"Operational Plan Checklist" - California

Operational Plan Checklist is a legal document that was released by the California Department of Health Care Services - a government authority operating within California.

Form Details:

  • Released on September 1, 2008;
  • The latest edition currently provided by the California Department of Health Care Services;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

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Operational Plan Checklist
The following list is provided as a guide to determine what to include in the audit file
when claiming for Medi-Cal Administrative Activities (MAA). The list is general and is
not intended to be all - inclusive.
Training Materials:
Copies of coordinator training materials indicating dates, locations, trainers, and attendance
lists.
Copies of all time survey trainings, dates, locations, trainers, and original attendance lists.
Time Survey Materials:
Original time survey logs signed by the employee and the employee’s supervisor.
Copies of time cards or other methods of validation staff attendance for the time study
period of each staff member participating in the time survey.
Copies of the computations that calculated the allowable administrative time.
The Claiming Unit Functions Grid
Duty Statements/Position Descriptions:
Duty Statements/Position Descriptions for staff performing MAA.
Invoice Documents:
MAA Summary Invoice
Invoice Variance Form
Activities and Medi-Cal Percentages Worksheet – Tape match
Copy of the Indirect Cost Rate from the CDE website
Time Survey Summary Report
Direct Charges Worksheet
Payroll Data Collection Worksheet
Payroll Data Collection & Other Summary Sheet (maintain actual staff ledger reports for
audit purposes)
Costs and Revenues Worksheet
Averaging Worksheet
Supporting Documentation
Claiming Unit Functions Grid
Checklist for Preparing the MAA Detail Invoice
Checklist for preparing the MAA Summary Invoice
Contracts:
The Contract between the Department of Health Care Services (DHCS) and the LEC or
LGA.
Contracts or sub-contracts between any LEA/LEC/LGA participating in MAA.
Contracts or Memorandums of Understanding (MOUs) between LEA an provider
organization (County Office of Education, private organization, etc.)
The contract with the Host Entity (if applicable), or DHCS.
Time Surveys (as above) if contractors are time surveying.
Organization Charts/Directory:
Charts that show the supervision responsibility of staff involved in MAA claiming down to the
level of clerical staff whose costs are included in the invoice.
Resource Directories:
Copies of documents used to promote Medi-Cal that directly relate to surveyed time for
such activities. Should include flyers, announcements and other materials pertaining to
Medi-Cal. Provide a statement that gives the locations where these materials will be
maintained for future DHCS and CMS review.
September 2008
Operational Plan Checklist
The following list is provided as a guide to determine what to include in the audit file
when claiming for Medi-Cal Administrative Activities (MAA). The list is general and is
not intended to be all - inclusive.
Training Materials:
Copies of coordinator training materials indicating dates, locations, trainers, and attendance
lists.
Copies of all time survey trainings, dates, locations, trainers, and original attendance lists.
Time Survey Materials:
Original time survey logs signed by the employee and the employee’s supervisor.
Copies of time cards or other methods of validation staff attendance for the time study
period of each staff member participating in the time survey.
Copies of the computations that calculated the allowable administrative time.
The Claiming Unit Functions Grid
Duty Statements/Position Descriptions:
Duty Statements/Position Descriptions for staff performing MAA.
Invoice Documents:
MAA Summary Invoice
Invoice Variance Form
Activities and Medi-Cal Percentages Worksheet – Tape match
Copy of the Indirect Cost Rate from the CDE website
Time Survey Summary Report
Direct Charges Worksheet
Payroll Data Collection Worksheet
Payroll Data Collection & Other Summary Sheet (maintain actual staff ledger reports for
audit purposes)
Costs and Revenues Worksheet
Averaging Worksheet
Supporting Documentation
Claiming Unit Functions Grid
Checklist for Preparing the MAA Detail Invoice
Checklist for preparing the MAA Summary Invoice
Contracts:
The Contract between the Department of Health Care Services (DHCS) and the LEC or
LGA.
Contracts or sub-contracts between any LEA/LEC/LGA participating in MAA.
Contracts or Memorandums of Understanding (MOUs) between LEA an provider
organization (County Office of Education, private organization, etc.)
The contract with the Host Entity (if applicable), or DHCS.
Time Surveys (as above) if contractors are time surveying.
Organization Charts/Directory:
Charts that show the supervision responsibility of staff involved in MAA claiming down to the
level of clerical staff whose costs are included in the invoice.
Resource Directories:
Copies of documents used to promote Medi-Cal that directly relate to surveyed time for
such activities. Should include flyers, announcements and other materials pertaining to
Medi-Cal. Provide a statement that gives the locations where these materials will be
maintained for future DHCS and CMS review.
September 2008