Attachment 1

Revenue Maximization Contract

Fiscal Year 2010 (Q4) Status Report

Reporting Period:
April 1, 2010 through June 30, 2010

Report Issued:
July 12, 2010

Prepared By:
Karen Boeger, Project Manager
OA-Division of Purchasing &
Materials Management (DPMM)

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Revenue Maximization Contract
Fiscal Year 2010 Q4 Status Report

Contract Purpose:
The Statewide Revenue Maximization/Cost Avoidance contract’s intended purpose is to maximize
federal and other revenue, particularly in light of stagnated general revenue growth in order to fund
critical and growing health care needs, education needs, etc. The two contractors, Maximus and
Public Consulting Group, Inc., are required to provide revenue maximization/cost avoidance
services designed to accomplish any of the following goals on behalf of the State of Missouri:

• Identify federal revenue enhancement opportunities for the State of Missouri that exist
under current federal statutes, regulations and/or policies for which the State of Missouri is
not currently maximizing potential federal earnings.

• Develop and assist in implementing necessary changes to state plans, regulations, policies
or procedures necessary to fully maximize these federal revenue enhancement
opportunities.

• Identify potential changes to federal statutes, regulations and/or policies that will maximize
federal reimbursement to the State of Missouri.

• Assist the State of Missouri in such ways as providing information, statistics,

documentation, etc., for furthering the federal adoption of potential changes to federal
statutes, regulations, and/or policies identified.

• Develop and assist in implementing federal and nonfederal cost savings and cost
containment concepts in order to minimize costs of services or maximize and enhance
existing recovery activities and develop additional means of recovery for costs incurred by
the State of Missouri.

Contract Specifics:
CONTRACT NUMBERS/
CONTRACTORS:
C302239001 (expired) – Maximus, Inc.
C302239002 (extended) – Public Consulting Group, Inc. (PCG)
C306222001 (current) - Maximus, Inc.
C306222002 (current) - Public Consulting Group, Inc. (PCG)

Contracts Initial Contract Period Current Contract Period

C302239001 (Maximus) 10/1/02-9/30/03 plus 3, 1-yr Expired 9/30/06
renewal options
C302239002 (PCG) 10/1/02-9/30/03 plus 3, 1-yr Extended to accommodate
renewal options completion of project work
underway for DSS on
WPR2004-001, (extended
through 9/30/07) and for
DMH on WPR2004-002 and
WPR2005-004 (extended
through 4/30/07). Last
extension ended 9/30/07.
C306222001 (Maximus) 10/1/06-9/30/07 plus 3, 1-yr Renewal not exercised.
CURRENT CONTRACT renewal options
C306222002 (PCG) 10/1/06-9/30/07 plus 3, 1-yr 10/1/09-9/30/10 (third/final
CURRENT CONTRACT renewal options renewal period)
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Revenue Maximization Contract
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CONTRACTING MECHANISM: When the project team identifies and approves a

revenue maximization/cost avoidance project
(either through identification of need by the
project team or by approving an idea presented by
a contractor), the project manager contacts both
contractors and requests a Work Plan from each
contractor for the potential revenue
maximization/cost avoidance project. The
proposed Work Plans are evaluated and awards to
the plan that would be most advantageous to the
State.

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Revenue Maximization Contract
Fiscal Year 2010 Q4 Status Report

FY03 Projects (C302239001/C302239002):

1. TITLE IV-E (WPR2003-001)
• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)
• Project Description: Developing and implementing an approved waiver will allow
the state to claim Title IV-E funds on guardianship expenditures which are
currently unmatched.
• Project Type: Revenue Maximization
• Awarded To: Maximus, Inc. on February 13, 2003
• Project Status: Introduction meeting held with Maximus. Contractor requested
some general data on guardianship caseload. Work pending federal
reauthorization legislation; HHS authority to grant program waivers lapsed and is
to be included in TANF reauthorization legislation, which is currently winding its
way through Congress.
• Revenue Impact:
Maximus and the Department of Social Services jointly determined that pursuing
the guardianship waiver was not in the state’s best interest.

2. FOSTER CARE MAINTENANCE PAYMENT METHODOLOGY (WPR2003-002)

• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)

• Project Description: Successful implementation of an allowable rate
reimbursement methodology will allow the state to come into compliance with Title
IV-E rate setting requirements and to defend past and future Title IV-E claims.
• Project Type: Cost Avoidance
• Awarded To: Maximus, Inc. on February 24, 2003
• Project Status: Maximus was engaged to help the state develop an allowable cost
based reimbursement methodology as a result of federal court order in MCCA v
Martin. Adequacy of state's residential treatment rates is the central issue in the
lawsuit. The court found that the state did not have a rate setting methodology in
place as required by federal regulation. Further consideration of adequacy of rates
is pending development of proper rate setting methodology. Maximus worked with
state staff to develop a methodology that was filed with the court in March 2003.
Plaintiffs have challenged the state's proposed methodology. Court requested
summary of areas of disagreement, which were filed on July 31, 2003. Court
entered final order finding state’s current reimbursement methodology is non
compliant with Title IV-E of the Social Security Act.
− As of December 1, 2003 DSS is proceeding to implement the cost based
methodology developed under this WPR. This implementation is
projected to take about 10 months.
− As of August 2, 2004, implementation of the reimbursement
methodology is progressing. Cost reports have been collected from
residential providers and are being analyzed to establish compliant Title
IV-E rates.
− As of November 1, 2004, initial rate setting process is complete. DSS is
resuming claims for Title IV-E reimbursement for residential treatments
services. FY 05 supplemental funding is requested to raise Title IV-E
contract rates paid to the level specified by the rate setting methodology.
Rates will not be raised unless and until funds are appropriated by the
General Assembly. Maximus continues its work on total cost review on
the residential treatment program to help develop a reimbursement
methodology that satisfies not only the Title IV-E rate setting

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Revenue Maximization Contract
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requirements of federal law while also maximizing reimbursement of
treatment contract payments as well.
− As of January 1, 2005, the contractor is completing development of a cost
report to accurately document total agency costs and is developing
models to analyze the impact of an industry tax as a General Revenue
alternative to support residential programs for children.
− As of April 1, 2005, the contractor has furnished an electronic cost report
to residential providers and has begun review and analysis cost data.
Current quarter time studies used to accurately develop rates are also in
process.
− As of July 1, 2005, emergency rules implementing new cost reporting
procedures are in effect and on-line training completed. Cost reports are
due August 15, 2005.
− As of October 1, 2005, Final regulations have been filed and cost reports
are being analyzed to document total costs.
− As of October 1, 2006, the contract has been extended and the results of
the second round of cost report are being analyzed.
- As of June 30, 2008 second round of cost report review completed.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $_N/A_ $_N/A_
Expenditures Avoided $ unknown, but $_N/A_
potentially multiple
millions
Cost to Implement Phase 1 $156,150 $180,154
Phase 2 $188,830
(Potential federal revenue losses [and hence GR costs] are difficult to meaningfully
project. The work completed under this WPR will allow the state to defend past
and future Title IV-E claims for residential treatment expenditures, estimated at
$7-$10 million per year. Cost to implement is based on firm fixed price for project
completion.) Second phase of work will focus on documenting total costs and
developing funding streams and financing strategies to maximize Title IV-E and
Medicaid funding streams.

FY04 Projects (C302239001/C302239002):

1. CHILDREN’S DIVISION/DIVISION OF YOUTH SERVICES REVENUE MAXIMIZATION
PROJECT (WPR2004-001)

• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)

• Project Description: Identification and implementation of claiming strategies that
will generate a net increase in total federal reimbursements to the state on its
expenditures for child welfare and juvenile justice programs.
• Project Type: Both Revenue Maximization and Cost Avoidance
• Awarded To: Public Consulting Group, Inc. on December 9, 2003
• Project Status:
− Award Date: December 9, 2003
− Award challenge was resolved on February 20, 2004 in favor of PCG.
Contractor has conducted research on DSS programs and expenditures,
work plans are being developed to enhance Medicaid targeted case
management and/or rehabilitation reimbursements for community-
based Children Division and Division of Youth Services services and DYS
treatment services. Medicaid and Title IV-E administration claims are
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being reviewed. Title IV-E time study training is being conducted by the
contractor.
− Revenue estimates will be formulated as project plans are developed.
Costs are based on contingency fees of 4 to 6 percent and are capped
− As of November 2004, the contractor is conducting training on and will
automate child welfare time study in order to enhance Title IV-E
administration claims. Eligibility determination staff specializing in Title
IV-E will be time studied and claiming will be redirected from children’s
pool to Title IV-E. Medicaid plan amendment to establish a
rehabilitation program for the Division of Youth Services has been
drafted. Public notice has been given in anticipation of claims being filed
in the October 2004 quarter.
− As of January 1, 2005, Medicaid plan amendment for DYS rehabilitation
services has been filed and work is underway to develop a rehabilitation
rate for DYS residential programs and to modify information systems
and recordkeeping to fully document reimbursement claims.
− As of April 1, 2005, the contractor is finalizing a response to CMS
regarding anticipated questions raised regarding the Medicaid plan
amendment. Work continues on the rate for DYS residential programs,
modification of information systems and recordkeeping to fully
document reimbursement claims.
− As of July 1,2005, responses have been provided and a follow-up phone
conference held in response to CMS’ threat to disapprove the pending
State Plan amendment.
− As of October 1, 2005, a revised SPA has been drafted based on three
remaining issues identified by CMS.
− As of October 1, 2005, the automated child welfare study has been
implemented and resulted in enhanced Title IV-E administration claims
resulting in increased federal earnings of $6.5 million.
− As of October 1, 2006, a contract has been adopted for operation of the
automated child welfare time study.
− WPR 2004-001 extended contract to provide transition to state for
operation of the automated child welfare time study or development of
an in-house automated time study.
− Transition to state operation will occur June 1, 2008.
− State operation of automated time study transition complete.
− CMS approval granted for DYS Medicaid State Plan
− Initial billing for FFY 2008 being developed for claiming during Jan –
Mar 2009.
− Test claims processed and full FFY 2008 submission for claiming will
occur in Apr-Jun 2009 quarter.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $10,000,000 $6,500,000
Expenditures Avoided n/a $_N/A_
Cost to Implement $420,000 $125,000
(Estimate of FY 06 revenues on projects begun to date.)

2. TEFRA EXCEPTION (WPR2004-002)

• Primary Agency: Department of Mental Health (Contact: Joseph L. Kuensting,

Reimbursement Administrator)

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• Project Description: Identify, calculate, and submit all TEFRA appeals for state
operated non PPS psychiatric hospitals
• Project Type: Revenue Maximization
• Awarded To: Public Consulting Group, Inc. initially awarded on September 16,
2003 renewed in 2006.
• Project Status:
- Three new exception requests prepared by PCG were filed with Tri-Span
November 21, 2006, were approved for payment on January 1, 2007, and
received payments March 2007

• Summary of TEFRA Requests:

TEFRA requests prepared by PCG and filed with Tri-Span

Facility FY $ Amount Date Filed Status
$856 approved for
settlement 1/5/07.
Payment received 3/07.
(NOTE: These amounts
were previously
Southeast MO MHC 03 $ 856 11/21/2006 inadvertently omitted.)

$319 approved for

settlement 1/5/07.
Southeast MO MHC 04 $ 319 11/21/2006 Payment received 3/07.

$34,365 approved for

settlement 1/5/07.
Western MO MHC 04 $ 72,520 11/21/2006 Payment received 3/07.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated
–FY05 $28,766 No requests settled
- FY06 $187,053 $283,854
- FY07 $124,937 $124,642
- FY08 $0 $0
Expenditures Avoided $_N/A_ $_N/A_
Cost to Implement 7 percent of net FY’ 06 $19,869
increased
reimbursements FY’ 07 $6,237

• Both the amount and timing of TEFRA appeals are highly variable and
difficult to predict. Appealable TEFRA underpayments are permitted by the
Medicare fiscal intermediary (TriSpan) based on certain conditions.
TriSpan notifies each facility for each cost report year of the appealable
dollar amounts. Appeals often take over 1 ½ years before payment is
received.
• In FY06, DMH hospitals began converting from TEFRA to the Prospective
Payment System (PPS). FY08 cost reporting period will be the last based
on TEFRA and no more exception requests will be made.

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3. REVENUE ENHANCEMENT PLAN (WRP2004-003) - Cancelled

• Primary Agency: Attorney General’s Office

• Project Description: development of a comprehensive revenue enhancement plan
designed to enable the AGO to claim allowable administrative reimbursement and
to secure available grants and/or other revenue enhancement opportunities for
which AGO may be eligible from all traditional and non-traditional federal
programs.
• Project Type: Revenue Maximization
• Project Status:
Agency confirmed 7/28/04 they have decided not to pursue this project.

4. REVENUE ENHANCEMENT PLAN (WPR2004-004)

• Primary Agency: Department of Economic Development (Contact: Dennis

Morrissey, Division of Administration)
• Project Description: Development of a comprehensive revenue enhancement plan
designed to enable the DED to claim allowable administrative reimbursement and
to secure available grants and/or other revenue enhancement opportunities for
which DED may be eligible from all traditional and non-traditional federal
programs.
• Project Type: Revenue Maximization
• Project Status:
− Work Plan Request Issue Date: December 10, 2003
− Work Plan Request Due Date: January 6, 2004
− Award Date: June 22, 2004
− The DED Revenue Maximization Team held a kick-off meeting with Public
Consulting Group, Inc. on June 29, 2004. The preliminary work plan and
project schedule was reviewed and with minor changes approved. PCG to
develop and provide the revenue enhancement plan as well as an
implementation schedule by mid to late October.
− DED and PCG committed to conference calls every other Monday to keep
everyone informed on the status of the project.
− PCG (Jerrold Wolf) was on site July 20 through July 22 and conducted
interviews with requested DED staff.
− LeeAnn Pasquini and Michael Niarchos are scheduled to be on-site August
9-11 to meet with DED Division Directors.
− A draft report was submitted to DED by PCG on October 6, 2004.
− A conference call was held with DED Revenue Maximization Team
members and PCG to discuss the draft on October 25, 2004.
− A final conference call was held with DED Revenue Maximization Team
members and PCG to discuss the final report on December 9, 2004.
− DED received the final report on December 13, 2004.
− The revenue generating recommendations included in the report would
require changes in statutes to implement. Prior to the beginning of 2006
Legislative Session, DED will review the implications of their
implementation.
− On July 5, 2005 the Governor signed SB 343, which authorizes DED to
charge the recipient of certain tax credits a fee in an amount of up to 2.5%
of the tax credits issued.
− On July 8, 2005 DED held the initial meeting regarding implementation of
SB 343.
− Billing, tracking, and collection processes designed.

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Revenue Maximization Contract
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− First fee collected October 5, 2005.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $1,160,000 – $4,100,000 $637,569
(as of 9/30/06)
Expenditures Avoided $0 $_N/A_
Cost to Implement $72,000 to Unknown $_N/A_
New Revenue Generated estimates projected by PCG. Cost to Implement includes
the cost of the study and an unknown cost to put into practice and administer the
revenue generating recommendations.

FY05 Projects (C302239001/C302239002):

1. SSA REVENUE MAXIMIZATION (WPR2005-001) - Cancelled

• Primary Agencies: Department of Elementary and Secondary Education-

Vocational Rehabilitation (Contact: Rick Longley). At this point DESE is the only
agency planning to pursue this, although Department of Mental Health and
Department of Social Services may need to join in at a later time.
• Project Description: Reviewing and enhancing current procedures for identifying
and processing reimbursement claims from the Social Security Administration
(SSA). Under this program, SSA reimburses state agencies for the costs of the
services they provide to beneficiaries with disabilities if such services result in the
person’s achieving work at a specified earning level. Improving the identification
and timely submission of qualified cases will result in maximizing revenue
reimbursements to the state.
• Project Type: Revenue Maximization
• Project Status:
− Issue Date: September 9, 2004
− Work Plan Due Date: October 12, 2004
− Agency confirmed 11/17/04 they have decided not to pursue this project.

2. REVENUE ENHANCEMENT PLAN (WPR2005-002) - Cancelled

• Primary Agency: Office of the Secretary of State (SOS).

• Project Description: determination of whether SOS is eligible to claim any other
administrative reimbursement and/or federal grants (beyond those for which SOS
is currently a recipient) and/or other revenue enhancement opportunities for which
SOS may be eligible from all traditional and non-traditional federal programs.
• Project Type: Revenue Maximization
• Project Status:
− Issue Date: October 15, 2004
− Work Plan Due Date: November 16, 2004
− Agency confirmed December 20, 2004 they have decided not to pursue
this project.

3. TITLE IV-E AUDIT PREPARATION/REVENUE MAXIMIZATION (WRP2005-003)

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Revenue Maximization Contract
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• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)
• Project Description: for the Missouri Department of Social Services/Children’s
Division to prepare for an upcoming Federal audit of its’ Title IV-E Foster Care
Program and to review specified foster care case records in an effort to enhance
federal revenue
• Project Type: Cost Avoidance and Revenue Maximization
• Awarded To: Public Consulting Group, Inc.(PCG) on February 9, 2005
• Project Status:
- PCG has had a team of Title IV-E eligibility experts on site in St Louis
- Eligibility files and case records continue to be reviewed.
- Audit preparation work has been completed. Case records continue to be
reviewed.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $_see below___ $ 385,404
Expenditures Avoided $_see below___ $ unknown_
Cost to Implement $_see below___ $32,760

4. COST-BASED PHYSICIAN ANALYSIS METHOD OF REIMBURSEMENT (WPR2005-004)

• Primary Agency: Department of Mental Health (Contact: Joseph L. Kuensting,

Reimbursement Administrator)
• Project Description: contract to provide a methodology for enhancing federal
revenue for the Department of Mental Health using the Medicare Cost-Based
Physician Analysis for teaching hospitals
• Project Type: Revenue Maximization
• Project Status:
− Award Date: August 22, 2005.
− DMH, with the assistance of PCG, sent a letter to TriSpan, the Medicare
fiscal intermediary, requesting a change in the method of physician
reimbursement for the four DMH teaching facilities. Letter received by
TriSpan. DMH received approval from TriSpan in letter dated March 3,
2006 to use the new methodology effective July 1, 2006.
− Retroactive approval for prior periods is being sought. PCG contacted
TriSpan on March 13, 2006 regarding reconsideration of effective date
back to July 1, 2005. DMH received approval from Tri-Span in a letter
dated May 22, 2006.
− As of May 2, 2007all 4 DMH teaching hospitals had been paid by Tri-
Span for their 8 month pass-through amounts, totaling $1,539,800.
After deduction of the prior period baseline and 10% audit withholds, the
net new revenue amounted to $994,646.
− As of May 23, 2007 the four DMH hospitals had received FY’06 interim
settlements from Tri-Span. The cost-based physician reimbursement
amounts totaled $1,539,800. After deduction of the prior period baseline
and 10% audit withholds, the net new revenue amounted to $757,710.
− From April 1, through June 30 2007 the hospitals received bi-weekly
remittances from Tri-Span for pass-through amounts. These payments
included gross new revenue totaling $516,000.
− In June, 2007, DMH paid PCG invoice for partial contingency fees
totaling $54,246. This payment was calculated subject to a 10% audit
withhold.

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− In FY 08, the hospitals received bi-weekly remittances from the Medicare
fiscal intermediary for pass-through amounts. These payments included
gross new revenue totaling $1,738,300.
− In September 2008 DMH paid PCG for partial contingency fees totaling
$20,000. This payment was calculated subject to a 10% audit withhold.
− As of June 30 , 2009, the hospitals received bi-weekly remittances from
the Medicare fiscal intermediary for pass-through amounts. These
payments included gross new revenue totaling $886,420 for FY 09.
− As of September 30, 2009, the hospitals received bi-weekly remittances
from the Medicare fiscal intermediary for pass-through amounts. These
payments included gross new revenue totaling $408,000 for FY 10.
− As of December 31, 2009, the hospitals received bi-weekly remittances
from the Medicare fiscal intermediary for pass-through amounts. These
payments included gross new revenue totaling $574,800 for FY 10.
− As of March 31, 2010, the hospitals received bi-weekly remittances from
the Medicare fiscal intermediary for pass-through amounts. These
payments included gross new revenue totaling $729,900 for FY 10.
− As of June 30, 2010, the hospitals received bi-weekly
remittances from the Medicare fiscal intermediary for pass-
through amounts. These payments included gross new
revenue totaling $838,500 for FY 10.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $661,119 (est. annual) FY’06 $757,710
FY’07 $994,646
FY’08 $1,738,300
FY’09 $886,420
FY’10 $838,500
Expenditures Avoided $_see below___ $_N/A_
Cost to Implement FY’06 $69,399 FY’06 $54,246
FY’07 $59,181 FY’07 $59,181
FY’ 09 $20,000 FY’ 09 $20,000
Estimate of expenditures avoided are unknown at this time until implementation of
change in method of physician reimbursement occurs.

FY06 Projects (C302239001/C302239002):

1. IT CONSOLIDATION: FEDERAL FUNDS (WPR2006-001)

• Primary Agency: Office of Administration, Information Technology Services

Division (Contact: Arlan Holmes)
• Project Description: review of federal grant programs impacted by the Office of
Administration’s statewide Information Technology (IT) consolidation and
recommendation of a standard methodology to charge IT expenditures to federal
grants.
• Project Type: Cost Avoidance
• Project Status:
- Award Date: October 5, 2005
- FY07 Implementation procedures recommendations due April, 2006
- As of December 27, 2006, ITSD workgroups are defining time accounting,
equipment tracking and other data systems essential for implementing
recommendations to avoid loss of federal funding. Pending outcome of

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these efforts, continuing contract consultant involvement is considered
premature. Amendment to PAQ may be forthcoming as IT Consolidation
progresses and may include further analysis and recommendations for
FY08 and thereafter.
- As March 26, 2007, ITSD workgroups continue defining time accounting,
equipment tracking and other data systems essential for implementing
recommendations to avoid loss of federal funding. ITSD does not now
anticipate amending its PAQ with PCG to include further work.
- As of June 27, 2007, no further work under the work plan is anticipated.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $_see below___ $_N/A_
Expenditures Avoided $_see below___ $_N/A_
Cost to Implement $_see below___ $_N/A_
ITSD does not anticipate any loss of federal funding in FY07 due to IT
Consolidation. Estimated federal grant dollars potentially lost as IT Consolidation
progresses are unknown.

2. PERFORMANCE-BASED CONTRACT FEDERAL FUNDS CLAIMING (WPR2006-002)

• Primary Agency: Department of Social Services, Children’s Division (Contact:

Jennifer Tidball)
• Project Description: creation of a methodology for increasing and/or maintaining
all costs associated with performance-based contracts identified by the agency that
are eligible for federal funding
• Project Type: Cost Avoidance
• Project Status:
- Award Date: June 9, 2006
- January 25, 2007 --Fiscal Claiming Recommendation submitted by
Maximus
- Increased efficiencies of child care monies spent with improved outcomes
for clients are the major criteria used for performance goals monitoring
and incentives provided to PBC’s.
- Project will end with a transition to state operation April 1, 2008.

• Revenue Impact:
ESTIMATED ACTUAL
New Revenue Generated $__N/A__ $_N/A___
Expenditures Avoided $_see below___ $_see below___
Cost to Implement $__N/A__ $50,786.64
-Children’s Division expects the PBC effort to be neutral/have less costs
over time. Actual claims have not been submitted and fiscal impact of
PBC’s are currently unknown.

FY08 Projects (C306222001/C306222002):

1. IDENTIFICATION AND CLAIMING OF FEDERAL REVENUE SOURCES FOR “CRISIS CARE

SERVICES” (WPR2008-001) - Cancelled

• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)

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• Project Description: for the Missouri Department of Social Services to obtain
assistance with identification and claiming of federal revenue sources for “Crisis
Care Services” for children in emergency situations to provide care for children of
all ages who are in need of safe, short-term care outside of their own homes due to
critical family circumstances.
• Project Type: Cost Avoidance and Revenue Maximization
• Project Status:
− Issue Date: 07/19/07
− Work Plan Due Date: 08/24/07
− WPR 2008-001 has been cancelled after evaluation of proposals.
Neither vendors felt the proposal was suited to a contingency fee
arrangement as desired by the Department.

2. COMPREHENSIVE PSYCHIATRIC SERVICES (CPS) MEDICARE INPATIENT CLAIMS

BILLING PRACTICE REVIEW (WPR2008-002)

• Primary Agency: Department of Mental Health (Contact Joseph L. Kuensting)

• Project Description: Review of the current billing practices for Medicare inpatient
claims at the state facilities to ensure that the state is maximizing reimbursement
for co-morbidities and prospective payment system (PPS) adjustments for eight of
the eleven psychiatric facilities operated by the Department of Mental Health,
Division of Comprehensive Psychiatric Services that are reimbursed as Medicare
Providers.
• Project Type: Cost Avoidance and Revenue Maximization
• Project Status:
− Issue Date: 04/03/08
− Work Plan Due Date: 04/25/08
− Award Date: 05/14/08
− DMH and PCG held a kick-off meeting June 10, 2008. PCG has notified
DMH for an initial request for data.
− PCG presented an initial draft of the report on 10/24/08.
− PCG completed final report. However, DMH has decided not to pursue
this project due to implementation resources required and the reduction
in potential recoveries with the future closure of DMH acute psychiatric
inpatient beds.

3. COMPREHENSIVE PSYCHIATRIC SERVICES (CPS) MEDICARE AND MEDICAID COST

REPORT PREPARATION AND SUBMISSION (WPR2008-003)

• Primary Agency: Department of Mental Health (Contact: Joseph L. Kuensting)

• Project Description: Preparation of cost reports for nine of the eleven
psychiatric facilities operated by the Department of Mental Health, Division
of Comprehensive Psychiatric Services for submission to the Medicare
intermediary and the state Medicaid agency for revenue maximization as
well as cost avoidance.
• Project Type: Cost Avoidance and Revenue Maximization
• Project Status:
− Issue Date: 04/03/08
− Work Plan Due Date: 04/25/08
− Award Date: 06/11/08
− DMH and PCG held a kick-off meeting June 10, 2008. PCG has notified
DMH for an initial request for data.

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− Fieldwork was completed by PCG on November 21, 2008 and reports
have been sent to Medicare and Medicaid intermediaries.
− Award Modification 001 to WPR2008-0003 approved 4/20/09 to allow
an additional one year for cost reports through June 30, 2010.
− DMH and PCG held a kick off meeting August 6, 2009. PCG has notified
DMH for an initial request for data.
− PCG conducted site visits with nine facilities September 14 thru
September 18, 2009.
− PCG submitted cost reports to MO HealthNet and Wisconsin Physicians
Service (WPS) November 30, 2009.
− Amendment 004 to contract for WPR 2008-003 approved
5/03/10 to allow an additional one year for cost reports
through June 30, 2011.

FY09 Projects (C306222001/C306222002):

1. WESTERN MISSOURI MENTAL HEALTH CENTER ACUTE PSYCHIATRIC SERVICES
TRANSITION ASSISTANCE SERVICES (WPR2009-001) - Cancelled

• Primary Agency: Department of Mental Health (Contact Joseph L. Kuensting)

• Project Description: Consulting services and assistance related to transitioning the
acute psychiatric services provided at Department of Mental Health in-patient
facilities to a local hospital for operation. Budget preparation, revenue distribution
plan development, Medicaid consultation, revenue identification for transition of
long term care clients to community based services, federal fund maximization and
other related assistance relating to financial merger of a state and private hospital.
• Project Type: Cost Avoidance and Revenue Maximization
• Project Status:
- Issue Date: 01/06/09
- Work Plan Due Date: 01/21/09
- Project cancelled 3/19/09. DMH advised they are unable to pursue this
project under the contract.

FY10 Projects (C306222002):

1. DSS Title XIX for University of Missouri Health System Affiliated Programs (WPR2010-001)
• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)
• Project Description: Assisting DSS by identifying and securing Title XIX-allowable
unclaimed costs of UMC Health System affiliated programs that are currently
appropriated General Revenue Funding for operations and service delivery.
Working with the DSS and UMC Health System officials in reviewing programs and
understanding current Title XIX claims of the UMC Health System to help focus
the review on unclaimed costs.
• Project Type: Revenue Maximization
• Project Status:
- Issue Date: 11/09/09
- Work Plan Due Date: 11/16/09
- Award Date: 12/14/09
- Call with PCG and the University of Missouri held December 17, 2009
to discuss coordination of the project.
- PCG follow up on site at the University of Missouri to review programs,
data, and expenditures for potential allowable Medicaid claims.
- PCG has submitted to DSS a preliminary report on claiming
opportunities review and advisement on next steps.

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 Attachment 1
Revenue Maximization Contract
Fiscal Year 2010 Q4 Status Report
- DSS has reviewed the preliminary report with OA Budget
and Planning. There does not appear to be significant
unclaimed Title XIX allowable costs.

2. DYS Medicaid Rehab Billing/Rate Setting (WPR2010-002)

• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)
• Project Description: Billing of Medicaid Rehabilitation services and development of
future billing rates under SPA 04-12. Also included is transition of these activities
to the Division of Youth Services
• Project Type: Cost Avoidance and Revenue Maximization
• Project Status:
- Issue Date: 11/09/09
- Work Plan Due Date: 11/30/09
- Award Date: 2/17/10
- PCG has worked with DYS to submit a claim for FFY 2009 billings.
- PCG and DYS have established the 2nd and 3rd weeks of July to
conduct a time study to be used for future billings (beginning FFY
2010)
- PCG and DYS are also beginning to work on a transition plan and
training for DYS to assume responsibility for submitting future
Medicaid claims.
- Facility training has been completed in anticipation of the
residential time study scheduled for the 2nd and 3rd weeks of
July 2010.

3. DSS TANF MOE Funds Sourcing and TANF ARRA/TANF Contingency Funds Claims
Maximization (WPR2010-003)
• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)
• Project Description: Identification and securing of qualified sources of TANF MOE
in the State of Missouri, reviewing current TANF federal reports to ensure that
Missouri is maximizing its TANF claims (and other grant claiming related to TANF
– e.g., use of SSBG/CCDF transfers) and identifying program opportunities to be
supported by TANF ARRA funds and TANF Contingency funds
• Project Type: Revenue Maximization
• Project Status:
- Issue Date: 11/09/09
- Work Plan Due Date: 11/23/09
- Award Date: 12/24/09
- Kick-off meeting between PCG and DSS held January 20, 2010.
- Status meetings between DSS and PCG now held every two weeks.
- PCG has completed an initial review of TANF 196 report expenditures
to ensure that expenditures are being appropriately categorized as
MOE or TANF and have made recommendations to DSS on TANF 196
adjustments that may benefit the State.
- PCG has reviewed budget documents and other resources to identify
potential programs that may be claimed to ARRA TANF Emergency
Contingency Funds (ECF).
- PCG is working with food banks on gathering and validating
expenditure data to determine if an ECF claim may be made.
- PCG has made several ECF project recommendations to the state and
conducted preliminary information from organizations and
stakeholders to determine if there is potential for an ECF claim.
- Project plan was amended to focus on ARRA TANF
Emergency Contingency Funds.

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 Attachment 1
Revenue Maximization Contract
Fiscal Year 2010 Q4 Status Report
- PCG has prepared and delivered two OFA-100 applications
on behalf of the state for ARRA TANF ECF funds to fund a
youth summer jobs program (June 1), food bank initiatives
and summer food program activities (June 21) . The federal
government has approved the summer youth jobs program
application. The application submitted for the other two
programs is pending with the federal government.
- PCG has submitted draft MOUs that DSS may use with
applicable parties once the ARRA TANF ECF programs are
implemented.
- PCG has provided technical assistance around management
and use of ARRA TANF ECF funds and matching
requirements to DSS as well as Department of Economic
Development (administering youth summer jobs program),
the food banks and Department of Health and Senior
Services (administering summer food program).
- A July 14 meeting is scheduled with PCG to review the TANF
MOE matrix, the draft MOU to be used with entities
obligating MOE and the TANF MOE assessment tool.

4. DYS Medicaid Rehab Expansion to Day Treatment and Community Mentoring (WPR2010-004)
• Primary Agency: Department of Social Services (Contact: Jennifer Tidball)
• Project Description: Determination of the feasibility of expanding claiming
under SPA 04-12 to DYS day treatment, community mentoring and other
DYS programs outside of 24-hour facilities.
• Project Type: Revenue Maximization
• Project Status:
- Issue Date: 11/09/09
- Work Plan Due Date: 12/07/09
- Award Date: 2/17/10
- PCG and DYS have set a time study for late August or early
September to determine earnings capacity.

5. MHD Medicaid Partnership Feasibility (WPR2010-005)

• Primary Agency: Department of Social Services (Contact: Jennifer
Tidball)
• Project Description: Assistance in assessing the opportunity to partner
as the Medicaid Agency with the University of Missouri (UMC) to
improve the delivery of clinical, administrative, financial and
technological services to the state and its consumers.
• Project Type: Revenue Maximization
• Project Status:
- Issue Date: 06/01/10
- Work Plan Due Date: 06/16/10
- Projected Award Date: 07/15/10 (currently in evaluation)

6. DYS Medicaid Rehab Retroactive Billing/Rate Setting (WPR2010-006)

• Primary Agency: Department of Social Services (Contact: Jennifer
Tidball)
• Project Description: Assistance with retroactive claims under Medicaid
Rehabilitation services and rate development for timeframes
associated with retroactive claims
• Project Type: Revenue Maximization
• Project Status:
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 Attachment 1
Revenue Maximization Contract
Fiscal Year 2010 Q4 Status Report
- Issue Date: 06/01/10
- Work Plan Due Date: 06/25/10
- Projected Award Date: 07/25/10 (currently in evaluation)

(End of Report)

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