the two Waiver Programs. Site visits were conducted at seven counties to review relevant Medi-Cal mental health statistics and program information. Statewide data also was collected from the State Department of Mental Health. The data was compiled and analyzed, and the results showed that both Waiver Programs did not impair Medi-Cal beneficiary access to services or reduce the quality of mental health services to Medi-Cal beneficiaries, and were more cost effective than the previous service delivery programs.
Project manager to provide financial technical assistance in the implementation of Medi-Cal mental health managed care. This three-year engagement included providing services on an on-call, as needed basis, and included the following tasks:
- Determine total FFS/MC funding for psychiatrist and psychologist services
- Determine the amount of State General Funds (SGF) to be transferred from the Department of Health Services (DHS) to the DMH for FFS/MC psychiatrist and psychologist services
- Prepare cost effectiveness demonstration calculations for the Freedom of Choice Waiver required to consolidate Medi-Cal psychiatrist and psychologist services
- Identify and evaluate alternative mechanisms for updating the baseline for Early Periodic Screening, Diagnosis, and Treatment Services (EPSDT)
- Conducting ad-hoc analyses and comparisons for DMH management.
Project manager to prepare cost effectiveness demonstration calculations for the San Mateo County Mental Health Field Test Waiver. As part of this study, we compiled historical paid claims data and estimated future costs under the Waiver and without the Waiver. The cost effectiveness calculations we prepared will be used in subsequent Waiver evaluations to determine whether the Waiver was cost effective or not.
Project manager to assist the Department in preparing a legislatively mandated analysis of the impact of the Health and Welfare Realignment Program on mental health services and funding. The Health and Welfare Realignment Program transferred financial responsibility for most of the mental health and public health programs, and some of the social service programs, from the state to local governments and provided counties with a dedicated revenue source to pay for these changes. Tasks we performed under this project included comparing each individual county’s revenues under realignment with growth in population and inflation and evaluating each county’s mental health expenditures and funding sources.
Project manager to prepare cost effectiveness demonstration calculations for the Medi-Cal Specialty Mental Health Services Freedom of Choice Waiver. As part of this study, we compiled historical paid claims data and estimated future costs under the Waiver and without the Waiver. The cost effectiveness calculations we prepared will be used in subsequent Waiver evaluations to determine whether the Waiver was cost effective or not.
Project manager to conduct an analysis of San Mateo County Mental Health Plan (MHP) pharmacy and laboratory costs under a federal Freedom of Choice Waiver in order to determine (1) whether the risk corridor should apply to historical expenditures and (2) what future year pharmacy and laboratory costs are estimated to be. The results of the analysis showed pharmacy and laboratory costs were not increasing at the rate projected by the MHP and that the MHP had been overpaid for some services.
Project manager to develop the rate setting methodology and computed the Statewide Maximum Allowance (SMA) for Therapeutic Behavioral Services (TBS). We also drafted a Medicaid State Plan Amendment as part of this project.
Project manager to evaluate the impact of negotiated rate reimbursement methodology on the State General Fund payments for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services funding through the Department of Mental Health. The results of the study showed that the negotiated rate reimbursement methodology had no impact to date on EPSDT State General Fund reimbursements.
Project manager to assist the Department with development of a new rate setting methodology for non-contract FFS/MC psychiatric hospital inpatient services. The current methodology does not provide sufficient incentives for Mental Health Plans or hospitals to enter into contracts, and the resulting rate paid to non-contract hospitals does not necessarily reflect market conditions. Tasks performed under this engagement included meeting with stakeholder groups to further define the issues and identify alternative rate setting approaches that provide meaningful incentives and assisting the Department with modifications to regulations and/or contract requirements.
Project manager to conduct an analysis of the case rate reimbursement system for the San Mateo County Mental Health Field Test Waiver. The San Mateo County Mental Health Plan operates under a federal Freedom of Choice Waiver whereby they are reimbursed based on case rates rather than based on units of service as the regular Short-Doyle/Medi-Cal (SD/MC) program. As part of this analysis, we analyzed Medi-Cal costs under the case rates and compared these costs to reimbursement under the case rates and what reimbursement would have been under the Short-Doyle/Medi-Cal program. Discrepancies were documented in a letter report to the Department.
Project manager to conduct an analysis of rebasing the Statewide Maximum Allowances (SMAs) for Short-Doyle/Medi-Cal (SD/MC) services. The $1 billion SD/MC program is a cost-based system where SMAs serve as maximum reimbursement rates. In 1993, we developed the rate methodology to establish the SMAs. The Department needed to rebase the SMAs to reflect more recent fiscal year 2001/02 cost data and to consider alternative rate methodologies. As part of this project, we computed SMAs under several alternative methodologies, compared the impact on federal and state reimbursement, and assisted the Department in obtaining a State Plan Amendment to implement the SMAs.
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