Consumer Directed Service Agency (CDSA) Financial Errors Monitoring Guide DADS Form 1723, Instructions, and Appendices.

Consumer Directed Consumer Directed Service Agency Service Agency

(CDSA)(CDSA)

Financial Errors Financial Errors Monitoring GuideMonitoring Guide

DADS Form 1723, Instructions, DADS Form 1723, Instructions, and Appendicesand Appendices

DADS Form 1723DADS Form 1723

Demographic InformationDemographic Information

1.1. Consumer and EmployerConsumer and Employer

2. CDSA Provider Agency2. CDSA Provider Agency

3.3. Monitor,Monitor, Review Date, Review Review Date, Review

Period, Review TypePeriod, Review TypeContract Monitoring Guide - Page 1

Financial Errors Financial Errors

2.2. TERMINATION TERMINATION of CDS during first 90 of CDS during first 90 days –days – CDSA bills:CDSA bills: (SFY 2004-05 / (SFY 2004-05 / SFY 2006-07SFY 2006-07))

a)a) 0 – 30 Days = $118.68 / 0 – 30 Days = $118.68 / $120.00$120.00

b)b) 31 – 60 Days = $89.01 / 31 – 60 Days = $89.01 / $90.00$90.00

c)c) 61 – 90 = $29.67 / 61 – 90 = $29.67 / $30.00$30.00

Contract Monitoring Guide - Page 1

Note:Note:1.1. ORIENTATION ORIENTATION by CDSA to Employer/DRP by CDSA to Employer/DRP

–– Not a billed serviceNot a billed service

Review documentation of services delivered with service delivery dates during the review period for each service area in CDS:

1. Timesheets, 2. Receipt, 3. Invoices, and4. Documentation of

a) Withholding and Accrual, OR b) Deposit and Payment


ERROR #1 ERROR #1 Reimbursement of services Reimbursement of services notnot documented as being delivereddocumented as being delivered

Error #1 Error #1 Reimbursement of services Reimbursement of services notnot documented as being delivereddocumented as being delivered

Withholdings and Accruals Must be billed only one time. May be billed either:

1. At time withholding/accrualwithholding/accrual is made, OR

2. At time of deposit/paymentdeposit/payment of the withheld or accrued amount.

WithholdingWithholding = Employee and Employer share for taxesAccrualsAccruals = Employer Unemployment Taxes, Benefits (Bonus, Administrative Purchases)


Error #1 Error #1 Reimbursement of services Reimbursement of services notnot documented as being delivereddocumented as being delivered

Withholdings and Accruals MUST be budgeted,


MUST be withheld or accrued only from “WORKED” hours MUST be billed only one time.

ERROR #3 ERROR #3 Reimbursement of services not Reimbursement of services not delivered to the consumer.delivered to the consumer.

Services delivered that were: Services delivered that were: 1.1. Not authorized, Not authorized, 2.2. * * Not “allowable,”Not “allowable,”3.3. Provided on behalf of someone Provided on behalf of someone

other than the consumer.other than the consumer.

* * Refer to Appendix XI and program-Refer to Appendix XI and program-specific requirements/guidelines.specific requirements/guidelines.


ERROR #4 ERROR #4 Reimbursement of services when Reimbursement of services when the consumer was not eligible. the consumer was not eligible.

Services delivered when the consumer Services delivered when the consumer was not eligible for : was not eligible for :

1.1. The program, The program, 2.2. The The **program service,program service,3.3. The funding source, orThe funding source, or4.4. Participation in CDS.Participation in CDS.

** Refer to program-specific requirements/guidelines. Refer to program-specific requirements/guidelines. Example: Not eligible for our-of-home respite.Example: Not eligible for our-of-home respite.


ERROR #5ERROR #5Reimbursement in excess of spending-Reimbursement in excess of spending-limit for administrative expenses by the limit for administrative expenses by the employeremployer

Budgeted amount for AdministrativeBudgeted amount for AdministrativeExpenses:Expenses:

• Budget will not be “Budget will not be “VALIDVALID” if in excess of ” if in excess of

spending limit established by HHSC spending limit established by HHSC

• Budget calculates the spending limit based Budget calculates the spending limit based

on payment rules for CDS.on payment rules for CDS.


ERROR #6ERROR #6CDSA is reimbursed in excess of CDSA is reimbursed in excess of allowable CDSA-portion of the allowable CDSA-portion of the service rateservice rate

Budgeted amount for CDSA-portion is Budgeted amount for CDSA-portion is calculated in the budget based on: calculated in the budget based on:

• The program, The program, • The service, and The service, and

• The service delivery date (SFY) The service delivery date (SFY)

Appendix VI:Appendix VI:

SFY 2004 – 2005 and SFY 2006 - 2007SFY 2004 – 2005 and SFY 2006 - 2007


Appendix XIV Financial MonitoringAppendix XIV Financial Monitoring Worksheet #1Worksheet #1

Financial Review Month:Financial Review Month: June 2005June 2005

REIMBURSEMENT / PAYMENT HISTORYREIMBURSEMENT / PAYMENT HISTORY

EMPLOYER PORTION PAYMENTS Service Begin

Date Service End

Date Number Units

Billed Amount Amount Paid

Bill Code Bill Code Type

06/01/05 06/15/05 709.12 $ 709.42 $ 709.12 G0717 Employer 06/16/05 06/30/05 146.26 $ 146.26 $ 146.26 G0717 Employer $ $ Employer

Employer Portion Totals: 855.36 $ 855.36 $ 855.36

CDSA PORTION PAYMENTS

Service Begin Date

Service End Date

Number Units

Billed Amount

Amount Paid Bill Code Bill Code Type

06/01/05 06/15/05 77.74 $ 77.74 $ 77.74 G0719 CDSA 06/16/05 06/30/05 16.03 $ 16.03 $ 16.03 G0719 CDSA $ $ CDSA

CDSA Portion Totals: 93.77 $ 93.77 $ 93.77

Appendix XIVAppendix XIV Financial Monitoring Financial Monitoring Worksheet Worksheet # 1# 1


REIMBURSEMENT / PAYMENT REIMBURSEMENT / PAYMENT HISTORYHISTORY

TOTAL PAYMENTS Service

Begin Date Service

End Date Number Units

Billed Amount

Amount Paid

Bill Code

Bill Code Type

06/01/05 06/15/05 855.36 $ 855.36 $ 855.36 G0717 Employer 06/16/05 06/30/05 93.77 $ 93.77 $ 93.77 G0719 CDSA

Totals for Service Category:

949.15 $ 949.15 $ 949.15



REIMBURSEMENT / PAYMENT HISTORYREIMBURSEMENT / PAYMENT HISTORY

EQUIVALENT UNITS FOR CALENDAR REVIEW EQUIVALENT UNITS FOR CALENDAR REVIEW MONTHMONTH

Employer Portion Unit Amount

Divided Into

Employer Portion Amount Paid

Equals Employer Portion Equivalent Units

$9.03 / $855.36 = 94.72

CDSA Portion Unit Amount

Divided Into

CDSA Portion Amount Paid

Equals CDSA Portion

Equivalent Units $0.99 / 93.77 = 94.72

Employer Portion

Equivalent Units Minus

CDSA Portion Equivalent Units

Equals Variance

94.72 - 94.72 = 0.00

DADS Form 1723 –DADS Form 1723 – Page 2Page 2


Service Group

Program Type/Name

Service Code

3 CBA 17V

Hour Day $0.82

CDSA PortionEmployer

Portion

Service Category

Personal Assistance Services

Unit Type

10.96%

(F#5) EmpPortion/

1.10=$9.03 $0.99 $10.02

(F#6) CDSA Billing %Total Unit

Rate

Appendix VI – Service Groups, Service Codes, Billing Codes and Partial Billing

Appendix VIII – Calculating Employer’s Maximum Admin. Expense Amount

Appendix VII – FY 2004 – 2005 Community-Based Payment Option

DADS Form 1723 –DADS Form 1723 – Page 2Page 2Financial Review Month:Financial Review Month: June 2005June 2005

Fiscal Audit Sample – Billing and Reimbursement History = $875.00

Review Period Timesheets - $835.00

Calculated Reimbursement Overage = $ 40.00

YES NO

X

Amount

Reimbursed:

$ 875.00

−

Amount Documented:

$ 835.00 =

Amount Not Documented:

$ 40.00

F#1. The provider agency is reimbursed for services/units, but documentation of services is missing or the record of time is blank for the period for which services are reimbursed. DADS applies the error to the total amount reimbursed for the billing peri

Explanation of Financial Errors FindingsDocumentation of services =

timesheet, invoice, receipt, documentation of services delivered forms, etc.


Financial Error #1: Documentation of services is missing or record of time is blank. Calculation of non-reimbursable, excess, Employer Portion Amount (paid and accrued.)

1. Excess Employer Portion Amount for Calendar Review Month – Employees.

EMPLOYEE Name or Initials

Hours Reimbursed

- Reimbursable Hours

= A. Excess Hours

Under Billed Hours

1 J . S. 80.00 - 75.00 = 5.00 0.00 2 B. S. 16.50 - 16.50 = 0.00 0.00 3 - = 4 - =

Totals: 96.90 91.90 A. 5.00 0.00





A. Excess Hours

X Actual Hourly Rate

= Excess

Gross Pay

1 J . S. 5.00 X $ 7.00 = $ 35.00

2 X $ = $ 3 X $ = $ 4 X $ = $

B. Excess Employer

Contributions for Excess

Hours

Total Excess Amount for

Employer Portion Reimbursed for

Employees

Totals: A. 5.00 $ 35.00 + B. $ = C. $

Calculation of non-reimbursable, excess Employer Portion Amount (paid and accrued) for Employees.



Calculation of Employer Contributions for Excess Hours reimbursed for Employees

Total Excess Gross Pay

X Per Cent = Excess Employer

Contribution Type of Contribution

X .0765 = $ 2.680 *FICA (SS/Medicare) X .0080 = $ .280 FUTA $ 35.00 X .0270 = $ .945 SUTA

Actual Amount of Benefits Reimbursed for Excess Hours: $ 3.750 Benefits

B. $ 7.655 *SS = 6.20% MDCR = 1.45%

Gross Pay = # Hours Worked times Hourly Rate + Benefits +

Overtime



Calculation of Employer Contributions for Excess Hours reimbursed for Employees

Gross Pay = # Hours Worked times Hourly Rate + Benefits + Overtime


A. Excess Hours

X Actual Hourly Rate

= Excess

Gross Pay

1 J . S. 5.00 X $ 7.00 = $ 35.00

2 X $ = $ 3 X $ = $ 4 X $ = $

B. Excess Employer

Contributions for Excess

Hours

C. Total Excess Amount for

Employer Portion Reimbursed for

Employees

Totals: A. 5.00 $ 35.00 + B. $ 7.66 = C. $ 44.32

Appendix XIV Financial MonitoringAppendix XIV Financial Monitoring Worksheet Worksheet ## 5 and # 65 and # 6

No Administrative Expense Budgeted for June 05

Financial Error #5: Reimbursement in excess of the maximum amount allowed for employer-related administrative services. Calculation of non-reimbursable, excess, Employer Portion Amount (paid and accrued.)

1. Calculation of Maximum Employer Administrative Costs for Calendar Review Month

Employer Administrative Expense Amount

Employer Maximum Amount per Unit $ 0.82/Unit

Reimbursable Employer Unit Equivalent for Month X 91.90/ Units

Maximum Reimbursable Employer Administrative Cost / Month = $ 75.36

Appendix XIV Financial MonitoringAppendix XIV Financial Monitoring Worksheet Worksheet ## 5 and # 65 and # 6

Financial Error #5: Reimbursement in excess of the maximum amount allowed for employer-related administrative services. Calculation of non-reimbursable, excess, Employer Portion Amount (paid and accrued.)

2. Calculation of Available (Current Month and Accrued) Employer Administrative Costs

Maximum Reimbursable Employer Administrative Cost / Month $ 00.00

Accrued Amount Remaining from Prior Months + $ 45.84

Total Reimbursable Employer Administrative Cost = $ 45.84

3. Calculation of Excess Employer Administrative Cost Reimbursed

Total Reimbursable (Available + Accrued) Employer Administrative $ 45.84

Actual Employer Administrative Amount Reimbursed - $ 00.00

F#5 Excess Amount of Employer Administrative Cost = $ 0.00

Appendix XIV Financial MonitoringAppendix XIV Financial Monitoring Worksheet # Worksheet # 5 and #65 and #6

Financial Error #6: Reimbursement in excess of the allowable CDSA Portion. Calculation of non-reimbursable, excess, CDSA Portion Amount paid.

1. Calculation of the total amount that the CDSA can bill for the CDSA Portion

Category Amount

Total Reimbursable Employer Amount for the Month $ 811.04

CDSA Billing % of Employer Portion X .10963 %

CDSA Portion Reimbursable Amount = $ 88.91

2. Calculation of excess billing or under billing by the CDSA for the CDSA Portion

CDSA Portion Reimbursable Amount $ 88.91

Reimbursed CDSA Portion -- $ 93.77

F#6 Excess CDSA Portion Amount Reimbursed = $ 4.86 CDSA Portion Under Billed $ 0.00

Financial Review Month: June 2005



F# 5. The provider agency is reimbursed in excess of the maximum amount allowed for employer-related administrative expenses. (Employer-Related Administrative Expenses: advertising/recruiting, training, criminal investigation checks, equipment, copy, mail, travel costs, supplies, uniforms, Hep B vaccinations, CPR) DADS applies the error to the total amount reimbursed in excess of the maximum amount allowed and/or budgeted for the cost. [Employer Portion / 1.10]

Maximum Admin:

Accrued +Total =

$ 0.00$ 45.84$ 45.84

−Amount

Reimbursed: $ 0.00

=

Excess Amount Reimbursed:

$ 0.00



F# 6. The provider agency is reimbursed in excess of the allowable CDSA portion. DADS applies the error to the total dollar amount reimbursed in excess of the allowable CDSA portion.

X

CDSA Reimbursed Amount: $ 93.77

−Reimbursable

Amount: $ 88.91

=Excess Amount

Reimbursed: $ 4.86

Note: The calculation worksheet is available in Appendix XIV of the Consumer Directed Services Handbook.

DADS Form 1723DADS Form 1723 – – Page 1Page 1

Texas Department of Aging and Disability Services

Consumer Directed ServicesConsumer Directed Services Agency (CDSA)

Financial Errors

Form 1723August 2005

Case Record Summary of Financial Errors100% Financial Recoupment

Error No.

Service Code

Service Category

Billing Type: Employer/

CDSA

Billing Code

Total Recoupment

1 17V CBA - PAS Employer G0717 $ 44.32 6 17V CBA - PAS CDSA G0719 $ 4.86

Total Recoupment Amount: $ 49.18

Consumer Name Sue Smith

Medicaid No. 123456789

Date of Review 12/05/05

Review Month 06 / 2005

DADS Form 3687DADS Form 3687 – – Page 1Page 1

Texas Department of Aging and Disability Services

Provider Agency Findings of Fiscal Monitoring Review

Form 3687June 2001

SERVICE CODE 1.

FINANCIAL AMOUNT TO BE RECOUPED

2. ADMINISTRATIVE

AMOUNT TO BE RECOUPED

3. TOTAL (Admin. &

Financial) AMOUNT

17V / G0717 CBA $ 249.18 $ 284.66

$ 31.21 17V / G0719 CBA $ 27.32 $ 31.21

11B / G0133 $ 35.48 $ 35.48

11B / G0172 $ 3.89 $ 3.89

1A 2A 3A

= A. Total to be

Recouped

$ 315.87 +

$ 0.00

$ 315.87 B.

Total Dollar Amt. Reimbursed for Clients Reviewed

$ 5,061.85

C. Error Rate (1A ÷ B) 6.24 %

DADS Form 3687DADS Form 3687 – – Page2Page2Texas Department of Aging and Disability Services

Form 3687June 2001 TYPE OF FINANCIAL ERROR

TOTAL REIMBURSEMENT

AMOUNT (From Item C – Financial Errors Standard Form)

SERVICE CODE CLIENT NAME (1) (2) (3) (4)

17V / G0717 Sue Smith $ 44.32 1

17V / G0719 Sue Smith $ 4.86 6

17V / G0717 Bob Travis $ 125.32 1

17V / G0719 Bob Travis $ 13.74 6

17V / G0717 Jack Jones $79.54 1

17V / G0719 Jack Jones $ 8.72 6

11B / G0133 Bob Travis $ 35.48 2

11B / G0172 Bob Travis $ 3.89 6

Employer Portion $ 284.66

CDSA Portion $ 31.21 6

ReimbursementReimbursement CDSA ResponsibilitiesCDSA Responsibilities

Verification:Verification: Spending Limits

Withholdings

Benefits

Hourly Wages

Overtime

Allowable

Program-specific

Funding Source

Validation:Validation:

Budget:

“VALID” Status

Budgeted Item

Service Provider:

Qualified

Eligible

Documentation of Service Delivery – Program Specific and CDS Criteria

1. Budget Verification and Validation

ReimbursementReimbursement CDSA ResponsibilitiesCDSA Responsibilities

Verification:Verification: Budgeted

Allowable

Reasonable

Necessary

Year-to-Date

Program-specific

Funding Source

Validation:Validation:

Service Provider:

Qualified / Maintained

Eligible / Maintained

Documentation of Service Delivery – Timesheets, Invoices, and Receipts

Program Specific Criteria

CDS Criteria

Employer-Approved

2. Spending Verification and Validation

CDSA CDSA Financial Financial

MonitoringMonitoring

Comments

Q & A

Consumer Directed Service Agency (CDSA) Financial Errors Monitoring Guide DADS Form 1723, Instructions, and Appendices.

Documents

financial review month

financial monitoring

calendar review month

review date

billed service slide

overtime slide

reimbursement of services

review type period