Wisconsin Medicaid Cost Reporting (WIMCR) Instruction Manual Guide to WIMCR Cost... ·...

WIMCR Support • [email protected] • (866) 803-8698

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Wisconsin Medicaid Cost Reporting (WIMCR)

Instruction Manual

Last Updated April 27, 2018

mailto:[email protected]


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TABLE OF CONTENTS

SECTION I – INTRODUCTION TO WIMCR COST REPORTING

A. WIMCR Program Overview B. CCS Program Overview C. CRS Program Overview D. Purpose of the WIMCR Cost Report E. Allowable and Reasonable Cost F. Time/Cost Tracking and Record Keeping Requirements G. Introduction to the WIMCR Cost Report Webtool

SECTION II – NAVIGATING THE COST REPORT Webtool

A. Accessing the WIMCR Webtool

B. Navigating the Dashboard • Accessing Cost Report • Progress Bar • County Overview • Resources • Important Dates

C. User Management and WIMCR Notifications

• Creating a User Account • User Levels • Purpose of Notifications • Notification Management

SECTION III – COMPLETING THE WIMCR COST REPORT

A. General Cost Report Functionality • Navigating Between Cost Report Pages • Timeout Functionality • Hover-Over Explanation • Report List Functionality • Save & Close vs. Save & Continue • Add/Delete Row • Import/Export • Printing • Program, Professional Type and Category Summary Data • Desk Reviews

B. Cost Report Pages

• County Agency Overview • WIMCR Direct Service Checklist

• Direct Service Data by Professional Type • Direct Service Non-Personnel Cost • WIMCR Direct Support • Supplemental Direct Service Information

o Group Services o Prenatal Care Coordination, Personal Care Nurses, Home Health o Crisis Intervention o CRS (Community Recovery Services) CLSS Per Diem Worksheet o CCS (Comprehensive Community Services) Regional Information

• WIMCR Overhead • Federal Funds and Reductions



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• Summary and Certification

C. WIMCR Desk Review • Goals of Updated WIMCR Desk Review

• Desk Review Structure and Process • PCG Response • Provider Response • Desk Review Email Notifications

SECTION V – MANAGEMENT REPORTS SECTION VI – CERTIFIED PUBLIC EXPENDITURE FORMS APPENDIX A – CRISIS STABILIZATION APPENDIX B – PROGRAM AND PROFESSIONAL LEVEL REQUIREMENTS



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SECTION I – INTRODUCTION TO WIMCR COST REPORTING

A. WIMCR Program Overview The WIMCR program, is a cost-based payment system for counties certified as Medicaid providers of community-based services.

WIMCR is administered by the Division of Health Care Access and Accountability (DHCAA) in the Wisconsin Department of Health

Services (DHS). County providers participating in WIMCR receive a Medicaid payment from DHS based on actual costs incurred, as

reported on annual cost reports.

WIMCR payments are funded by General Purpose Revenue (GPR) and federal Medicaid matching funds. Each county’s Community

Aids Basic County Allocation (BCA) will be:

• Readjusted to reflect Medicaid cost reporting payments.

• Increased by maintenance of effort (MOE) amounts.

• Checks received by counties will reflect total WIMCR payment and MOE. DHS has implemented a new policy which eliminated

the BCA clawback. There will no longer be a CARS adjustment following the receipt of the initial WIMCR check.

The WIMCR tool includes services provided by county agencies for calendar year dates of service. These services include:

• Adult mental health day treatment service

• Child/adolescent day treatment services

• Community support program services (the non-federal share of this service is provided by the county)

• Crisis intervention services, hourly (the non-federal share of this service is provided by the county)

• Crisis Stabilization per diem services (the non-federal share of this service is provided by the county)

• Home health services

• Outpatient mental health and substance abuse services, including evaluation, psychotherapy, substance abuse counseling,

and intensive in-home mental health services for children under HealthCheck

• Outpatient mental health and substance abuse services provided in the home and community (the non-federal

share of this service is provided by the county)

• Personal care services

• Prenatal care coordination services

• Substance abuse day treatment

• Targeted case management services (the non-federal share of this service is provided by the county)

• Comprehensive community service (CCS)

• Community recovery services (CRS)

Centers for Medicare and Medicaid Services (CMS) require that

federal payments are based on actual allowable and

documented costs calculated using an assured cost-based

accounting methodology. Consequently, county agencies are

required to submit a cost report which reflects all WIMCR, CCS

and CRS services that are provided by Medicaid certified

providers.

Each county agency providing one or more WIMCR, CCCS and/or CRS service programs paid for by Medicaid, and listed above, is

required to complete an annual WIMCR cost report. Cost reports are not required for any service program for which Medicaid

payments were not received for the applicable time period.

For a county to receive its proper share of the payments, each county agency’s cost report must reflect all of their cost associated

WIMCR Cost Reporting: The requirement that each county

agency will submit only one report with consolidated data for

all applicable WIMCR services was implemented for dates of

service on or after January 2013. In the past, all county

providers were required to submit a unique cost report for

each Medicaid provider ID for every WIMCR service program

paid for by Medicaid.



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with all applicable WIMCR programs. Medicaid payments to counties may be withheld or recouped if a complete cost report is not

submitted in a timely manner.

As county agencies navigate through the WIMCR cost report, the report will trigger edits following the completion of each cost report

section. These edits are designed to ensure the appropriateness and accuracy of the information reported.

The State, the WIMCR coordinator, and/or single county or state auditors may also follow-up with county agencies with cost reports

that result in unusually low or high rates compared to other county agencies. Additionally, the WIMCR coordinator will monitor

all significant year to year changes in WIMCR cost reported by each county agency. Agencies that receive funding for Wisconsin

Medicaid Cost Reporting programs directly from the Department of Health Services are subject to audit. The audit guidelines are

posted within the 2018 DHS Audit Guide and are used in conjunction with the “2015 State Single Audit Guidelines Main Document,”

and appendices from other departments. These documents are online at https://doa.wi.gov/Pages/State-Single-Audit-

Guidelines-%28SSAG%29---2017.aspx.

This manual serves to guide providers through the completion of the WIMCR cost reports. The following addresses the purpose of

the cost reports, how to submit reports into the system, what a reporting system user should expect when submitting reports, and

additional features of the system. If additional assistance is needed, please contact the WIMCR support staff by calling the WIMCR

toll-free hotline at (866) 803-8698 or via email at [email protected].

B. CCS Program Overview Comprehensive community services (CCS) is a behavioral health care program that provides a flexible array of individualized community

based psychosocial rehabilitation services to youth and adults. CCS provides services to people of all ages, including youth to elderly

living with a mental illness and/or substance use disorder. CCS is for individuals who need ongoing services beyond occasional outpatient

care, but less than the intensive care provided in a hospital setting. The individual works with a dedicated team of service providers to

develop a treatment and recovery plan to meet the individual's unique needs and goals. CCS reduces an individual's reliance on costly

high-end services, such as emergency room visits.

The Wisconsin 2013‐15 Biennial Budget (Wisconsin Act 20) authorized the Department of Health Services to increase funding for CCS to

promote program regionalization among county and tribal program participants. Accordingly, effective for dates of service on and after

July 1, 2014, ForwardHealth will provide reimbursement to counties and tribes certified as regional CCS programs, for allowable program

costs for both the federal and non‐federal share of Medicaid and BadgerCare Plus.

CCS is fully integrated within the WIMCR tool and is completed in conjunction with reporting the other WIMCR programs. Like the current

cost reporting methodology for the WIMCR programs, cost information will be collected by professional type for both county staff and

contracted staff. To receive the appropriate share of CCS payments, it is important for each county participating in CCS to report the

costs associated with their CCS program. Please note that CCS does not follow the same cost settlement methodology as WIMCR

programs.

C. CRS Program Overview

Community Recovery Services (CRS) is a behavioral health care program that helps individuals living with a mental illness reach their full

potential. Service providers and the consumer work together to improve the individual’s quality of life in the community through an

outcomes-based planning and support process focused on the individual’s unique recovery need.

CRS includes three services:

• Community Living Supportive Services (CLSS): These services include activities intended to assure successful community

living, such as meal planning/preparation, household cleaning, personal hygiene, medication reminders, medication side effect

monitoring, parenting skills, and community resource access and utilization, emotional regulation skills, crisis coping skills,

shopping, transportation, recovery management skills and education, financial management, social and recreational activities,

and developing and enhancing interpersonal skills.


https://doa.wi.gov/Pages/State-Single-Audit-Guidelines-%28SSAG%29---2017.aspx

https://doa.wi.gov/Pages/State-Single-Audit-Guidelines-%28SSAG%29---2017.aspx



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• Peer Support Services: These services include assistance from an individual who has lived the experience of mental illness

and is trained to support others in their recovery journey.

• Supported Employment Services: These services include activities to assist individuals to obtain and maintain competitive

employment.

Community Recovery Services (CRS) has been integrated into the Wisconsin Medicaid Cost Report (WIMCR) tool. For

CY2017 dates of service, costs associated with the following CRS Services: Peer Support (H0038), Supported

Employment (H2023), and Community Living Supportive Services (H0043-U8, 15-minute increment) should be reported

within the webtool. Costs associated with Community Living Supportive Services (H0043-U9, per-diem) will be cost-

settled in a separate, Microsoft Excel-based tool (available on the WIMCR dashboard).

D. Purpose of the WIMCR Cost Report

The purpose of the cost report is to identify your total cost per unit of service. The cost per unit includes WIMCR Direct Costs and

General Overhead Costs for all program clients (not just for Medicaid clients).

Once your dollar cost per unit of service is identified, your Medicaid reimbursement for those services is determined by analyzing

the Medicaid claims submitted by your agency for the reporting year.

Please note that, according to DHS 106.02(9)(d), Wis. Admin. Code, providers are required to retain all evidence of

billing and cost reporting information necessary to support the truthfulness, accuracy and completeness of the

reports.

Additionally, 2 CFR § 200 Subpart D, Section 200.333 requires that the State cost allocation basis for indirect cost

(Direct Support and Overhead) be in sync with the cost allocation plans used by the local unit of government and

components. In accordance with Appendix VII 2 CFR § 200 D.1.a, “All departments or agencies of the

governmental unit desiring to claim indirect costs [Direct Support and Overhead personnel] under Federal awards

must prepare an indirect cost rate proposal and related documentation to support those costs”. Additionally, a

non-federal entity may utilize a cost allocation plan if the case an indirect cost rate is not used.

Web-based cost reports must be completed for each applicable service (please see the “WIMCR Program Overview” section above

for a complete list of applicable services). Reported costs must be consistent with the Department of Health and Family Services’

allowable cost policy as described in the Allowable Cost Policy Manual and OMB Circular A-87. A link to this manual is provided

on the WIMCR dashboard page.

1. Agency Wide Costs

Agency wide FTE count and cost information is a required component of the WIMCR cost

report. Information relating to total agency cost and FTEs will be used to appropriately

allocate overhead cost to each WIMCR program. Additionally, agency wide information

will play a critical role in desk review edit checks. Total cost applied to each WIMCR

program will be compared to each category of total agency wide cost to ensure

reasonability.

Update to WIMCR Cost

Reporting: Single County

Audit must be submitted and

reflect the amounts reported in

your County Agency Overview.



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2. WIMCR/CCS/CRS Direct Costs

Allocation of direct care staff to a program (e.g., Substance Abuse Day Treatment, Child/Adolescent day treatment, etc.)

must be consistent with the way in which Medicaid defines the program. Therefore, if a staff person is providing services to

different programs, and those programs are billed to Medicaid, the portion of the staff person’s time spent and the associated

costs in each program must be allocated separately. To properly allocate cost associated with an individual clinician, each

clinician’s total paid hours must be recorded within the WIMCR cost report and distributed between all applicable WIMCR

programs and other, non WIMCR activities.

Supervisors and county administrative staff may be reported if the agency is in compliance with 2 CFR § 200, Subpart E,

Section 200.413(c). Direct costs. The compensation of administrative and clerical staff may be reported if the employees

meet the following conditions: administrative or clerical services are integral to a project or activity; individuals involved can

be specifically identified with the project or activity, and these costs are not also recovered as overhead costs (see WIMCR

Direct Support, page 39 and WIMCR Overhead, page 47 for additional information)

In accordance with Appendix VII 2 CFR § 200 D.1.a, “All departments or agencies of the governmental unit desiring to claim

indirect costs [Direct Support and Overhead personnel] under Federal awards must prepare an indirect cost rate proposal and

related documentation to support those costs”. Additionally, a non-federal entity may utilize a cost allocation plan if the case

an indirect cost rate is not used.

3. General Overhead

The overhead personnel time and cost and overhead non-personnel cost must reflect the total agency-wide overhead cost.

Allocation of the non-direct service staff time and overhead to service areas within the program is determined by the FTE

allocation method and automatically factored into each agency’s cost reports.

4. WIMCR/CCS Procedure Codes

A list of the codes and descriptions used to bill Medicaid for the services covered under each program has been identified in

the WI forward health portal provider handbooks (https://www.forwardhealth.wi.gov/WIPortal ). Please refer to the

provider handbooks to identify direct care staff and to determine who should be reported under each program. In some

cases, you may allocate staff to a program even though they may not provide Medicaid-covered services (i.e., a bachelor’s

level staff person in an outpatient clinic). It is still necessary to identify these staff members on the report since it affects

allocation of non-direct costs (part of the non-direct costs support these staff members)

WIMCR/CCS/CRS Direct Cost: Includes cost that supports

direct program operation of one or more specific WIMCR/CCS/CRS

programs. WIMCR/CCS/CRS Direct represents direct program

staffing, client services and program support. Also included are

direct program non-personnel.

General Overhead: Commonly reflects central services related to

overall agency operations that are allocable to all agency programs,

including WIMCR, CCS and CRS. General overhead includes general

support and general non-personnel.


https://www.forwardhealth.wi.gov/WIPortal


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5. Intergovernmental Agreements

Counties have the flexibility to enter contractual arrangements for service provision either among regional county entities or

with non-county contractors. Additionally, a region may contract with a county outside of the region for services. This outside

county would be treated as a subcontractor and would not have a county section on the cost report.

If counties or tribes opt to contract with other counties or tribes within their region, each must report the appropriate revenues

and expenditures to avoid double-counting costs. The county or tribe employing all shared staff will report total salary and

benefits paid to each shared employee, as well as a revenue offset for all contract revenue received from another county or

tribe for services provided by the regional shared employee. Similarly, the county or tribe employing all shared staff should

report total hours (direct service) or FTEs (overhead) as well as an offset for hours worked on behalf of another reporting entity.

CMS compliance requires that any reported Intergovernmental Agreement costs must meet the “reasonable cost” criteria set

out in 2 CFR 225. To be considered reasonable, costs shall not exceed that which would be incurred by a prudent person

under the circumstances prevailing at the time the decision was made to incur the cost. For more information, see the

Allowable and Reasonable Cost section on page 7 of the Guide to WIMCR Cost Reporting.

Intergovernmental Agreements Terminology

• Intergovernmental Agreements: An intergovernmental agreement occurs when an employee of one county or

tribal reporting entity provides services on behalf of a second reporting entity and the second reporting entity

reimburses the first reporting entity for services provided. The graphic below shows an example intergovernmental

agreement.

• Regional Shared: The term regional shared is used to identify an individual or a category of overhead used to

support multiple counties.

• Revenue Offset: A revenue offset is the dollar amount paid from one county to another for services provided by a

regional shared clinician or overhead provider.

An example of a regional shared direct service clinician is outlined within the Direct Service and Support section. An additional

example of a shared Overhead provider is outlined within the General Overhead Costs section.

Example: Intergovernmental Agreement Reporting Guidance

Direct Service Intergovernmental Agreements Example



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The example below demonstrates how a regional shared clinician should be reflected on the cost report of the county or tribe

employing the shared clinician (County A) as well as the county or tribe contracting out for the shared clinician’s services (County

B).

Overhead Intergovernmental Agreement Example

The example below demonstrates how a regional shared overhead provider should be reflected on the cost report of the county

or tribe employing the shared employee (County A) as well as the county or tribe contracting out for the shared employee’s

services (County B).

E. Allowable and Reasonable Cost

Allowable costs must meet the criteria of 2 CFR 200; and the Provider Reimbursement Manual, CMS Publication 15-1. The most

significant section of the allowable cost requirement is the “reasonable cost” criteria. To be considered reasonable, costs shall

not exceed that which would be incurred by a prudent person under the circumstances prevailing at the time the decision was

made to incur the cost. The reasonableness criteria are particularly important when the governmental entity is predominately

federally funded. The hyperlink to the 2 CFR 200 website is:

https://www.gpo.gov/fdsys/pkg/FR-2013-12-26/pdf/2013-30465.pdf

Reported costs must correspond to existing financial reports, county wide cost allocation plans and additional supporting

documentation maintained by each entity for the reporting period.

In determining reasonableness of a given cost, 2 CFR 200 states that consideration must be given to:

• Whether the cost is of a type generally recognized as ordinary and necessary for the operation in performance of the

function for which the cost was incurred.

• The restraints or requirements imposed by such factors as sound business practices; arms-length transactions; Federal,

State, and other laws and regulations; and terms and conditions of the Federal award or entitlement.

• Market prices for comparable goods or services.

OverviewCounty A Basic

InformationCounty A Cost

County A

Hours

County B Basic

InformationCounty B Cost

County B

Hours

CCS Direct Service Clinician: Clinician 1 is a full time

employee of County A (40 hrs per week, 2080 hours per

year), receiving a salary of $50,000 and benefits of

$20,000. Clinician 1 spends 10% of their time

providing CCS direct services on behalf of County B.

County B pays County A $15,000 for Clinician 1's time.

County A

reports

Clinician 1 as

an "Agency

Employee -

Regional

Shared", and

reports an NPI

County A

reports salary

of $50,000,

benefits of

$20,000 and a

Regional

Revenue

Offset of

$15,000.

County A

reports total

paid hours of

2080, and

"Region

Direct" hours

of 208

County B

reports

Clinician 1 as

a "Contractor -

Regional

Shared" and

reports an NPI

County B

reports

$15,000

contract cost

County B

reports 208

CCS Direct

Service Hours

Intergovernmental Agreement Example - Direct Service

Overview County A Cost County B Cost

Overhead Provider: Administrative Assistant 1 is a

full time employee of County A (40 hrs per week, 2080

hours per year), receiving a salary of $75,000 and

benefits of $25,000. Administrative Assistant 1 spends

20% of their time providing general administrative

services on behalf of County B. County B pays County A

$25,000 for Administrative Assistant 1's time.

County A

reports Salary

of $75,000,

benefits of

$25,000 and

revenue offset

of $25,000

County B

reports

Contract Cost

of $25,000

Intergovernmental Agreement Example - OverheadCounty B Category and FTECounty A Category and FTE

County B reports Clinician 1

as an Administrative

Assistant and selects "Yes"

for Regional Shared. County B

reports Total FTE of .2

County A reports Clinician 1

as an Administrative

Assistant and selects "Yes"

for Regional Shared. County A

reports Total FTE of 1, and

Regional Shared FTE of .8


https://www.gpo.gov/fdsys/pkg/FR-2013-12-26/pdf/2013-30465.pdf


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• Whether the individuals concerned acted with prudence in the circumstances considering their responsibilities to the

county agency, its employees, the public at large, and the Federal Government.

• Significant deviations from the established practices of the county agency which may unjustifiably increase the Federal

awards’ cost.

* Please note that room and board and the vaccines in VFC programs are not considered reasonable costs.

*Additionally, the financial liability for fringe benefit and pension costs for retirees not associated with the ordinary and necessary

operation of WIMCR programs are not considered reasonable costs.

The Provider Reimbursement Manual, CMS Publication 15-1 provides additional clarification of reasonable costs. PRM 15-1 is a

Medicare reimbursement manual; however, the Centers for Medicare and Medicaid Services (CMS) expects Medicaid programs

to operate in accordance with the principals set forth in PRM 15-1 as well. This publication states:

2100. PRINCIPLE

All payments to providers of services must be based on the reasonable cost of services covered under title XVIII of the Act and

related to the care of beneficiaries or, in the case of acute care hospitals, the prospective payment system (PPS). (See Chapter

28 on PPS.) Reasonable cost includes all necessary and proper costs incurred in rendering the services, subject to principles

relating to specific items of revenue and cost.

2102. DEFINITIONS

2102.1 Reasonable Costs. --Reasonable costs of any services are determined in accordance with regulations establishing the

method or methods to be used, and the items to be included. Reasonable cost considers both direct and indirect costs of

providers of services, including normal standby costs. The objective is that under the methods of determining costs, the costs

for individuals covered by the program are not borne by others not so covered, and the costs for individuals not so covered are

not borne by the program.

Costs may vary from one institution to another because of scope of services, level of care, geographical location, and utilization.

It is the intent of the program that providers are reimbursed the actual costs of providing high quality care, regardless of how

widely they may vary from provider to provider, except where a institution’s costs are found to be substantially out of line with

other institutions in the same area which are similar in size, scope of services, utilization, and other relevant factors. Utilization,

for this purpose, refers not to the provider's occupancy rate but rather to the way the institution is used as determined by the

characteristics of the patients treated (i.e., its patient mix - age of patients, type of illness, etc.).

Implicit in the intention that actual costs be paid to the extent they are reasonable is the expectation that the provider seeks to

minimize its costs and that its actual costs do not exceed what a prudent and cost conscious buyer pays for a given item or

service. (See §2103.) If costs are determined to exceed the level that such buyers incur, in the absence of clear evidence that

the higher costs were unavoidable, the excess costs are not reimbursable under the program.

If a provider undergoes bankruptcy proceedings, the program makes payment to the provider based on the reasonable or actual

cost of services rendered to Medicaid beneficiaries and not based on costs adjusted by bankruptcy arrangements.

2102.2 Costs Related to Patient Care. --These include all necessary and proper costs which are appropriate and helpful in

developing and maintaining the operation of patient care facilities and activities. Necessary and proper costs related to patient

care are usually costs which are common and accepted occurrences in the field of the provider's activity. They include personnel

costs, administrative costs, costs of employee pension plans, normal standby costs, and others. Allowability of costs is subject

to the regulations prescribing the treatment of specific items under the Medicaid program.



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2102.3 Costs Not Related to Patient Care. --Costs not related to patient care are costs which are not appropriate or necessary

and proper in developing and maintaining the operation of patient care facilities and activities. Costs which are not necessary

include costs which usually are not common or accepted occurrences in the field of the provider's activity.

Such costs are not allowable in computing reimbursable costs and include, for example:

• Cost of meals sold to visitors;

• Cost of drugs sold to other than patients;

• Cost of operation of a gift shop;

• Cost of alcoholic beverages furnished to employees or to others regardless of how or where furnished, such as cost of

alcoholic beverages furnished at a provider picnic or furnished as a fringe benefit;

• Costs of gifts or donation;

• Costs of entertainment, including tickets to sporting and other entertainment events;

• Cost of personal use of motor vehicles;

• Costs of fines or penalties resulting from violations of Federal, State, or local laws;

• Costs of educational expense for spouses or other dependents of provider of services, their employees or contractors,

if they are not active employees of the provider or contractor.

• Cost of meals served to executives that exceed the cost of meals served to ordinary employees due to the use of

separate executive dining facilities (capital and capital-related costs), duplicative or additional food service staff (chef,

waiters/waitresses, etc.), upgraded or gourmet menus, etc.; and

• Cost of travel incurred in connection with non-patient care related purposes.

F. Time/Cost Tracking and Record Keeping Requirements

Counties must have a method of tracking time and costs for Direct Service, Direct Support and Overhead Personnel providers.

WIMCR Direct Hours include:

• Face to face medical services

• Medicaid allowable activities included in the relevant ForwardHealth Handbook

Direct Support Services include:

• WIMCR Program Supervision

• WIMCR Planning and Coordination

• WIMCR Administration

• WIMCR Clerical support

Overhead Personnel include:

• General agency support staff that spend fewer than 25% of their paid hours supporting the WIMCR program should

be reported within Overhead Personnel.

Counties must have a method in place to segregate time/cost applicable to WIMCR services and maintain the records of the

allocation of time. Counties may use the following options for the state to use to track time. Other methods of time tracking

must be approved by DHS prior to reporting.

1. Personnel activity reports (PAR) or employee day log

2. Time Studies (with CMS approval)

CMS requires that an 100% time tracking methodology documentation must be maintained. (Note: CMS has not provided a

definitive list of acceptable time tracking methodologies. Any CMS required changes to the way a county tracks time and cost

would be applicable to future years reports.) Documentation must be available on request during monitoring reviews and

financial audits. Without proper documentation, costs associated with Direct Service, Direct Support, and Overhead Personnel

are unallowable costs. Tracking a clinician’s time based solely on billed unit activity is not an acceptable time tracking

methodology.


https://www.forwardhealth.wi.gov/WIPortal/Online%20Handbooks/Display/tabid/152/Default.aspx


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G. Introduction to the WIMCR Cost Report Webtool

The WIMCR Cost Report Tool was developed by Public Consulting Group (PCG) under contract with Wisconsin DHS to support the

WIMCR program. The WIMCR Cost Report Tool has been designed to serve as a comprehensive resource for county agencies

participating in WIMCR. The WIMCR Cost Report Tool will primarily function as the web-based cost reporting tool for the county

agencies as they complete their WIMCR cost reports on an annual basis. It will also function as a repository of useful information for

the county agencies, including a dynamic dashboard with historical WIMCR data, summary claims data, helpful WIMCR resources,

important dates for WIMCR, and upcoming training schedules. County agencies will also be able to view WIMCR reports such as the

Provider Summary Report (PSR), County Treasury Report (CTR) and Certified Public Expenditure Form (CPE).

The following sections of this guide provide additional details about the specific components and functionality within the WIMCR Cost

Report Tool.

SECTION II – NAVIGATING THE COST REPORT Webtool

A. Accessing the WIMCR Webtool

For first time users, a system generated email will be sent to you when you are granted access to the system. This email will include your

username and temporary password.

In the login box on the welcome page, you will enter your username in the first box. Your username is the email address you provided

when requesting access to the system. The temporary password provided in the confirmation email should be entered in the next box.

You will be prompted to change your password when you sign in.

If you have forgotten your password, click on the blue “Forgot Your Password?” link under the “Sign In” button. An email will be sent

to the email address used as your username, with a temporary password. Upon logging into the system with this temporary password,

you will be required to change your password.

Below is a screenshot from the WIMCR webtool login function from the WIMCR webtool login page:

B. Navigating the Dashboard

Once in the WIMCR Cost Report Tool, the user will be taken to the Dashboard page of the system. The Dashboard page serves

as the home screen for the entire system. From the Dashboard page, the user can access the cost report and the management

reports or perform administrative functions such as creating new users, managing user notifications and resetting user passwords.

a. Accessing Cost Report

Users may work on their WIMCR cost report or view prior year cost reports. Users can select which year they would like to

access by going to the top right corner of the Dashboard page, above the Progress Bar. Once the year is selected, users can

begin to work on their cost report or view prior year reports. There are two ways to access the WIMCR cost report from the

Dashboard page. Users can access the cost report by selecting the “View Cost Report” button which is included within the

WIMCR Dashboard progress bar screen.



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Alternately, a user can select the “WIMCR” tab from the top of any screen within the WIMCR cost report.

b. Progress Bar

At the top of the Dashboard page, the user will see a Progress Bar that identifies the status of their WIMCR cost report for

the current period. The Progress Bar will indicate where the county agency is in the cost reporting process relative to five key

checkpoints within the cost report and desk review processes; Cost Report Started, Cost Report Certified, Desk Review - PCG

Review, Desk Review - Provider Response, Desk Review - Complete, and CPE Form Approved. Once a county has completed

the work associated with each checkpoint along the Progress Bar, the circle for that item will turn blue with an arrow indicating

the status of the next task prior to the next checkpoint.

For example, once a county agency has begun their cost report, the ‘Cost Report Started’ circle will turn green with the arrow

pointing towards the ‘Cost Report Certified’ circle. The arrow between these two checkpoints will remain yellow, indicating

that the cost report is in process. Once the cost report has been certified, the line between the two checkpoints as well as

the ‘Cost Report Certified’ circle turn blue to reflect completion of those tasks. In addition to indicating the status, the Progress

Bar will also include the date of the last activity for each checkpoint. Once a cost report is certified, the Progress Bar will

indicate the date the certification was completed below the ‘Cost Report Certified’ checkpoint.

c. County Overview

Within the County Overview section on the Dashboard page, the user will be able to access two sets of information regarding

their county agency’s WIMCR program; historical data and paid claims data. These two items will provide further details on

the county agency’s WIMCR program. Users will be able to access this information by clicking on the respective button under

the County Overview section of the Dashboard page.

i. Historic Data

The Historic Data will provide an overview of the county agency’s historical performance in the WIMCR program. The

data will display: WIMCR payments and the MOE amounts for the most recently completed three years. Please see

example below.



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Figure I. County-Wide WIMCR Data by Cost Report Year

Historical Data also includes overview graphs by individual program. These graphs will include: WIMCR payments and

the MOE amounts for the most recently completed three years for each WIMCR program the county provides.

ii. Paid Claims Data

The Paid Claims data provides a summary of the claiming activity of the county agency by WIMCR program. Paid Claims

data includes data for the current WIMCR reporting year only. County agencies are encouraged to review claiming data

when completing their reports. This data is used as a benchmark for desk reviews throughout the report. For example,

if a county agency does not report a program they have claiming data for, they will receive a desk review edit prompting

them to review the information reported.

d. Resources

The Resources section of the Dashboard page will provide quick access for users to some of the important documents and

links to important pages for WIMCR. This section of the Dashboard page will house recent training materials, frequently asked

questions documents, and links to external sites such as the Access Wisconsin Portal.



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e. Important Dates

The Important Dates section of the Dashboard page will be used to communicate important dates related to WIMCR ranging

from important deadlines, such as that for the submission of the cost reports to desk review completion dates and the

availability of WIMCR reports. The important dates will also include up-to-date information about upcoming WIMCR training

opportunities.

C. User Management and WIMCR Notifications

a. Creating a User Account

An account can be created by contacting PCG at [email protected] or (866) 803-8698. The following information is required to

create an account for WIMCR webtool:

• First Name

• Last Name

• County

• County Agency

• Email

• Phone

• User Level – see user level information below.

• Notification status

b. User Levels

Each county agency must identify those individuals that will have access to the WIMCR webtool and at what level. The following

descriptions outline the ability of each of the three levels of access to the WIMCR webtool:

County Level Administrator: Required to “manage” the county agency’s contacts and notifications (or web-based system

users), and the only level with the ability to certify costs. County Level Administrator includes the role of Report Editor.

Report Editor: Can add, delete, or edit information in the WIMCR cost reporting system prior to certification by the County

Level Administrator.




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Report Viewer: Can only view information entered by a designated county agency into the WIMCR cost reporting system and

cannot add, delete, or edit information.

County Level Administrators are the only users with the ability to certify (submit) a WIMCR cost report. Consequently, each agency

completing a WIMCR cost report must designate at least one individual as a “County Level Administrator”. The role of “report

editor” is recommended for agency employees who will be entering cost information, but will not be certifying cost. The role of

“viewer” is recommended for agency administrators and county auditors who will need access to the information entered in the

agency’s WIMCR report, but will not be responsible for entering data.

c. Purpose of Notifications

WIMCR notifications are designed to provide recipients with information about the WIMCR cost reporting process, and updates

on their agency’s WIMCR cost report status. The WIMCR webtool will automatically generate notifications in each of the

following scenarios:

Notification Name

Certified Cost Report

Cost Report is open for completion

Provider Summary Reports are Viewable

County Treasurer Reports are Viewable

Cost Report Deadline Reminder

Cost Report Past Due Reminder

Desk Review Complete

Initial Desk Review Response Required

User Account Created

User Password Reset

In addition to the automated notifications outlined above, notifications will also be used to provide general WIMCR program

updates and information on an ad hoc basis.

d. Notification Management

Upon creation of a new WIMCR user account, individuals must either be designated as a notification recipient or opt out of

receiving notifications. There are two possible options for each user’s notification status - “yes” or “no”. Those with a

notification status of “yes” will receive regular updates via email related to their agency’s WIMCR report as well as general

WIMCR notifications. Those with a notification status of “no” will receive an email with their WIMCR webtool login credentials

when an account is created; however, they will not receive subsequent WIMCR emails unless their notifications status is

changed. It is recommended that county agencies have more than one (1) person designated as a notification user.

To update a webtool user’s notification status, contact the County Level Administrator or PCG ([email protected], (866) 803-

8698).




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SECTION III – COMPLETING THE WIMCR COST REPORT

A. General Cost Report Functionality

A. Navigating Between Cost Report Pages

The WIMCR cost report must be completed sequentially. The cost report list will guide each provider through the navigation

process by restricting access to each page until all required predecessors have been completed. The report list is designed to

help each user navigate through the WIMCR cost report.

B. Time-Out Functionality

The WIMCR tool will log a user out of the site if there has been inactivity for 30 minutes. Before this occurs, a notification will

pop up warning the user that they will be logged off. The user must click “Stay Logged in” in order to continue with their

session. If the timeout process completes, you will be logged off the tool and any work that you have not saved will not be

retained.

C. Hover-Over Explanation

Throughout the cost report, column and row headers within each screen are equipped with pop-up explanations which provide

clarifying information. Pop-up explanations may include definitions, examples and instructions relating to open data fields on

each screen. The purpose of the pop-up explanation is to preempt many of the frequently asked questions from providers to

assist in the seamless navigation of the WIMCR webtool and the WIMCR cost report.

D. Report List Functionality

The WIMCR cost report follows a logical progression: agency-wide information, direct services checklist, direct cost information

(including Direct Service Non-Personnel cost and Direct Support), supplemental direct cost information, overhead and federal

funds. Often, data entered on a screen impacts components of one or more subsequent screens. Therefore, it is necessary to

adhere to the sequential order of the screens. The report list is designed to indicate which components of the WIMCR cost

report are available for completion and which components are unavailable.

The report list page is the central screen of the WIMCR report. The report list allows users to navigate to each screen and serves

as a chronological roadmap to completing the cost report. Each item on the report list screen is a link to a portion of the WIMCR

cost report.



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Completed

The report list will indicate when a screen has been completed with a circle and a checkmark. Completed screens can

still be viewed and updated; however, no additional information is required.

Available for Completion

When a screen is available for completion the report list will reflect a blue shaded circle. As you are in the process of

completing the report, one successive report link will be in available for completion. All preceding links will be completed

per the example above, and all subsequent links will be unavailable per the example of a locked screen below. If the

provider has not yet accessed the screen or the screen is partially completed, the screen will remain available for

completion.

Locked

When a screen is unavailable until a preceding component of the cost report is completed, the report list will reflect a

circle with a lock and faded text. To unlock the screen and access the corresponding component of the WIMCR cost

report, one or more preceding screens must be completed.

Report List Subsections

Many components of the WIMCR cost report reflected on the report list page will have additional subsections which

must be completed. A provider will be able to access subsections by clicking on the link of the corresponding cost

report component. If a component has applicable subsections (such as Direct Service and Support below), the link to

the cost report component will open the subsections for viewing. Once a subsection has been completed a small blue

sphere will appear next to that subsection.



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E. Save & Close vs. Save & Continue

Each screen requiring data entry will be displayed as a pop-up in front of the report list page. As a provider navigates to each

page, they will have the option of clicking the “save & close” button, to save all data that’s been entered and return to the report

list page.

The “save & continue” button will allow each user to save previously entered data and continue to the next applicable screen of

their WIMCR cost report.

F. Add/Delete Row

Throughout the cost report, the provider can enter the requested cost information directly into the web-based system by clicking

the “Add New Row” button.

Alternately, the provider can delete a row of information entered in the professional level subsections of the direct service and

support sections of the cost report. To delete a row, select the line of data by clicking on any data field and then click the trash

can in the bottom left corner of the screen. The trash can has an arrow next to it in the example below.

G. Import/Export

For a provider to download (export) an Excel spreadsheet, you will be required to enter the requested information into excel,

and upload (import) into the web-based system.



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The “export” button will automatically open an Excel spreadsheet with a header for each column on the corresponding

professional type Basic Information, Cost, Hours and Direct Time Allocation screens, along with any data which has been entered

in the cost report by the provider.

To import the Excel spreadsheet into the WIMCR webtool, the provider should save the formally exported spreadsheet, select

the “Browse” button, find the previously saved import spreadsheet and select the “Import” button. If there are any issues with

the formatting of the import spreadsheet, the system will display an error message at the top of the page notifying the user of

the location and type of issue. Once a file is imported into the WIMCR webtool, the imported spreadsheet will replace all data

previously entered in the webtool. It is critical that each user saves all relevant data outside of the WIMCR webtool or includes

all data in the cost report in the import spreadsheet to avoid losing data when the import process occurs.

Using the Import/Export feature is optional to each provider. The Import/Export feature provides an optional solution for

providers with many lines of data or any who are looking to expedite the data entry process.

H. Printing

Specified Pages of WIMCR webtool have a "Print" option. This allows users to print comprehensive data from specified pages of the cost report. The pages with a print option will include:

1. Paid claims data in "County Overview" on dashboard screen 2. Summary and Certification page 3. All program summary pages

I. Program, Professional Type and Category Summary Data

Upon completion of each section of the WIMCR cost report, summary data will be displayed. All links to summary data will have

the word “summary” in the title to differentiate them from screens where data entry is required. Providers have the option of

viewing summary data which will show how much cost for each category (i.e. direct service professional type, direct support,

direct service non-personnel, overhead) has been allocated to each WIMCR program by clicking on the corresponding summary

link.

For each Professional Level reported, there will be a summary report generated that can be used as a resource for providers.

Each summary report will become available once all required cost information impacting the corresponding cost report

component has been entered. The example below shows a link to a Master’s Degree Level summary data which is displayed

following the completion of all Master’s Degree Level cost information.

As soon as all required sections of the WIMCR cost report have been completed, a “Summary and Certification” page will become

available which will display all information previously entered in the WIMCR cost report. A “County Level Admin” user must

access the summary and certification page and certify the allocation of all reported cost to each WIMCR program reported on

the agency’s WIMCR cost report.

From the “summary and certification” page, the user will be able to navigate to all other summary information by clicking on

the corresponding column and row headers. Column headers displayed along the top of the screen will provide links to program

level summary data, row headers displayed vertically on the left-hand side of the screen will provide links to summary data by

cost category.



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J. Desk Reviews

The WIMCR webtool is designed to process desk reviews during the cost report completion process. As soon as data is entered

into a screen within the WIMCR webtool, all applicable desk review edits will be triggered immediately. By incorporating the

desk review process throughout the process of cost report completion, the system addresses potential audit risks as soon as all

relevant information has been entered in the cost report. This method will expedite the WIMCR desk review process while

simultaneously helping to avoid errors which may impact subsequent sections of the cost report.

There are two types of WIMCR desk review edits – Level 1 edits which indicate an error has been made which required resolution,

and Level 2 edits which indicate that the data entered by the provider falls outside of the expected range and an explanation or

adjustment is required.

Level 1 Edit Resolution

Level 1 edits can only be resolved by returning to a prior cost report screen and updating the data entered in the WIMCR cost

report. If the data is correct, a PCG WIMCR reviewer can override a Level 1 edit. To contact a PCG reviewer, call (866) 803-

8698 or email [email protected]. An example of a Level 1 edit is a required field which has been left blank.

Level 2 Edit Resolution

Level 2 edits occur when a data element or the relationship between multiple data elements falls outside of the usual or expected

range. Level 2 edits are a part of the WIMCR cost reporting process. If a level 2 edit is triggered and the data entered in the

cost report is accurate, a provider can proceed to a subsequent section of the WIMCR cost report by providing a reasonable

explanation. An example of a Level 2 edit would be an individual clinician’s salary exceeding the expected value.

Desk Review Next Steps – Level 2 Edits

Each explanation entered in response to a Level 2 edit will be reviewed by a PCG reviewer during the desk Review process

following the certification of each agency’s cost report. Detailed explanations which specifically address the desk review edit will

be approved. If the PCG reviewer believes that additional clarification is needed, the provider will receive an email notifying

them that a follow up response is required. The example below shows an individual clinician with benefits outside of the expected

threshold. To resolve the edit, the provider must enter an explanation into the “Desk Review User Override” column or ‘Click to

Return’ to the previous page to modify any erroneous data.

Example provider responses:

A. Michael’s Benefit costs are accurate

B. Michael opts for a higher prices insurance plan to include better vision coverage hence why his benefits are unusually high

C. Michael’s insurance plan includes the cost of coverage for four of his family members. This results in a higher than normal

insurance rate.

Response A may result in a PCG reviewer following up during the desk review process with a request for additional clarification.

Responses B and C provide a reasonable and detailed explanation which adequately address Michael’s unusually high benefit

cost.




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B. Cost Report Pages

One cost report will be completed for each WIMCR provider agency regardless of the number of separate WIMCR programs and provider

IDs provided by that agency. This is an update to the WIMCR cost reporting process designed to avoid unnecessary duplicative reporting.

Additionally, it is expected that in many instances clinicians and resources are shared between multiple WIMCR programs within a single

county agency or provider agency. The updated WIMCR reporting methodology which consolidates all WIMCR programs into a single

WIMCR cost report allows each provider to ensure that all clinician time and cost is appropriately allocated among all WIMCR programs.

Cost information reported on the County Agency Overview screen within the WIMCR cost report must align with total expenditures during

the reporting period as documented in the county agency’s general ledger. Additionally, the county agency is subject to the federally

required A-133 Single Audit which attests to the cost report and includes allocation of costs.

Personnel Expenditures and Operational Expenditures reported on the County Agency Overview must reflect all cost incurred by the

county agency during the calendar year reporting period as documented within financial reports maintained by the county agency.

Interdepartmental Charges reflect the portion of county wide overhead cost allocated to the county agency. Interdepartmental Charges

reported must align with a county wide cost allocation plan showing the allocation of Interdepartmental Charges to the reporting entity.

A. County Agency Overview



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The county agency overview page is a key component of the WIMCR desk review process which allows the WIMCR webtool to

compare all costs which will be allocated to

various WIMCR programs provided by an

individual agency to the total agency wide cost

for that agency. It is expected that total agency

wide cost will exceed total WIMCR cost for each

agency.

In some instances, information entered in the

county agency overview screen will impact the

cost allocation on subsequent sections of the

cost report. The FTE information entered in the

county agency overview page will impact the

allocation of reported overhead cost. Total FTEs

providing WIMCR program services will be

compared to total agency wide FTEs for

overhead allocation purposes. Additionally, the

interdepartmental charges entered in the county

agency overview screen will be added to

“Overhead Non-Personnel cost” and factored

into the total agency wide overhead to be

allocated.

• Total Agency Employed FTEs (mandatory

field)

Total FTEs reflected on agency wide payroll. Includes FTEs with limited or no involvement in WIMCR programs. 1 FTE is equal

to 40 hours per week and 2,080 hours per year. An FTE calculator is located on the Dashboard page of the report to help

counties report FTEs.

Example:

Part time (20 hrs per week) employee = .5 FTE

Full time (40 hrs per week) employee = 1 FTE

• Total Agency Contracted FTEs to which agency allocates overhead (optional field)

Total FTEs providing services per a contractual agreement to whom agency allocates overhead cost. Includes FTEs with limited

or no involvement in WIMCR programs. If your agency does not allocate overhead cost to contracted staff, this field should be

left blank.

Example:

Agency has 20 total contractors. Agency does not allocate overhead cost to contractors. Total Contracted FTEs to which agency

allocates overhead = 0.

Agency has 20 total contractors. 10 of the agency's contractors are factored into the agency's overhead allocation methodology.

Total Contracted FTEs to which agency allocates overhead = 10.

• Total Annual Agency Personnel Expenditures (mandatory field)

Gross agency wide salary and benefit cost. Total payroll expenditures related to Total Agency Employed FTEs.

• Total Annual Agency Operation Expenditures (mandatory field)

All non-personnel cost relating to day-to-day agency operations including contract cost, building cost and materials and supplies.

• Interdepartmental Charges (mandatory field for all county agencies – optional field for multi-county agencies)

A lump sum portion of county wide overhead cost allocated to a particular county agency.

County Agency Overview - Desk Review Checks

To navigate to the next section of the cost report, users will need

to ensure that any desk review checks associated with the

information provided on this screen are addressed. Examples of

potential desk review checks that may be triggered based on the

data entered on this screen include:

Required Field Left Blank

If no value has been entered for "Total Annual Agency

Personnel Expenditures”, “Total Annual Agency Operations

Expenditures" or "Interdepartmental Charges”, the WIMCR

webtool will trigger an edit requiring an explanation. Multi-

county agencies will not see an edit relating to

“interdepartmental charges”.

Total cost per FTE is unusually low

Total agency wide cost divided by total reported FTEs falls

below the expected threshold.



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B. WIMCR Direct Service Checklist

The WIMCR Direct Service Checklist screen determines which WIMCR programs and professional types will be reflected on an

agency’s WIMCR cost report. Selections made on the WIMCR Direct Service Checklist will define the structure of the WIMCR

cost report. It is critical that the WIMCR programs and professional types reflected on the Direct Service Checklist are accurate

and comprehensive.

• WIMCR Programs Based on

Medicaid Paid Claims

WIMCR Programs Based on

Medicaid Paid Claims field is a

locked field which is not

editable to the provider. This

field is prepopulated with the

provider IDs and program

names of all known Provider

IDs associated with an agency

under which Medicaid claims

have been submitted at the

time in which cost report

completion initially opens.

These programs are

prepopulated based on

Medicaid claiming activity. If a

program or provider ID is listed

in error, please contact a PCG

WIMCR coordinator at

[email protected] or (866)

803-8698 to remove the provider ID.

Note: Cost reports are completed in the year following each Calendar Year of WIMCR service provision. There is a 12-month

claiming window within which a WIMCR provider can bill Medicaid. Consequently, provider agencies may continue to submit

claims simultaneously with cost report completion. It is possible that a provider ID/WIMCR program combination is missing from

this list because claims have not yet been submitted

.

• Additional Psychosocial Rehabilitation Programs (check all that apply)

The additional Psychosocial Rehabilitation Programs(PRP) checklist allows the provider to indicate any additional PRP programs

that are being serviced at an agency. This checklist includes the programs CCS, CSP and CRS. If a program is selected from the

PRP checklist, it is mandatory that one or more provider IDs under which claims are submitted for that program is also selected.

If a provider ID under which claims are submitted is missing from the dropdown list, please contact a PCG WIMCR coordinator

at [email protected] or (866) 803-8698 to register an additional provider ID.

Direct Service Checklist - Desk Review Checks

To navigate to the next section of the cost report, users will need to ensure that

any desk review checks associated with the information provided on this screen are

addressed. Examples of potential desk review checks that may be triggered based

on the data entered on this screen include:

Missing Provider ID

Please enter a provider ID corresponding to each WIMCR service selected from

the WIMCR Programs Checklist

Professional Type with Corresponding Paid Claims Not Selected

If there is paid claims data associated with a particular professional type and

agency, that agency is required to enter cost data associated with the

professional type. For example, if claims were submitted for OPMHSA services

provided by Bachelor’s Level staff, Bachelor’s Level should be selected from

the WIMCR direct service checklist and cost information should be reported for

Bachelor’s Level staff.





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• Provider ID:

The provider ID that is associated with the Comprehensive Community Service (CCS) program can vary depending on the type

of regionalization your agency is a part of. If you are a lead county within a multi county region, please use your Billing Provider

ID. If you are not a lead county in a multi county region, please use your Rendering ID. If your type of regionalization is shared

services, population based or 51.42, please use your Billing Provider ID for your provider ID. This piece of information is crucial

for making sure there is no discrepancy in your reported ID and what we have based on our claims extract for your agency. If

you have any questions on which Provider ID you should be listing for CCS, please contact a PCG WIMCR coordinator at

[email protected] or (866) 803-8698.

• Psychosocial Rehabilitation Program (PRP) Services

The Programs that are encompassed within our PRP section of the direct service checklist have an array of services that are

provided and being funded through Medicaid. Please select all services that are applicable for each of your Psychosocial

Rehabilitation Programs. Each PRP has the same generated checklist, but some services are only applicable to certain PRP

services and for that we make each service that isn’t applicable to your PRP unavailable to select.

• Additional WIMCR Programs (check all that apply)

The additional WIMCR programs checklist allows the provider to indicate any additional WIMCR programs and provider IDs

which were not included in the Medicaid Programs Based on Paid Claims list. The checklist includes the name of each additional

WIMCR program as well as a multi-select dropdown list which includes all provider IDs associated with a particular provider.

If a program is selected from the checklist, it is mandatory that one or more provider IDs under which claims are submitted for

that program is also selected. If a provider ID under which claims are submitted is missing from the dropdown list, please

contact a PCG WIMCR coordinator at [email protected] or (866) 803-8698 to register an additional provider ID.

PRP Services CSP CCS CRS

Community Living Functional Restoration X X X

Crisis Intervention X

Diagnostic Evaluations X X

Medication Management X X

Peer Support X X

Physical Health Monitoring X X

Psychotherapy X X

Recovery Management X X

Screening and Assessment X X

Service Facilitation X X

Service Planning X X

Substance Abuse Counseling X





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• WIMCR Professional Types (check all that apply)

In addition to the identification of WIMCR programs provided by each agency, the direct service checklist page is designed to

capture a comprehensive list of professional types providing WIMCR services. The professional types of all clinicians providing

one or more WIMCR services should be selected from the WIMCR professional type checklist. Subsequent WIMCR cost report

data must be completed at the professional type level for each professional type selected from the WIMCR direct services

checklist (see Direct Service Data by Professional Type).

For many WIMCR programs, when claims are submitted to Medicaid, a modifier is included which indicates the professional type

of the individual providing the service. Instances where a claim has been submitted by a provider agency identifying a specific

professional type as the provider of a WIMCR service, the name of that WIMCR service has been prepopulated in the “WIMCR

Services Based on Medicaid Claims” field next to the corresponding professional type. The purpose of this feature is to alert the

provider that their agency has billed Medicaid for services provided by a particular professional type and they should enter

corresponding cost information for that professional type.

Many WIMCR programs are billed to Medicaid as an “average” professional type (AMHDT, SADT, CADT, PNCC, TCM and CRS).

These programs will be excluded from the “WIMCR Services Based on Medicaid Claims” field, because there is no way to

determine which professional type provided a service based on paid claims. This is important to note because there may be

professional types with no “WIMCR Services Based on Medicaid Claims” that should be selected from the WIMCR Professional

Type Checklist.

Professional type naming conventions vary among different WIMCR programs. See below for a crosswalk of the professional

type names used in the WIMCR webtool, and the various names and descriptions used for each professional type



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Professional Type Clinicians Included Advanced Practice Nurse Practitioner

• Advanced Practice Nurse Practitioner

• APNP with Psychiatric Specialty

• Physician's Assistant - Psychosocial Rehabilitation

Bachelor’s Degree Level • Licensed Occupational Therapist - Psychosocial Rehabilitation

• Certified Alcohol and Drug Abuse Counselors

• Certified Rehabilitation Counselors

• Other Bachelor’s Degree Level

• Bachelor’s Degree Level RN

• Substance Abuse Counselor/Bachelors

• Bachelor’s Degree Level

Master’s Degree Level • Substance Abuse Counselor/Masters

• Licensed Clinical Social Worker

• Certified Social Worker

• Certified Alcohol and Drug Abuse Counselor

• Occupational Therapist

• Licensed Nurse Practitioner

• Licensed Professional Counselor

• Licensed Registered Nurse

• Licensed Marriage and Family Therapist

• Certified Advance Practice Social Worker

• Certified Independent Social Worker

• Masters Level with 3000 Hours

• Master’s Degree Level

Psychiatrist/MD • Psychiatrist

• Clinical Student/Resident

• MD

Less than Bachelor’s Degree Level • Mental Health Tech

• Certified Peer Specialist

• Psychosocial Rehabilitation Technician

• Associates Degree Level

• Licensed practical nurse

• Other Provider Type

• Occupational Therapy Assistants

• Paraprofessional

• Personal Care Worker

• Home Health Aide

• Less than bachelor degree level

Occupational Therapist • Occupational Therapist

PhD Psychologist/Doctoral Level • Doctoral Level

• Clinical Student/Resident

• PhD Psychologist

Physical Therapist • Physical Therapist

Physician Assistant • Physician Assistant

Registered Nurse/Licensed Practical Nurse

• Licensed Practical Nurse

• Registered Nurse

Speech Pathologist • Speech Pathologist

Qualified Treatment Trainees • Clinical Student

• Qualified Treatment Trainees (QTT)



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• Certification of WIMCR Direct Service Checklist

Checklist certification warning: By clicking to certify all WIMCR services and professional types, you are verifying that the list

of WIMCR programs and professional types selected above is accurate and complete. To certify, click on the button below at

the bottom of the screen.

Users will then see the error message below. Once a user clicks “OK” they will not be able to update their direct service checklist

screen without contacting PCG.

C. Direct Service Data by Professional Type

The Direct Service Data by Professional Type pages of the cost report allow for the reporting of all personnel (salary, benefit,

or contract) costs for the direct service clinicians employed by or under contract with the county agency. A separate page will

be available for each professional type identified on the Professional Type Checklist within the WIMCR Direct Service Checklist

page. For example, if a county agency has selected Master’s Degree Level, Psychiatrist/MD, and Registered Nurse/Licensed

Practical Nurse on the Professional Type Checklist of the WIMCR Direct Service Checklist page, these would be the only three

professional types available to report data for on the Direct Service Data by Professional Type page.

The user may begin entering data for a specific professional type by selecting that professional type from the list shown on the

Direct Service by Professional Type page. For each professional type, the user will need to navigate through four (4) separate

screens to provide the necessary data and complete the reporting for that professional type. The four (4) pages are:

a. Professional Type Basic Information

b. Professional Type Cost

c. Professional Type Hours

d. Professional Type Direct Service Time Allocation Statistics

In completing the Direct Service by Professional Type pages, users will be required to complete the four screens in the defined

order. Once a user has completed a screen, they may go back to edit that screen however a user cannot complete the next

screen before they have completed the preceding screen.

There will be a progress bar at the top of each of the four WIMCR direct service professional type screens which will indicate

the status of the WIMCR cost report for each direct service professional type. Once a section has been completed, the

corresponding component will be highlighted in dark blue on the WIMCR progress bar (see the “Basic Information” component

in the example below). Completed sections of the cost report can be accessed by clicking on the corresponding component from



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the WIMCR progress bar. An item which is currently in process, will be highlighted in bright blue (see the “Cost” component

below). Lastly, components which are not yet completed will be highlighted in light blue (see “Hours” and “Direct Time Allocation”

components below).

Professional Type Basic Information Screen

The Professional Type Basic Information Screen is used to capture the basic information needed to identify the direct service staff

for whom the county agency will be reporting costs and allocating expense to the WIMCR program for. The data captured within

this screen includes the First Name and Last Name of the direct service staff, County Job Title, National Provider ID (NPI),

Employment Status, and Allocation of Overhead costs.

Users should add as many rows as necessary to include all staff for the professional type.

The information provided on the Professional Type Basic Information Screen will establish the structure for the subsequent screens

for that professional type. Users will only be able to provide cost, hour, and allocation information for the professionals they have

included on the Basic Information Screen. Users will be able to navigate back to this screen to add or remove staff as necessary

however they will not be able to begin entering cost information until they have completed the Basic Information Screen.



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• Last Name (Mandatory Field)

The user will report the last name of the staff

member they are adding to the cost report.

• First Name (Mandatory Field)

The user will report the first name of the staff

member they are adding to the cost report. The

name used for the staff should match the name

included on the county agency’s supporting

documentation. For example, if a staff member

is identified in the county agency’s payroll as

Steven, the First Name included in the cost

report should be Steven and not “Steve” to avoid

any discrepancies in the event of an audit.

• County Job Title (Optional Field)

The user can utilize this field to provide the staff

member’s job title according to county agency

records. For example, the county agency may

identify the staff they include on the MD

Professional Type page as Physician, MD, or Psychiatrist.

• Provider NPI (Optional Field)

The user can utilize this field to report the unique 10-digit NPI number assigned to each individual clinician.

• Status (Mandatory Field)

The user will utilize this field to identify the employment status of each clinician reported. The user will identify whether each

clinician is directly employed by the agency (Agency Employee) or provides services per a contractual agreement (Contractor).

• Allocate Overhead Cost (Mandatory Field)

The user will utilize this field to identify whether overhead cost is allocated to each contracted clinician and regional shared

contracted clinicians. This field has been defaulted to "yes" for agency employed clinicians as well as regional shared agency

employees.

Counties may only allocate overhead costs to contractors if the allocation is consistent with the county’s cost allocation plan for

central service costs. Indirect cost rates associated with both county-wide central service overhead and health department

overhead may only be applied to contractors, for WIMCR cost reporting purposes, if the county applies overhead rates to

contractors for county government budget development purposes.

The state will review county cost allocation plans at its discretion to verify consistency between the county-wide cost allocation

plan method and the contractor allocated overhead method for WIMCR cost reporting.

Professional Type Cost Screen

After completing the Professional Type Basic Information Screen, the county agency user will then be able to navigate to the

Professional Type Cost Screen. Users will be able to report the salary and benefit costs for any staff that were identified as an Agency

Employee or contract costs for any staff that were identified as a Contractor.

Professional Type Basic Information Screen - Desk Review

Checks

To navigate to the next section of the cost report, users will need

to ensure that any desk review checks associated with the

information provided on this screen are addressed. Examples of

potential desk review checks that may be triggered based on the

data entered on this screen include:

First or last name missing

Please enter a first and last name for all professionals.

Duplicate Entry

The name of an individual clinician appears twice in your cost

report. Please confirm that there are no duplicative staff

entries.



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• Last Name

This field will be prepopulated based on the information provided on the Professional Type Basic Information Screen.

• First Name


• Salary

The user will report the gross salary amounts paid to any staff identified as an Agency Employee. The amount reported in this

field should be inclusive of all cost from which payroll taxes are deducted, including Regular wages or extra pay, Paid time off

(e.g., sick or annual leave), Overtime, Bonuses or longevity, Stipends, and Cash Bonuses and/or cash incentives.

Do not include any reimbursements for expenses such as mileage or other travel reimbursements.

• Benefits

Benefits include employer-paid health/medical, life, disability, or dental insurance premiums, as well as employer-paid child day

care for children of employees paid as employee benefits on behalf of your staff, retirement contributions, and worker’s

compensation costs. Report the expended amounts paid by the county agency which are directly associated with each staff

member by type of employee benefit.

The following employee benefits can be captured:

Employee Insurance- Amounts for the employer’s share of any insurance plans, such as life, health, dental, and accident

insurance.

Social Security Contributions- Employer’s share of amounts paid by the district for social security. This can include

Social Security- OASDI and Medicare-Hospital Insurance.

State Retirement System Contributions- Employer’s share of amounts paid by the district for retirement and long-

term disability contributions.

Tuition Reimbursement- Amounts reimbursed by the county agency to any employee qualifying for tuition

reimbursement based on county agency policy.

Unemployment Insurance- Amounts paid by the county agency to provide unemployment insurance for its employees.

Workers’ Compensation- Amounts paid by the county agency to provide workers’ compensation insurance for its

employees.



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Other Health Benefits (Employer Paid) - Amounts paid by the county agency to provide health benefits, other than

insurance, for its current or former employees.

Other Employee Benefits (Employer Paid) - Employee benefits other than those classified above, including fringe

benefits such as automobile allowances, housing or related supplements, moving expenses, and paid parking.

• Contract

The user will utilize this field to report any costs incurred for the purchase of professional services provided by staff identified

as a Contractor. Contracted staff costs include compensation paid for services contracted by the county agency with any outside

agency or individual (such as an independent clinician).

The reported costs should be the total costs for the agency or individual as paid by the county agency for the reporting period.

• Gross

The Gross field is calculated by the system. For staff that are identified as an Agency Employee, this field represents the sum of

the amounts reported in the Salary and Benefit fields. For staff that are identified as a Contractor, this field represents the amount

reported in the Contract field.

• Regional Revenue Offset

The Regional Revenue Offset field is designated for all regional shared employees. A regional shared employee can be either an

agency employee or a contracted employee. The contractual agreement and how the shared employee is reported will dictate

how this field will be utilized. A regional offset is required if a county agency has a contractual agreement with a third-party

vendor, incurs cost on behalf of multiple counties in a region and collects payments from other counties in the region for services

provided by the third-party vendor. In that example, the agency that receives the revenue for paying on behalf of other counties

in the region must also report revenue offset.

Similarly, if you have a contractual agreement with another county’s employee, then you must report the contracted amount

paid to the county that incurred cost on your behalf. If you have reported a regional shared agency employee, please report

the full salary and benefits of the employee in their proper fields. Then you must report the amount that reflects the agreed

upon contracted costs for providing your agency employees services at another agency within your WIMCR/CCS Region, in the

Regional Revenue Offset field.

Contracted Shared Employee example: County A has an agreement to contract out 10% of an employee’s time and

salary/benefits to County B. County B must then report 10% of the employee’s salary/benefits under the contract field.

Regional Shared Employee example: County A has an agreement to contract out 10% of an employee’s time and

salary/benefits to County B. County A reports this employee as a regional shared employee, and must report the full salary and

benefits of this employee under salary and benefits and then must also report 10% of this employee’s salary/benefits under

regional revenue offset. The regional revenue offset reported for County A must match the contract cost reported

for County B.



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Professional Type Hours Screen

After completing the Professional Type Cost Screen, the county agency user will then be able to navigate to the Professional Type

Hours Screen. Users will be able to report the paid hours for all staff identified on the Basic Information Screen. Hours can be broken

out between Direct Hours, Direct Support Hours, Paid Time Off (PTO), and Other Hours.

The Professional Type Hours Screen will not be available for data entry until the user has completed the Basic Information Screen

and Cost Screen.

Professional Type Cost Screen - Desk Review Checks

To navigate to the next section of the cost report, users will need to ensure that any desk review checks associated with

the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered

based on the data entered on this screen include:

Salary is unusually high

Salaries listed for an individual clinician exceed the expected threshold.

Benefits are unusually high

Benefits costs listed for an individual clinician exceed the expected threshold.

Contract cost is unusually high

Contract costs listed for an individual clinician exceed the expected threshold.

Benefit to salary ratio is unusually high

Benefits for an individual clinician are more than an established percentage of salary cost, which is unusually high.

Salary or contract cost missing

Please enter a [contract/salary] cost for an individual clinician.

Salary with no benefits

No benefit cost reported for an individual clinician.



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• Last Name


• First Name


• Direct Hours

The user will input the hours providing direct medical WIMCR services in this field. Direct services are those that would be

billable to Medicaid if all recipients were Medicaid eligible.

WIMCR Direct Hours include:

• Face to face medical services

• Medicaid allowable activities included in the relevant ForwardHealth Handbook

• Direct Support Hours

WIMCR Direct Support hours should include all time spent on a WIMCR program aside from WIMCR Direct Hours (providing

face-to-face medical services).


https://www.forwardhealth.wi.gov/WIPortal/Online%20Handbooks/Display/tabid/152/Default.aspx


35






• Paid Time Off (PTO)

Paid Time Off (PTO) includes sick time, vacation

time, and personal time used by the employee

during the reporting period.

• Other Hours

Other Hours includes all other paid hours

supporting any program or activity outside of

WIMCR/CCS/CRS.

• Total Paid Hours

Total Paid Hours is a system generated field

based on the sum of the hours reported in the

WIMCR Direct Hours, WIMCR Direct Support

Hours, PTO, and Other Hours fields.

• Paid Hours Net of PTO

Paid Hours Net of PTO is a system generated

field based on the values of Total Paid Hours

field less the PTO field.

• Regional Direct

This field is strictly for any reported regional shared agency employees. Please report all Direct Service hours that your employee

has accumulated by providing Direct Services or face to face services within another agency of your WIMCR/CCS Region.

• Regional Support

This field is also for the sole use of any reported regional shared agency employees. Please report all Direct Support hours that your

employee has accumulated by providing the array of services that qualify as direct support within another agency of your WIMCR/CCS

Region.

Regional Shared Agency Employee Example County A has an agreement to contract out 10% of an employee’s time and salary

to County B. County A reports this employee as a regional shared employee, and must report the full hours(includes Direct

Service/Support, PTO and Other Hours) of this employee in their proper fields, County A must then report all of the agreed upon

direct service hours and direct support hours that this employee has provided outside of your agency, under the applicable Regional

hour’s fields of this section.

Regional Shared Contracted Employee Example: County A has an agreement to contract out 10% of an employee’s time and

salary to County B. County B must report 10% of the employee’s time under the proper hour’s allocation fields (Direct Service/Direct

Support, PTO and Other Hours). The hours that are reported in this section for County B must match the Regional Direct/Support

Hours reported by County A for this employee. If you have any questions on how to accurately report this, please contact a PCG

WIMCR coordinator at [email protected] or (866) 803-8698.

Professional Type Hours Screen - Desk Review Checks

To navigate to the next section of the cost report, users will need to

ensure that any desk review checks associated with the information

provided on this screen are addressed. Examples of potential desk review

checks that may be triggered based on the data entered on this screen

include:

No WIMCR Direct Hours Reported

No hours are allocated to WIMCR direct service for an individual

clinician. If any clinician does not provide direct medical WIMCR

services, their information should be reported under "WIMCR Direct

Support"

Hours reported for all personnel are unusually low

The total paid hours reported for all [professional type] staff are

unusually low.

WIMCR Direct hours are unusually high

The ratio of Direct Hours to Total Paid Hours exceeds the established

threshold.

Total paid hours unusually high

The total paid hours reported for an individual clinician are unusually

high.



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Professional Type Direct Time Allocation Statistics Screen

After completing the Professional Type Hours Screen, the county agency user will then be able to navigate to the Professional Type

Direct Time Allocation Statistics Screen. Users will be able to report the WIMCR Direct Services hours for all staff identified on the

Basic Information Screen. Hours should be broken out across the WIMCR programs for which the professional type can provide

services. The WIMCR programs will be limited to only those programs that were selected on the WIMCR Direct Services Checklist

screen.

The Professional Type Direct Time Allocation Statistics Screen will not be available for data entry until the user has completed the

Basic Information Screen, Cost Screen, and Hours Screen.



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• Last Name

This field will be prepopulated based on

the information provided on the

Professional Type Basic Information

Screen.

• First Name


the information provided on the

Professional Type Basic Information

Screen.

• Direct Hours


the WIMCR Direct Hours reported on

the Professional Type Hours Screen.

Users will only be able to allocate hours

to the WIMCR programs up to the total

WIMCR Direct Hours reported for a

clinician on the Professional Type

Hours Screen.

• WIMCR Program Fields

The user will enter the total WIMCR

Direct Hours for each program

available for the professional type based on the WIMCR programs selected on the WIMCR Direct Service Checklist. For example,

when completing the Direct Service allocations for the MD professional type, the user would only be able to report WIMCR Direct

Hours for CSP, OPMHSA, and TCM if those were the only services selected on the WIMCR Direct Service Checklist that were

applicable to the MD professional type. To report WIMCR Direct Hours to other programs for an MD, the user would need to

return to the WIMCR Direct Services Checklist to select the applicable WIMCR program(s).

The user will only be able to report Direct Hours across the applicable WIMCR programs up to the WIMCR Direct Hours reported for

each clinician on the Professional Type Hours Screen.

Professional Type Summary Screen

Once a user has completed the four screens for a professional type, they will be able to view a summary for that professional type.

The Professional Type Summary Screen will show how the cost and hours have been allocated across the WIMCR programs based

on the information provided in the Professional Type Cost, Professional Type Hours, and Professional Type Direct Time Allocation

Statistics Screens. Each professional type summary screen is a locked screen which can be accessed for informational purposes. No

data can be entered directly into the professional type summary screen.

Professional Type Direct Time Allocation Statistics Screen - Desk

Review Checks

To navigate to the next section of the cost report, users will need to ensure

that any desk review checks associated with the information provided on

this screen are addressed. Examples of potential desk review checks that

may be triggered based on the data entered on this screen include:

Paid Hours allocated does not equal WIMCR direct hours

All reported WIMCR direct hours must be allocated among WIMCR

programs for each clinician.

Medicaid paid claims exceed WIMCR direct hours

Medicaid paid claims (converted to hours) exceed WIMCR direct hours

for a [professional type (if applicable)] staff providing [WIMCR

program] services.

Cost per paid hour is unusually high/low

Total cost divided by total paid hours for an individual clinician is

unusually high or low.



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D. Direct Service Non-Personnel Cost

The Direct Service Non-Personnel Cost page of the cost report will allow the county user to report all the non-personnel costs

associated with the Direct Service clinicians included on the various Professional Type pages of the cost report. Allowable costs on

this page are limited to three non-personnel cost categories:

• Clinician Travel

Expenses reported under the Clinician Travel category are those expenses that are incurred by the county agency for a clinician

to travel to and from a location for the provision of a direct service. This may include mileage expenses, tolls, meals, lodging,

and other similar expenses.

• Clinician Training

Expenses reported under the Clinician Training category are those expenses that are incurred by the county agency related to

the training of direct service clinicians. This may include expenses for conference attendance, continuing education needed to

maintain licensure.

• Direct Medical Service Materials

Expenses reported under the Direct Medical Service Materials category are those expenses that are incurred by the county

agency for the purchase of materials and supplies that are used in the provision of a Direct WIMCR service.

Users will report the total cost for each of these categories by WIMCR program. The WIMCR programs will be defined based on the

programs selected on the WIMCR Direct Service Checklist. Users will also be able to report the Direct Service Non-Personnel expenses

for non WIMCR programs in the Non WIMCR field.

Users will report a lump sum value for each category of non-

personnel expenses. The tool will automatically be set on

“yes” Override Allocation which will allow you to self-allocate

the total cost by program. This option is appropriate if you

have supporting documentation that allows you to discretely

breakout non-personnel costs by program. If you cannot

breakout the non-personnel cost by program please select

“no” under Override Allocation to use the WIMCR system

generated allocation methodology.

Providers are reminded that the expenses reported on this

page should be inclusive of the expenses incurred for only

those staff that were included on the Direct Service Data by

Professional Type pages. In other words, if a clinician is not

a provider of a direct medical WIMCR service, the cost of travel, training and Direct Medical Service Materials associated with that

clinician should not be included.

Direct Service Non Personnel – Desk Review Checks

To navigate to the next section of the cost report, users will

need to ensure that any desk review checks associated with

the information provided on this screen are addressed.

Examples of potential desk review checks that may be

triggered based on the data entered on this screen include:

Non-personnel cost to salary & benefit or contract

cost ratio is unusually high

The ratio of direct service non-personnel cost to

personnel cost is unusually high.



39

The Direct Service Non-Personnel Category field includes the three categories of allowable direct service non-personnel expenses.

These fields will be prepopulated in the system.

• Total Cost

The user will enter the total cost associated with each of the direct service non-personnel expense categories. This cost will be

allocated to the defined WIMCR programs and Non WIMCR fields based on the distribution of the WIMCR direct service program

hours and Other Non WIMCR hours as reported on the Direct Service Data by Professional Type pages.

• WIMCR Program and Non WIMCR Fields

The expenses will be allocated to each of the defined WIMCR program and Non WIMCR fields based on the distribution of the

WIMCR direct service program and Other Non WIMCR hours as reported on the Direct Service Data by Professional Type pages.

E. WIMCR Direct Support

In addition to WIMCR direct service clinicians, many agencies employee staff who are focused specifically on providing Direct Support

services to the WIMCR program; however, they do not provide a WIMCR Direct Service at any point.

WIMCR Direct Support hours should include all time spent on a WIMCR program aside from WIMCR Direct Hours (providing face-to-

face medical services).






To qualify as a WIMCR Direct Support provider, an

individual must meet the following 2 criteria:

1. Do not provide a WIMCR Direct face-to-

face service – individual clinicians who provide

a direct service in addition to direct support

should be reported under the appropriate direct

service professional type.

2. Spend at least 25% of their time providing

WIMCR direct support activities – general

agency support staff that spend fewer than 25%

of their paid hours supporting the WIMCR

program should be reported within Overhead

Personnel.

WIMCR Direct Support providers meeting the above

criteria are reported individually. The cost reporting

process for direct support providers mirrors the reporting

process for direct service clinicians outlined above.

In the Direct Time Allocation section, the tool will automatically be set on “yes” Override Allocation which will allow you to self-allocate

the Direct Support hours by program. This option is appropriate if you have supporting documentation that allows you to discretely

breakout Direct Support hours by program. If you cannot breakout the Direct Support hours by program please select “no” under

Override Allocation to use the WIMCR system generated allocation methodology.

Direct Support – Desk Review Checks

To navigate to the next section of the cost report, users

will need to ensure that any desk review checks associated

with the information provided on this screen are

addressed. Examples of potential desk review checks that

may be triggered based on the data entered on this screen

include:

All Professional Type Basic Information, Cost and

Hours desk review checks.

Direct support reporting mirrors direct service

reporting, consequently the same edit checks are

applicable.

Ratio of WIMCR Direct Support Hours to total paid

hours is below required threshold

To qualify as a direct support provider, an individual

must spend at least 25% of their paid hours on

WIMCR direct support activities.



40

F. Supplemental Direct Service Information

Due to the unique structure of each individual WIMCR program, there is a need for supplemental information relating to several

WIMCR programs. Each agency will only see the supplemental report screens associated with WIMCR programs that they are

providing. It is possible for an agency to not have access to any supplemental reports

Due to the unique structure of each individual WIMCR program, there is a need for supplemental information relating to several

WIMCR programs. Each agency will only see the supplemental report screens associated with WIMCR programs that they are

providing. It is possible for an agency to not have access to any supplemental reports.

Group Services (Optional)

Any provider agency providing PNCC, OPMHSA, OPMHSA-HC, CSP or CCS services are required to report group services hours and

total group services participants if they are providing any WIMCR services in a group setting. If the provider does not provide WIMCR

services in a group setting, they are not required to report WIMCR group services data.



41

The following fields are reflected for each

unique program/professional type combination

applicable to a particular agency on the group

services supplemental screens.

• WIMCR Direct Hours (Prepopulated)

Hours providing direct medical WIMCR

services. WIMCR Direct Hours are inclusive of

Group and Individual services

• Group Services Hours (Open Field –

Data Entered by Provider if Applicable)

Total number of hours corresponding to each

WIMCR Program and Professional Type

providing a WIMCR medical service to a group

of clients (as opposed to an individual client)

• Individual Services Hours

(Prepopulated)

Total number of hours corresponding to each

WIMCR Program and Professional Type

providing a WIMCR medical service to an

individual client.

Individual Services Hours are prepopulated based on the following formula:

Individual Services Hours = Total WIMCR Direct Hours - Group Services Hours

• Billable Units (Prepopulated)

Increments in which Medicaid is billed (i.e. 1 hour unit, 15-minute increment, etc.)

• Group Services Units (Prepopulated)

Prepopulated conversion from total hours reported to total number of units of service provided based on Billable Units.

• Group Participant Units (Open Field – Data Entered by Provider if Applicable)

Total duplicated number of participants attending all Group Services Units.

For example: For 2 group sessions, 1 session has 11 participants and the second session has 15 participants, for

a total of 26 participants. Even if 4 participants attend both sessions, the group participant unit count is 26.

• Average Participants Per Unit (Prepopulated)

Group Participant Count ÷ Group Services Units

Group Services – Desk Review Checks





Group service hours exceeds WIMCR direct hours

Group service hours exceeds WIMCR direct hours for a specific

professional type.

Paid claims exceeds WIMCR group services hours reported


for a [professional type (if applicable)] staff providing [WIMCR

program] group services.

Average participants per unit less than 2

Group services require a minimum of two participants. Services

provided to a single individual cannot be billed as a group service.



42

Prenatal Care Coordination, Personal Care Nurses, Home Health (Mandatory)

In the case of PNCC, PC provided by nursing staff and HH services, one or more procedure codes are billed as a “Visit”. Consequently,

the previously reported hours allocated to direct service providers working on each program is not adequate information to determine

how many units of service (or visits) were provided. Thus, a supplemental sheet is necessary to appropriately calculate a cost per

unit of service provided for each program.

Visits reported on the supplemental direct service information screens for Home Health, Prenatal Care Coordination and Personal

Care should reflect the actual hours of direct service provided during the reporting period as well as the total number of visits of

service during the corresponding direct service hours.

The following fields will be available on the

supplemental reports for Prenatal Care

Coordination, Personal Care Nurses and

Home Health:

• Hours (Prepopulated)

Previously reported - hours providing

direct medical WIMCR services.

• Visits (Open Field)

Total number of units of service

(measured in individual visits) provided

to PNCC/PC/HH clients during

previously reported PNCC/PC/HH hours.

• Conversion Factor (Prepopulated)

Hours ÷ Visits

The conversion factor measures the

average amount of time it takes to

provide a single visit. The conversion

factor will be automatically applied to

the cost per hour for each associated

service to calculate the cost of providing one visit.

Prenatal Care Coordination, Personal Care Nurses, Home – Desk

Review Checks





(PNCC only) Hours reported for PNCC visits exceed total PNCC

hours

Total hours allocated to specific PNCC services exceeds WIMCR direct

PNCC hours.

(PC, PNCC, HH) Paid claims exceeds WIMCR program hours

reported


for a staff providing [WIMCR program] group services.

(PC, PNCC, HH) Conversion factor is outside of expected range

The ratio of hours to visits is outside of the expected range. This



43

Crisis Intervention (Stabilization Per Diem)

For additional information on Crisis Stabilization view the Crisis Stabilization Guide (appendix A). Crisis Stabilization is a WIMCR

program which falls completely outside of the WIMCR reporting process which allocates clinician cost and agency overhead to various

WIMCR programs. All cost associated with WIMCR Crisis Stabilization will be reported on the crisis stabilization supplemental form

which mirrors the format of the Crisis Stabilization WIMCR

form located on the Dashboard.

The following fields will be captured on the Crisis Stabilization

WIMCR supplemental form:

• Name of Facility

Report the name of each facility where Crisis Stabilization

services are provided

• Residential Staff Cost

Gross residential facility salary and benefit cost.

• Operating Cost

All non-personnel cost relating to day-to-day facility

operations including contract cost and materials and

supplies.

• Space Cost

Total cost of residential facility space including building

maintenance and utilities.

• Total Cost

Residential Staff Cost + Operating Cost + Space Cost

• Total Participant Days

Total days of service provided at each residential facility during the reporting period.

• Total Cost Per Diem

Total Cost ÷ Total Participant Days

Crisis Intervention (Stabilization Per Diem) –

Desk Review Checks

To navigate to the next section of the cost report, users

will need to ensure that any desk review checks

associated with the information provided on this screen

are addressed. Examples of potential desk review checks

that may be triggered based on the data entered on this

screen include:

Total cost per diem unusually high/low

The average cost per diem for Crisis Stabilization

services falls outside of the usual range.

Medicaid paid claims exceed total participant

days reported

Medicaid paid claims for Crisis Stabilization services

exceed total participant days per the WIMCR cost

report.



44

Community Recovery Services (CRS) CLSS Per Diem Worksheet

Community Living Supportive Services (CLSS) billed as a per-diem service under procedure code H0043-U9, is a CRS-related service

which falls completely outside of the WIMCR reporting process which allocates clinician cost and agency overhead to various WIMCR

programs. All cost associated with CLSS billed as a per diem will be reported on a Microsoft Excel-based tool that is available on the

WIMCR Dashboard. Costs reported in this form will be cost settled outside of the WIMCR tool. Completed forms should be emailed

to [email protected].

The following fields will be captured on the CLSS Per Diem Worksheet:

• Facility Name

Name of residential facility where CRS CLSS services where provided during reporting period.

• Residential Staff Cost

Gross residential facility salary and benefit cost.

• Operating Cost

All non-personnel cost relating to day-to-day facility operations including contract cost and materials and supplies.

• Space Cost

Total cost of residential facility space including building maintenance and utilities.

• Total Cost

Residential Staff Cost + Operating Cost + Space Cost

• Total Participant Days

Total days of service provided at each residential facility during the reporting period.

• Total Cost Per Diem

Total Cost ÷ Total Participant Days

If you have any questions on how to accurately report CLSS Per Diem costs, please contact a PCG WIMCR coordinator at

[email protected] or (866) 803-8698.

CCS (Comprehensive Community Services) Regional Information

Agencies who provided CCS services must fill out the CCS Regional Information tab.

o Regional formation:

▪ Initial formation of a region may occur at the beginning of a month from July 1, 2014, to December 31, 2015.

▪ One annual update to regional structure is allowed (first of the month).

▪ Effective January 1, 2016, additions and removals must occur on January 1.

o Regionalization incentive:

▪ Non-regional CCS providers will continue to receive only the federal share of reimbursement.

▪ Regional CCS providers will realize enhanced CCS payments through interim claiming and a cost-based

reimbursement method.




45

• Did you participate in a CCS regional model during the reporting period? (Yes/No)

o The following criteria need to be complete to be considered a CCS region: Division of Mental Health and Substance Abuse

Services (DMHSAS) approval

o Division of Quality Assurance (DQA) certification

o Medicaid provider enrollment

If your CCS Region meets all the above criteria, please select yes, otherwise, please select no. If you have any questions, please

contact a PCG Coordinator at (866) 803-8698 or email us a [email protected]

• Name of Region (mandatory)

Please provide the Name of your Region, this field is crucial during the desk review process to be able to tie out all CCS Regional

participants.

• Regional Certification Number (mandatory)

Please provide the Regional Certification Number that is designated to your Region.

• Type of Region (mandatory)

Please indicate from the dropdown list which type of region you are participating in. Below is a brief narrative of how each region

operates.

Multi County Agency

Multiple counties/tribes partner together to operate a regional CCS program across their counties/tribes; a lead county or tribe

is identified. Below is visual depiction of how a shared service region interacts. If you are a member of a multi county region

you must complete the Rendering Provider ID section of the cost report. This number will be used to determine your agency

specific Medicaid billed units from the rest of your region.

County 3 Lead

County 1

County 4

County 2




46

Shared Services

Multiple Counties/tribes partner together to operate a regional CCS program and there are no lead county billing services on

behalf of the other regional participants. This region would indicate that services are being shared between all the participants.

Below is visual depiction of how a shared service region interacts.

51.42 Model

Multiple counties that have partnered together to form a separate 51.42 legal entity operate a regional CCS program through

the 51.42 entity.

Populations-Based Model

A single county with a population exceeding 350,000 residents, or a single tribe, regardless of population size, operates a

regional CCS program.

• Lead County (if applicable)

This field is only required for a Multi County Region. If you have selected a Multi-County Region, then you are required to report if

you are the Lead County for this region.

• Additional Counties (if applicable)

This field is required for Multi County Regions, as well as Shared Services Regions. We require you list out each additional Agency

that is encompassed within your CCS Region.

• Regional Lead Billing Provider ID (if applicable)

This field is required for Multi County Regions. Please input the Billing Provider ID of the Regional Lead that bills on behalf of your

county.

• County Rendering Provider ID (if applicable)

This field is required for Multi County Regions. Your county’s CCS Rendering Provider ID is populated based on the ID you selected

in the Direct Service Checklist. Please verify that the ID is correct. The Rendering Provider ID is used to ensure that your county’s

CCS claims are correctly assigned and not attributed to other counties in your region.

• Date of Initial Formation of Region (mandatory)

The user is required provide the initial formation date of the applicable CCS Region.

County 4

County 3

County 1

County 2



47

The remaining bottom 3 fields of the CCS Region history need to be filled out only if any alteration has occurred to the CCS

Region since it was formed. The user then must provide the date the alteration happened and then give a descriptive narration of

the alteration that had occurred to the users Region. If no alterations occurred, then the bottom 3 fields do not need to be filled

out. If you have any questions on your CCS regional information, please contact a PCG Coordinator at (866) 803-8698 or email us

at [email protected]

G. WIMCR Overhead

To appropriately allocate a portion of each agency’s overhead cost to the WIMCR program, each agency should report their entire agency-

wide overhead cost which will then be allocated among the various WIMCR programs based on the FTE allocation methodology.

Overhead Personnel

Providers of central services related to overall agency operations that are allocable to all agency programs, including WIMCR. The

following fields are related to overhead personnel reporting.

• Regional shared (Yes/No)

Please identify whether any FTEs the user selects for overhead personnel are regional shared employees that have been shared

within your WIMCR/CCS Region.

• Overhead Personnel Cost Category (Dropdown Menu)

See the chart below for possible overhead personnel cost categories. If the category is not listed in the drop-down menu, county

agency users may select the “Other-Please Describe” category.




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• FTE Count

FTEs Count Total FTEs applicable to each Overhead service. 1 FTE is equal to 40 hours per week and 2,080 hours per year.

Example:

Part time (20 hours per week) employee = .5 FTE

Full time (40 hours per week) employee = 1 FTE

Regional FTE Count

First, regardless of having Regional shared Yes or No, please report the full FTE count in the FTE Count field. In the Regional FTE count

field, please report the amount of FTE(s) out of your total FTE count that are regionally shared overhead personnel.

Regional FTE Count example: County A has an Overhead Personnel FTE that is regionally shared. County A agrees to let this FTE provide

10% of their time and services to County B. Under the FTE count field, this FTE would count as 1, however under the Regional FTE

count, this employee counts as .9FTE to County A. Per the regional shared format, 90% of the FTE(s) time is spent at County A. County

A has the full FTE in the FTE count field, but netting out the time spent at County B will offset the time this FTE spent at County B, this

will remove any duplicative reporting.

County B in this scenario will check this FTE as “Yes” for regional shared and report the time spent (In the above example 10%) under

the Total FTE count field as .1FTE. Nothing is to be reported in the regional shared FTE Count.

Please refer to the intergovernmental example of overhead personnel on page 8 to provide a more detailed example.

• Salary, Benefits, Contract Cost and Gross

See direct service professional type for a definition of salary, benefits, contract cost and gross. All cost data should be reported

in aggregate for all FTEs reflected in the FTE count within each overhead personnel cost category.

Revenue Offset

The Revenue Offset field is applicable only if the user has selected “Yes” for being regional shared overhead personnel FTE(s) and is

the county in which the FTE is being contracted from. The amount reported in this field should be the agreed upon contract cost of

having an employee provide said service to another agency within your WIMCR/CCS Region.



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Revenue Offset Example: If County A agrees to contract out 10% of an employee’s salary/benefits and time to County B. County A

must report the employee’s full salary/benefits in the proper fields for overhead, then report the 10% of salary/benefits under Revenue

offset. County B would report this FTE as regional shared as well under overhead personnel but report the 10% contract cost under the

contract field. The contact cost and Revenue offset fields must match between the two counties.

Overhead – Desk Review Checks

To navigate to the next section of the cost report, users will need to ensure that any desk review checks associated with

the information provided on this screen are addressed. Examples of potential desk review checks that may be triggered

based on the data entered on this screen include:

Total direct service plus direct support plus overhead personnel salary and benefit cost exceeds agency

wide Personnel Expenditures

Agency wide personnel expenditures is meant to capture all personnel cost; consequently, cumulative

personnel expenditures should not exceed agency wide personnel.

Total OH Non-Personnel Minus Intergovernmental Charges greater than agency wide operation

expenditures

Agency wide operation expenditures is meant to capture all operation cost; consequently, cumulative

non-personnel expenditures should not exceed agency wide operation cost.

Total cost per FTE unusually high/low

Total cost per FTE falls outside of the expected range.

Ratio of total overhead cost (personnel plus non-personnel) allocated to WIMCR divided by all WIMCR cost

exceeds expected threshold (above expected but below unallowable).

Overhead amounting to greater than 40% of total direct service (personnel and non-personnel) and direct

support cost. This edit will require an explanation.

Ratio of total overhead cost (personnel plus non-personnel) allocated to WIMCR divided by all WIMCR cost

exceeds unallowable threshold

This edit will trigger in addition to the edit above is overhead amounts to greater than 50% of total direct

service (personnel and non-personnel) and direct support cost. NOTE: This edit is the only edit with

the potential to automatically change cost report values. It will automatically limit total

WIMCR overhead cost to 50% of all other WIMCR cost.



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Overhead Non-Personnel

Non-personnel cost applicable to overall agency operations that are allocable to all agency programs, including WIMCR.

• Regional Shared(Yes/No)

Please identify if any overhead non-personnel cost the user selects are regional shared costs within your WIMCR/CCS Region.

• Overhead Non-Personnel Cost Category (Dropdown Menu)

See the chart below for possible overhead Non-personnel cost categories. If a category is not listed in the drop-down menu,

county agency users may select the “Other-Please Describe” category.



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• Interdepartmental Charges

The Interdepartmental charges that were reported on the County Agency Overview Page is a lump sum portion of county wide

overhead cost allocated to a county agency. The reported Interdepartmental charges are automatically carried over to this

section of the report.

• Cost

See the chart below for possible overhead Non-personnel cost categories

• Revenue Offset

If the user selects “yes” for reported regional shared non-personnel costs and is in fact the county that is sharing these services,

then please report the agreed upon amount of shared services in this field. If you are the County that is contracting these

services, please report all costs under the “Total Cost” field. Any shared services between two counties must have matching

Revenue Offsets and Total Costs.

• Overhead Cost Allocation

Overhead cost has been automatically allocated to each WIMCR program and non WIMCR based on the FTE method. If your

agency has a preferred overhead allocation methodology, please see the overhead cost override information below.

Overhead Cost Allocation Methodology (FTE Method)

1) Agency Reports total agency employed FTEs and total contracted FTEs to whom the agency allocates overhead.

2) Agency identifies which WIMCR clinicians are appropriate for overhead allocation on an individual clinician basis.

When a clinician is entered by a county agency, the agency will identify contractors and agency employees. Overhead cost will

automatically be allocated to agency employees. For all clinicians who are identified as contractors, the agency will be required

to identify whether overhead should be applied based on agency accounting practices.



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3) Computing total overhead cost per FTE. This step determines the average share of overhead per FTE based on total

overhead cost reported divided by total agency wide FTEs. Agency wide FTEs includes all FTEs that are directly employed by

the agency and contractors that to whom overhead is allocated.

4) Applying the average overhead per FTE to WIMCR FTEs per program. This step determines the portion of overhead

cost which can be attributed to a specific WIMCR program.

Cost Reported (Numerator):

Total Overhead Cost x (Direct Service Program hours Net of

Non-Overhead Staff hours + Direct Support Program Hours

Net of Non-Overhead staff hours) ÷ 2080

Total Agency wide FTE (Denominator):

Total Agency Wide FTE - Overhead Personnel FTE

Alternative to FTE Method (Override)

1) Comprehensive overhead proposal is submitted to PCG and DHS. If an agency contends that there is a more appropriate

and accurate overhead allocation methodology based on the structure of the agency, PCG will collect detailed information

regarding the proposed method of overhead allocation.

2) PCG and DHS will collect all override requests and determine an appropriate review process. Once the cost reporting

period has ended and PCG has compiled all requests to override the prepopulated overhead cost allocation, PCG and DHS will

determine an appropriate method for reviewing and approving or denying override requests.

3) If approved, PCG will allow the agency to override data on WIMCR overhead allocation page. If a determination is

made that the overhead allocation methodology proposed by the agency is both reasonable and appropriate, the agency will be

able to update the values reflected on their overhead allocation page.

4) PCG will review all data manually entered by the agency and confirm that it is consistent with what was reflected

in the override request documentation. Once PCG has approved the updated overhead allocation as reflected in the WIMCR

webtool, the agency will be able to recertify their report.



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H. Federal Funds and Reductions

WIMCR providers are required to report the receipt of federal

grant funding which is used to offset the cost of a WIMCR

program. The following are data fields on the Federal Funds

screen of the WIMCR Cost Report:

• Total Allocated Cost

Total Allocated Cost includes previously reported direct service

cost, direct support cost and overhead cost which has been

allocated to each individual WIMCR program. Full time (40 hours

per week) employee = 1 FTE

• Federal Funds and Reductions

Please use this space to identify any federal grant dollars applied

to offset the cost of your agency's WIMCR programs.

Federal dollars include, but are not limited to:

- Substance Abuse Block Grant

- Mental Health Block Grant

- Social Services Block Grant

• Net Cost

Total Allocated Cost - Federal Funds and Reductions

Items to report under Federal Funds and Reductions*

✓ Any federal funding source received by a county and used to fund WIMCR costs

✓ Examples of federal funding sources that might need to be reported:

✓ Mental Health Block Grant

✓ Substance Abuse Block Grant

✓ Social Services Block Grant

✓ Birth to three allocation applied to WIMCR TCM

Items to exclude from Federal Funds and Reductions

x Any funding source that is not applied to any WIMCR cost

x Any state funding that is used to cover the local share of WIMCR cost

x Medicaid fee for service payments received - these will automatically be netted out of the final cost settlement as part

of the Provider Summary Report (PSR) calculation

x Basic County Allocation (BCA)

x Maintenance of Effort (MOE) dollars

* If you are unsure how to report your federal funds or believe that a funding source should be excluded from being reported, please contact PCG.

Federal Funds and Reductions – Desk

Review Checks

To navigate to the next section of the cost report,

users will need to ensure that any desk review

checks associated with the information provided

on this screen are addressed. Examples of

potential desk review checks that may be

triggered based on the data entered on this

screen include:

Federal funds exceed total program costs

The total value of federal funds used toward a

specific WIMCR program cannot be greater than

the cost of the entire WIMCR program.



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I. Summary and Certification

This page outlines the summary of all costs entered in the cost report. Links are available to additional summary data by program

and category. By clicking on ‘Certify’, the County Level Administrator can certify the cost report. The message below will be

displayed and will ensure that providers understand the requirements and results of certification.

INTENTIONAL MISREPRESENTATION OR FALSIFICATION OF ANY INFORMATION CONTAINED HEREIN MAY BE PUNISHABLE

BY FINE AND/OR IMPRISONMENT UNDER FEDERAL AND/OR STATE LAW.

CERTIFICATION BY OFFICER OF THE PROVIDER

I HEREBY CERTIFY that:

1. I have examined this statement, and accompanying Supporting Schedules, the allocation of expenses and services, and the

attached Worksheets for the period from 1/1/20XX to 12/31/20XX and that to the best of my knowledge and belief they are

true and correct statements prepared from the books and records of the Provider in accordance with applicable instructions.

2. This statement is of expenditures that the undersigned certifies are allocable and allowable to state Medicaid program under

Title XIX of the Social Security Act (the Act), in accordance with all procedures, instructions and guidance issued by the single

state agency and in effect during the Year ended XX/XX/XXXX.

3. The expenditures included in this statement are based on the actual cost of recorded expenditures.

4. The required amount of state and/or local funds were available and used to pay for total computable allowable expenditures

included in this statement, and such state and/or local funds were in accordance with all applicable federal requirements for the

non-federal share match of expenditures (including that the funds were not Federal funds in origin, or are Federal funds

authorized by Federal law to be used to match other Federal funds, and that the claimed expenditures were not used to meet

matching requirements under other Federally funded programs).

5. Federal matching funds are being claimed on this report in accordance with the Cost Report instructions provided by the

Department of Health and Family Services effective for the above reporting period.

6. I am the officer authorized by the referenced government agency to submit this form and I have made a good faith effort

to assure that all information reported is true and accurate.

7. I understand that this information will be used as a basis for claims for federal funds, and possibly state funds, and that

falsification and concealment of a material fact may be prosecuted under federal or state civil or criminal law.

What Happens When a Report is Certified?

Once certified, the report has been completed and it is locked and ready for desk review. No edits can be made to the

information. If changes are needed, please contact PCG to have the report certification rolled back. The progress bar on the

dashboard page will show that the report is certified.



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C. WIMCR Desk Review

A. Goals of Updated WIMCR Desk Review

The WIMCR desk review process has been integrated throughout the cost report to ensure that providers completing WIMCR

cost reports are aware of all potential audit risks. Following the completion of each screen within the WIMCR cost report, the

provider will submit clarification on each applicable audit risk.

B. Desk Review Structure and Process

The WIMCR webtool is designed to process desk reviews during the cost report completion process. As soon as data is entered

in a screen within the WIMCR webtool, all applicable desk review edits will be triggered immediately. By incorporating the desk

review process throughout the process of cost report completion, the system will address potential audit risks as soon as all

relevant information has been entered into the cost report. This method will expedite the WIMCR desk review process while

simultaneously helping to avoid errors which may impact subsequent sections of the cost report.

Following the certification of a WIMCR cost report, all desk review edits that appeared throughout the report will be summarized

on a single “desk review” page for PCG review. Once the desk review process is initiated following the closing of the WIMCR

cost reporting period, the provider will be able to view all desk review explanations provided during the completion of the WIMCR

cost report. As soon as a WIMCR coordinator has reviewed all desk review edits, an email will be sent to the provider notifying

them that their initial desk review has occurred and informing them whether additional clarification is required or the desk review

is complete and no further action is required.

C. PCG Response

The WIMCR Coordinator will review the desk review summary screen including provider explanations for all audit risks.

The WIMCR Coordinator will indicate within the WIMCR webtool if there is a need for clarifications and revisions to the cost

report. It is crucial that you update your contact information stored within the WIMCR webtool each year, because the

WIMCR Coordinator will contact the user associated with each cost report via e-mail and telephone. Cost reports with

pending reviews may be delayed from final settlement payment, until each report’s review is completed by the WIMCR

Coordinator and revisions are verified by the user.

A PCG user will respond individually to each audit risk that arises. If the explanation entered by the provider during the cost

reporting period adequately addresses the associated audit risk, a PCG reviewer will simply approve the provider’s

explanation and no further action will be required. When this occurs, the PCG reviewer will enter an explanation like the

review below:

A PCG Desk Reviewer has reviewed your explanation and no further action is required.

If the PCG desk reviewer completes a desk review and no further action is required, the provider will receive a “desk review

complete” email notification. If one or more items require additional clarification, the PCG reviewer will request follow up

from the provider.

D. Provider Response

When a provider response is required following an initial PCG desk review, the provider has two options.

a. If all data entered in the WIMCR cost report is accurate and verified, the provider will respond with an additional

clarifying explanation. Additionally, (if requested by a PCG reviewer), the provider may be required to email supporting

documentation to PCG at [email protected].

b. If an error was made during the completion of a WIMCR cost report. The provider can roll back their cost report

certification and update their cost data.




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E. Desk Review Email Notifications

Following each review of the WIMCR desk review by a PCG reviewer, one of the below emails will be automatically sent to each

notification recipient within an agency. If there are still pending desk review edits which require additional clarification, the

“Desk Review Action Required” email will be sent. If all desk review audit risks have been appropriately resolved, the agency’s

designated notification recipients will receive a desk review complete email. The receipt of a desk review complete email serves

as confirmation that the agency has completed their desk review process and no further action is required.

SECTION V – MANAGEMENT REPORTS

What Happens Next?

Once all submitted cost reports have been reviewed and finalized, the cost report data is transferred from the web tool and the

reported cost per unit from the cost report is applied to the number of Medicaid paid units with dates of service in the Calendar

Year. The cost for Medicaid services is then reconciled against the Medicaid interim claim payments for dates of services in the

Calendar Year. This is a comparison of "revenue vs. costs" for each program for which a cost report is submitted. This comparison

identifies your operating deficit and WIMCR payment amount. A "Provider Summary Report" is then created. This report is the

"Revenue vs. Cost" analysis that evaluates whether a WIMCR program is eligible for additional funds (e.g. costs exceeded

revenue) or whether revenue exceeded costs. Important points to note regarding this report:

• The Provider Summary Report reflects paid units of service for the Medicaid-eligible population only.

• The Provider Summary Report displays units of service for those programs that were claimed for dates of services

in the Calendar Year, regardless of payment date.

• A notification that the Provider Summary Report has been shared within the WIMCR webtool is e-mailed to all

designated WIMCR notification recipients. To ensure all important emails continue to reach your inbox, please add

the WIMCR Coordinator’s email address ([email protected]) to your address book.

Federal regulations require Medicaid payments to be made to only Medicaid-certified providers. The WIMCR checks will be made

payable to the Medicaid provider, but they will be mailed to the county treasurer by the Medicaid Claims Administrator and will

be accompanied by the county treasurer reports . The Medicaid providers will be sent electronic copies of both the county

treasurer reports and the provider summary reports.



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Evaluating the provider summary report can be beneficial to check the reasonability of the cost report you have submitted. The

reported costs on the provider summary report should match the cost per unit from the cost report. The payment on the provider

summary report should match the WIMCR payment on the county treasurer report.

SECTION V – Certified Public Expenditure Forms

Per Centers for Medicare and Medicaid (CMS) rules and regulations, county providers must sign a Certified Public Expenditure (CPE) Form

for each cost report that they have submitted. A county designee must sign the CPE form to attest that the WIMCR expenditures made

during the cost reporting period are allocable and allowable to the State Medicaid program under Title XIX of the Social Security Act, and

in accordance with all procedures, instruction and guidance issued by DHS during the state fiscal year.

The CPE form will become available for review once the management reports have been distributed.

Once inside the CPE section, counties can download their form. A signed PDF version of the CPE form must be uploaded into tool.

Afterwards, a PCG reviewer will approve the form once signatures have been verified.



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APPEXNDIX A: INSTRUCTIONS FOR COMPUTATION OF RESIDENTIAL

CRISIS STABILIZATION ALTERNATIVE CARE – PER DIEM COSTS

WORKSHEET

A. Computation of Residential Crisis Stabilization Alternative Care - Per Diem Costs

These instructions correspond to the model worksheet for calculating cost-based rates for crisis stabilization residences. When

counties develop their own forms for rate setting, they should use the following minimal guidelines:

1. The forms and instructions should make it clear that only costs related to the crisis stabilization residences should be

included. (For instance, if the caregiver and his family live in a separate living area within the residence, family

related costs should not be included.)

2. The form should permit the entry of all allowable costs.

3. Where the residence wishes to have more than one standard rate for the entire residence, there should be a

segregation of costs between different services that the residence plans to make available.

B. Model Worksheet Form

The Computation of Residential Crisis Stabilization Alternative Care – Per Diem Costs Worksheet was developed to meet the

guidelines listed above. The form requires identification and allocation of allowable costs and the number of participant days.

Column (1) Total Facility Costs. Enter all allowable costs associated with the residence, its operation, and services. If persons

other than residents live in the residence, the costs associated with their living space and living expenses should not be

included in the Total Facility Costs. Column (1) should show costs from the calendar year related to Medicaid cost report

claiming.

Column (2) Costs Not Allocated to Residential Rate. When it can be anticipated that some residence members will require

services provided by the residence with clearly different, identifiable costs, the residence may propose and the county may

approve service rates in addition to the Residential Rate. The costs for these services must be included in the Total Facility

Costs as identified in column (1). Please note that the costs in column (2) and column (3) should add up to the costs in

column (1).

Column (3) Costs Allocated to Residential Rate. In most situations, the amounts in column (3) will be identical to column (1).

This column will show residence costs for room, board, administration, and, at a minimum, the services required by

administrative rules.

There are two kinds of cases where column (1) will not equal column (3):

a. When the residence charges for services that are not a part of the per diem rate. In this situation, the Total Facility

Costs in column (1) will be distributed between column (2) and column (3). Column (3) contains those costs that will

be allocated to service rates other than the Total Facility Costs.

b. When the residence provides more than one level of care with clearly different costs associated with each level of

care. When there is more than one level of care, each with its own associated all-inclusive rate, it is recommended

that there be a separate page 1 completed for each level of care. The Total Facility Costs would be entered once in

column (1) and that amount would be allocated to column (3) on separate page 1 worksheets. Please note that the

amounts in column (3) when totaled should equal the amounts in column (1).



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Column (4) Room and Board. These costs are not an eligible Medicaid cost. While the recommended worksheet shows

allocation between columns (4) and (5), counties and crisis residence managers should consult the most recent Medicaid

Waivers Manual to assure that they have current guidelines on the separation of room and board costs.

Starting in 2008, counties must report residential salaries and fringe benefits related to room and board in

column 4. These amounts may be determined by time study continuous time records or any other method

approved by the Allowable Cost Policy Manual. Paid time related to cleaning, sleeping, food preparation and

maintenance should be reported as room and board. However, any of these activities may be considered crisis-

related if performed with a member as part of their crisis treatment.

Column (5) Crisis Per Diem Service. These costs are an eligible Medicaid cost.

C. Model Worksheet Form

The following information is used to allocate costs and determine the per diem rate:

1. NUMBER OF SQUARE FEET

Enter square feet associated with the crisis per diem service in column (4) and square feet associated with room and

board in column (5). Square feet associated with maintenance and common areas should be excluded. If persons

other than residents live in the residence, square feet associated with their living space should not be included in the

square feet.

2. NUMBER OF PARTICIPANT DAYS

Enter the total days during the cost reporting period for all residents associated with the costs in column (3). Total

days must be determined in the same manner as days that are billed to Medicaid. Review your policy for billing

Medicaid days before counting total days.

D. Allowable Costs to Include in Rates

CMS compliance requires that any reported Crisis Stabilization costs must meet the “reasonable cost” criteria set out in 2 CFR

225. To be considered reasonable, costs shall not exceed that which would be incurred by a prudent person under the

circumstances prevailing at the time the decision was made to incur the cost. For more information, see the Allowable and

Reasonable Cost section on page 7 of the Guide to WIMCR Cost Reporting.

Wisconsin Statutes require that Purchase of Service rates be based on actual allowable costs. These costs have been

identified in the Allowable Cost Policy Manual distributed by the Department of Health and Family Services (DHFS).

While Wisconsin Statutes permit allowances for profit for proprietary agencies and retention of excess revenues by not-for-

profit agencies, there should be no allowance for profit or excess revenue added to the following cost categories.

The following list of descriptions of allowable cost items is recommended as consistent with the Allowable Cost Policy Manual

distributed by DHFS on February 28, 1995. Purchaser and Provider agencies are responsible to assure that they use the most

current allowable cost policies.

3. RESIDENTIAL STAFF SALARIES (INCLUDING IN-HOUSE SUPERVISION)

Include salaries earned by the crisis staff and their in-house supervision. Salaries earned are defined as for current

services and include gross compensation paid in the form of cash, products, or services.

4. RESIDENTIAL STAFF FRINGE BENEFITS

Fringe benefits are allowances and services provided to employees in addition to regular salaries and wages for the

residential staff.



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Fringe benefits will be budgeted as a percent of salaries based on prior year actual with necessary adjustments. If

fringe benefits rate is more than 30 percent, a detailed schedule must be included. The employer's share of fringe

benefits may include, but are not limited to, the following:

- Health and Medical Insurance Plans

- Life Insurance

- Professional Liability Premiums

- Retirement plans if paid pursuant to an IRS approved plan

- Social Security Tax

- Unemployment Compensation Taxes or benefits paid if under a self-insured plan

- Other benefits paid by agencies pursuant to negotiated union contracts

Worker's Compensation Insurance costs may be incurred as an insurance premium, a premium paid to a funded self-

insured plan, or as a direct payment of benefits when awarded if self-insured.

5. TOTAL RESIDENTIAL STAFF

Total of salaries and fringe benefits to be carried forward to Medicaid cost reporting.

6. TRAVEL REIMBURSEMENT TO STAFF

Employee reimbursement for actual, reasonable, and necessary expenses incurred. This would include personal car

mileage (not to exceed the federal/IRS rate), public transit, lodging, and meals while traveling. Allowable staff travel

must be related to the provision of patient care ordered by a physician

7. CLIENT TRANSPORTATION

Costs incurred in transporting clients such as contract services, public transit, mileage payments to staff or volunteers

(not to exceed the federal/IRS rate), and emergency transportation.

8. RESIDENTIAL STAFF RECRUITMENT

Expenses related to advertising for candidates for vacant positions.

9. RESIDENTIAL STAFF DEVELOPMENT, EDUCATION

Training costs including conference registrations, travel, lodging, and costs for in-house training for staff

development which directly benefits the program.

10. SUPPLIES FOR HOUSEHOLD

a. Medical: Items such as first aid supplies are charged here.

b. Household: This account should include brooms, brushes, cleaning compounds, disinfectants, drinking cups,

insecticides, mops, polish, scrub buckets, toilet paper, drapes, curtains, shades, and other housekeeping

supplies. It should also include the cost of laundry soaps, detergents, powders, ammonia, blueing, starch,

pressing cloths, etc.

c. Linens: Such things as towels, washcloths, and bedding will be charged to this account.

11. SUPPLIES/SPECIAL COSTS FOR CRISIS PER DIEM SERVICE

a. Office: This account reflects supplies and expenses related to operation of the administrative offices. It includes such things as general office supplies, postage, forms, and stationery. Receipts and refunds for these items will be credited directly to this account.

b. Programs: Various items needed for carrying out those activities for/with clients such as direct medical service materials and supplies

c. Assistance to individuals: Additional items needed to carry out participants’ plan of care and integral to the patient care.

d. Other: Supplies necessary to medical services not included in other categories.



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12. FOOD

The cost of food provided to clients. Meals provided to staff who have no meal period and must remain on duty are

also allowable. Meals provided to other staff must be for a charge. These fees should be credited to this account.

13. ADVERTISING (ALLOWABLE)

Include the cost of advertising through the various media for program-related purposes.

14. TELEPHONE FOR RESIDENCE

This includes regular billing, installation, removal of telephones, and long-distance calls, as well as answering services

for additional telephone services as needed to enable personnel to be contacted on an emergency basis.

15. TELEPHONE FOR RESIDENT

If there are identifiable costs related to resident use of telephone, enter those costs.

16. PRINTING

Cost of printing and reproduction services necessary for agency administration and client programs.

17. INSURANCE OTHER THAN UNEMPLOYMENT AND PROPERTY

Surety bonds and other forms of insurance, exclusive of property and payroll-related insurance, will be charged to

this account.

18. TAXES OTHER THAN UNEMPLOYMENT AND PROPERTY

a. Corporate Income Taxes: The tax liability of incorporated vendors.

19. LICENSES

Licenses necessary to operate the agency.

20. PROFESSIONAL FEES

All professional fees incurred in the normal course of providing service to clients or complying with the terms of the

county contract should be charged here. This would include legal, accounting, auditing, data processing, and

consulting costs.

21. VEHICLE REPAIRS AND MAINTENANCE

This account will include vehicle-operating expenses, such as gas, oil, grease, tires, batteries, and licenses. Repair

parts purchased and repairs made by outside concerns to such equipment will also be included in this account.

22. MAINTENANCE AND REPAIRS ON EQUIPMENT FOR CRISIS PER DIEM SERVICE

Cost of service and parts to repair and maintain equipment used for administration and per diem service activities.

23. MAINTENANCE AND REPAIRS ON EQUIPMENT FOR ROOM AND BOARD

Cost of service and parts to repair and maintain equipment used for room and board

24. RENTALS OF EQUIPMENT FOR CRISIS PER DIEM SERVICE

Cost of rental and repairs of equipment furnishings used for administration and per diem service activities.

Rent for equipment will be paid with the following requirements:

a. For major items, a copy of the lease must be included. The purchaser may request a listing of limited

partnership investors.

b. Where applicable, proper capital lease accounting must be used.

c. Rental rates may not exceed fair market value for similar property and equipment.

25. RENTALS OF EQUIPMENT FOR ROOM AND BOARD

Cost of rental and repairs of equipment furnishings used for room and board.



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26. DEPRECIATION ON EQUIPMENT FOR CRISIS PER DIEM SERVICE

Furnishings and equipment with a cost of less than -5,000 should be expensed in one year and charged to this

account.

Depreciation is an allowable expense under the following conditions:

The depreciation must be:

- Identifiable and recorded in the agency's accounting records;

- Based on the historical cost of the asset or fair market value at the time of donation in the case of donated

assets, assets must have a cost or value of less than -5,000 or more and a useful life of more than one (1)

year; and

- Prorated over the estimated useful life of the asset using the straight-line methods.

27. DEPRECIATION ON EQUIPMENT FOR ROOM AND BOARD

Furnishings and equipment with a cost of less than -5,000 should be expensed in one year and charged to this

account.

28. INTEREST ON EQUIPMENT FOR CRISIS PER DIEM SERVICE

Interest on equipment used for administration and per diem service activities.

Interest associated with liability in excess of agency net assets will not be allowed.

29. INTEREST ON EQUIPMENT FOR ROOM AND BOARD

Interest on equipment used for administration and per diem service activities.


30. OTHER COSTS RELATED TO ROOM AND BOARD

Costs for room and board not included in other categories.

31. TOTAL OPERATING COSTS

Total of categories 6 through 30

32. MAINTENANCE STAFF SALARIES

Include salaries earned by maintenance and custodial staff. Salaries earned are defined as for current services and

include gross compensation paid in the form of cash, products, or service.

33. MAINTENANCE STAFF FRINGE BENEFITS

Fringe benefits are allowances and services provided to employees in addition to regular salaries and wages for the

maintenance staff.

Fringe benefits will be budgeted as a percent of salaries based on prior year actual with necessary adjustments. If

fringe benefits rate is more than 30 percent, a detailed schedule must be included. The employer's share of fringe

benefits may include, but are not limited to, the following:

- Health and Medical Insurance Plans

- Life Insurance

- Professional Liability Premiums

- Retirement plans if paid pursuant to an IRS approved plan

- Social Security Tax

- Unemployment Compensation Taxes or benefits paid if under a self-insured plan

- Other benefits paid by agencies pursuant to negotiated Union contracts



63

Worker's Compensation Insurance costs may be incurred as an insurance premium, a premium paid to a funded self-

insured plan, or as a direct payment of benefits when awarded if self-insured.

34. INSURANCE ON REAL ESTATE PROPERTY

Premiums for fire, liability, and boiler. If the provider coverage is included with other groups in a single policy, an

equitable distribution of the premium should be recorded on the provider records

35. UTILITIES

Water, electricity, gas, and other fuels will be charged to this account. This account also includes costs related to

cable or satellite television systems used by residents.

36. BUILDING MAINTENANCE AND REPAIRS

Improvements which result in an increase in useful life over current useful life shall be capitalized (see

DEPRECIATION). Expenditures that do not extend useful life, but merely keep the residence in ordinary efficient

operating condition, are classified as repairs and maintenance.

All materials and parts used in repairing and maintaining the building will be included in this account.

Charges to this account include such things as lubricants, light bulbs, fuses, ash cans, fire extinguishers and other

supplies used in providing heat, light, power, air conditioning, ventilation, and water softening.

37. RENTAL FOR SPACE

Rent for property will be paid with the following requirements:

a. For major items, a copy of the lease must be included. The purchaser may request a listing of limited

partnership investors.

b. Where applicable, proper capital lease accounting must be used.

c. Rental rates may not exceed fair market value for similar property and equipment.

38. DEPRECIATION BUILDING AND LAND IMPROVEMENTS

Depreciation is an allowable expense under the following conditions: The depreciation must be:

- Identifiable and recorded in the agency's accounting records;

- Based on the historical cost of the asset or fair market value at the time of donation in the case of donated

assets, assets must have a cost or value of less than -5,000 or more and a useful life of more than one (1)

year; and

- Prorated over the estimated useful life of the asset using the straight-line methods.

39. INTEREST ON PROPERTY -- MORTGAGE


Interest on newly constructed buildings should be capitalized according to Generally Accepted Accounting principles

-- A NOTE ABOUT MORTGAGE (PRINCIPAL) PAYMENTS

Mortgage (principal) payments are not allowable costs. These payments represent acquisition costs and are

reimbursed through the depreciation expense.

40. REAL ESTATE TAXES

Real Estate Taxes or payments in lieu of tax which the agency is legally required to pay.

41. TOTAL SPACE COSTS (ALLOCATED BASED UPON SQUARE FEET)

Total space cost is allocated to the crisis stabilization per diem service based upon square feet related to crisis

stabilization per diem.

42. TOTALS

Cost in Totals column (5) Crisis Per Diem Service should be transferred to the web for


WIMCR Support • [email protected] • (866) 803-8698 64

APPENDIX B – PROGRAM AND PROFESSIONAL LEVEL REQUIREMENTS

The chart below provides additional detail related to which professional levels are approved to provide each Psychosocial Rehabilitation service.

County Agencies eligible to allocate Direct Service provider time to programs if the professional level of the clinician corresponds to one of the approved professional levels for that

program as listed below.

SPA Service Description

Allowable Providers Program Procedure

Code

Screening and Assessment

Licensed Psychiatrists, Licensed physicians, Licensed physician assistants, Licensed psychologists, Licensed nurse practitioners, Licensed advanced practice nurse prescribers, Licensed practical nurses, Licensed

registered nurses, Licensed independent clinical social workers, Licensed professional counselors, Licensed marriage and family therapists, Licensed occupational therapists, Certified social workers, Certified advance practice social workers, Certified independent social workers, Certified alcohol and drug abuse counselors, Certified occupational therapy assistants, Certified rehabilitation counselors, Master’s level professional,

Clinical Student/Resident, Bachelors level professional, Psychosocial rehabilitation technician

CRS N/A

CCS H2017

CSP H0039

Diagnostic Evaluations

Licensed Psychiatrists, Licensed physicians, Licensed physician assistants, Licensed psychologists, Licensed nurse practitioners, Licensed advanced practice nurse prescribers, Licensed registered nurses, Licensed

independent clinical social workers, Licensed professional counselors, Licensed marriage and family therapists, Licensed occupational therapists, Certified social workers, Certified advance practice social workers, Certified independent social workers, Master’s level professional, Clinical Student/Resident

CRS N/A

CCS H2017

CSP H0039

Service Planning




CRS N/A

CCS H2017

CSP H0039

Service Facilitation




CRS N/A

CCS H2017

CSP H0039





Code

Medication Management




CRS N/A

CCS H2017

CSP H0039

H0034

Physical Health Monitoring




CRS N/A

CCS H2017

CSP H0039

Peer Support Certified Peer Specialists

CRS H0038

CCS H2017

CSP N/A

Community Living Functional

Restoration

Licensed Psychiatrists, Licensed physicians, Licensed physician assistants, Licensed psychologists, Licensed nurse practitioners, Licensed advanced practice nurse

prescribers, Licensed practical nurses, Licensed registered nurses, Licensed independent clinical social workers, Licensed professional counselors, Licensed marriage and family therapists, Licensed occupational therapists, Certified social workers, Certified advance practice social workers, Certified independent social

workers, Certified alcohol and drug abuse counselors, Certified peer specialists, Certified occupational therapy assistants, Certified rehabilitation counselors, Master’s level professional, Clinical Student/Resident,

Bachelors level professional, Psychosocial rehabilitation technician

CRS H0043

H2023

CCS H2017

CSP H0039





Code

Recovery Management

Licensed Psychiatrists, Licensed physicians, Licensed physician assistants, Licensed psychologists, Licensed nurse practitioners, Licensed advanced practice nurse

prescribers, Licensed practical nurses, Licensed registered nurses, Licensed independent clinical social workers, Licensed professional counselors, Licensed marriage and family therapists, Licensed occupational therapists, Certified social workers, Certified advance practice social workers, Certified independent social workers, Certified alcohol and drug abuse counselors, Certified occupational therapy assistants, Certified

rehabilitation counselors, Master’s level professional, Clinical Student/Resident, Bachelors level professional, Psychosocial rehabilitation technician

CRS N/A

CCS H2017

CSP H0039

Psychotherapy

Licensed Psychiatrists, Licensed physicians, Licensed psychologists, Licensed nurse practitioners, Licensed advanced practice nurse prescribers, Licensed independent clinical social workers, Licensed professional counselors, Licensed marriage and family therapists, Certified social

workers, Certified advance practice social workers, Certified independent social workers, Clinical Student/Residents

CRS N/A

CCS H2017

CSP H0039

Substance Abuse Counseling

Licensed Psychiatrists, Licensed physicians, Licensed psychologists, Certified alcohol and drug abuse counselors, Clinical Student/Resident

CRS N/A

CCS H2017

CSP N/A

Crisis Intervention

Licensed Psychiatrists, Licensed psychologists, Licensed registered nurses, Licensed independent clinical social workers, Certified social workers, Certified advance practice social workers, Certified independent social workers, Certified rehabilitation counselors, Bachelors level

professional, Psychosocial rehabilitation technician

CRS N/A

CCS N/A

CSP H0039


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