"Cmaa Claiming Plan Amendment Checklist" - California

Cmaa Claiming Plan Amendment 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 January 1, 2008;
  • The latest edition currently provided by the California Department of Health Care Services;
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CMAA CLAIMING PLAN AMENDMENT CHECKLIST
LGA:
Fiscal Year:
Quarter:
Claiming Unit Name:
Date:
This Checklist must accompany the CMAA Claiming Plan amendment package/e-mail.
DO NOT resubmit the entire CMAA Claiming Plan – please submit ONLY the pages that are changing. Mail the claiming plan
amendment package to:
Department of Health Care Services
Safety Net Financing Division
Administrative Claiming, Local & Schools Services Branch
Attn: (CMAA program analyst name)
1501 Capitol Avenue, Suite 71.2101
P.O. Box 997436, MS 4603
Sacramento, CA 95899-7436
Place
CMAA Claiming Plan Amendment:
Required
an (X)
Documents:
before
the
item(s)
1. Addition of new CLAIMING UNIT:_____________________________________________
Submit new amendment
Name
package including a
Certification Statement
Is the Claiming Unit a Community Based Organization (CBO)? Yes
No
and Table of Contents.
Submit new amendment
2. Addition of new MAA Category to an existing Claiming Unit; e.g., adding PP&PD
package including a
Certification Statement
Adding Activity:_______________________________________________________________
and Table of Contents.
Submit new amendment
3. Addition of a new Subcontractor to an existing Claiming Unit performing MAA.
package including a
Certification Statement
Name of new Subcontractor:____________________________________________________
and Table of Contents.
Types
4. Change in
of activities and/or services in the contract for which Medi-Cal services or
MAA activities are performed.
Describe changes____________________________________________________________
Submit new amendment
package including a
__________________________________________________________________________
Certification Statement
and Table of Contents.
For the following, send an e-mail to your program analyst along with any necessary documents for
each requirement. This Checklist must accompany the MAA Claiming Plan e-mail:
Place an
DELETE:
Required
(X)
Documents:
before
the
item(s)
1. Previously approved Subcontractor from an existing Claiming Unit.
Name of Subcontractor:________________________________________________________
None.
2. Previously approved Claiming Unit.
Claiming Unit Name:_________________________________________________________
None.
Revised Claiming Unit
3. Previously approved Activity from an existing classification.
Functions Grid and Duty
Statements, as applicable.
Deleted Activity :______________________________________________________________
4. Previously approved Classification.
Revised Claiming Unit
Functions Grid.
Deleted Classification:_________________________________________________________
Revised: 1-08
CMAA CLAIMING PLAN AMENDMENT CHECKLIST
LGA:
Fiscal Year:
Quarter:
Claiming Unit Name:
Date:
This Checklist must accompany the CMAA Claiming Plan amendment package/e-mail.
DO NOT resubmit the entire CMAA Claiming Plan – please submit ONLY the pages that are changing. Mail the claiming plan
amendment package to:
Department of Health Care Services
Safety Net Financing Division
Administrative Claiming, Local & Schools Services Branch
Attn: (CMAA program analyst name)
1501 Capitol Avenue, Suite 71.2101
P.O. Box 997436, MS 4603
Sacramento, CA 95899-7436
Place
CMAA Claiming Plan Amendment:
Required
an (X)
Documents:
before
the
item(s)
1. Addition of new CLAIMING UNIT:_____________________________________________
Submit new amendment
Name
package including a
Certification Statement
Is the Claiming Unit a Community Based Organization (CBO)? Yes
No
and Table of Contents.
Submit new amendment
2. Addition of new MAA Category to an existing Claiming Unit; e.g., adding PP&PD
package including a
Certification Statement
Adding Activity:_______________________________________________________________
and Table of Contents.
Submit new amendment
3. Addition of a new Subcontractor to an existing Claiming Unit performing MAA.
package including a
Certification Statement
Name of new Subcontractor:____________________________________________________
and Table of Contents.
Types
4. Change in
of activities and/or services in the contract for which Medi-Cal services or
MAA activities are performed.
Describe changes____________________________________________________________
Submit new amendment
package including a
__________________________________________________________________________
Certification Statement
and Table of Contents.
For the following, send an e-mail to your program analyst along with any necessary documents for
each requirement. This Checklist must accompany the MAA Claiming Plan e-mail:
Place an
DELETE:
Required
(X)
Documents:
before
the
item(s)
1. Previously approved Subcontractor from an existing Claiming Unit.
Name of Subcontractor:________________________________________________________
None.
2. Previously approved Claiming Unit.
Claiming Unit Name:_________________________________________________________
None.
Revised Claiming Unit
3. Previously approved Activity from an existing classification.
Functions Grid and Duty
Statements, as applicable.
Deleted Activity :______________________________________________________________
4. Previously approved Classification.
Revised Claiming Unit
Functions Grid.
Deleted Classification:_________________________________________________________
Revised: 1-08
LGA: _____________________________________FY___________Quarter_____
Claiming Unit Name: _________________________________________________
Place an
(X)
CHANGE:
before
Required
the
Documents:
item(s)
5. A Classification from the STAFF JOB CLASSIFICATION GRID, as described in box #9, on
the Claiming Unit Functions Grid.
Revised Claiming Unit
Functions Grid and Duty
Classification change:_________________________________________________________
Statement.
Revised Activity Sheet (s)
6. In the Methodology used in calculating the Medi-Cal discount percentage for MAA.
and Claiming Unit Functions
Grid.
7. In the Methodology used for determining how the time and costs for MAA will be developed
and documented.
Revised Activity Sheet (s)
8. In how (methodology/basis) the rate is calculated for Transportation costs.
Revised Activity Sheet (s)
9. The Address, Phone Number or Contact Person for the Claiming Unit.
Revised pages where this
information appears.
10. The Name of the Claiming Unit.
Revised pages where the
Name Changed to:___________________________________________________________
Claiming Unit name
appears.
11. In the total Number of Staff for which MAA will be claimed -- increase or decrease of 25%
Revised Claiming Unit
or more than the number in the approved Claiming Plan.
Functions Grid.
12. In the number of staff who are SPMP or Non-SPMP, as described in box #10, on the
Revised Claiming Unit
Claiming Unit Functions Grid.
Functions Grid.
13. In the Targeted Population, e.g., addition of pregnant women who need treatment.
Revised Activity Sheet.
14. Within the “Medi-Cal Covered Health Services” for which PP&PD is performed.
Revised PP&PD Activity
Sheet.
15. In the Description of the specific Claiming Unit Functions performed by the Claiming
Revised Claiming Unit
Unit, as described in box #8, on the Claiming Unit Functions Grid.
Functions Grid.
Place an
(X)
ADD:
before
Required
the
Documents:
item(s)
16. New Campaign, Program or Activity that is different from those approved for Outreach
Revised Activity Sheet(s).
“A”, “B1", and/or “B2" to an existing Claiming Unit.
17. New Position Classifications performing MAA, (which include approved MAA activities)
as described in box #9, on Claiming Unit Functions Grid, on page M-5-2-7 of the Provider
Revised Claiming Unit
Manual.
Functions Grid and Duty
New position classification:______________________________________________________
Statements.
18. New MAA Activity to an existing position classification performing MAA as described in
box #9 and #11 on the Claiming Unit Functions Grid.
Revised Claiming Unit
Functions Grid and Duty
Position and new activity:______________________________________________________
Statement.
Request assistance from
19. Other (please describe)_____________________________________________________
DHCS regarding required
documentation.
___________________________________________________________________________.
Revised: 1-08
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