CFR Review Tool Webex Transcript

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[Donna] This is Donna Cater. Welcome to this afternoon´s presentation of a CFR Crosswalk. I have a slideshow to go through. What this is is a tool to be used for reviewing your CFR, because, as you know, we don´t have the ability to allow providers to redo their CFRs often because then it wreaks havoc with all of our regional averages and with our acuity scores and all those types of things. So, it´s very important that the CFRs are reviewed prior to them coming in, and I know that January 4 for New York City this year is when–actually for all CFRs, January 4 is the end of the review date which is why we put this on so quickly for you, because we wanted to give you the most amount of time to be able to review your CFRs. We will be putting the PowerPoint, this recorded session out on the web along with the tool, and you will be able to access it. Sometimes it´ll go through OPA, and you should be able to access it. The tool with go through OPA. The PowerPoint and the recorded presentation will be on our webpage, and you will be able to access those by close of business on Tuesday, so not until Tuesday. So, I just did the introduction, and then we´re gonna work through the CFR tool, and then we´re gonna have a little bit of discussion. On every one of these slides you´ll see at the bottom there is a disclaimer that this is a CFR review tool and should only be used for that purpose. This is not a calculation of your rate tool. This is a CFR review tool, and when we get to it, I will show you what I mean.
The purpose of the tool is designed to help with the review of the CFR and help providers understand the importance of correct CFRs. The tool will show you your current CFR, the line items that we use to pull in to your current rate sheets, and as you enter information from your CFR to calculate what you think, to review what your CFRs in the 2019 rates will be. You´ll see them side by side so errors in the CFR should be very prominent. The tool is not designed to calculate a reimbursement, and it is not designed to be used to make management decisions based on reimbursement. What that means is if you go through and you put in your CFR information, it does calculate a rate, but there are many, many, many things within this tool that change as we go along and as we update bases, so you can´t put something into the tool and say, okay, that calculated my rate, now I´m going to open a thousand more IRAs because I can see what my rate is gonna be. That is not what this is meant to do. It is meant to help you review your CFRs and help you to understand where the line items from the crosswalk that we sent you in 2014, how they actually get into your rates. So, we hope this will be a helpful tool to you. The crosswalk, the first tab on the tool is the crosswalk services, and the tool has a tab for Supervised IRAs, Supportive IRAs, Pre–voc, Day Habilitation, ICF/IIDs excluding CRPs, because as you know CRPs are a fee–based rate and they are not in this methodology. So, when you are inputting your information for ICFs, you need to exclude any CRPs from those line items. Again, my disclaimer is at the bottom.
I´ll give you a template overview. There are protected cells. Those protected cells are from approximately A to H or J or K or something like that, and you cannot change those protected cells. On the right–hand side there will be data entry on a tab called CFR Crosswalk tab. Then there are hard–coded elements. These hard–coded elements are the reason that we are telling you this is not a rate calculation tool. The reason being that your minimum wage is a hard–coded number, and it´s a protected cell that you cannot change. The 3.25 DSP compensation increase is a hard–coded number that will stay in there. But as you know, as those costs show up in a cost report, we will be taking some of those hard–coded compensation increases out, because they should be reflective in your CFR. Budget neutrality factors, those are something that´s calculated at the very end based on the rest of the calculations, so those are just hard–coded as to whatever it was on 7/1/18. Those will be hard–coded to that, so if you were a 1.01 then that´s what yours is hard–coded to. Budget neutrality factor for hours, that´s a calculation within the acuity factor that we use, and that is also hard–coded. State wide average hours, that´s hard–coded as well as your acuity factor, and that´s because until we have re–run the DDP and your cost reports, the new cost reports, the information for the acuity and the state wide average hours, we left the same. We do know that over time starting back in 2014–15, those were both re–based years, and ´17 was a re–based year. There were changes to state wide average hours. So, those are hard–coded and cannot be calculated or manipulated by the providers. Regional average salaries, as you know, 25% based on a WEF, 25% of a regional average salary is used in the calculation of your rates. Those have been hard–coded, but they cannot be calculated until we´ve pulled in all of the new CFRs, so that again is a hard–coded element and it is a protected cell that you cannot change. Regional average contracted clinical brick, same thing, and the capital. Capital you know changes on every July and January, and until we get our new CFRs those are also hard–coded from what they were previously. I know that sounds like we´ve hard–coded the whole tool and that it isn´t going to help you, but I think you´ll be surprised.
The file contains four tabs, I talked about this: a CFR Crosswalk, a Rate Development IRA tab, a Rate Development Pre–Voc and Group DayHab tab, and a Rate Development ICF tab.
The next slide is the CFR Crosswalk tab, and the components on that are the CFR schedule and line number, the category used in the rate, the CFR line, the name per the CFR manual, the 2015 CFR data used in rate development for all of the five services, and the CFR review tool, and I´ll show you that´s where you as an agency, as a provider, can edit that information. Then there´s a memo line that we use in here as well.
I´m gonna go through just an IRA on the tool for you. The Supervised IRA, the Supportive IRA, the Day Habilitation and the Pre–Voc, they look identical. They work identical other than the differences to some of the methodology meaning the property is in Day Habilitation and Pre–voc, it is not a component that is in your IRAs. Because this tool is only doing a CFR check of your operating components, it is not doing a CFR check of your capital or your state supplements or the room and board calculations, so it´s only going to compare the operating components. There is a caution on here. You´ll see that there is a caution on each one of the tabs. This one is the IRA one. The caution is: As the rates are developed the hard–coded elements listed above will change with the updates of the base year data, so the calculated rates albeit they are on the template, they will not be indicative of your final rate. So, please don´t use them as ´this is what my rate should be´ and when you get your rate sheets in July or you get your rate sheets in January, you come back and say hey that´s not what my tool calculated, because I´m going to tell you that you cannot calculate an accurate rate with this. This is not the purpose of this tool. It is really to use as a CFR check to make sure that you have all of the elements necessary that will be included in your rate calculation. We have rate development for Pre–voc and Day Hab. We have rate development for ICF.
I am going to call up the tool for you now. This is the tool, and as I talked about, the CFR Crosswalk is the first tab. Rate Development IRA, it looks identical to your six–page rate sheet except for we´ve taken the things at the bottom off because those are not important to the CFR check, Rate Development Pre–Voc and Day Hab, and Rate Development ICF. So, let´s walk through an IRA one. If you look at Column D and E, this is the rate that you currently–and this is not a provider we just plugged in played numbers–this particular one shows you a Supervised IRA and a Supportive IRA, and it shows you your current rate sheet if you were to compare the first columns, the D and E, to your current rate sheet you´ll see that it´s the exact same. When you get this template in your OPA account, you will get the template and it will look exactly like this with your information in Columns D and E and all of these yellow lines over here and hard–coded numbers in the white ones in G and H. That´s what you will get when you get your own. This is a tool specific to each of the providers. It is not a totally blank tool, because we wanted it to be as simple as possible. I know it´s not simple. I´m not going to say that. My rate setters struggled with it, because you get so lost in some of these things that it becomes difficult. So, I´m not going to say it´s simple, but we wanted it to be as user friendly as possible.
Where you will start is on the CFR Crosswalk, and you can end on the CFR Crosswalk, too. It´s up to you how far you work this tool and what you do with it. As I told you before, Columns A, B, C are columns that have the identifiers, the CFR lines numbers, the category and the rate, and the CFR line name per the CFR manual. Then your tool will have Columns D through P hidden, because that´s doing calculations in there. They will be password protected, and they will be hidden so that you cannot open those up and see those. All it is doing is it´s doing the methodology in those columns. You will see from Column Q is the Supervised IRA column, R is the Supportive IRA, S is Group DayHab, T is a Pre–Voc, and U is the ICF. This information comes from your current rates that you have, and it should match what was on your current rate sheet that we used in the calculation. Then, if I go to the supervised, Columns V through Z are where providers have the ability to plug in their information. The first line is CFR Line 16, right here, you can see it in Column 1 Line 5, CFR 1 Line 16 Program Support. Now, I know that the CFRs are site specific, so that means that you have many CFR 1 Line 16´s for your Supervised IRAs. You need to input the total into this cell that I have right here which is V5. You need to input the total, and I´m just going to input the total that I have for one, and it´s 5,226,691. Now, I can already tell that that´s probably incorrect, because if I go back and I look at my previous one, it´s 10,175,100. So, I would probably go back and say huh, something is not right, because when I look at Q and I see that in my rate calculation there was ten million 175, and now I only have five million. I must have input that wrong or I need to review that line on my cost report. So, I´m going to make the correction right now, and I can make the correction, and then I can go to the next one. The next one that I want to input is ERE Total Fringe, CFR Line 20, and my number for that one is–Joe´s telling me there´s white here and I can put something in for Vacation Leave Accrual if I would like, but we aren´t going to use it in our calculation. Oh, we need to put something in there, so there I´m gonna put zero, because I can see previously I had a zero as well. We will make sure that all of the things that you need to input will be yellow when you see it on Tuesday. I have Joe Pingelski here with me, and Todd Coy, and Kathy Schubert looking over my shoulder to make sure that this is all working the way it´s supposed to so that we can–

[Joe] It´s yellow because when you delete the data, the data that you deleted was zero, so technically it didn´t change because it´s still zero.

[Donna] Okay. Understood. Okay, so now the next one is Row 8, CFR 1, Line 21, which is Food, and I can input my numbers there. So now I´ve input three of those. Now if I go to–I am doing IRAs–if I go to my Rate Development IRAs tab I can see that some of the places that changed, and they´re all yellow right now because I deleted everything and made them zeroes, but they´ll come right over here and the numbers will fill in, so let me go back to the Crosswalk page.

[Joe] Watch out for the IRA. Those columns like food are used for the board costs, so those you won´t see because the board costs are part of the room and board calculation, so for IRA you would not need to enter food, but for DayHab and Pre–Voc and ICF you would need to, because we´re not recalculating the room and board supplement on this.

[Donna] So, I just did while Joe was explaining that we aren´t using room and board, I just went through and changed these back. Now, again, they´re going to be yellow, but rather than sitting here and having you watch me input all these things, I just copied my first column, and I´ll change the units, the certified capacity. I´m gonna change it to 105 rather than the hundred that´s over here, then I go to my Rate Development page and you can see that my rate is different. And the reason my rate is different is one because my capacity is different and because two my CFR Line 16 is also different than it was back here in Q. So, these two are different, and that´s why the calculation is different, But like I said, the most important thing to do is to go through and input the totals from your cost report into Column V, do a quick compare to here to make sure, to Column Q, do a quick compare between Q and V, to see if it makes sense to you, because you will see, and I´m going to copy this one because this is one of the biggest ones that we hear all the time. I´m gonna copy this and I´m gonna put it in the Group Day Hab area, and I´m going to go down to To/From Transportation which is Line 68B, and I am going to zero that out, and I would when I do my compare I would say hey, I had 23 thousand dollars there last year, two years later I have zero. Did I get rid of all of my transportation, or did I forget to put it on the CFR, or did I mis–input it? That´s one of the biggest places that we really need to pay attention to. Is the transportation in there, and is it reasonable? Then, Line 68B, which is on here, is the last line of CFR 1 that needs to be input. The rest of the form which is from Line 36 to 48, so 12 more lines, those have to come from your CFR 4. The only two documents that you need in front of you when using this tool is you need your CFR 1 and you need your CFR 4s and 4As. The rest of the CFR you don´t need because of the way it rolls up. So, you´ll go to Line 37, and what Line 37 is requesting that you input is CFR 4 and its position title code 300. Now, I know that you´re gonna have more than one employee with a 300, so you will want to input all of their clinical hours there in that row. The next one is the Direct Care Hours, and that´s another one. So, right now this particular provider has 319,473 hours of direct care from their CFR 4, position title code 200, all the 200s, not just 200, all the 200s. And if I were to go to that cell and I were to put in zero, that would say that I have no direct care hours in my Supervised IRA. If you put a zero in there, I can guarantee if we go back to our IRA that the things that have come through now, it doesn´t even calculate a rate, because there´s no direct care hours. So, in turn that means that it has nothing to put any personal service dollars into, no ERE goes in there when there´s no direct care hours, none of your employee related expenses go in, none of your program support goes in, none of your general and admin goes in, that is all based off of the direct care hours. If you don´t have any direct care hours there, then the rate can´t calculate.
So, that is basically the tool. And you can see that in A the rest of the lines are the 400 series, the 300 series, and it´s looking for hours or it´s looking for dollars. You have to watch Column C, and if you´d like to have your 2015 Cost Report out to be able to look at it and look at what´s in Q through U, that kinda gives you an idea of what was there. The one thing I´m gonna caution about that is you have to realize that the dollars that are in Q through U are based on a certain capacity, and so that corresponds with this Line 50, so that´s where you would put in your capacity or your units depending on whether it´s Day Hab or Pre–voc, and these are off of your CFR. They are Line 10 or Line 13 if it´s Day Habilitation or if it´s ICF. Whatever the units are that´s what you would be putting in there, and just use the lines that we tell you, CFR 1 Line 10 or Line 13 depending on which service you´re doing, and that´s what you would put in there. You would not put in–on the CFR manual it´s called Certified Capacity.

[Joe] Well, 10 is called Certified Capacity. That´s what you would use for your IRAs and your ICFs. Line 13 is your units of service which is what you would use for Pre–voc data.

[Donna] So that´s the two differences here, the certified capacity. And you all know that on Day Hab and Pre–voc we set rates based on units, so that´s what´s in this column, which is S50, and in this column which is T50. What is in Row 50 Column Q and what is in Row 50 Column R is Certified Capacity from the CFR. So those are from the CFR. It´s not what you have today. Again, it´s from the CFR. What you have today is a whole different exercise, but that is not what this tool is for. This tool is to check what´s in your CFR to make sure that all of the rows that are necessary to set a rate are filled in and to make sure that your CFR is as accurate as possible when it gets here. We do have this calculation of rates on this page, but as I said, I´d caution everybody, that is not what this is for. I could take these pages right off, but I wanted to give as much detail and to show you how it actually goes right into your rates and calculates into your rates. I thought that was the most helpful thing which is why I didn´t delete this. If I get eight thousand questions, I can guarantee you, I may delete it. So, this is the tool that we have set up. We think it´s going to help people to review their CFR. Again, it is not to calculate your rate, it is not to dispute the rate I have calculated for you. It is strictly a tool to do a review of your CFR. If you have IT people out there, I said this the other day when I spoke to a group, if you have IT people out there that are pretty savvy and they wanna start playing around with this tool as a budgeting tool and they wanna amend it based on information that they have, by all means go right ahead. Don´t come back to me and tell me you broke the tool. But if you take it off of OPA and use it, you can rename it and do whatever you´d like with it. It is really just a tool to check your CFR to be sure that you´ve filled in all of the important rows and columns of the CFR and to be sure that they are close to what they were in the previous year unless your capacity has changed drastically.
I can take a few questions if somebody wants to send me a question. I know it´s a lot. You all have the BML address which is That´s our BML address, and you can send your questions via email. You can get the tool and start playing with it, and say hey you know what, this doesn´t seem to be working on my side. We can review it on our side to make sure that it is doing what it´s supposed to. You are the biggest help to us in doing these types of things. This has been asked for, for a very long time. The one thing I want to impress upon people again is that you really need to add up all of Line 16, all of your Line 17s, all of your Line 20s. There are no totals on the cost report where it´s rolled up by site, so you need all of your sites.
So, I just got a question and it went pretty fast. Oh, they´re all coming in fast. We are going to mute the phone for one minute and try to get all the questions in one place. Hang on one second.
One of the questions was: Is there a way for us to add something to add all of the lines together from the CFR by program code? I just, there´s no way for me to do that, because everybody out there has their information in different software; some of you have it in Excel, some of you have it in Lotus, some of you have it in databases, Word. I honestly don´t know, so there´s no way for our developers to say this is a tool to be able to add all of your lines by title code. I don´t believe that´s going to be possible.
The next question says: What would be a reason to use this tool? Is it for the purpose of rate estimation? My first slide talked about this is not a rate development tool. This is a CFR check tool. I can give you an example of many, many, many providers, more than two handfuls of providers, who once we have produced their rate send us an email to tell us that they inadvertently left something off their cost report that was needed in the rate development and they would like us to allow them to review, to resubmit a CFR, and have us recalculate the rate. We cannot do that anymore. That is not possible, which is why you received a letter probably four weeks ago saying please review your CFR to make sure it is as accurate as possible. This tool allows you to review your CFRs to make sure they are accurate and make sure that all of the components that should be on the CFR are on the CFR.
The next question is: Are we able to add panels that we could create for all of our Supervised IRAs then link the totals? Absolutely. Once you have this, you can add pages to it and you can put in your information and then you can link right to it. Absolutely. That is not a problem. This tool will belong to you. I´m not gonna ask for it back, I´m not gonna ask to ever see it, but if you wanna add columns those things will not be protected. The only things that´ll be protected are columns between C and Q on the CFR Crosswalk which is where we do the calculations and on the Rate Development pages, which is right here. On the Rate Development pages, you will not be able to change anything between A and E, and as far as changing things on G and H, you won´t be able to do that either, because they´ll be called in from the CFR Crosswalk. So, the Rate Development pages will call in information, but it will not be able to be changed by you. The only thing you can change is the CFR Crosswalk page.
I think there´s one more question here. What happens if we inadvertently entered incorrect units of service in the CFR? Is there a way to adjust the rate? Again, this has nothing to do with the rate. If you realize that you inadvertently entered incorrect units on your CFR you have between now and January 4 to correct that. Make that correction, and get it submitted to OPWDD for use when we start the ´19 rates. But, January 4 is the last day. So, if you start working with this tool and you realize hey, you know what, I left out transportation and I am not gonna get reimbursed for my transportation, you have between now and January 4 to get that CFR corrected and into OPWDD.
We opened a group dayhab in 2017, so is this tool applicable? If you opened a Group Day Hab and you never had a Group Day Hab prior, this tool is not applicable, because, well it depends on when you opened it and if you were a calendar year or if you opened it at the end of the year and you had a full year cost, then yes. If not, then we will be giving you regional average rates and this tool probably isn´t applicable. So, we´ll probably have to wait and see when you opened that Group Day Hab, but this probably may not be useful for that one service.
If revisions are necessary after reviewing the CFR, what is the process and what is the deadline? The deadline to get it in is January 4 because that´s when we are pulling. The next day we will be pulling together the data, and as far as the process, I am gonna have to–Jackie is listening to me, but unfortunately, I can´t figure out how to let her talk, so I´m going to have to put that out for you as a Q&A if there is a different process. My first thought would be go back to the letter that we sent you six weeks ago. It should tell you exactly what the process is to resubmit your CFR, but I do know that if it is not in by January 4, it will not be considered. So, you need to go back to that letter, but we will definitely put that letter again, front and center, with the process in it.
Someone is telling me, and I don´t know if this is true or not, but it´s someone answering someone else´s question. It says for CFR totals by program, see the DMH–1 schedule. So, let us look at that. If that has your totals on it, then by all means that can be used as well. So, we will go back and check that out and put it out when we put this out by close of business Tuesday.
So, I think that´s all of the time that we have. Someone is telling me they did not get a letter. The letter I´m speaking about, about the CFR corrections. If whoever that is can email our BML, which is, we will review, because they were all sent through OPA. If you do not use OPA then you may not have received it, but it is there waiting for you. Every agency should have OPA, and I believe they do.
With that we are going to stop recording, and we are going to wish you all a very good weekend, and we will get this out through OPA by the end of business on Tuesday. Thank you all so much.