DEPARTMENT OF HEALTH CARE FINANCE

Transcription

1 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q1: Please provide a current organizational chart for DHCF. Please provide information to the activity level. In addition, please identify the number of full time equivalents (FTEs) at each organizational level and the employee responsible for the management of each program and activity. If applicable, please provide a narrative explanation of any organizational changes made during FY11 or to date in FY12. Please see Attachment 1 to DHCF Q1 - Current organizational chart Please see Attachment 2 to DHCF Q1 - FTE s identified by activity level, along with employee responsible for the management of each program/activity In FY 2011, the DHCF received approval from the Department of Human Resources and the Office of the City Administrator to realign talent and operations, ensuring maximum performance for the department and to efficiently deliver services of the agency. The realignment had the following impact: No reduction in force of any DHCF employee; Realignment of positions, requiring new supervisory report relationships; No changes in duties, responsibilities, and work activities of non-managerial staff; No changes in union status of current positions; and Better alignment of agency functions to improve the District of Columbia health outcomes. The organizational changes were approved and made effective for the Agency on June 5,

2 DEPARTMENT OF HEALTH CARE FINANCE Executive Management Team Deputy Director (Finance) Ombudsman Chief Operating Officer Health Care Finance Director Staff Assistant Chief of Staff Special Assistant Deputy Chief of Staff Human Resources Chief Financial Operations Office of the General Counsel (GC Support Personnel) Deputy Director (Medicaid) Wayne Turnage, Director Date As of February 21, 2012 Draft Attachment 1 to DHCF Q1 FY11 Org Chart Page 1 of 27

3 DEPARTMENT OF HEALTH CARE FINANCE Office of the Director Deputy Director (Finance) ES G. Nathan Director Executive W. Turnage Deputy Director (Medicaid) ES Linda Elam Staff Assistant CS Cecelia Tilghman Medical Director ES Robert Vowels Spec. Proj. Officer CS VACANT Executive Assistant Chief of Staff Chief Operating Officer Deputy Chief of Staff (OCA) ES ES ES ES I. Summers M. Byrd B. Emanuel S. Bunn Ombudsman Human Resources Special Assistant Program Analyst MS MS ES ES M. Holt K. McRae H. McCabe R.Washington As of February 21, 2012 Page 2 of 27

4 DEPARTMENT OF HEALTH CARE FINANCE Office of the Chief of Staff Chief of Staff M. Byrd Public Affairs Specialist CS D. White Policy Analyst CS /12 B. Isiaq As of February 21, 2012 Page 3 of 27

5 DEPARTMENT OF HEALTH CARE FINANCE Office of the Chief Operating Officer Staff Assistant CS Mirka Shephard Office of the Chief Operating Officer B. Emanuel Information Technology Division of Acquisition and Grants Management Office of Planning & Performance Management HIT/HIE Project Mgmt. Office Division of Support Services (3) (3) (1) (6) (6) As of February 21, 2012 Page 4 of 27

6 Office of the Chief Operating Officer Staff Assistant CS Mirka Shepard Chief Operating Officer [ES ] Brenda Emanuel Office of Planning & Performance Mgmt. Management Analyst CS Pamela Dickerson Information Technology Supv. IT Specialist MS Daren Edwards Info Privacy Officer CS LaRah Payne IT Specialist (Term) CS Herbert Massey Division of Acquisition and Grants Management Contract Compliance Ofc. MS Jacqueline Alpert Contract Specialist CS Lillian Beavers VACANT Pgm Support Assistant CS VACANT HIT/HIE Project Management Office Program Manager HIT.5 / HIE.5 MS VACANT Project Mgr. (HIT Medicaid) CS VACANT Project Manager (HIE) CS VACANT Mgmt. Analyst (HIT) CS VACANT Policy/Legal Analyst (HIE) CS VACANT Division of Support Services Support Svcs. Manager [MS ] T. Hamilton Management Analyst CS C. Adams Staff Assistant CS Adrienne Cooper Management Analyst CS VACANT Office Services Assistant CS Kevin Glover Staff Assistant HIT.5 / HIE.5 CS Program Support Assistant CS N. Patton As of February 21, 2012 Page 5 of 27

7 Office of the Director Office Ombudsman & Health Care Bill of Rights 1 Student Intern D. Watson O. Stewart Ombudsman [MS ] Maude Holt Clinical Case Worker [CS ] Management Analyst [CS ] Management Analyst [CS /12] Policy Analyst [CS ] Darnell Lee Charlita Brown Carmencita Kinsey Chaise Lancaster (11) Kivon Allen (Term Appt) As of February 21, 2012 Page 6 of 27

8 Office of the Director Office of Human Resources Supervisory Mgmt. Liaison Officer MS Kim McRae Student Interns CS Christina Lipscombe Student Interns CS N. Sanders N. Murphy O. Stewart Management Liaison Specialist CS Linda Johnson Shalonda Frazier Management Assistant CS 344 8/9 Danna Gill (8) As of February 21, 2012 Page 7 of 27

9 Department of Health Care Finance Office of Financial Operations Agency Fiscal Officer Grade 16 Staff Assistant Grade 9 Kim Lorick Darrin Shaffer Budgeting Budget Officer Grade 15 Angelique Rogers Sr. Budget Analyst Grade 13 Musili Akinshemoyin Budget Analyst Grade 11 Rebecca Knotts Budget Analyst Grade 11 James Simms Reimbursements Reimbursement Supervisor Grade 15 Fred Hoeflinger Reimb. Specialist (Hospitals) Grade 14 Pat Hinsley Reimb. Specialist (Nursing Homes) Grade 13 Andrea Clark Reimb. Specialist (ICF MR) Grade 13 Art Jones Accounting & Financial Reporting Accounting Officer Grade 15 Tom Kennedy Sr. Accountant Grade 13 Shikha Minocha Accountant Grade 12 Nicholas Tripoli Accountant Grade 12 Binod Gupta Payroll Specialist Grade 9 Vacant A/P Technician Grade 9 Crystal Whittaker As of February 21, 2012 Page 8 of 27

10 Department of Health Care Finance General Counsel General Counsel (Acting) Sheryl Johnson Attorney Advisor Irene Hui Attorney Advisor Ajay Gohill Attorney Advisor VACANT VACANT As of February 21, 2012 Page 9 of 27

11 DEPARTMENT OF HEALTH CARE FINANCE Staff Assistant [CS ] Cecelia Tilghman Deputy Director (Medicaid) Linda Elam Medical Director R. Vowels Special Project Officer VACANT Health Care Delivery Management Administration (HCDMA) Health Care Policy & Research Administration (HCPRA) Health Care Operations Administration (HCOA) Health Care Reform & Innovation Adm. (HCRIA) Division of Managed Care Division of Regulations & Policy Management Division of Claims Management (MMIS / TPL) Health Insurance Exchange Elders Division of Long Term Care Spec. Needs Div. of Clinician, Pharmacy, & Acute Provider Services Division of Quality & Health Outcomes Division of Research & Rate Setting Analysis Division of Eligibility Policy Division of Program Integrity (PI / UM / Fraud) Division of Public and Private Provider Services Division of Affordable Care Reform Initiatives & Grants Development Div. of Children s Health Services As of February 21, 2012 Page 10 of 27

12 Department of Health Care Finance Health Care Delivery Management Administration 1 Director of Health Care Delivery Management Administration [MS ] Ann Page Staff Assistant CS 301 9/11 Patricia Commer (9) Division of Managed Care Division of Clinician, Pharmacy & Acute Provider Services Division of Long Term Care Division of Quality and Health Outcomes Division of Children s Health Services As of February 21, 2012 Page 11 of 27

13 Health Care Delivery Management Administration Division of Managed Care 1 Program Manager [MS ] Lisa Truitt Management Assistant [CS ] Dolly Cruz Project Manager HSCSN [CS ] Jacqulyn Childs Project Manager DC Chartered Health [CS ] F. Stovall Project Manager Unison [CS ] Lovie Davis Management Analyst [CS ] Elisa Fauntleroy Program Analyst [CS ] Linda Barton Walker 1 Includes Alliance, Medicaid & SCHIP and all populations. As of February 21, 2012 Page 12 of 27

14 Department of Health Care Finance Health Care Delivery Management Administration Division of Long Term Care Program Manager [MS ] Yvonne Iscandari Management Assistant [CS ] Leah Wiley Elders and Persons with Physical Disabilities Branch Project Manager [MS ] VACANT Money Follows the Person 2 Project Manager [CS ] Leyla Sarigol Transition Coordinator [CS ] J. Gould B. Woods Project Coordinator [CS ] Angela Katsakis Continuing Care for Persons with Special Needs Branch Project Manager [MS ] Mary Devasia 2 The 3 FTEs are Federally funded FTEs. As of February 21, 2012 Page 13 of 27

15 Health Care Delivery Management Administration Division of Long Term Care Elders and Persons with Physical Disabilities Branch 1 Management Assistant [CS /9] Wonda Hodge (8) Project Manager [MS ] VACANT EPD Waiver Operations Unit Program Analyst [CS ] VACANT Program Specialist [CS ] Debra White VACANT Program Specialist [CS ] Ethan Ware Elbridge James State Plan and Other Services Unit Management Analyst [CS ] James Brannum Pamela Hodge Program Specialist [CS ] Celestine Lara EPD Waiver Monitoring/Compliance Unit Management Analyst [CS ] Paula Johnson Program Specialist [CS ] Janice Harris Loretta Smith As of February 21, Includes Alliance, Medicaid & SCHIP and all populations. Page 14 of 27

16 Health Care Delivery Management Administration Division of Long Term Care Special Needs Populations Branch 1 Management Assistant [CS /9] Wonda Hodge (8) Project Manager [MS ] Mary Devasia Chronic Conditions Unit Management Analyst [CS ] M. Bolling T. Williams Nurse Specialist I [CS ] S. Payne (Term) Matilla Morgan ID/DD Monitoring/Compliance Unit Program Analyst [CS /14] Clydie Smith (13) Program Specialist [CS ] K. Watkins VACANT Department of Health Care Finance 1 Includes Alliance, Medicaid & SCHIP and all populations.

17 As of February 21, 2012 Page 15 of 27 Department of Health Care Finance Health Care Delivery Management Administration Division of Clinician, Pharmacy, & Acute Provider Services Program Manager [MS ] VACANT Management Assistant 1 [CS 344 9] Khiana Jefferson Pharmacy Management Branch Preferred Drug List DUR/P&T Point of Sale Contract Management Pharmacist [CS ] Charlene Fairfax Program Analyst [CS ] Antonio Lacey Management Analyst [CS ] VACANT Pharmacist [CS ] Keli Edwards As of February 21, 2012 Page 16 of 27

18 1 Position also supports Division of Children s Health Services at 0.5 FTE Health Care Delivery Management Administration Division of Quality & Health Outcomes Program Manager [MS ] Cecelia Hawkins Managed Care Liaisons Preventive & Acute Care Liaison Chronic & Long Term Care Liaisons Management Analyst [CS ] Y. Williams Management Analyst [CS ] A. Patterson Management Analyst [CS ] J. Waldon Yeager As of February 21, 2012 Page 17 of 27

19 Health Care Delivery Management Administration Division of Children s Health Services 1 Program Manager [MS ] Colleen Sonosky Management Assistant 1 [CS 344 9] Khiana Jefferson Program Analyst CS G. Bell Foxworth Management Analyst [CS ] Valentine Breitbarth Management Analyst [CS ] VACANT As of February 21, 2012 Page 18 of 27 1 Position also supports Division of Clinician, Pharmacy, & Acute Provider Services at 0.5 FTE

20 Department of Health Care Finance Health Care Policy & Research Administration 1 Supervisory Health Care Program Manager [MS ] Claudia Schlosberg Management Assistant [CS ] Karla Andrews Project Manager [CS ] VACANT Division of Eligibility Policy Division of Regulation & Policy Management Division of Research Analysis & Rate Setting Special Project Coordinator **Position used to Fund Deputy Chief of Staff, Director s Office** As of February 21, Includes Alliance, Medicaid & SCHIP and all populations. Page 19 of 27

21 Health Care Policy & Research Administration Division of Regulation & Policy Management 1 Supervisory Policy Analyst [MS ] M. Diane Fields Policy Analyst Medicaid/SCHIP Alliance [CS ] O. Richardson Policy Analyst Medicaid/SCHIP Alliance [CS ] R Chakkappan Policy Analyst (Term Appt.) [CS ] Julianka Bell 1 Includes Alliance, Medicaid & SCHIP and all populations. 2 Underline and Italics indicates a person who is to be transferred As of February 21, 2012 to this position Page 20 of 27

22 Health Care Policy & Research Administration Division of Research, Analysis & Rate Setting 1 Supervisory Program Analyst [MS ] Benjamin Finder Data Analyst [CS ] J. Sumner C. Grubert Data Analyst [CS /12] Kathleen Rogers VACANT VACANT As of February 21, Includes Alliance, Medicaid & SCHIP and all populations. Page 21 of 27

23 Health Care Policy & Research Administration Division of Eligibility Policy 1 Supervisory Management Analyst [MS ] Lucy Wilson Kear Management Analyst Medicaid/SCHIP Eligibility Alliance Eligibility DC Supplemental Program 2 [CS ] D. Lewis Management Analyst Medicaid/SCHIP Eligibility Alliance Eligibility [CS /12 Anthony Proctor VACANT 1 Includes Alliance, Medicaid & SCHIP and all populations. 2 DC Supplemental Program: Single Point of Contact for SSA As of February 21, Underline and Italics indicates a person who is to be transferred to this position Page 22 of 27

24 Department of Health Care Finance Health Care Operations Administration 1 Supervisory Health Care Program Manager [MS ] Donald Shearer Management Assistant [CS ] VACANT Division of Claims Management Division of Program Integrity Division of Public and Private Provider Services PBM/MMIS Contract Management Project Manager [CS ] Juan Peralta As of February 21, 2012 Page 23 of 27

25 Health Care Operations Administration 1 Division of Claims Management Supervisory Program Analyst [MS ] Patricia Squires Program Support Clerk [CS ] Henrietta Walker Third Party LiabilityBranch Lead Collection Specialist [CS ] Joseph Willis IT Specialist [CS ] Eva Kao Nine Blanco Reimbursement Specialist [CS /11] VACANT Reimbursement Analyst [CS ] Kenneth Gause Collection Specialist [CS ] LaVerne Powell Collection Specialist [CS ] VACANT Management Analyst [CS ] Alganesh Kuflom Kristie Price Management Analyst [CS ] Lawrence Williams Cheryl Dodd 1 Includes Alliance, Medicaid & SCHIP and all populations. As of February 21, 2012 Page 24 of 27

26 Management Assistant [CS /9] Health Care Operations Administration 1 Division of Program Integrity Program Manager [MS ] Karen Shaw Program Support Assistant [CS /8] Pamela Stevenson External Program Audits Project Coordinator [CS ] Brenda Sutton Internal Program Integrity Management Analyst [CS ] VACANT Investigations/Compliance Branch Chief Investigator [MS ] Yolanda Brooks Surveillance & Utilization Branch Nurse Specialist II [CS ] Gloria Watson Investigator [CS /12/13] Brenda Williams (12) Mary Buckley (12) Donald Carr (12) Larry Johnson (11) Nurse Specialist I [CS ] Dorcas Jones Betty Ehikhamenor Utilization Review Specialist [CS ] Adrian Williams Utilization Review Specialist [CS /12] Regina James (12) Cecil Moore (12) VACANT As of February 21, Includes Alliance, Medicaid & SCHIP and all populations. Page 25 of 27

27 Health Care Operations Administration 1 Division of Public and Private Provider Services 1 Supervisory Management Analyst [MS ] Laurie Rowe Public Providers Branch Management Analyst DDS DCPS/OSSE CFSA DMH DOH/FEMS [CS ] Marlena Edwards VACANT Provider Inquiries Branch Management Analyst [CS ] Suprenia Robinson Ann Thomas Derrick Bailey Provider Enrollment & Outreach Branch Management Analyst [CS /12] Phillice Jackson Spencer (12) Natasha Lewis (11) Provider Inquiries Branch Management Analyst [CS ] Wanda Patterson As of February 21, 2012 Page 26 of 27

28 ** Department of Health Care Finance Health Care Reform & Innovation Administration Program Manager [MS ] Jennifer Campbell Affordable Care Reform Innovation & Grants Development Project Manager, CS R. Ayalur Health Insurance Exchange Project Manager, CS Bonnie Norton A. Alonso A. Hamlette As of February 21, 2012 Page 27 of 27

29 Sum of FTE x Dist % FY 12 Prog Code Program Act Code Activity Total Employee Managing Pgm 1000 AMP M010 Personnel Kim McRae M060 Contracting & Procurement Jacqueline Alpert M080 Property Management Tondalaya Hamilton M100 Information Technology Daren Edwards M180 Fleet Management Tondalaya Hamilton M200 Commmunications Melisa Byrd M220 Customer Service Tondalaya Hamilton M260 Performance Management Melisa Byrd AMP Total F OCFO C140 Budget Operations Angelique Rogers C141 Accounting Operations Tom Kennedy C143 Agency Fiscal Operations Angelique Rogers OCFO Total HCDMA D000 Support Services Ann Page D010 Division of Long Term Care Yvonne Iscandari D020 Division of Managed Care Lisa Truitt D030 Division of Clinicians, Pharmacy, & Acute Provider Ann Page, Acting D040 Division of Quality & Health Outcomes Cecelia Hawkins D050 Division of Children's Health Colleen Sonosky HCDMA Total HCPR P200 Support Services Claudia Schlosberg P210 Division of Regulations & Policy Management Mary Fields P220 Division of Rate Setting & Data Analysis Benjamin Finder P230 Division of Eligibility Policy Lucy Wilson Kear HCPR Total HCOA O300 Support Services Donald Shearer O310 Division of Claims Management Patricia Squires O320 Division of Program Integrity Karen Shaw O330 Division of Public & Private Provider Services Laurie Rowe HCOA Total HCRI R400 Health Care Reform & Innovation Jennifer Campbell HCRI Total Grand Total Q1

30 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q2: Please provide the following budget information for DHCF, including the amount budgeted and actually spent, for FY11 and to date in FY12. In addition, please describe any variance between the amount budgeted and actually spent for FY11 and to date in FY12: - At the agency level, please provide the information broken out by source of funds and by Comptroller Source Group and Comptroller Object; - At the program level, please provide the information broken out by source of funds and by Comptroller Source Group and Comptroller Object; and - At the activity level, please provide the information broken out by source of funds and by Comptroller Source Group. Please see Attachment 1 to DHCF Q2 By Fund, CSG, and Object Please see Attachment 2 to DHCF Q2 By Program, Fund, CSG and Object Please see Attachment 3 to DHCF Q2 By Activity, Fund and CSG

31 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 1010 PERSONNEL , , , , , , , , , , , Total 190, , , , , , , , , , , , , , , , Total 161, , , , Total 351, , , , TRAINING & DEVELOPMENT , , Total 16, , , Total , Total 16, , CONTRACTING & PROCUREMENT , , , , , , , , , , , , , , , , Total 161, , , , , , , , , , , , , , , , , , , (13,636.82) 8, Total 180, , , , Total 342, , , , PROPERTY MANAGEMENT , , , , , , , , , Q2

32 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 1030 PROPERTY MANAGEMENT , , , , , , , , , , , , , , Total 1,217, ,299, ,176, ,031, , , , , , , , , , , , , , , , , , , , , , Total 887, , , , Total 2,105, ,152, ,138, ,875, INFORMATION TECHNOLOGY , , , , , , , , , , , , , , , , , , , , , , , , , Total 692, , , , , , , Q2

33 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 1040 INFORMATION TECHNOLOGY , , , , , , ,454, Total 172, , ,074, , , , , , , , , , , , , , , , , , , , ,948, , , , , Total 456, , ,216, , Total 1,320, ,142, ,937, , LEGAL , , , Total 298, , , , , , Total 186, , , Total 485, , , FLEET MANAGEMENT , , , , , , , , , , , , , Total 35, , , , Q2

34 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 1070 FLEET MANAGEMENT Total , , , , , , , , , , , , Total 90, , , , Total 126, , , , COMMUNICATIONS , , , , , , , , , Total 56, , , , , , , , , , , , , Total 62, , , , Total 119, , , , CUSTOMER SERVICE , , , Total , , , , , Total , , , , , , Total , , Q2

35 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 1085 CUSTOMER SERVICE , , Total , Total , , LANGUAGE ACCESS , , , Total 25, , , , , , Total 22, , , Total 47, , , PERFORMANCE MANAGEMENT , , , , , , , , , , , , , , , , , , ,081, ,061, ,082, , , Total 1,752, ,134, ,513, , Total , , , , , , , , , , , , , , , , , , , , , ,090, ,038, , , (58.00) Total 1,790, ,722, ,382, , Total 3,542, ,857, ,895, , Q2

36 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 110F BUDGETING OPERATIONS , , , , , , , , Total 163, , , , Total , , , , , , , , , Total 150, , , , F Total 314, , , , F ACCOUNTING OPERATIONS , , , , , , , , , , , , , , , Total 289, , , , (1,260.08) 28, (193.83) 5, Total - (1,453.91) 34, , , , , , , , , , , , , , , , , , Total 591, , ,086, , F Total 881, , ,930, , Q2

37 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 140F AGENCY FISCAL OFFICER , , , , , , , , , , , , Total 127, , , , (0.00) Total - (0.00) , , , , , , , , , , , Total 102, , , , F Total 229, , , , CHRONIC & LONG TERM CARE , , , , , , , , , , , , , , , , , , Total 708, , ,024, , , , , , , , , , , , , , , , , , , ,955, , Q2

38 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 2001 CHRONIC & LONG TERM CARE ,739, ,739, ,451, , Total 3,918, ,901, ,026, , , , , , , , , , , , , , , , , , , , , , Total 1,055, , ,130, , Total 5,682, ,525, ,180, ,005, MANAGED CARE MGT , , , , , , , , , , ,991, ,333, ,860, Total 3,248, ,660, ,492, , , , , , , , , , , , ,938, ,212, ,564, Total 2,275, ,552, ,892, , Total 5,524, ,212, ,385, , PREVENTIVE AND ACUTE CARE , , , , , , , , , , , , , Total 382, , , , , , , , Q2

39 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 2003 PREVENTIVE AND ACUTE CARE , , , , , , , , , , , Total 464, , , , Total 846, , ,448, , DIV OF QUALITY & HEALTH OUTCOMES , , , , Total 169, , , , Total , Total 169, , HEALTH CARE BILL OF RIGHTS OMBUDSMAN , , , , , , , , , Total 3, , , , , , , , , , , , , Total 80, , , , , , , , , , , , , , , , , , , , , , , Total 263, , , , Q2

40 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 2005 HEALTH CARE BILL OF RIGHTS OMBUDSMAN , , , , , , , , , , , , , , , , , , , , , , , Total 517, , , , Total 864, , ,120, , DIV.OF CLINICIANS, RX& ACUTE PROVIDER SV , , , , Total 203, , , , Total , Total 203, , , HEALTH CARE DELIVERY MGT SUPPORT SVCS , , , , , , , , , , , , , , , , , , ,100, , , , , Total 478, ,430, , , , , , , , , , , , , , , , , Q2

41 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 2010 HEALTH CARE DELIVERY MGT SUPPORT SVCS , , , , , , , , Total 368, , , , Total 846, ,751, ,250, , POLICY UNIT MANAGEMENT , , , , , , , , , Total 143, , , , , , , , ,638, Total 1,720, , , , , , (3,000.00) - 2, , , , , Total 66, , , , Total 1,931, , , , PUBLIC PROVIDER LIAISON MGMT , , , , , , Total 69, , , , , , , , , Total 99, , , Total 169, , , DATA ANALYSIS , , , , , , , , Total 161, , , , Q2

42 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 3003 DATA ANALYSIS , , , , , , , , Total 162, , , , Total 323, , , , MEMBER MANAGEMENT , , , , , , , , , , , Total 136, , , , , , , , , , , , , , , , Total 97, , , , Total 233, , , , HEALTH CARE POLICY & PLANNING SUPPORT , , , , , , , , , , , Total 408, , , , , , , , , , , , , , , , , , , , , , , , , , , Total 252, , , , Total 660, , , , PROGRAM OPERATIONS Total Q2

43 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 4001 PROGRAM OPERATIONS Total Total QUALITY MANAGEMENT , , , , ,232, ,217, ,596, , Total 1,327, ,347, ,907, , , , , , , , , , ,652, ,652, ,315, , Total 3,773, ,772, ,570, , Total 5,101, ,119, ,477, , UTILIZATION MANAGEMENT , , , , Total 179, , , , , , , , , , , , Total 245, , , , Total 425, , , , PROGRAM INTEGRITY , , , , , , , Total 282, , , , , , , , , , , , , , , Total 278, , , , Total 560, , ,043, , PHARMACY MANAGEMENT , , , , , Total 54, , , , Q2

44 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 4006 PHARMACY MANAGEMENT , , , , , , , , , Total 156, , ,174, , Total 211, , ,705, , HEALTH CARE ACCOUNTABILITY SUPPORT SVCS , , , , , , , , , , , , , , , , , , Total 365, , , , , , , , , , , , , , , , , , , , , , , Total 362, , , , Total 727, , , , MEDICAID PROVIDER PAYMENT 2,085,668, ,111,299, ,064,391, ,051, Total 2,085,668, ,111,299, ,064,391, ,051, MEDICAID PUBLIC PROVIDER PAYMENTS ,280, ,829, ,747, ,586, Total 39,280, ,829, ,747, ,586, , , Total 400, , Total 39,680, ,829, ,947, ,586, ALLIANCE PROVIDER PAYMENTS ,548, ,589, ,310, ,783, Total 37,548, ,589, ,310, ,783, ,426, ,426, ,426, Total 14,426, ,426, ,426, Total 51,974, ,015, ,736, ,783, HEALTHY DC PROVIDER PAYMENTS (1,693,000.00) ,790, ,900, Total 5,097, ,900, Q2

45 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 5004 Total 5,097, ,900, MEDICAID INFORMATION SYSTEMS , , ,643, ,625, ,623, Total 3,643, ,625, ,623, , , (8,203.06) ,960, ,960, ,871, Total 10,960, ,960, ,871, , Total 14,604, ,585, ,495, , SYSTEMS OPERATIONS , , , , , , , , , , Total 290, , , , , , , , , , , , , , , Total 615, , , , Total 905, , , , ADMINISTRATIVE CONTRACT MANAGEMENT , , , , , , , , , Total 104, , , , , , , , , , , Q2

46 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 6004 ADMINISTRATIVE CONTRACT MANAGEMENT ,298, Total 60, , ,414, Total 165, , ,988, DIV OF PRGM INTEGRITY (PI/UM/FRAUD) , , , , (4,172.79) Total 553, , , , (5,342.12) (70.56) 0250 Total , Total 553, , DIV. OF PUBLIC & PRIVATE PROVIDER SVCS , , , , Total 100, , , , Total , Total 100, , HEALTH CARE OPERATIONS SUPPORT , , , , , , , , , , , , , , , ,359, ,681, ,911, ,243, , , , Total 2,725, ,347, ,467, , , , , , , , , , , Q2

47 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 6010 HEALTH CARE OPERATIONS SUPPORT , , , , , , , , ,987, ,948, ,654, , , , Total 5,398, ,353, ,109, , Total 8,123, ,700, ,577, , HEALTHY DC MANAGEMENT , , , , (0.00) 42, , , Total 1,195, (0.00) 245, , , , , , , , , , , , Total 657, , , , Total , Total 1,853, , , HEALTH INSURANCE EXCHANGE , ,989, Total - - 1,992, Total - - 1,992, AFFORDABLE CARE REFORM & GRANTS DEVLP , ,626, , ,356, Q2

48 Department of Health Care Finance Budget Information by Activity, Source of Funds, Comptroller Source Group, and Comptroleer Object Data ProgramProgram Code 3 Title Approp Fund Comp Source Fiscal Year 2011 Budget Fiscal Year 2011 Total Expenditures Fiscal Year 2012 Budget Fiscal Year 2012 YTD Expenditures 8002 AFFORDABLE CARE REFORM & GRANTS DEVLP , Total - - 8,200, , Total - - 8,200, , HC REFORM & INNOVATIVE SUPPORT SVS , , Total , Total , MEDICAID PROVIDER PAYMENT INTERFACE Total Total Grand Total 2,243,091, ,230,489, ,218,789, ,465, Q2

49 Department of Health Care Finance FY11 Oversight Questions Department of Health Care Finance (DHCF) Q3: Please complete the attached Program and Activity Detail Worksheet for each program and activity within the DHCF. Please see attachments: DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response DHCF Q3 Response

50 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Agency Management Program (AMP) Activity Title and Org. Code Customer Service (Ombudsman & Health Care Bill of Rights) Responsible Individual Name Maude Holt Responsible Individual Title Ombudsman Number of FTEs Activity Functions/Responsibilities The Office of the Ombudsman provides District residents with information and advocacy on topics including eligibility for programs, access to health care services and quality of care. The office also has responsibility for the District s Health Care Bill of Rights activities. Services within the Activity Provide information regarding District programs, such as Medicaid and the Alliance. Assist District residents with appeals of adverse health care coverage decisions Assist District residents with completing their Medicaid/Alliance application In 2011, the office served over 3,313 residents and processed 108 commercial appeals and 68 Fair Hearings request Provide assistance to District residents with understanding and resolving health care bills and accessing care. Provide assistance to District residents with their transportation complaints Assist with re-certification of Medicaid and Alliance residents Provide information to residents regarding the Qualified Medicare Beneficiary program FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached).

51 DHCF Oversight Q3 Attachment FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

52 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Delivery Management Administration (HCDMA) Activity Title and Org. Code Division of Long-Term Care (DLTC) 2001 Responsible Individual Name Yvonne Iscandari Responsible Individual Title Program Manager, Division of Long Term Care Number of FTEs 25 Activity Functions/Responsibilities The DLTC provides oversight and monitoring of programs targeted to elders, persons with physical disabilities, and persons with intellectual and developmental disabilities. Through program development and day-to-day operations, the DLTC also ensures access to needed cost-effective, high quality chronic and long-term care services for Medicaid beneficiaries residing in home and community-based or institutional settings. Services within the Activity Access to the following Home and Community-Based Services, including two 1915 (c) Home and Community-Based Waivers (HCBW): o Home health care and personal care assistance (PCA) through the Medicaid state plan; o Elders and Persons with Physical Disabilities (EPD) Waiver administration, operation, and oversight; o Intellectual/Developmental Disabilities (ID/DD) Waiver -- oversight of the Department on Disability Services Developmental Disabilities Administration s (DDS/DDA s) operation of the ID/DD waiver; o Intermediate Care Facility for the Intellectually/ Developmentally Disable (ICF/ID); o Money Follows the Person (MFP) Demonstration Grant for institutionalized persons returning to community living. Institutional care: oversight of service delivery and reimbursement determinations o Intermediate Care Facility for the Intellectually/ Developmentally Disable (ICF/ID); o Nursing home facilities.

53 DHCF Oversight Q3 Attachment FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

54 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Delivery Management Administration (HCDMA) Activity Title and Org. Code Managed Care Management 2002 Responsible Individual Name Lisa Truitt Responsible Individual Title Associate Director, Division of Managed Care Number of FTEs 7 Activity Functions/Responsibilities Medicaid and Alliance Contractual Oversight of three (3) health plans Ensuring 225,000 Medicaid and Alliance beneficiaries receive health care and case management services Oversight of enrollment broker and actuarial services contracts Services within the Activity Two on-site visits annually documented with written reports Monthly conference calls or meetings with documented meeting notes Community Forums each quarter for providers and beneficiaries to present concerns to DHCF and Plan representatives Monitoring access by calling primary medical providers in the District to obtain appointments as Medicaid managed care enrollees. Review and decision of Marketing and Health Promotion activities and materials Conduct enrollment activities into the special needs plan, Health Services for Children with Special Needs (HSCSN). Management of MCO kick-payments for newborn deliveries Facilitate monthly collaborative Early Intervention (EI) meetings with MCOs, OSSE, Georgetown Child Development Program and EI providers with documented meeting notes Monitor and track EI referrals to ensure proper and timely provision of services FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached).

55 DHCF Oversight Q3 Attachment FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

56 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Delivery Management Administration (HCDMA) Activity Title and Org. Code Division of Children s Health Services (2003) Responsible Individual Name Colleen Sonosky Responsible Individual Title Number of FTEs 4 Activity Functions/Responsibilities Associate Director, Division of Children s Health Services Oversight of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services benefit (as defined under 1905(r) of the Social Security Act for all Medicaid enrolled children 0-21 Program Administration of Salazar Consent Decree Requirements Services within the Activity Service Delivery Management of well-child, primary care, specialty care services for children 0-21 under the EPSDT benefit Coordination with other child-serving agencies serving children in Medicaid Salazar Reporting and Monitoring FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date). DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

57 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Delivery Management Administration (HCDMA) Activity Title and Org. Code Quality Management Responsible Individual Name Responsible Individual Title Number of FTEs 4 Activity Functions/Responsibilities Cecelia Hawkins Program Manager, Division of Quality and Health Outcomes (QHO) Division of Quality and Health Outcomes. Services within the Activity Health care quality management strategy development, measurement, analysis and reporting. Current priorities include nursing facilities and home health care. Managed care quality improvement. Current initiatives include the Perinatal Collaborative, Chronic Illness Collaborative Pharmacy and Acute Provider Services quality improvement. FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

58 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Delivery Management Administration (HCDMA) 2000 Activity Title and Org. Code Division of Clinician, Pharmacy & Acute Provider Services 2007 Responsible Individual Name Vacant Responsible Individual Title Program Manager Number of FTEs 5.25 Activity Functions/Responsibilities Daily oversight of and coordination with the Pharmacy Benefit Management contract Administration of the Pharmacy and Therapeutics Committee and Preferred Drug List Coordination of Drug Utilization Review Board education interventions and medication usage safety and efficacy reviews Oversight and management of the Alliance pharmacy benefit contract Management of the Durable Medical Equipment / Prosthetics, Orthotics and Supplies (DME/POS) benefit Transportation Dental Services within the Activity Point of sale electronic pharmacy claims adjudication and processing for FFS program beneficiaries Prior authorization review and approval Coverage determinations for new FDA approved medications Utilization and cost analyses Oversight of NEMT contract FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached).

59 DHCF Oversight Q3 Attachment FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

60 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Delivery Management Administration (HCDMA) 2000 Activity Title and Org. Code Health Care Delivery Management Support Services 2010 Responsible Individual Name Ann Page Responsible Individual Title Director of Health Care Delivery Management Administration Number of FTEs 2 Activity Division of Long Term Care Functions/Responsibilities Division of Clinician, Pharmacy and Acute Provider Services Division of Managed Care Division of Children s Health Services Division of Quality and Health Outcomes Services within the Activity Management of managed care contracts and fee-for-service dental and transportation contracts Implementation of the Elders and Persons with Physical Disability (EPD) long term care waiver and oversight of the long term care waiver for individuals with intellectual and Developmental disabilities ( ID/DD) Management of the broad array of benefits in the fee-forservice Medicaid delivery system, including nursing homes and ICFMRs Management of issues related to children s health care, including compliance with the Salazar Court Order, Health care quality management strategy development, measurement, analysis and reporting. Managed care quality improvement. Current initiatives include the Perinatal Collaborative, Chronic Illness Collaborative FY11 Performance Measures In FY 11, HCDMA did not maintain performance measures at the program or activity level for all benefits and delivery systems. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes In FY11 DHCF did not maintain performance measures at the program or activity level. Please see DHCF FY11 Performance Plan

61 DHCF Oversight Q3 Attachment (attached). FY12 Performance Measures In FY12 DHCF did not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) In FY 12 DHCF did not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

62 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Policy & Research Administration 3000 Activity Title and Org. Code Division of Regulation and Policy Management 3001 Responsible Individual Name Diane Fields Responsible Individual Title Associate Director, Division of Regulation and Policy Management Number of FTEs 4 Activity Functions/Responsibilities Regulation and Policy Management Services within the Activity Maintain District Medicaid State Plan. Maintain District Medicaid Rulemakings. Write Medicaid state plan amendments for submission to Council and CMS Write District rulemakings that expand upon newly acquired Medicaid authorities. Analyze issues and present recommendations on issues being considered for Medicaid SPAs, legislation and rulemakings. Create and implement strategies that support the integration of newly approved SPAs and rulemakings into DHCF, sister agencies and with District beneficiaries. Consult and support DHCF administrations through Medicaid analysis, SPA/rulemaking research and retrieval. Coordinate and/or facilitate DHCF s relationship with CMS on issues regarding the promulgation of state plan amendments. FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

63 DHCF Oversight Q3 Attachment

64 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Policy & Research Administration 3000 Activity Title and Org. Code Data Analysis and Rate Setting Responsible Individual Name Benjamin Finder Responsible Individual Title Associate Director, Division of Research, Analysis, and Rate Setting Number of FTEs 6 Activity Data Analytics Functions/Responsibilities Reimbursement methodology Research Services within the Activity Develops, coordinates and monitors data analysis projects for all Administrations in DHCF related to program and policy issues, reimbursement/rate setting, utilization, quality and financial oversight Directs and coordinates data analysis required for Medicaid State Plan Amendments, rule filing packages, and annual and monthly reports Develops and produces trend analyses for all DHCF programs to determine spending patterns for each program Analyzes information, such as rate-to-cost coverage of all Medicaid and Alliance providers in any given calendar year, to allow for the identification of administrative efficiencies and coverage/delivery policy areas for improvement. FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

65 DHCF Oversight Q3 Attachment

66 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Policy & Planning Administration 3000 Activity Title and Org. Code Division of Eligibility Policy 3004 Responsible Individual Name Lucy Wilson-Kear Responsible Individual Title Associate Director, Division of Eligibility Policy Number of FTEs 4 Activity Functions/Responsibilities Eligibility Policy Services within the Activity Ensures that State Plan Amendments related to eligibility and member management conform to requirements of the Centers for Medicare and Medicaid Services (CMS), District laws and rules, Mayor's Orders and court decisions FY11 Performance Measures Develops and implements policy collaborations with other District service delivery agencies to accomplish health system reforms intended to improve the delivery of services to vulnerable populations and, where possible, leverage the use of local dollars with federal matching funds DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

67 DHCF Oversight Q3 Attachment FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

68 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Policy & Research Administration 3000 Activity Title and Org. Code Health Care Policy & Planning Support 3010 Responsible Individual Name Claudia Schlosberg Responsible Individual Title Director of Health Care Policy & Research Administration Number of FTEs 3 Activity Functions/Responsibilities Maintains Medicaid and CHIP State Plan, which govern eligibility, scope of benefits and reimbursement policies for the District s Medicaid and CHIP programs Drafts rules and waivers, and ensures coordination and consistency among health care and reimbursement policies developed by various DHCF Administrations Ensures program compliance with existing and new Federal and District laws, rules, policies procedures, and the State Plan. Services within the Activity Oversees Division of Regulations and Policy Management, Division of Research, Analysis, and Rate Setting and Division of Eligibility Policy, Recommends and coordinates revisions to existing or proposed legislation Develops policies in concert with and to meet the needs of various internal and external stakeholders in a manner consistent with Department mission, and with a focus on drawing down appropriate Federal Financial Participation FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

69 DHCF Oversight Q3 Attachment FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

70 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Operations Administration (HCOA) 6000 Activity Title and Org. Code Division Of Claims Management Responsible Individual Name Patricia Squires Responsible Individual Title Associate Director, Division Of Claims Management Number of FTEs 13 Activity Office of Health Care Operations (HCOA) Functions/Responsibilities Services within the Activity Oversight for day to day operations of HCOA Supports the COTR in oversight for day to day operations of the MMIS Fiscal Agent, Affiliated Computer Services (ACS) Responsible for review and development of Ad Hoc submissions and system changes to the FA Oversight for HCOA contract payments FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

71 DHCF Oversight Q3 Attachment Program and Activity Detail Worksheet Program Title and Org. Code Health Care Operations Administration (HCOA) Activity Title and Org. Code Division of Program Integrity 6005 Responsible Individual Name Karen Shaw Responsible Individual Title Associate Director, Division of Program Integrity Number of FTEs 17 Activity Fraud investigations Functions/Responsibilities Program integrity/safeguards oversight Coordination of external audits Promote appropriate use of Medicaid services Services within the Activity Develop and refer cases of suspected Medicaid provider fraud to law enforcement Identify and implement program safeguards that will enhance the Medicaid program Retrospective review of provider claims and documentation to detect and correct provider billing errors, and failure to comply with certain program standards; Educate providers on correct billing; Manage contract for prospective, concurrent and additional retrospective review of Medicaid services. Recover payments made for services not in accord with billing and related standards. FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY12 Performance Plan for agency-wide performance measures.

72 DHCF Oversight Q3 Attachment FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY12 Performance Plan for agency-wide performance measures.

73 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Operations Administration (HCOA) 6000 Activity Title and Org. Code Division of Public & Private Provider Services 6006 Responsible Individual Name Laurie Rowe Responsible Individual Title Associate Director, Division of Public and Private Provider Services Number of FTEs 9 Activity Office of Provider Services Functions/Responsibilities Services within the Activity Provide service and response to public and private providers on issues related to claims submission or payment Implement new provider programs Process provider enrollment Implement the Administration Services Organization FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

74 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Operations 6000 Activity Title and Org. Code Health Care Operations Support Services Responsible Individual Name Donald Shearer Responsible Individual Title Director, Health Care Operations Administration Number of FTEs 3 Activity Division of Claims Management Functions/Responsibilities Division of Program Integrity Division of Public and Private Provider Services PBM/MMIS Contract Management Services within the Activity Administration of programs that pertain to the payment of claims, management of the fiscal agent contract, management of the administrative services contract, management of the payment systems, provider enrollment and other provider requirements; and program integrity. FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

75 Program and Activity Detail Worksheet DHCF Oversight Q3 Attachment Program Title and Org. Code Health Care Reform and Innovation Administration Activity Title and Org. Code Health Care Reform & Innovative Support Services Responsible Individual Name Dr. Jennifer B. Campbell Responsible Individual Title Director of Health Care Reform and Innovation Administration Number of FTEs 5 Activity Functions/Responsibilities Develop and implement Affordable Care Act / Health Insurance Exchange (HIX)policies and procedures Establish DC infrastructure for possible health care exchanges/reform activities Liaise with Health Reform Implementation Committee (HRIC) Identify cost-effectiveness in public and private coverage in DC Services within the Activity Planning and Implementation of the Health Insurance Exchange by 2014 Oversee the implementation of health care reform FY11 Performance Measures DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY11 Performance Outcomes DHCF does not maintain performance measures at the program or activity level. Please see the DHCF FY11 Performance Plan for agency-wide performance measures (attached). FY12 Performance Measures DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan. FY12 Performance Outcomes (to date) DHCF does not maintain performance measures at the activity level. For performance measures related to this program, please see DHCF FY12 Performance Plan.

76 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q5: Do you anticipate any FY12 spending pressures or has the CFO identified spending pressures? If so, please provide a detailed narrative of the spending pressure, including any steps that are being taken to minimize the impact on the FY12 budget. The Mayor has filed an FY 2012 supplemental budget that addresses two spending pressures at DHCF. They are described in more detail below. 1. $6.0 million Utilization & Complex Care. This relates to the update of the DRG rates paid to hospitals for inpatient care. This rate update was presented as budget neutral, and the FY 2012 budget was formulated based on this assumption. However, after implementation, DHCF learned that this update was not budget neutral because of changes in patterns of utilization and the complexity of inpatient care. 2. $4.2 million Alliance DSH. Through discussion with CMS, DHCF has determined that we cannot use DSH funds to offset Alliance expenditures after December 31, This funding replaces the lost DSH funding. In addition, there are two areas that may lead to spending pressures. 1. Face-to-face recertification of Alliance beneficiaries. DHCF is relying on this effort to reduce the enrollment of the Alliance program. The policy changes have been implemented, and it remains to be seen whether the savings achieved will be sufficient to meet the budget assumptions. 2. Rate increases for the Managed Care Organizations (MCOs). DHCF must adjust the MCOs rates effective May 1, To meet CMS requirements, the new rates must be certified by a credentialed actuary as actuarially sound. Preliminary indications are that the new rates will be higher than anticipated. As with any potential spending pressure, DHCF is making every effort to absorb any MCO rate increase within the existing budget. At this time, DHCF cannot quantify this potential spending pressure.

77 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q6: Please provide an update on all the cost-savings initiatives included in DHCF s FY12 budget. Specifically, please provide updated projections of savings and their impact on the Alliance and Medicaid populations. Please see Attachment 1 to DHCF Q6 FY 2012 Savings Status Chart.

78 FY 2012 DHCF Budget Saving Initiatives Status Update January 24, 2012 Budgeted Local Initiative Description Status Fund Saving $1.3 million Change pharmacy pricing methodology Change brand name drug pricing from Average Wholesale Price (AWP) minus 10% to Wholesale Acquistion Cost (WAC) plus 3%. Implemented October 1, At this time, DHCF estimates the annual WAC is considered roughly equal to 82% of AWP, so this is a 5% rate savings is achievable. cut. $2.9 million Change treatment of therapies in Nursing Home rate methodology Exclude the cost of therapies (PT, OT, & Speech) from the calcuation of the nursing and resident care component of the nursing home rate because these costs are generally for Medicare beneficiaries. State Plan Amendment drafted. Target effective date is April 1, DHCF will absorb impact of delay. $1.2 million Improved management of PCA Benefit Implement a combination of benefit management techniques including: 1) revision of the physician order form to require an explicit explanation of why PCA services are needed; 2) requiring that a beneficiary s physician not the PCA agency Medical Director prescribe PCA services; 3) limiting the use of staffing agencies; 4) engaging a Long Term Care Support Services contractor to determine the need for PCA services. Implemented on a rolling basis. At this time, DHCF estimates the annual savings is achievable. $10.7 million Face to face recertifications for Alliance beneficiaries $16.1 million Alliance beneficiaries must appear, in person, and provide required documentation in order to recerify their eligibility for the program. Implemented October 1, 2011 budget assumed July 1, 2011 implementation. Alliance beneficiaries declining. DHCF & DHS monitoring to determine if enrollment decline sufficient to meet savings target.

79 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q7: Please provide a complete accounting of all federal stimulus funds received, used, or carried over for FY11 and FY12. Please see Attachment 1 to Q7 FY11 Federal Stimulus Accounting.

80 Question #7: Please provide a complete accounting of all federal stimulus funds received, used, or carried over for FY11 and FY12. Agency Grant Name Grant Number Grant Phase Grant Begin Date Grants end dates Total Grant Award Amount FY10 Expenditures Amount carried over to FY11 FY11 Expenditures Amount carried over to FY12 Amount loaded for FY12 Remaining Amount HT0 ARRA FUNDS 09ARRA/19ARRA 10/11 10/1/2009 6/30/ ,853, ,256, n/a $ 89,596, $ - $ - $ - HT0 ARRA: HEALTH INFORMATION EXCHANGE 03RAHI 10 2/8/2010 2/7/2014 5,189, , ,934, $ 172, $ 4,762, $ 3,074, $ 1,687, Total HT0 250,042, ,511, ,934, ,769, ,762, ,074, ,687, Please note that the ARRA funding expired June 30, ARRA funding was allocated annually based on the anticipated expenditures for the FY, that is the reason there is N/A in the "Amount Carried Over to FY11" colum I:\Committee on Health\FY 11 Oversight\Agency Responses\DHCF\Q7\Attachment 1 to DHCF Q7 FY11 Federal Savings Accounting.xlsx Page 1

81 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q8: What were the requirements attached to Medicaid federal stimulus dollars? What controls were put in place to ensure the District was abiding by requirements for Medicaid stimulus dollars? How were Medicaid federal stimulus dollars used and what effect did their use have on the District s Medicaid program? What impact, if any, will the loss of the stimulus dollars have on the provision of services? There were three primary requirements for the use of Medicaid stimulus funding. First, Medicaid stimulus funding was limited to increasing the federal share of Medicaid provider payments. Other Medicaid spending expansions for the childless adult population, administration, and DSH were excluded. Second, Medicaid programs that accepted stimulus funds were prohibited from making program eligibility any more restrictive than it was on July 1, Third, states and the District were prohibited from using Medicaid stimulus funding to replenish reserve or contingency often called rainy day funds. To track stimulus funding, the District created a separate fund detail within the District s accounting system. Abiding by the requirements limited the choices available to policy-makers, and with the knowledge of those restrictions the prohibited policy changes were not made. The Medicaid stimulus funding was in the form of increased federal Medicaid reimbursement for programmatic spending. As a result, the same level of Medicaid spending required the District to contribute less local funding. The direct benefit was a local funds savings to the District. In the formulation of the FY 2012 budget, the expired stimulus funding was replaced with local funding. As a result, the loss of Medicaid stimulus funding had no impact on the provision of services.

82 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q9: Please provide a complete accounting of all intra-district transfers received by or transferred from DHCF during FY11 and to date in FY12. For each, please provide a narrative description as to the purpose of the transfer and which programs, activities, and services within DHCF the transfer affected. Please see Attachment 1 to Q9 Intra-District Activity

83 Department of Health Care Finance Intra District Acivity Q9 Intra-Districts Received (Seller) Project Fund Intra District Number and Detail Title phase 0701 DHFDMH/ DHFDDS/ IASTEP/11 DHCF DMH MHRS MRDDA - WAIVER APRA: A Step Program Transferri ng Agency DMH DDS DOH Program responsible for monitoring 5000 (Health Care Finance) 5000 (Health Care Finance) 5000 (Health Care Finance) Activity Description FY2011 Amount 5001 (Medicaid Provider Payments) 5001 (Medicaid Provider Payments) 5001 (Medicaid Provider Payments) To pay for Medicaid claims paid by DHCF to providers for Mental Health Rehabilitation Services. FY2012 Budget 15,666,524 10,200,000 DDS Local Share for Medicaid Home & Community Based Services (HCBS) for persons with Developmental Disabilities (DD) 1,200,000 N/A To support the A Step program - 200,000 Total 16,866,524 10,400,000 Intra-Districts Transferred (Buyer) Fund Object Class & Detail Index Funds Intra District MOU is are budgeted Title budgete in d in Receiving Agency Program responsible for monitoring Activity Description FY2011 Amount FY12 Budget T M CEQI DCOA 4000 (Health Care Accountabity Admin) 4002 (Quality Management) DCOA to allow nursing homes to purchase My InnerView Quality Profile & Satisfaction Surveys 210, , T M Expansion LTC Ombudsman Services DCOA 4000 (Health Care Accountabity Admin) 4002 (Quality Management) DCLTCOP monitors provisions of long-term care services & quality for Medicaid beneficiaries. 100, , T M 0409 L M Aging & Disability Resource Center (ADRC) DCOA Single Audit OCFO 4000 (Health Care Accountabity Admin) 1000 (Agency Management Program) 4002 (Quality Management) 1090 (Performance Management Support the cost of the ADRC program DHCF/DOH Single Audit Costs 742,997 1,000, ,392 TBD Q9

84 Fund Detail MOU is budgete d in Object Class & Index Funds are budgeted in 0409 L M 0409 T M Intra District Title Receiving Agency ICS OCFO My InnerView DCOA Program responsible for monitoring 1000 (Agency Management Program) 4000 (Health Care Accountabity Admin) Activity Description FY2011 Amount FY12 Budget 1090 (Performance Management 4002 (Quality Management) Innovate Cost Solutions 165,550 TBD Addendum being prepared with exact amt by DCOA. DHCF has agreed to pay once OFOS has approved Direct Payment for outstanding invoices from FY10 44,203 - Q TBD Aging & Disability Resource Center (ADRC) DCOA 2000 (Health Care Delivery Management Admin) 2001 (Chronic & Long Term Care) To provide support for the ADRC program. DHCF acts as a pass thru for this grant between the federal agency DHHS and DCOA. The MOU is funded through a grant (63MAOA) 151, MMFP7 Money Follows the Person DCOA 2000 (Health Care Delivery Management Admin) 2001 (Chronic & Long Term Care) To improve the quality of life of institutionalized District residents. 72, , TBD On-Time Quality Care Initiative DCOA 4000 (Health Care Accountabity Admin) 4002 (Quality Management) DCHCA to establish a geropsychology services program to serve all 18 DC Nursing Homes 192, , MEAP Medicare Enrollment Assistance DCOA 2000 (Health Care Delivery Management Admin) 2001 (Chronic & Long Term Care) Awarded under Medicare Improvements for Patients and Providers Act for Beneficiary Outreach and Assistance Program (MIPPA). 93MEAP 16, FMMTW 0409 R ACAC1 MIG Ticket to Work HC Bill of Rights Assessment HC Bill of Rights Assessment DDS DISB DISB 2000(Health Care Delivery Mgmt) 2000 (Health Care Delivery Management Admin) 2000 (Health Care Delivery Management Admin) 2001 (Chronic & Long Term Care) 2005 (Ombudsman & HC Bill of Rights) 2005 (Ombudsman & HC Bill of Rights) Transfer of the Ticket to Work program from DHCF to DDS Assessment of Insurers on behalf of DHCF Utilization of the Stat- Based System 234, ,587 81,000 80,000 18,500 TBD Q9

85 Fund Detail MOU is budgete d in Object Class & Index Funds are budgeted in 0417 R M 0502 L M L5312 Intra District Title Maintenance of Website Pharmaceutical Funding DOH-Health Care Finance Drug Purchase Receiving Agency OCTO Program responsible for monitoring 2000 (Health Care Delivery Management Admin) DOH-CHA 5000 (Health Care Finance) DOH-CHA 5000 (Health Care Finance) Activity Description FY2011 Amount FY12 Budget 2006 (Ombudsman & HC Bill of Rights) 5001 (Medical Provider Payment) 5001 (Medical Provider Payment) Develop, implement and maintain Ombudsman's website 1115 Waiver admin cost for Pharmaceutical services Drug Purchases - ADAP, Medicaid 1115 Waiver, and Alliance programs 7,413 TBD 126, ,000 22,660,295 17,170,691 Q M Linkage and Tracking Program DOH-CHA 2000(Health Care Delivery Mgmt) 2001 (Chronic & Long Term Care) To support the Medicaid program Linkage and Tracking which improves the health outcomes for children between the ages of 0 and 22 at risk for developmental delays 256, , L M Programatic Support OAG 1000 (Agency Management Program) 1060 (Legal) DHCF has requested legal services for OAG to provide litigation, advicegiving and programmatic support to its operations. 403, , ACAC1 CAPS Database OCTO 2000 (Health Care Delivery Management Admin) 2005 (Ombudsman & HC Bill of Rights) To implement the CAPs Database 4,700 TBD L M 0409 L M Server Support OCTO Janitorial Services DOH-CHA 4000 (Health Care Accountabity Admin) 2000 (Health Care Delivery Management Admin) 4110 (Accountability Servicest) 2001 (Chronic & Long Term Care) Server Support for 2100 MLK Avenue Janitorial Services for DC Ambulatory Care Center located on DC General Campus 7, , L M 0494 L1040 T M 0494 L1040 T M Fixed Cost DPW ITServUS OCTO City Wide Server Operations OCTO 1000 (Agency Management Program) 1000 (Agency Management Program) 1000 (Agency Management Program) 1070 (Fleet Management) 1040 (Information Technology) 1040 (Information Technology) DPW Maintenance Cost 5,385 6,500 City Wide ITServUS - Fixed Cost - OCTO Assessment City Wide Server Ops - Fixed Cost - OCTO Assessment (CAMHI) 18,767 62, ,200 96,960 Q9

86 Q9 Fund Detail MOU is budgete d in Object Class & Index Funds are budgeted in 0494 L1040 T M 0494 L1040 T M 0494 L1040 T M Intra District Title City Wide Web Maintenance Receiving Agency OCTO Quickbase OCTO City Wide Web Operations OCTO Program responsible for monitoring 1000 (Agency Management Program) 1000 (Agency Management Program) 1000 (Agency Management Program) Activity Description FY2011 Amount FY12 Budget 1040 (Information Technology) 1040 (Information Technology) 1040 (Information Technology) City Wide Web Maint - Fixed Cost - OCTO Assessment Quickbase - OCTO Assessment Server Support for managed services for files and printing - OCTO Assessment 7,930 8,000-3,825 16,066 15,880 Q9

87 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q10: Please provide a complete accounting of all reprogrammings received by or transferred from DHCF during FY11 and to date in FY12. For each, please provide a narrative description as to the purpose of the transfer and which programs, activities, and services within DHCF the reprogramming affected. Please identify the programs, activities, and services by name and number. Please see Attachment 1 to DHCF Q10 FY11 Reprogrammings

88 Q10 FY Fund Detail Fiscal Year 2011 From To Grant #/ Project # PH Request Amount Purpose Program Program Name Activity Activity Name Service Service Name Program Program Name Activity Activity Name Service Service Name Local , The funds need to be reprogrammed within the Non Personal Services Objects to align the budget in accordance with the RMTS results. This is required to ensure the agency is in compliance with the approved time study allocation. All All All All All All All All All All All All Local 11 5,567, Local 11 1,541, Local 11 57,783, Local Local , The funds are needed to support the Health Care Reform MCO Waiver (134% 200%) which was effective October, 1, The funds need to be reprogrammed within the Personal Services objects so that the budget is allocated in accordance with the realignment approved June 6, 2011 and to allocate additional local budget as a result of the RMTS allocation results. The funds need to be reprogrammed within the Subsidiaries Object (0502) to reallocate Medicaid Provider Payment funding to align with actual expenditures. The funds need to be reprogrammed within Non Personal service objects to support the purchase of fare cards courier services, and VPN access. The funds need to reprogrammed within Personal Services Objects based on revised funding splits per the RMTS results and revised expenditures based on movement from the Indirect Cost Recovery Program to the Public Assistance Cost Allocation Program Health Care Finance 5001 Medicaid Provider Payments 5101 DSH 5000 Health Care Finance 5001 Medicaid Provider Payments 5151 Health Care Reform Waiver (134% 200%) All All All All All All All All All All All All 5000 Health Care Finance F OCFO 120F Medicaid Provider Payments Accounting Operations Multiple Multiple 5000 Health Care Finance 5001 AF20 Accounting Operations 100F OCFO 120F Medicaid Provider Payments Accounting Operations Multiple Multiple All All All All All All All All All All All All AF20 Accounting Operations O Type 11 7, The funds need to be reprogrammed to support the MOU with DISB to develop and implement an assessment system against the health insurers for the funding of their external grievance procedures, per the Health benefits Plan Members Bill of Rights Act Health Care Delivery Mgmt 2005 Ombudsman 2500 Ombudsman 2000 Health Care Delivery Management 2005 Ombudsman 2500 Ombudsman DHFDMH 11 10,200, The funds need to be reprogrammed due to an error that occurred during the FY2011 formulation. This portion was initially allocated to the DMH Public Provider Payment budget in error; it should be allocated to the MHRS Medicaid Provider Payment budget Health Care Finance 5002 Public Provider Payments 5204 DMH 5000 Health Care Finance 5001 Medicaid Provider Payments 5138 MHRS MMFP , IEAC 11 3, The funds are needed for the provider payments which is the main purpose of the grant. The funds are needed to purchase translation software and equipment to be used for planning and implementation activities related to health insurance exchange Health Care Delivery Management Healthy DC Mgmt 2001 Chronic & Long Term Care/ Training & Development 2100 Chronic & Long Term Care/ Training & Development 2000 Health Care Delivery Management 2001 Chronic & Long Term Care/ Training & Development 2100 Chronic & Long Term Care/ Training & Development 7001 EPMI 7100 EPMI 7000 Healthy DC Managemen 7001 EPMI 7100 EPMI ARRA , The funds need to be reprogrammed due to an error that occurred during the FY2011 formulation. This portion was initially allocated to the DMH Public Provider Payment budget in error; it should be allocated to the MHRS Medicaid Provider Payment budget Health Care Finance 5002 Public Provider Payments 5204 DMH 5000 Health Care Finance 5001 Medicaid Provider Payments 5138 MHRS 1 of 3

89 Q10 FY Fund Detail From To Grant #/ Project # PH Request Amount Purpose Program Program Name Activity Activity Name Service Service Name Program Program Name Activity Activity Name Service Service Name The funds need to be reprogrammed within the Subsidiaries Object Health Care Medicaid Provider Medicaid Provider (0502) to reallocate Medicaid Provider Payment funding to align Multiple Multiple 5000 Health Care Finance 5001 Finance Payments Payments with actual expenditures. Multiple Multiple MMMD ,468, MMMD MMMD , MMMD 11 1,750, MMMD , MMMD 11 19,029, MMMD 11 29, MMMD 11 2,500, MMMD , MMMD 11 10,944, The funds need to be reprogrammed within Non Personal service objects to support the purchase of fare cards courier services, and VPN access. The funds need to reprogrammed within Personal Services Objects based on revised funding splits per the RMTS results and revised expenditures based on movement from the Indirect Cost Recovery Program to the Public Assistance Cost Allocation Program. The funds are needed to support the personal service costs with the Agency management Program that will be allocated to the Medicaid Indirect Administrative revenue earnings. The funds need to be reprogrammed to support the cost for the requirements of the Health Information Technology initiative for the Centers for Medicare and Medicaid Services. The funds need to be reprogrammed due to an error that occurred during the FY2011 formulation. This portion was initially allocated to the DMH Public Provider Payment budget in error; it should be allocated to the MHRS Medicaid Provider Payment budget. The funds are needed to support the expenditures for the indirect administrative costs associated with PACAP. This new allocation will replace the former IDCR allocation. The funds are needed to support the expenditures associated with the transportation of special needs children; responsibility was formerly housed in DCPS, but responsibility has moved to OSSE, so funding needs to be reprogrammed accordingly. The funds are needed to support the expenditures based on the revised funding splits. The TPL contract expenditures will be adjusted from being funded entirely through the Third Party Liability Fund 0631 to a 55/45 split with Medicaid The funds are needed to support the Health Care Reform MCO Waiver (134% 200%) which was effective October, 1, MMMD , The funds are needed to reprogram budget authority to align the budget per the RMTS results. This is required to ensure the agency is in compliance with the approved time study allocation The funds need to be reprogrammed within the Non Personal MMMD , Services Objects to align the budget in accordance with the RMTS results. This is required to ensure the agency is in compliance with the approved time study allocation MMMD , The funds are needed to reprogram the Medicaid Entitlement budget with expenditures The funds need to be reprogrammed based on actual spending ARRA 11 3,034, projections for stimulus payments within the Medicaid Provider Payments activity. 100F OCFO 120F Accounting Operations AF20 Accounting Operations 100F OCFO 120F Accounting Operations All All All All All All All All All All All All / Health Care Finance Health Care Finance Health Care Finance Health Care Delivery Mgmt/ Agency Management Health Care Finance Health Care Finance Health Care Finance / Public Provider Payments Medicaid Provider Payments Public Provider Payments Chronic & Long Term Care/ Training & Development Public Provider Payments Public Provider Payments Medicaid Provider Payments 5201 DC Public Schools Health Care Reform MCO (Below 133) 1000 Agency Management Program Agency Management Program AF20 Accounting Operations Multiple Multiple Multiple Multiple DMH 5000 Health Care Finance / AM15 Chronic & Long Term Care/ Training & Development 1000/ 100F Agency Management Program/ OCFO 1090/ 110F/ 120F 5201 DC Public Schools 5000 Health Care Finance DC Public Schools 5000 Health Care Finance DSH 5000 Health Care Finance 5001 Information Technology Medicaid Provider Payments Performance Mgmt/ Budgeting Operations/ Accounting Operations Public Provider Payments Medicaid Provider Payments Medicaid Provider Payments AM40 Information Technology 5138 MHRS AM90/ AF10 / AF Performance Mgmt/ Budgeting Operations/ Accounting Operations OSSE: Children with Special Needs Transportation Third Party Liability Health Care Reform Waiver (134% 200%) Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple All All All All All All All All All All All All 1000 Agency Mgmt Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple Multiple 5000 Health Care Finance 5001 Medicaid Provider Payments Multiple Multiple 5000 Health Care Finance 5001 Medicaid Provider Payments Multiple Multiple 2 of 3

90 Q10 FY Fund Detail From To Grant #/ Project # PH Request Amount Purpose Program Program Name Activity Activity Name Service Service Name Program Program Name Activity Activity Name Service Service Name The funds need to be reprogrammed to align the budget in 2000/ Health Care 2005/ Ombudsman/ 2500/ Ombudsman/ Third 2000/ Health Care Delivery 2005/ Ombudsman/ Ombudsman/ 2500/5116 accordance with the RMTS results. This required to ensure the 5000 Delivery 5001 Medicaid Provider 5116 Party Liability 5000 Management/Health 5001 Medicaid Provider Third Party Liability , 063 O Type 11 54, Fiscal Year 2012 To Date ( ) Ded Tax 12 56,297, Realign the dedicated taxes budget for 0050 from initial attributes to align the budget per the CMS reporting categories. This is required to allow the agency to most accurately record expenditures to comply with CMS reporting Health Care Finance 5001 / 5003 Medicaid Provider Payments/ Alliance Provider Payments Multiple Multiple 5000 Health Care Finance 5001 / 5003 Medicaid Provider Payments/ Alliance Provider Payments Multiple Multiple Local ,764, Realign the local budget for 0050 from initial attributes to align the budget per the CMS reporting categories. This is required to allow the agency to most accurately record expenditures to comply with CMS reporting Health Care Finance 5001 / 5003 Medicaid Provider Payments/ Alliance Provider Payments Multiple Multiple 5000 Health Care Finance 5001 / 5003 Medicaid Provider Payments/ Alliance Provider Payments Multiple Multiple Local 12 23,444, Realign the local budget for PS and NPS from initial attributes to align the budget with the structure that the agency is currently operating under (per the realignment approved June 6, 2011). Realign the o type budget for 0050 from initial attributes to align O Type 12 1,030, the budget per the CMS reporting categories. This is required to allow the agency to most accurately record expenditures to comply with CMS reporting Realign MMIA grant from initial attributes to align the budget with MMIA , the structure that the agency is currently operating under (per the realignment approved June 6, 2011). Realign HIT grant from initial attributes to align the budget with the MHIT 12 2,908, structure that the agency is currently operating under (per the realignment approved June 6, 2011). Realign HHPA grant from initial attributes to align the budget with HHPA , the structure that the agency is currently operating under (per the realignment approved June 6, 2011). Realign HIE grant from initial attributes to align the budget with the RAHI 10 3,074, structure that the agency is currently operating under (per the realignment approved June 6, 2011). Realign HIX grant from initial attributes to align the budget with the INSX 12 1,650, structure that the agency is currently operating under (per the realignment approved June 6, 2011) MMMD, 21MCHP 12 1,437,424, Realign the Medicaid budget for 0050 from initial attributes to align the budget per the CMS reporting categories. This is required to allow the agency to most accurately record expenditures to comply with CMS reporting. All All All All All All All All All All All All / 100F Health Care Finance Agency Management / OCFO Agency Mgmt Health Care Delivery Management Medicaid Provider Payments Multiple Multiple Multiple Multiple Agency Mgmt 1040 Information Technology Chronic & Long Term Care Information Technology 5114 Physician Services 5000 Health Care Finance 5001 AM AM40 Information Technology Chronic & Long Term Care Information Technology 1000/ 100F Healthy DC 7001 EPMI 7100 EPMI Health Care Finance 5001/ 5002/ 5003 Medicaid Provider/ Public Provider/ Alliance Payments Agency Management Program/ OCFO Agency Management Program Health Care Delivery Management Agency Management Program Health Care Reform & Innovation Multiple Multiple 5000 Health Care Finance Medicaid Provider Payments F015 Physician Services Multiple Multiple Multiple Multiple 1040 Information Technology M100 Information Technology 2001 Long Term Care D010 Long Term Care / 5002/ 5003 Information Technology Health Insurance Exchange Medicaid Provider/ Public Provider/ Alliance Payments M100 R410 Information Technology Health Insurance Exchange Multiple Multiple 3 of 3

91 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q11: Please provide DHCF s capital budgets for FY11 and FY12, including the amount budgeted and actually spent. Were all capital projects completed as planned? Did these capital projects have any impact on the operating budget of DHCF? If so, please provide an accounting of such impact. Please provide a narrative for each program funded by the capital budget. Please see Attachment 1 to DHCF Q11 FY11 Capital Project Listing.

92 Department of Health Care Finance Capital Project Listing Suppress Items - Total is Null or Zero (Rows and columns) Budget Authority MPM01C-ADMINISTRATIVE SERVICES ORGANIZATION (AS Narrative Is the Project Completed as planned? Impact on Operating Budget The purpose of this project is to implement and operate a claims and payment management system to ensure appropriate reimbursement for Medicaid services and to fully utilize federal financial participation p with limited or no The build of this project is anticipated to be completed this fiscal year Yes, the administrative portion of the ASO project is paid from local (55%)/Medicaid (45%) in the operating budget. In FY11 $ 143,333 was allocated to administrative cost and in FY12 the ASO contract is risk of audit repayments budgeted for $ 2,090,625 MPM02C-MMIS UPGRADE The purpose of this project is to fund the build of the Medicaid interface portion of Oracle Enterprise Business Suite. This system will translate the claims data from MMIS to the Oracle (the SOAR replacement system). This project will be completed this fiscal year in order to move to the new system October 1, 2012 This project does not have an effect on the operating budget for the Department of Health Care Finance Q11

93 Budget Authority Budget Authority Allotment Expenditures Encumbrances Pre Encumbrances Authority Balance 0300-CAPITAL FUND - OTHER $2,200, $2,200, $1,009, $1,190, $0.00 $ CAPITAL FUND - FEDERAL $2,200, $2,200, $1,009, $1,190, $0.00 $0.00 Appropriated Fund $4,400, $4,400, $2,018, $2,381, $0.00 $ CAPITAL FUND - OTHER $378, $378, $0.00 $0.00 $239, $138, CAPITAL FUND - FEDERAL $309, $309, $0.00 $0.00 $195, $113, Appropriated Fund $687, $687, $0.00 $0.00 $435, $252, Q11

94 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q12: Provide a complete accounting of all DHCF s Special Purpose Revenue Funds for FY11 and to date in FY12. Please include the following: - Revenue source name and code; - Source of funding for each; - Description of the program that generates the funds; - Activity that the revenue in each special purpose revenue fund supports; - Total amount of funds generated by each source or program in FY11 and to date in FY12; and - FY11 and to date FY12 expenditure of funds, including purpose of expenditure. Please see Attachment 1 to DHCF Q12 Special Purpose Revenue

95 Q12 Department of Health Care Finance (HT0) Special Purpose Revenue (Fund 0600) Revenue Source Name Revenue Source Code Quality of Care Fund 0110 Source of Funding Nursing Home Facilities Description of Program that Generates the funds FY 2011 Generated Funds FY 2012 (YTD through 12/31/11) Generated Funds assessment of 6% per annum of net resident revenue N/A $ 10,000,000 Activity Supported FY 2011 Expenditures FY 2012 Expenditures (YTD through 12/31/11) Purpose of Expenditure Healthy DC Fund 0111 Health Insurance Companies Fees collected from District Health Insurance Companies N/A $ 6,400,000 Third Party Liability Collection 0631 The public who has made fraudulent insurance claims or reimbursement from Insurance companies Fines and Penalties collected on findings of Medicaid fraud, as well as reimbursements for payments made by Medicaid that should have been paid by a third party insurance company. $ 910,394 $ 1,750,994 Medicaid Provider Payments (Activity 5001) $ 750,000 $ Support costs associated with Medicaid Provider Payments as well as payments to the vendor providing the service. Health Benefit Grievance Plan 0632 Health Insurance Companies Revenue generated from an assessment charged to all Health Insurance Companies. $ 644,810 $ 6,259 The Ombudsman's Office (Activity 2005) $ 309,962 $ 73,389 Support Health Care Bill of Rights focused activities of the Ombudsman's office. Recovery Auditing Contract (New Revenue Source currently in the approval process) 633 Overpayments stemming from fraudulent and/or erroneous billing which has been refunded by Medicaid providers. Auditing of Medicaid providers to identify overpayments. The provider refunds the overpayment to the Medicaid program. Medicaid pays RAC contractor a percentage of the recovery. $ $ Medicaid Provider Payments (Activity 5001) $ $ HCSN Revolving Fund 0670* Insurance Companies, Hospitals, and Medicaid Collections due to DC General Hospital. $ 418 $ Alliance Provider Payments (Activity 5003) $ $

96 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q13: Please provide a complete accounting of all grant lapses in FY11, including a detailed statement on why the lapse occurred and corrective action taken by DHCF. Please also indicate if the funds can still be used and/or whether they carried over into FY12. Please see Attachment 1 to DHCF Q13 FY11 Grant Lapse and FY12 Year to Date Activity.

97 Department of Health Care Finance Q13: FY11 Grant Lapse and FY12 Year to Date Activity FY11 Oversight Hearing Agency Grant Name Program Manager Grant Type F = Federal P = Private CFDA # (Federal) Grant Number Grant Phase Grant Begin Date Grants with end dates betweeen 10/01/2010 and 09/30/11 Total Grant Award Amount Expenditures prior to FY 2011 (Including IDCR) Year-to-date Grant Balance Revised FY 11 Budget Cash/Accr/ID Expenditures HT0 MEDICAID INFRASTRUCTURE: TICKET TO WORK Transferred to DDS Federal MMTW 10 1/1/ /31/ , , $ 406, , , HT0 FY10 STATE CHILDRENS HEALTH INSURANCE PROGRAM Multiple Federal MCHP 10 10/1/2009 9/30/ ,547, $ 12,547, ,547, ,547, HT0 FY11 MEDICAID PROVIDER ASSISTANT GRANT Multiple Federal MMMD 11 10/1/2010 9/30/2011 1,498,806, $ 1,498,806, ,498,806, ,498,806, HT0 FY11 ARRA FUNDS Multiple Federal ARRA 11 10/1/2010 9/30/ ,840, $ 90,840, ,840, ,840, HT0 CHRONIC & LONG-TERM CARE Transfer to DCOA Federal MAOA 06 9/30/2005 9/30/ , , $ 151, , , HT0 ARRA: HEALTH INFORMATION EXCHANGE Brenda Emanual Federal RAHI 10 2/8/2010 2/7/2014 5,189, , $ 4,934, , , HT0 MEDICAID TRANSFORMATION GRANT LaRah Payne Federal MTRN 07 2/1/2007 9/30/2011 9,864, ,143, $ 1,720, ,720, , HT0 AFFORDABLE CARE ACTS CONSUMER ASSISTANCE GRANT Maude Holt Federal ACAC 11 10/15/2010 6/14/ , $ 149, , , HT0 STATE PLANNING & ESTABLISHMENT GRANT F/ACA EXCHANGES Brenda Emanual Federal IEAC 11 9/30/ /31/ , $ 999, , , HT0 MONEY FOLLOWS THE PERSON Leyla Serigol Federal MMFP 07 5/1/2007 3/31/ ,593, ,477, $ 14,115, ,343, ,343, HT0 MEDICAID ENROLLMENT ASSISTANCE GRANT Transfer to DCOA Federal MEAP 09 6/1/2009 5/31/ , , $ 16, , , Total HT 11 1,641,137, ,447, ,624,689, ,609,086, ,607,024, Q13

98 Unexpended Grant Award Unexpended Budget Authority Encumbrance Pre-encumbrance Current Yr Obligations Total Cumulative Obligations Forecasted Obligations Grant Lapse (Grant Award less Total Oblig's) Grant Carry Over available in FY12 Comments $ $ $ 406, $ 749, $ $21.62 lapsed. $ - $ $ 12,547, $ 12,547, $ - No lapse. $ - $ $ 1,498,806, $ 1,498,806, $ - No lapse. $ - $ $ 90,840, $ 90,840, $ - Entitlement Grant: No lapse. $ - $ $ 151, $ 367, $ - $ 4,762, $ - - $ 172, $ 427, $ 4,762, No lapse anticipated; No lapse anticipated; MOU has been signed and ready to advance; expenditures anticipated to be slightly less than MOU. $ 1,719, $ 1,719, $ 1, $ 8,144, $ 1,719, The agency did not expend the funds in FY11 because there was not sufficient time to accomplish the objectives in the 2.5 months that remained in that extension period. When we requested a six month extension in April 2011, it was with the assumption that we would have six months to get the final work done. The CMS approval process took over three months which we did not account for; and CMS did not extend the time period to allow us six months from their approval date. In order to spend the funds during that time, we would have had to submit an RFP for the deliverables because the previous contract for the Patient Data Hub expired in April There clearly was not enough time in the 2.5 months left in that extension (by the time we got the approval in July 2011) to do a bid/solicitation, select a vendor and do the final deliverables. $ 69, $ $ 80, $ 80, $ 69, $ 342, $ 342, $ 657, $ 657, $ 342, No lapse anticipated -- no cost extension awarded through 12/31/11. $ 10,772, $ $ 3,343, $ 10,821, $ 10,772, $ - $ $ 16, $ 28, $ - No lapse. 17,665, ,062, ,607,024, ,623,471, ,719, No lapse anticipated; program received additional funding and continuation of the grant through 03/31/2016. Q13

99 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q14: Please provide the following information for all grants awarded to DHCF during FY11 and to date in FY12, broken down by DHCF program and activity: - Grant Number/Title; - Approved Budget Authority; - Expenditures (including encumbrances and pre-encumbrances); - Purpose of the grant; - Grant deliverables; - Grant outcomes, including grantee performance; - Any corrective actions taken or technical assistance provided; - Funding source; - Is the grant a result of federal health care reform; - DHCF program and activity supported by the grant; and - DHCF employee responsible for grant deliverables. Please see Attachment 1 to DHCF Q14 Grant Information.

100 DEPARTMENT OF HEALTH CARE FINANCE (HT0) FY st QUARTER GRANT LAPSE REPORT THRU 1/12/2012 Department of Health Care Finance (HT0) FY11 Oversight Hearing Question 14 Response: Grant Information Sheet Program/Activity Contact Person Grant Number Grant Phase AMP/ Ombudsmans Office Maude Holt 11ACAC 11 AFFORDABLE CARE ACTS CONSUMER ASSISTANCE GRANT Grant Name Revised FY 12 Budget Current Yr Obligations $ 69, $ 13, To purchase equipment and supplies and to pay for staff training and membership in the IOA ( International Ombudsman Association) travel, and other costs. Purpose of Grant Grant Deliverables Grant Outcomes, inclusing grantee Performance Promotional Supplies; Major Advertisements, Copier/Scanner/Colored Printer, IOA Dues. All requests are still pending the government internal systems. Corrective Action taken or Technical Assistance Provided Requests have been initiated for equipment, promotional supplies and the International Ombudsman Association (IOA) membership enrollment. Funding Source Result of Health Care Reform (Y/N) DHHS/CMS/OCIIO Y AMP/ Chief Operating Officer Brenda Emanuel 03RAHI 10 HEALTH INFORMATION EXCHANGE Health Care Reform and InnovaJennifer Campbell 11IEAC 11 STATE PLANNING & ESTABLISHMENT GRANT F/ACA EXCHANGES $ 3,074, $ 270, To develop Strategic and Operational Plans for a Districtwide Health Information Exchange (HIE) and subsequently to implement the planning elements to design and deploy a District-wide HIE to enable the secure exchange of o Strategic and Organizational Plans for the HIE o Stakeholder Engagement and formation of Governance Model o Procurement of Direct Project Solution for point to patient care information to front-poinline providers and organizations o Participation in National exchange participating in the HIE for the and Regional Meetings on purpose of improving the HIE delivery of services, improving the quality of care, reducing the cost of duplicative services, and ultimately improving the health outcomes for District residents. $ 342, $ 342, Health insurance Exchange Planning and Implementation o Strategic and Operational Plans approved May 2011; grantee performance. o Policy Board Rule pending approval by the Mayor o RFP for Direct Solution let in Dec o Proposals submitted Jan. 2012; currently evaluating proposals o DHCF and DOH participation in meetings from 2010 through present Initial planning documents Health insurance related to strategic and Exchange Planning operational plans for the Health Insurance Exchange. o Technical Assistance provided by Deloitte through ONC o Technical Assistance also provided by AHRQ Background research on the Distirct's health insurance market and initial planning documents related to program integration, it infrastructure, and sustainability DHHS/ONC Y Grant active - all deliverables to date satisfactory None Page 1 I:\Committee on Health\FY 11 Oversight\Agency Responses\DHCF\Q14\Draft Attachment 1 to DHCF Q14 - FY11 Grant Information.xlsx

101 DEPARTMENT OF HEALTH CARE FINANCE (HT0) FY st QUARTER GRANT LAPSE REPORT THRU 1/12/2012 Health Care Delivery Mgmt Ann Page 21HHPA 12 HEALTH HOMES PLANNNING OPPORTUNITY GRANT $ 500, $ - To plan for a health homes program. to plan for a health homes program plan Project manager position descrioption developed; position to be posted. Preliminary data analysis underway to identify target populations. DHHS/CMS Y AMP/ Chief Operating Officer Brenda Emanuel 21MHIT 12 MEDICAID HEALTH INFORMATION TECHNOLOGY PORTION OF ENTITLEMENT GRANT $ 2,908, $ 641, To develop an agency-specific HIT plan and road-map for the District s Medicaid HIT projects and to submit the I- APD for the procurement of a contract to develop the EHR o Agency-specific State Medicaid HIT Plan (SMHP) o I-APD for the procurement of an EHR Incentive Payments Incentive Payments Program for program structure the District. o Procured vendor o Some TA guidance contract in Spring 2011; provided by CMS grantee performance very good o SMHP submitted October 2011 and approved by CMS December 2011 o RFP for EHR Incentive Program drafted and sent to OCP in Fall of 2011 DHHS/CMS Y Health Care Reform and InnovaJennifer Campbell 21SHIX 12 STATE OPERATED HEALTH INSURANCE EXCHANGES Health Care Finance Darrin Shaffer 12MCHP 11 FY 11 CHILDREN'S HEALTH INSURANCE PROGRAM AMP and AFO Darrin Shaffer 21MMIA 12 FY 12 INDIRECT COST ADMIN PORTION OF MEDICAID ENTITLEMENT $ 8,200, $ 4,007, Health Insurance Exchange Planning and Implementation $ 11,044, $ 3,169, Funds the federal share of the indirect administrative cost of operating the Medicaid program. $ 567, $ 202, Funds the federal share of the indirect administrative cost of operating the Medicaid program. IT, governance, and financial planning and implementation documents related to the District's health insurance exchange. Completion of federal reporting including, but not limited to, the CMS-37 and CMS-64 Completion of federal reporting including, but not limited to, the CMS-37 and CMS-64 Grant active - no deliverables to date CMS review of quarterly Medicaid claims have not identified any problems. CMS review of quarterly Medicaid claims have not identified any problems. None DHHS/CMS/OCIIO Y None DHHS/CMS N None DHHS/CMS N Health Care Finance Darrin Shaffer 21MMMD 12 FY 12 PROVIDER PYMT PORTION OF MEDICAID ENTITLEMENT $ 1,424,076, $ 457,943, Funds the federal share of Medicaid provider payments. Completion of federal reporting including, but not limited to, the CMS-37 and CMS-64 CMS review of quarterly Medicaid claims have not identified any problems. None DHHS/CMS N All Programs/Activities Darrin Shaffer 21MMAD 12 FY 12 DHCF ADMIN PORTION OF MEDICAID ENTITLEMENT $ 36,558, $ 20,017, Funds the federal share of the administrative cost of operating the Medicaid program. Completion of federal reporting including, but not limited to, the CMS-37 and CMS-64 CMS review of quarterly Medicaid claims have not identified any problems. None DHHS/CMS N Page 2 I:\Committee on Health\FY 11 Oversight\Agency Responses\DHCF\Q14\Draft Attachment 1 to DHCF Q14 - FY11 Grant Information.xlsx

102 DEPARTMENT OF HEALTH CARE FINANCE (HT0) FY st QUARTER GRANT LAPSE REPORT THRU 1/12/2012 Health Care Delivery Mgmt Leyla Serigol 74MMFP 07 MONEY FOLLOWS THE PERSON $ 2,532, $ 506, To transition people from institutions to community residences. 12 $ 1,489,874, $ 487,113, Succesfully transitioned individuals and realizing cost savings from using lower cost community based long term care services. # of individuals successfully transitioned to community (FY 11: 47 unique individuals) Transition services provided to Medicaid beneficaries. DHHS/CMS N Page 3 I:\Committee on Health\FY 11 Oversight\Agency Responses\DHCF\Q14\Draft Attachment 1 to DHCF Q14 - FY11 Grant Information.xlsx

103 Department of Health Care Finance FY12 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q17: Please describe the Office of Contracting and Procurement s role in providing oversight and management for all contracts and procurement within DHCF? How does this activity help to ensure that the programmatic needs of the DHCF are being met? How does this activity ensure that contracting actions are standardized across various programs? The Division of Acquisition and Grants Management, within the Office of the Chief Operating Officer, is responsible for managing and overseeing DHCFs procurements. The division is comprised of the Contracts Compliance Officer, a Contract Specialist and a vacant Contract Specialist position. DHCF posted and filled the position of the Contracts Compliance Officer in FY11. The District s Chief Procurement Officer provided the DHCF Contracts Compliance Officer with $25,000 contracting authority (Please see Attachment 1 to Q17 Delegation of Contracting Authority FY11). All purchases over $25,000 are monitored and executed by the Office of Contracting and Procurement. The Division has provided DHCF leadership, administrations, and program managers with guidance and support through all phases of the procurement cycle regardless of where the procurement authority for a particular procurement lies. This divsion also continues to provide external support for vendors on all contracts and purchases and has served as an interface with the OCFO to support DHCF program managers in the identification of funding for contracts. The Division is currently completing the National Certification for Procurements, which all staff are expected to have completed by May of It is the goal of the Division to become a strategic partner in DHCF s mission to improve the health outcomes of District residents by contributing the procurement expertise needed to assist DHCF administrations and programs in achieving their distinct objectives. In support of this goal, the Compliance Officer will maintain consistent communication with program managers and contract administrators through the attendance of regularly scheduled DHCF managers meetings and meetings with individual administrations to address current and future procurement issues. The Division will regularly monitor the department s acquisition plan, milestone schedules, and monthly Purchase Order Reports to ensure new contracts are awarded when needed and existing contracts are producing the required results and deliverables in accordance with the terms and conditions of their respective contracts. The Contracts Compliance Officer will maintain constant communication with DHCF leadership on action necessary to correct timing and performance issues. The Division will also promote consistency in the contracting processes across all DHCF administrations and programs through the issuance of DHCF Contracting and Procurement Standard Operating Procedures and the distribution of templates and samples for frequently used

104 Department of Health Care Finance FY12 Oversight Questions procurement documents. Additionally, the Contracts Unit plans to utilize technology available including the Department s shared drive to post procurement related information so that all DHCF staff are able to access as well as the use of the Department s web site to post all Department contracts.

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107 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q18: Does your agency use purchase orders and purchase cards to acquire supplies or services? If so: - What safeguards has your agency put in place to prevent waste, fraud, and abuse; - How many purchase cards were issued in FY11 and to date in FY12; - Who has been issued a purchase card in FY11 and to date in FY12; - What is the maximum amount that can be purchased with a card; - What limitations are placed on the items that can be purchased; and - What has been purchased using these methods in FY11 or to date in FY12? The DHCF Agency Program Coordinator (APC) serves as the agency liaison with the Program Management Office (PMO) and the Bank to ensure that the Authorizing Official and cardholders maintain accurate accounting and balances of card purchases. This process is intended to mitigate any overspending, exceeding budget limits, and to prevent fraud, waste, and abuse. Also, Monthly Agency Review Team (ART) meetings are held with the APC, Agency Director (AD) and the Designated Billing Official (DBO) to review the PaymentNet Reports for completeness, adequate documentation. - How many purchase cards were issued in FY11 and to date in FY12: 2 in FY11 and 0 in FY12 - Who has been issued a purchase card in FY11 and to date in FY12: Crystal Adams and Tondalaya Hamilton - What is the maximum amount that can be purchased with a card: $2,500 a day; $10,000 per month. - What limitations are placed on the items that can be purchased; and In FY11, the Purchase Request Form (PRF) and policy were developed to provide a mechanism for obtaining proper approvals for all DHCF purchase orders and credit card transactions. All purchases must receive the proper sign off by the program and administrative staff prior to the purchase being made. All purchases are reviewed on a monthly basis by the ART Review Team to determine patterns in spending and necessity. - What has been purchased using these methods in FY11 or to date in FY12?

108 Department of Health Care Finance FY11 Oversight Questions For purchases in FY11 and to date in FY12, only Office supplies, IT equipments, and transcribing services with approved PRF s have been processed using this method.

109 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q19: Please provide the Committee with DHCF s fixed costs budget and actual dollars spent for FY10, FY11, and to date in FY12. Include the source of funding and the percentage of these costs assigned to each DHCF administration. Please provide the percentage change between the DHCF s fixed costs budget for these years and a narrative explanation for any changes. How has the creation of the Department of General Services affected your fixed costs? Please see Attachment 1 to DHCF Q19 Fixed Cost Comparisons

110 Department of Health Care Finance FY11 Budget Oversight Hearing Fixed Cost Comparison Q#19: (a) Please provide the Committee with DHCF's fixed cost costs budget and actual dollars spent for FY10, FY11 and to date in FY12. Include the source of funding and the percentage of these costs assigned to each DHCF administration. (b) Please provide the percentage change between the DHCF's fixed costs budget for these years and a narrative explanation for any changes. (c) How has the creation of the Department of General Services affected your fixed cost? A) LOCAL (Fund 0100) FY10 FY11 FY12 Budget Actual Budget Actual Budget Actuals (thru 12/31/11) 0030 electric, water, etc 191, ,599 1, telephones 48,700 41,754 44,422 47, Rent 1,060,419 1,060, , , , , janitorial 0034 security 42,385 23, , , , occupancy 199, ,580 Total 1,493,984 1,475,039 1,098,507 1,179, ,775 1,262,259 Federal Medicaid Grant (Fund 0250) FY10 FY11 FY12 Budget Actual Budget Actual Budget Actuals (thru 12/31/11) 0030 electric, water, etc telephones 47,393 36,346 36, Rent 633, , , , janitorial 0034 security 161, ,536 74, occupancy Total 161, , , , ,722

111 Special Purpose Revenue (Fund 0600) FY10 FY11 FY12 Budget Actual Budget Actual Budget Actuals (thru 12/31/11) 0030 electric, water, etc 0031 telephones 0032 Rent 0033 janitorial 0034 security 0035 occupancy Total Total Fixed Cost for DHCF FY10 FY11 FY12 Budget Actual Budget Actual Budget Actuals (thru 12/31/11) 0030 electric, water, etc 191, ,599 1, telephones 48,700 89,147 80,768 83, Rent 1,060,419 1,060,419 1,375,937 1,321,105 1,733,948 1,733, janitorial 0034 security 204,330 23, , ,880 1, , occupancy 199, ,580 Total Fixed Cost for DHCF 1,655,929 1,475,039 1,837,387 1,931,347 1,815,955 2,078,981 The Department of Health Care Finance allocates 100% of the fixed cost to the Agency Management Program/Property Management Activity. (B) (C) From FY10 to FY11, the fixed cost budget increased 10%. This increase is attributed to the change in facility location. In FY10, the agency was located at 825 North Capital, the FY10 assummed that the agency was moving to 33 N Street (which did not occur). In FY10 our telephone cost still remained in DOH, in FY11, the services were properly allocated to DHCF From FY11 to FY12, the fixed cost decreased (1.18%). This decrease is the result of the agency moving out of 2100 MLK. N/A

112 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q20: Please provide a current list of all properties supported by the DHCF budget. Please indicate whether the property is owned by the District or leased and which DHCF program utilizes the space. If the property is leased, please provide the lease term. For all properties, please provide an accounting of annual costs (i.e. rent, security, janitor services). Please see Attachment 1 to DHCF Q20 FY11 DHCF DRES Property Assessment.

113 DRES 2012 Municipal Facilities: Non Capital 2012 Forecast Facility Address Facility Name DRES SF Proration Managed Total Utilities Auto Fuel Total Rent Total Janitorial Total Occupancy Total Security 2012 Total Cost PSF 2100 MLK Jr. Ave. SE yes 38, % 202,076 1,222, ,424, North Capitol S yes 4,000 3% - 208, , , Auto Fuel Auto Fuel no 100% , , ,430, ,214 1,639, /21/2012 1

114 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q21: What steps has DHCF taken during FY11 and to date in FY12 to identify fixed costs efficiencies and reduce costs? DHCF continues to implement several plans that assist the District government in reducing fixed costs as it relates to IT, hardware, and facility expenses. The following initiatives have been implemented: Partnered with the Office of the Chief Technology Officer (OCTO) to consolidate IT needs resulting in decreasing overall IT expenses Planning phase with the Department of General Services (DGS) to consolidate our office space into a District owned facility. This will ultimately decrease rental/lease expenses, and reduce cost associated with equipment purchasing and maintenance. The plan is for all DHCF staff to be centrally located in FY13 Continuous evaluation of floor plans to ensure efficient space allocation Utilized the Office of Contracting and Procurement s (OCP) surplus property inventory as opposed to purchasing new items to furnish the agency s swing move Moved staff from a non-district owned facility to a District-owned facility

115 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q23: Please provide a list of all FY11 FTEs for DHCF, broken down by program and activity. In addition, please provide current vacancy information. In addition, for each position please note whether the position is filled (and if filled, the name of the employee) or whether it is vacant. Please see Attachment 1 to DHCF Q23 FY11 FTEs for DHCF by Program and Activity 1

116 FY2012 Schedule A Report as of January 12, 2012 Prog Code Program Act Code Activity Title Name Vac Stat FTE x Dist % 1000 AMP M010 Personnel SUPERVISORY MANAGEMENT LIAISIO McRae,Kim F AMP M010 Personnel SUPERVISORY MANAGEMENT LIAISIO McRae,Kim F AMP M010 Personnel Management Liaison Specialist Johnson,Linda D F AMP M010 Personnel Management Liaison Specialist Johnson,Linda D F AMP M010 Personnel Management Liaison Specialist Frazier,Shalonda L F AMP M010 Personnel Management Liaison Specialist Frazier,Shalonda L F AMP M010 Personnel Student Intern Lipscombe,Christina F AMP M010 Personnel Student Intern Lipscombe,Christina F AMP M010 Personnel Management Assistant Gill,Danna K F AMP M010 Personnel Management Assistant Gill,Danna K F AMP M060 Contracting & Procurement Contract Compliance Officer Alpert,Jacquelyn F AMP M060 Contracting & Procurement Contract Compliance Officer Alpert,Jacquelyn F AMP M060 Contracting & Procurement Contract Specialist V AMP M060 Contracting & Procurement Contract Specialist V AMP M060 Contracting & Procurement Contract Specialist Beavers,Lillian J F AMP M060 Contracting & Procurement Contract Specialist Beavers,Lillian J F AMP M080 Property Management Program Support Asst (OA) Patton,Nikole L F AMP M080 Property Management Program Support Asst (OA) Patton,Nikole L F AMP M080 Property Management Support Services Manager Hamilton,Tondalaya F AMP M080 Property Management Support Services Manager Hamilton,Tondalaya F AMP M080 Property Management Management Analyst V AMP M080 Property Management Management Analyst V AMP M080 Property Management Management Analyst Adams,Crystal I F AMP M080 Property Management Management Analyst Adams,Crystal I F AMP M100 Information Technology INFORMATION TECHNOLOGY SPECIAL Massey II,Herbert E F AMP M100 Information Technology INFORMATION TECHNOLOGY SPECIAL Massey II,Herbert E F AMP M100 Information Technology Supervisory IT Specialist Edwards,Daren M F AMP M100 Information Technology Supervisory IT Specialist Edwards,Daren M F AMP M100 Information Technology Information & Privacy Officer Payne,LaRah D F AMP M100 Information Technology Information & Privacy Officer Payne,LaRah D F AMP M100 Information Technology Program Manager V AMP M100 Information Technology Program Manager V AMP M100 Information Technology PROJECT MANAGER V AMP M100 Information Technology PROJECT MANAGER V AMP M100 Information Technology Staff Assistant Snowden,Carmelita W F AMP M100 Information Technology Staff Assistant Snowden,Carmelita W F AMP M100 Information Technology Policy/Legal Analyst V AMP M100 Information Technology Policy/Legal Analyst V AMP M100 Information Technology PROJECT MANAGER V AMP M100 Information Technology PROJECT MANAGER V AMP M100 Information Technology MANAGEMENT ANALYST V AMP M100 Information Technology MANAGEMENT ANALYST V AMP M100 Information Technology Special Projects Officer V AMP M100 Information Technology Special Projects Officer V AMP M180 Fleet Management Office Services Assistant Glover,Kevin L F AMP M180 Fleet Management Office Services Assistant Glover,Kevin L F AMP M200 Commmunications Policy Analyst Isiaq,Abidemi S F AMP M200 Commmunications Policy Analyst Isiaq,Abidemi S F AMP M200 Commmunications Public Affairs Specialist White,Dorinda F AMP M200 Commmunications Public Affairs Specialist White,Dorinda F AMP M220 Customer Service MANAGEMENT ANALYST Brown,Charlita R F AMP M220 Customer Service MANAGEMENT ANALYST Brown,Charlita R F AMP M220 Customer Service Management Analyst Lancaster,Chaise A F AMP M220 Customer Service Management Analyst Lancaster,Chaise A F AMP M220 Customer Service Program Manager Holt,Maude R F AMP M220 Customer Service Program Manager Holt,Maude R F AMP M220 Customer Service Student Intern Murphy,Natasha Z F AMP M220 Customer Service Student Intern Sanders,Nadia E F 0.138

117 FY2012 Schedule A Report as of January 12, 2012 Prog Code Program Act Code Activity Title Name Vac Stat FTE x Dist % 1000 AMP M220 Customer Service Student Intern Watson,Daisha R F AMP M220 Customer Service Student Intern Stewart,Omari F AMP M220 Customer Service Student Intern Murphy,Natasha Z F AMP M220 Customer Service Student Intern Sanders,Nadia E F AMP M220 Customer Service Student Intern Watson,Daisha R F AMP M220 Customer Service Student Intern Stewart,Omari F AMP M220 Customer Service POLICY ANALYST Allen,Kivon L F AMP M220 Customer Service POLICY ANALYST Allen,Kivon L F AMP M220 Customer Service MANAGEMENT ANALYST Kinsey,Carmencita K F AMP M220 Customer Service MANAGEMENT ANALYST Kinsey,Carmencita K F AMP M220 Customer Service Clinical Case Worker Lee Redish,L Darnell F AMP M220 Customer Service Clinical Case Worker Lee Redish,L Darnell F AMP M260 Performance Management Management Analyst Dickerson,Pamela F. F AMP M260 Performance Management Management Analyst Dickerson,Pamela F. F AMP M260 Performance Management Executive Assistant Summers,Galek I F AMP M260 Performance Management Executive Assistant Summers,Galek I F AMP M260 Performance Management Director Turnage,Wayne M F AMP M260 Performance Management Medical Officer Vowels,Robert B F AMP M260 Performance Management Medical Officer Vowels,Robert B F AMP M260 Performance Management Deputy Chief of Staff Bunn,Sheila E. F AMP M260 Performance Management Program Analyst Washington,Radeena P F AMP M260 Performance Management Program Analyst Washington,Radeena P F AMP M260 Performance Management Chief of Staff Rapp,Melisa S. F AMP M260 Performance Management Chief of Staff Rapp,Melisa S. F AMP M260 Performance Management Deputy Director Elam,Linda D. F AMP M260 Performance Management Deputy Director Elam,Linda D. F AMP M260 Performance Management Special Projects Officer V AMP M260 Performance Management Special Projects Officer V AMP M260 Performance Management Dep. Dir. for Medicaid Finance Nathan,Ganayswaran F AMP M260 Performance Management Dep. Dir. for Medicaid Finance Nathan,Ganayswaran F AMP M260 Performance Management Chief Administrative Officer Emanuel,Brenda L F AMP M260 Performance Management Chief Administrative Officer Emanuel,Brenda L F AMP M260 Performance Management Staff Assistant Cooper,Adrienne F F AMP M260 Performance Management Staff Assistant Cooper,Adrienne F F AMP M260 Performance Management Staff Assistant Shephard,Mirka F AMP M260 Performance Management Staff Assistant Shephard,Mirka F AMP M260 Performance Management Staff Assistant Tilghman,Cecelia M F AMP M260 Performance Management Staff Assistant Tilghman,Cecelia M F AMP M260 Performance Management Special Assistant V AMP M260 Performance Management Special Assistant V HCDMA D000 Support Services Healthcare Program Mgr Page,Ann E F HCDMA D000 Support Services Healthcare Program Mgr Page,Ann E F HCDMA D000 Support Services STAFF ASSISTANT Commer,Patricia F HCDMA D000 Support Services STAFF ASSISTANT Commer,Patricia F HCDMA D010 Division of Long Term Care NURSE CONSULTANT Payne,Sharon D F HCDMA D010 Division of Long Term Care NURSE CONSULTANT Payne,Sharon D F HCDMA D010 Division of Long Term Care Program Specialist Watkins,Kishia M F HCDMA D010 Division of Long Term Care Program Specialist Watkins,Kishia M F HCDMA D010 Division of Long Term Care Program Support Asst (OA) Hodge Logan,Wonda M F HCDMA D010 Division of Long Term Care Program Support Asst (OA) Hodge Logan,Wonda M F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Bolling,Michael D F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Bolling,Michael D F HCDMA D010 Division of Long Term Care PROJECT MANAGER V HCDMA D010 Division of Long Term Care PROJECT MANAGER V HCDMA D010 Division of Long Term Care PROJECT MANAGER Sarigol,Leyla D F HCDMA D010 Division of Long Term Care Program Specialist V HCDMA D010 Division of Long Term Care Program Specialist V HCDMA D010 Division of Long Term Care Program Analyst V 0.45

118 FY2012 Schedule A Report as of January 12, 2012 Prog Code Program Act Code Activity Title Name Vac Stat FTE x Dist % 2000 HCDMA D010 Division of Long Term Care Program Analyst V HCDMA D010 Division of Long Term Care Program Specialist James III,Elbridge G F HCDMA D010 Division of Long Term Care Program Specialist James III,Elbridge G F HCDMA D010 Division of Long Term Care Program Specialist Ware,Ethan E F HCDMA D010 Division of Long Term Care Program Specialist Ware,Ethan E F HCDMA D010 Division of Long Term Care Nurse Specialist I Morgan,Matilla N F HCDMA D010 Division of Long Term Care Nurse Specialist I Morgan,Matilla N F HCDMA D010 Division of Long Term Care Program Specialist Harris,Janice M F HCDMA D010 Division of Long Term Care Program Specialist Harris,Janice M F HCDMA D010 Division of Long Term Care Program Specialist White,Debra F HCDMA D010 Division of Long Term Care Program Specialist White,Debra F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Johnson,Paula R F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Johnson,Paula R F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Brannum Jr.,James F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Brannum Jr.,James F HCDMA D010 Division of Long Term Care Program Manager Iscandari,Yvonne A F HCDMA D010 Division of Long Term Care Program Manager Iscandari,Yvonne A F HCDMA D010 Division of Long Term Care Program Specialist Smith,Loretta F HCDMA D010 Division of Long Term Care Program Specialist Smith,Loretta F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Williams,Theadora F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Williams,Theadora F HCDMA D010 Division of Long Term Care Program Analyst Smith,Clydie A F HCDMA D010 Division of Long Term Care Program Analyst Smith,Clydie A F HCDMA D010 Division of Long Term Care PROJECT MANAGER Devasia,Mary F HCDMA D010 Division of Long Term Care PROJECT MANAGER Devasia,Mary F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Hodge,Pamela Leeatta F HCDMA D010 Division of Long Term Care MANAGEMENT ANALYST Hodge,Pamela Leeatta F HCDMA D010 Division of Long Term Care Management Assistant Wiley,Leah C F HCDMA D010 Division of Long Term Care Management Assistant Wiley,Leah C F HCDMA D010 Division of Long Term Care Project Coordinator Katsakis,Angela S. F HCDMA D010 Division of Long Term Care Project Coordinator Katsakis,Angela S. F HCDMA D010 Division of Long Term Care Program Specialist Lara,Celestine F HCDMA D010 Division of Long Term Care Program Specialist Lara,Celestine F HCDMA D010 Division of Long Term Care TRANSITION COORDINATOR Gould,Jacqueline R. F HCDMA D010 Division of Long Term Care TRANSITION COORDINATOR WOODS,BEYSHINAH F HCDMA D020 Division of Managed Care MANAGEMENT ANALYST Fauntleroy,Elisa F HCDMA D020 Division of Managed Care MANAGEMENT ANALYST Fauntleroy,Elisa F HCDMA D020 Division of Managed Care Program Analyst Barton Walker,Linda D F HCDMA D020 Division of Managed Care Program Analyst Barton Walker,Linda D F HCDMA D020 Division of Managed Care Program Manager Truitt,Lisa Ann F HCDMA D020 Division of Managed Care Program Manager Truitt,Lisa Ann F HCDMA D020 Division of Managed Care Project Manager Davis,Lovie O F HCDMA D020 Division of Managed Care Project Manager Davis,Lovie O F HCDMA D020 Division of Managed Care Project Manager Childs,Jacqulyn S F HCDMA D020 Division of Managed Care Project Manager Childs,Jacqulyn S F HCDMA D020 Division of Managed Care Project Manager V HCDMA D020 Division of Managed Care Project Manager V HCDMA D020 Division of Managed Care Management Assistant Cruz,Dolly J. F HCDMA D020 Division of Managed Care Management Assistant Cruz,Dolly J. F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Management Assistant Jefferson,Khiana L F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Management Assistant Jefferson,Khiana L F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Management Analyst V HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Management Analyst V HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Pharmacist Edwards,Keli F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Pharmacist Edwards,Keli F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider PHARMACIST Fairfax,Charlene D F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider PHARMACIST Fairfax,Charlene D F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Program Analyst Lacey,Antonio E F 0.25

119 FY2012 Schedule A Report as of January 12, 2012 Prog Code Program Act Code Activity Title Name Vac Stat FTE x Dist % 2000 HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Program Analyst Lacey,Antonio E F HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Program Manager V HCDMA D030 Division of Clinicians, Pharm, & Acute Provider Program Manager V HCDMA D040 Division of Quality & Health Outcomes Management Analyst V HCDMA D040 Division of Quality & Health Outcomes Management Analyst V HCDMA D040 Division of Quality & Health Outcomes Management Analyst Williams,Yolonda R F HCDMA D040 Division of Quality & Health Outcomes Management Analyst Williams,Yolonda R F HCDMA D040 Division of Quality & Health Outcomes Program Manager Hawkins,Cecelia F HCDMA D040 Division of Quality & Health Outcomes Program Manager Hawkins,Cecelia F HCDMA D040 Division of Quality & Health Outcomes Management Analyst Walden Yeager,June M F HCDMA D040 Division of Quality & Health Outcomes Management Analyst Walden Yeager,June M F HCDMA D050 Division of Children's Health Management Assistant Jefferson,Khiana L F HCDMA D050 Division of Children's Health Management Assistant Jefferson,Khiana L F HCDMA D050 Division of Children's Health Program Manager Sonosky,Colleen A F HCDMA D050 Division of Children's Health Program Manager Sonosky,Colleen A F HCDMA D050 Division of Children's Health Program Analyst Bell Foxworth,Gwendolyn F HCDMA D050 Division of Children's Health Program Analyst Bell Foxworth,Gwendolyn F HCDMA D050 Division of Children's Health Management Analyst Breitbarth,Valentine N F HCDMA D050 Division of Children's Health Management Analyst Breitbarth,Valentine N F HCDMA D050 Division of Children's Health Management Analyst V HCDMA D050 Division of Children's Health Management Analyst V HCPR P200 Support Services Supvy. Healthcare Program Mgr Schlosberg,Claudia F HCPR P200 Support Services Supvy. Healthcare Program Mgr Schlosberg,Claudia F HCPR P200 Support Services Management Assistant Andrews Simmons,Karla F HCPR P200 Support Services Management Assistant Andrews Simmons,Karla F HCPR P200 Support Services PROJECT MANAGER V HCPR P200 Support Services PROJECT MANAGER V HCPR P210 Division of Regulations & Policy Management Policy Analyst Chakkappan,Roopa R F HCPR P210 Division of Regulations & Policy Management Policy Analyst Chakkappan,Roopa R F HCPR P210 Division of Regulations & Policy Management Policy Analyst Richardson,Orriel L. F HCPR P210 Division of Regulations & Policy Management Policy Analyst Richardson,Orriel L. F HCPR P210 Division of Regulations & Policy Management POLICY ANALYST Bell,Julianka Andres F HCPR P210 Division of Regulations & Policy Management POLICY ANALYST Bell,Julianka Andres F HCPR P210 Division of Regulations & Policy Management Supervisory Policy Analyst Fields,Mary D F HCPR P210 Division of Regulations & Policy Management Supervisory Policy Analyst Fields,Mary D F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst Rogers,Katherine K F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst Rogers,Katherine K F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst V HCPR P220 Division of Rate Setting & Data Analysis Data Analyst V HCPR P220 Division of Rate Setting & Data Analysis Data Analyst Sumner,John W F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst Sumner,John W F HCPR P220 Division of Rate Setting & Data Analysis Supervisory Program Analyst Finder,Benjamin D F HCPR P220 Division of Rate Setting & Data Analysis Supervisory Program Analyst Finder,Benjamin D F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst Grubert,Christopher F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst Grubert,Christopher F HCPR P220 Division of Rate Setting & Data Analysis Data Analyst V HCPR P220 Division of Rate Setting & Data Analysis Data Analyst V HCPR P230 Division of Eligibility Policy MANAGEMENT ANALYST V HCPR P230 Division of Eligibility Policy MANAGEMENT ANALYST V HCPR P230 Division of Eligibility Policy Supervisory Management Analyst Wilson Kear,Lucy F HCPR P230 Division of Eligibility Policy Supervisory Management Analyst Wilson Kear,Lucy F HCPR P230 Division of Eligibility Policy Management Analyst Lewis,Danielle R. F HCPR P230 Division of Eligibility Policy Management Analyst Lewis,Danielle R. F HCPR P230 Division of Eligibility Policy Management Analyst Proctor,Anthony S F HCPR P230 Division of Eligibility Policy Management Analyst Proctor,Anthony S F HCOA O300 Support Services Management Assistant Lewis,Natasha P. F HCOA O300 Support Services Management Assistant Lewis,Natasha P. F HCOA O300 Support Services Supvy. Healthcare Program Mgr Shearer,Donald F 0.55

120 FY2012 Schedule A Report as of January 12, 2012 Prog Code Program Act Code Activity Title Name Vac Stat FTE x Dist % 6000 HCOA O300 Support Services Supvy. Healthcare Program Mgr Shearer,Donald F HCOA O300 Support Services PROJECT MANAGER Peralta Jr.,Juan A F HCOA O300 Support Services PROJECT MANAGER Peralta Jr.,Juan A F HCOA O310 Division of Claims Management Program Support Clerk Walker,Henrietta J F HCOA O310 Division of Claims Management Program Support Clerk Walker,Henrietta J F HCOA O310 Division of Claims Management Collection Specialist Powell,Laverne F HCOA O310 Division of Claims Management Collection Specialist Powell,Laverne F HCOA O310 Division of Claims Management MANAGEMENT ANALYST Williams,Lawrence D. F HCOA O310 Division of Claims Management MANAGEMENT ANALYST Williams,Lawrence D. F HCOA O310 Division of Claims Management Management Analyst Price,Kristie D. F HCOA O310 Division of Claims Management Management Analyst Price,Kristie D. F HCOA O310 Division of Claims Management Management Analyst Kuflom,Alganesh F HCOA O310 Division of Claims Management Management Analyst Kuflom,Alganesh F HCOA O310 Division of Claims Management Supervisory Program Analyst Squires,Patricia F HCOA O310 Division of Claims Management Supervisory Program Analyst Squires,Patricia F HCOA O310 Division of Claims Management Lead Collection Specialist Willis,Joseph F HCOA O310 Division of Claims Management Lead Collection Specialist Willis,Joseph F HCOA O310 Division of Claims Management Collection Specialist V HCOA O310 Division of Claims Management Collection Specialist V HCOA O310 Division of Claims Management Collection Specialist V HCOA O310 Division of Claims Management Collection Specialist V HCOA O310 Division of Claims Management Reimbursement Analyst Gause,Kenneth C. F HCOA O310 Division of Claims Management Reimbursement Analyst Gause,Kenneth C. F HCOA O310 Division of Claims Management INFORMATION TECHNOLOGY SPEC. Blanco,Nine C F HCOA O310 Division of Claims Management INFORMATION TECHNOLOGY SPEC. Blanco,Nine C F HCOA O310 Division of Claims Management INFORMATION TECHNOLOGY SPEC. Kao,Eva D F HCOA O310 Division of Claims Management INFORMATION TECHNOLOGY SPEC. Kao,Eva D F HCOA O310 Division of Claims Management MANAGEMENT ANALYST Dodd,Cheryl D F HCOA O310 Division of Claims Management MANAGEMENT ANALYST Dodd,Cheryl D F HCOA O320 Division of Program Integrity Utilization Review Specialist WILLIAMS,ADRIAN L F HCOA O320 Division of Program Integrity Utilization Review Specialist WILLIAMS,ADRIAN L F HCOA O320 Division of Program Integrity Nurse Specialist II Watson,Gloria A F HCOA O320 Division of Program Integrity Nurse Specialist II Watson,Gloria A F HCOA O320 Division of Program Integrity Nurse Specialist I Ehikhamenor,Betty A F HCOA O320 Division of Program Integrity Nurse Specialist I Ehikhamenor,Betty A F HCOA O320 Division of Program Integrity Nurse Specialist I Jones,Dorcas M F HCOA O320 Division of Program Integrity Nurse Specialist I Jones,Dorcas M F HCOA O320 Division of Program Integrity Utilization Review Specialist Moore,Celciel Wilbon F HCOA O320 Division of Program Integrity Utilization Review Specialist Moore,Celciel Wilbon F HCOA O320 Division of Program Integrity Chief Investigator Brooks,Yolanda E F HCOA O320 Division of Program Integrity Chief Investigator Brooks,Yolanda E F HCOA O320 Division of Program Integrity Project Coordinator Sutton,Brenda M F HCOA O320 Division of Program Integrity Project Coordinator Sutton,Brenda M F HCOA O320 Division of Program Integrity Program Manager Shaw,Karen M. F HCOA O320 Division of Program Integrity Program Manager Shaw,Karen M. F HCOA O320 Division of Program Integrity Program Support Asst (OA) Stevenson,Pamela F HCOA O320 Division of Program Integrity Program Support Asst (OA) Stevenson,Pamela F HCOA O320 Division of Program Integrity MANAGEMENT ANALYST V HCOA O320 Division of Program Integrity MANAGEMENT ANALYST V HCOA O320 Division of Program Integrity Investigator Johnson,Larry F HCOA O320 Division of Program Integrity Investigator Johnson,Larry F HCOA O320 Division of Program Integrity Investigator Buckley,Mary E. F HCOA O320 Division of Program Integrity Investigator Buckley,Mary E. F HCOA O320 Division of Program Integrity Investigator Williams,Brenda L F HCOA O320 Division of Program Integrity Investigator Williams,Brenda L F HCOA O320 Division of Program Integrity Utilization Review Specialist James,Regina M. F HCOA O320 Division of Program Integrity Utilization Review Specialist James,Regina M. F HCOA O320 Division of Program Integrity Utilization Review Specialist V 0.55

121 FY2012 Schedule A Report as of January 12, 2012 Prog Code Program Act Code Activity Title Name Vac Stat FTE x Dist % 6000 HCOA O320 Division of Program Integrity Utilization Review Specialist V HCOA O320 Division of Program Integrity Investigator Carr,Donald L F HCOA O320 Division of Program Integrity Investigator Carr,Donald L F HCOA O330 Division of Public & Private Provider Services Management Analyst V HCOA O330 Division of Public & Private Provider Services Management Analyst V HCOA O330 Division of Public & Private Provider Services Management Analyst Patterson,Wanda S. F HCOA O330 Division of Public & Private Provider Services Management Analyst Patterson,Wanda S. F HCOA O330 Division of Public & Private Provider Services Management Analyst V HCOA O330 Division of Public & Private Provider Services Management Analyst V HCOA O330 Division of Public & Private Provider Services Management Analyst Jackson Spencer,Phillice E F HCOA O330 Division of Public & Private Provider Services Management Analyst Jackson Spencer,Phillice E F HCOA O330 Division of Public & Private Provider Services Supervisory Management Analyst Rowe,Laurie F. F HCOA O330 Division of Public & Private Provider Services Supervisory Management Analyst Rowe,Laurie F. F HCOA O330 Division of Public & Private Provider Services MANAGEMENT ANALYST Bailey,Derrick C. F HCOA O330 Division of Public & Private Provider Services MANAGEMENT ANALYST Bailey,Derrick C. F HCOA O330 Division of Public & Private Provider Services MANAGEMENT ANALYST Thomas,Ann B F HCOA O330 Division of Public & Private Provider Services MANAGEMENT ANALYST Thomas,Ann B F HCOA O330 Division of Public & Private Provider Services MANAGEMENT ANALYST Robinson,Suprenia A F HCOA O330 Division of Public & Private Provider Services MANAGEMENT ANALYST Robinson,Suprenia A F HCOA O330 Division of Public & Private Provider Services Management Analyst Edwards,Marlena D F HCOA O330 Division of Public & Private Provider Services Management Analyst Edwards,Marlena D F HCRI R400 Health Care Reform & Innovation Program Manager Campbell,Jennifer B. F HCRI R400 Health Care Reform & Innovation PROJECT MANAGER Hamlette,Martin L F HCRI R400 Health Care Reform & Innovation PROJECT MANAGER V HCRI R400 Health Care Reform & Innovation PROJECT MANAGER Alonso,Alexander O F HCRI R400 Health Care Reform & Innovation PROJECT MANAGER Norton,Bonnie L F 1 100F OCFO C140 Budget Operations BUDGET ANALYST Simms,James F 1 100F OCFO C140 Budget Operations BUDGET OFFICER Rogers,Angelique F F OCFO C140 Budget Operations BUDGET OFFICER Rogers,Angelique F F OCFO C140 Budget Operations SENIOR BUDGET ANALYST Akinshemoyin,Musili T F F OCFO C140 Budget Operations SENIOR BUDGET ANALYST Akinshemoyin,Musili T F F OCFO C140 Budget Operations BUDGET ANALYST Knotts,Rebecca T F 1 100F OCFO C141 Accounting Operations REIMBURSEMENT SPEC Jones,Arthur T F F OCFO C141 Accounting Operations REIMBURSEMENT SPEC Jones,Arthur T F F OCFO C141 Accounting Operations ACCOUNTANT Tripoli,Nicholas F 1 100F OCFO C141 Accounting Operations ACCOUNTS PAYABLE TECH Whittaker,Crystal F F OCFO C141 Accounting Operations ACCOUNTS PAYABLE TECH Whittaker,Crystal F F OCFO C141 Accounting Operations ACCOUNTING OFFICER Kennedy,Thomas F F 1 100F OCFO C141 Accounting Operations REIMBURSEMENT SPEC Clark,Andrea F F OCFO C141 Accounting Operations REIMBURSEMENT SPEC Clark,Andrea F F OCFO C141 Accounting Operations Reimbursement Supervisor Hoeflinger,Frederick F F OCFO C141 Accounting Operations Reimbursement Supervisor Hoeflinger,Frederick F F OCFO C141 Accounting Operations Reimbursement Specialist Graham Hinsley,Patricia F F OCFO C141 Accounting Operations Reimbursement Specialist Graham Hinsley,Patricia F F OCFO C141 Accounting Operations SENIOR ACCOUNTANT Minocha,Shikha F 1 100F OCFO C141 Accounting Operations ACCOUNTANT Gupta,Binod F 1 100F OCFO C143 Agency Fiscal Operations AGENCY FISCAL OFFICER Shaffer,Darrin A F F OCFO C143 Agency Fiscal Operations AGENCY FISCAL OFFICER Shaffer,Darrin A F F OCFO C143 Agency Fiscal Operations STAFF ASSISTANT Lorick,Kimberly F F OCFO C143 Agency Fiscal Operations STAFF ASSISTANT Lorick,Kimberly F 0.45

122 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q24: How many employee performance evaluations were completed in FY11? To date in FY12? What is the process for establishing employee goals, responsibilities, and objectives? What steps were taken to ensure that all DHCF employees are meeting individual job requirements? What remedial actions were taken for employees that failed to meet employee goals, responsibilities, and objectives? In FY11, the DHCF completed 104 performance evaluations. Currently FY12 evaluations are not due until October 2012 and none have been completed. During the evaluation planning stage, the establishment of employee goals, responsibilities, and objectives are performed jointly with the current supervisor of record and the subordinate-level employee. This involvement allows both individuals to understand the priorities, goals, and objectives established for the position and the agency. The DHCF supervisors perform monthly, quarterly and/or mid-year reviews. This process allows the supervisor to discuss and document the employee s performance during the rating period. Additionally, this process ensures that an employee is meeting individual job requirements established and defined by the current position description. All DHCF employees have computer access which allows flexibility in utilizing the eperformance system in planning, tracking, and evaluating performance for both the supervisor and employee at all times during the evaluation process. Employees can readily document their performance; maintain information associated with projects, assignments, and other miscellaneous activities. During FY11, the DHCF has overall performance evaluation ratings of 3.0 Valued Performer; 4.0 Highly effective performer; and 5.0 Role Model performer. Based on these ratings, no remedial actions have occurred for failure to meet employee goals, responsibilities, and objectives during this rating period October 2010 to September

123 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q25: How many vacancies were posted during FY11? To date in FY12? Which positions? Why was the position vacated? In addition, please note how long the position was vacant, what steps have been taken to fill the position, and whether or not the position has been filled. The DHCF had 84 vacancies posted in FY11. The DHCF has 33 vacancies posted in FY12. In FY11, a mandated freeze on hiring was imposed to District Government agencies. After the transition of administrations, the OCA agreed with budgetary approval from the Chief Financial Office to allow the DHCF to proceed with filling all current vacancies identified and budgeted. The DHCF began recruitment efforts to fill all current vacancies. Currently, in FY12, the DHCF has a 15% vacancy rate with approval to proceed with OCA approval to fill current vacancies. Please see Attachment 1 to DHCF Q25 FY11 Vacancies Please see Attachment 1 to DHCF Q25 FY12 Vacancies 1

124 REF# POSITION TITLE Series Grade Status Special Projects Officer CS Filled Special Projects Officer CS Closed Special Projects Coordinator CS Filled Lead Collection Specialist CS Cancelled Lead Collection Specialist CS Cancelled Lead Collection Specialist CS Filled Chief Operating Officer MS Filled Program Manager MS Cancelled Program Manager MS Cancelled Program Manager MS Filled Policy Analyst CS Filled Supvy. Healthcare Program Mgr. MS Cancelled Supv. Healthcare Program Mgr. MS Filled Program Manager MS Cancelled Program Analyst CS Filled Contract Specialist CS Filled Management Analyst CS Filled Management Analyst CS Filled Management Analyst CS Filled Utilization Review Specialist CS Filled Data Analyst CS Filled** Data Analyst CS Filled Program Support Assistant CS Filled Program Manager MS Cancelled Project Manager CS Filled Management Analyst CS Filled Management Analyst CS Filled Program Manager MS Filled Program Manager MS Filled Management Analyst CS Cancelled Program Manager MS Filled Program Manager MS Filled Pharmacist CS Filled Policy Analyst CS Filled Project Manager MS Filled Q25

125 Project Manager MS Filled Supvy. Healthcare Program Mgr. MS Filled Management Assistant CS Cancelled Management Assistant CS Filled Program Support Assistant CS Filled Management Analyst CS Cancelled Management Analyst CS Filled Collection Specialist CS Filled Management Analyst CS Filled Project Manager CS Cancelled Staff Assistant CS Cancelled Staff Assistant CS Cancelled Staff Assistant CS Filled Public Affairs Specialist CS Filled Policy Analyst CS Filled Facilities Services Manager CS Cancelled Management Analyst CS Cancelled Facilities Services Manager CS Cancelled Data Analyst CS VACANT Program Manager MS Cancelled Management Analyst CS Cancelled Policy Analyst CS Cancelled Program Analyst CS VACANT Management Analyst CS Filled Program Manager MS Cancelled Program Manager MS Filled Program Manager MS Filled Project Manager CS Cancelled Project Manager CS Filled Project Manager CS Cancelled Utilization Review Specialist CS Filled Support Services Manager MS Filled Utilization Review Specialist CS VACANT Management Analyst CS Cancelled Management Assistant CS Cancelled Management Analyst CS Cancelled Program Manager MS Cancelled Q25

126 Staff Assistant CS Cancelled Staff Assistant CS Filled Contract Compliance Officer MS Filled Management Analyst CS ON HOLD Management Analyst CS Filled Management Analyst CS Filled** Program Analyst CS Filled Management Analyst CS Filled Supv IT Specialist MS Filled Health Care Program Manager MS Filled Project Manager CS Cancelled Management Analyst CS Filled Q25

127 REF# POSITION TITLE Series Grade Status Project Manager MS Reposted Project Manager MS VACANT, Currently Recruiting Management Assistant CS Filled Management Assistant CS Filled Management Analyst CS Reposted Management Analyst CS Filled Contract Specialist CS Reposted Contract Specialist CS Reposted Contract Specialist CS VACANT, Currently Recruiting Management Analyst CS Reposted Management Analyst CS Reposted Management Analyst CS Filled Management Assistant CS Filled Project Manager CS Reposted Project Manager CS Reposted Project Manager CS Filled Project Manager CS Filled Project Manager CS Filled Staff Assistant CS Filled Data Analyst CS Filled Program Manager MS VACANT, Currently Recruiting Special Projects Officer CS VACANT Management Analyst CS VACANT, Currently Recruiting Project Manager MS VACANT, Currently Recruiting Management Analyst CS VACANT, Currently Recruiting Management Analyst CS Filled Program Specialist CS Reposted Program Specialist CS VACANT, Currently Recruiting Program Analyst CS VACANT, Currently Recruiting Management Analyst CS Reposted Management Analyst CS VACANT, Currently Recruiting Project Manager CS VACANT, Currently Recruiting Management Analyst CS Reposted Management Analyst CS VACANT, Currently Recruiting NOTE: The majority of all positions reposted resulted from the area of consideration for the DHCF employees, and no internal interest in the position Q25

128 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q26: Please provide an update on the implementation of the MMIS system. How is the system helping the Department fight fraud and abuse in the Medicaid program? How is the system helping the Department support sister agencies? The new MMIS has been operational since December 21, The MMIS supports many of the department s core functions to include provider enrollment, maintenance of the provider and beneficiary databases, third party liability, claims adjudication, prior authorization, federal reporting and provider reimbursement. Currently the MMIS contains information on over eight thousand (8,000) providers and nearly two hundred twenty five thousand (225,000) beneficiaries. On a monthly basis, the MMIS processes an average of one million (1,000,000) claims totaling an average of one hundred million dollars ($100,000,000) in provider payments. The department continues to leverage features incorporated in the new MMIS such as the Interactive Voice Recognition (IVR) system, the web portal and the data mart. As a part of the implementation process, CMS is required to conduct a review of the MMIS to ensure that the functionality and requirements submitted in the Advance Planning Document. CMS completed their on-site review in August Based on their review, DHCF received certification of the MMIS retroactive to the December 21, 2009 implementation date. DHCF received official notice regarding the certification on January 5, The certification allows the District to book a $6,308, accounts receivable for the operation of the MMIS. A feature of the new MMIS is the enterprise fraud and abuse detection system (efads). This system drills down into claims data and automatically produces reports based on pre-defined criteria. These reports identify potentially fraudulent patterns for DHCF staff to research and investigate. The efads system allows DHCF staff to develop their own reports based on industry best practices or local trends. If fraudulent activity is identified, the MMIS can be used to place providers on review preventing any further claims from being paid. The MMIS can also be used to recoup monies owed to the District by placing providers into credit balances. The MMIS allows sister agencies to register on the web portal and leverage all the functionality of the secure site. Sister agencies can submit claims, submit requests for prior authorization, access the Medicaid fee schedule and check the status of their claims and prior authorization requests. Sister agencies will also have access to their own message center on the web portal used to share documents in a secure manner. Through the message center sister agencies can obtain electronic copies of their remittance advices and reports that can be used to track specific programs.

129 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q27: What, if any, fraudulent trends were identified by efads during FY11 and to date in FY12? What actions were taken by DHCF regarding the fraudulent trends? In Fiscal Year 2011, DHCF staff conducted analysis of dental claims data using the efads system. The analysis revealed that some dental providers were billing for procedure codes in a manner that could be construed as a fraudulent trend. For example, some dental providers were billing duplicate claims for the same service, billing for services that were not provided or billing in excess of dental service limits. Subsequent to the Program Integrity investigation, DHCF established edits in the MMIS system that will prevent dental providers from being reimbursed for the same service. For example, dental providers will not be reimbursed for removing the same tooth from a beneficiary. Edits have also been established to prevent a dentist from billing for filling a tooth that has been removed.

130 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q29: Please identify each incident of Medicaid abuse or fraud investigated in FY11 and to date in FY12 and any associated sanction/penalty. What problem areas or patterns have been discovered regarding fraud in the District s Medicaid program? DHCF conducted audits of two different provider types during Fiscal Year The total amount of funds recouped in FY11 was approximately $1,011,573. The audits conducted include: Home Health Providers The Surveillance and Utilization Review Branch conducted focused audits to determine if services billed and paid under the Medicaid program were provided, and that providers were compliant to rules and regulations that governed this provider type. Issues identified during onsite audits included: Plan of Care not signed within 30 days of its prescription. Lack of documentation to support billing. MRDD/ Supportive Living Providers The Surveillance and Utilization Review Branch conducted focused audits to determine if services billed and paid under the Medicaid program were provided, and that providers were compliant to rules and regulations that governed this provider type. The issues that were identified during the audits of these providers include: Lack of Prior Authorizations. Lack of documentation to support billing. Medicaid Integrity Program Audits The federal Centers for Medicare and Medicaid Services (CMS) contracts with audit providers throughout the country to conduct audits of Medicaid providers in each of the states that participate in the Medicaid program. CMS contracted with Booze Allen auditors before the beginning of Fiscal Year 2011 and changed to Health Integrity, LLC auditors during Fiscal Year CMS contracted with auditors to conduct on-site audits of Acute Care Facilities. The focus of the audits was to determine if services billed and paid under the State Medicaid program were provided in compliance with State and Federal Medicaid laws and regulations, and to identify provider billing and/or payment irregularities within the State s Medicaid program. Health Integrity continues to audit this type of provider in Fiscal Year Some of the issues identified during these audits include: Review of inpatient one-day stay / Medical necessity Inpatient readmissions within 7 days of discharge

131 Department of Health Care Finance FY11 Oversight Questions DEPARTMENT OF HEALTH CARE FINANCE Q30: Please provide a service level breakout of expenditures for Activity Codes 5001 (Medicaid Provider Payments), 5002 (Medicaid Public Provider Payments), and 5003 (Alliance Provider Payments) for FY11 and to date in FY12. In addition, please provide a service level breakout of expenditures for Comptroller Source Group 0050 (Subsidies and Transfers) for FY11 and to date in FY12. Please see Attachment 1 to DHCF Q30 Activity Code 5001 Detail

132 Column Labels FY11 FY12 Total Sum of Budget Total Sum of Expenditures Row Labels Sum of Budget Sum of Expenditures Sum of Budget Sum of Expenditures % CHILDLESS ADULT WAIVER 16,512, ,816, ,112, ,160, ,625, ,977, ,567, ,845, ,633, ,548, ,201, ,393, ,944, ,971, ,478, ,612, ,423, ,584, APRA A-STEP 900, , , , , , CHILD & FAMILY SERVICES (CFSA) 1,500, , ,500, , ,500, , ,500, , CHILDLESS ADULT WAIVER (50-64)-MEDICAID 79, (68,367.58) 79, (68,367.58) , (16,213.99) 20, (16,213.99) , (52,153.59) 59, (52,153.59) CLINIC SERVICES - MENTAL HEALTH 979, ,464, ,237, , ,216, ,868, , , , , , , , , ,565, , ,294, ,017, CLINIC SERVICES - MENTAL HEALTH CHIP 29, , , , , , , , , , , , , , , , CLINIC SERVICES - MHRS 57,711, ,906, ,000, ,825, ,711, ,731, ,211, ,406, ,800, ,053, ,011, ,460, ,500, ,500, ,200, ,771, ,700, ,271, CLINIC SERVICES - MHRS CHIP 181, , , , , , , , , , CLINIC SERVICES - PRIVATE 12,148, ,550, ,718, ,196, ,867, ,747, ,991, ,150, ,715, , ,707, ,109, ,156, ,399, ,002, ,237, ,159, ,637, CLINIC SERVICES - PRIVATE CHIP 15, , , , , , , , , , , , , , COBRA COBRA/RECIPIENT OOP 446, , , , , , , , , , , , COST SETTLEMENTS 8,096, ,098, ,000, (242,410.00) 20,096, ,856, Q30

133 0100 2,300, ,300, ,600, (72,723.00) 5,900, ,227, ,796, ,798, ,400, (169,687.00) 14,196, ,628, DAY TREATMENT 24,968, ,452, ,686, ,646, ,654, ,099, ,085, ,383, ,126, ,994, ,212, ,377, ,883, ,068, ,559, ,652, ,442, ,721, DAY TREATMENT - CHIP 28, , , , , , , , , , , , DC CHARTER SCHOOLS 2,050, , ,050, , ,050, , ,050, , DC CHARTER SCHOOLS - CHIP 12, , , , , , , , DC PUBLIC SCHOOLS 16,469, ,755, ,469, ,755, ,469, ,755, ,469, ,755, DC PUBLIC SCHOOLS - CHIP 135, , , , , , , , DENTAL SERVICES 18,452, ,221, ,973, ,039, ,426, ,260, ,638, ,875, ,812, ,518, ,450, ,393, ,814, ,345, ,161, ,520, ,976, ,866, DENTAL SERVICES - CHIP 114, , , , , , , , , , , , , , , , DIAGNOSTIC SCREEN & PREVNTIVE SVS - CHIP DIAGNOSTIC SCREEN & PREVNTIVE SVS. 615, , , , , , DMH INTRA-DISTRICT 4,770, ,770, ,770, ,770, DMH INTRA-DISTRICT SCHIP (OLD MHRS) DSH PAYMENT - MEDICAID 70,422, ,908, ,422, ,908, ,123, ,609, ,123, ,609, ,298, ,298, ,298, ,298, DURABLE MED EQUIP (DME)-MEDICAID 25,050, ,184, ,803, ,407, ,853, ,592, ,279, ,309, ,341, ,322, ,621, ,631, ,770, ,875, ,462, ,085, ,232, ,960, DURABLE MED EQUIP (DME)-MEDICAID - CHIP 3, , , , , , , , , , Q30

134 DURABLE MEDICAL EQUIPMENT (DME)-SCHIP EMERGENCY HOSPITAL SERVICES 6,552, ,684, ,656, ,643, ,209, ,327, ,672, ,679, ,698, , ,371, ,174, ,880, ,005, ,957, ,148, ,838, ,153, EMERGENCY HOSPITAL SERVICES - CHIP 40, , , , , , , , , , , , , , , , EPD WAIVER 93,194, ,132, ,809, ,348, ,003, ,480, ,273, ,947, ,942, ,904, ,215, ,852, ,920, ,184, ,866, ,444, ,787, ,628, EPSDT SCREENING SERVICES - CHIP 15, , , , , , , , , , , , , , EPSDT-MEDICAID 410, , , , , , , , , , , , , , , , , , FEDERALLY-QUALIFIED HEALTH CENTER 17,922, ,621, ,170, ,232, ,092, ,854, ,875, ,543, ,254, , ,130, ,515, ,046, ,078, ,916, ,260, ,962, ,339, FEDERALLY-QUALIFIED HEALTH CENTER - CHIP 39, , , , , , , , , , , , , , , , FIRE & EMS SVS. (AMBULANCE) 3,000, ,145, ,000, ,145, ,000, ,145, ,000, ,145, FIRE & EMS SVS. (AMBULANCE) - CHIP HEALTH CARE REFORM MCO (BELOW 133) HIV/AIDS WAIVER-MEDICAID 1,117, , ,117, , , , , , , , , , HMO PAIDMENT SCHIP HMO PAYMENTS-MEDICAID 1,741, ,594, ,741, ,594, ,741, ,594, ,741, ,594, HOME HEALTH SERVICES 7,009, ,067, ,118, ,310, ,127, ,378, ,611, ,028, ,835, ,093, ,446, ,121, ,398, ,039, ,282, ,217, ,680, ,256, Q30

135 HOME HEALTH SERVICES - CHIP HOSPICE BENEFITS 5,648, ,332, ,470, ,678, ,118, ,010, ,435, ,343, ,641, , ,076, ,846, ,212, ,989, ,829, ,174, ,041, ,163, HSCSN 122,726, ,344, ,726, ,344, ,817, ,840, ,817, ,840, ,908, ,503, ,908, ,503, HSCSN - CHIP , , , , ICF/MR - CHIP 143, , , , ICF/MR INTENSIVE CARE MENTALLY RETARDED 71,958, ,947, ,958, ,947, ,515, ,231, ,515, ,231, ,999, ,999, ,442, ,716, ,442, ,716, ICF/MR PASS THROUGH 7,796, ,844, ,796, ,844, ,896, , ,896, , ,900, ,291, ,900, ,291, ICF/MR PRIVATE 57,172, ,176, ,172, ,176, ,637, ,448, ,637, ,448, ,534, ,728, ,534, ,728, IMMIGRANT KIDS 7,394, ,936, ,982, ,756, ,377, ,693, ,394, ,936, ,982, ,756, ,377, ,693, INPATIENT - DSH PAYMENTS 68,483, ,623, ,483, ,623, ,799, ,487, ,799, ,487, ,683, ,136, ,683, ,136, INPATIENT - GME PAYMENTS 6,000, ,000, ,800, ,800, ,200, ,200, INPATIENT CHIP 827, , , , , , , , INPATIENT IN STATE 308,563, ,964, ,336, ,728, ,899, ,692, ,632, ,632, ,466, ,497, ,099, ,129, ,135, ,007, ,193, ,329, ,007, ,794, ,325, ,676, ,230, ,471, ,555, INPATIENT OUT STATE 19,723, ,791, ,712, ,550, ,436, ,342, ,272, ,272, ,808, ,265, ,080, ,537, ,450, ,519, ,904, ,285, ,355, ,805, LABORATORY & RADIOLOGICAL SERVICES 15,912, ,252, ,660, ,442, ,572, ,694, Q30

136 0100 3,722, ,401, ,900, ,933, ,623, ,335, ,189, ,850, ,760, ,509, ,949, ,359, LABORATORY & RADIOLOGICAL SERVICES -CHIP 22, , , , , , , , , , , , , , , , MANAGED CARE ORGANIZATIONS (MCO) 573,158, ,843, ,935, ,219, ,037,094, ,063, ,179, ,911, ,813, ,890, ,992, ,802, ,610, ,610, ,417, ,027, ,610, ,368, ,321, ,705, ,328, ,074, ,650, MANAGED CARE ORGANIZATIONS (MCO) - CHIP 12,483, ,948, ,178, ,283, ,662, ,231, ,848, ,313, ,848, ,313, ,634, ,634, ,178, ,283, ,813, ,917, MANAGED CARE ORGANIZATIONS (MCO)ALLIANCE 44,444, ,471, ,444, ,471, ,017, ,044, ,017, ,044, ,426, ,426, ,426, ,426, MCO-MANAGED CARE ORGANIZATION-HEALTHY DC 5,097, ,900, ,097, ,900, ,097, ,900, ,097, ,900, MEDICAID PART A 2,775, ,386, ,689, , ,464, ,942, , , , , ,502, , ,079, ,795, ,882, , ,962, ,184, MEDICAID PART B 31,166, ,244, ,298, ,360, ,465, ,604, ,202, ,742, ,289, ,508, ,491, ,250, ,964, ,502, ,008, ,852, ,973, ,354, MEDICAID PART B - NON FFP 2,331, , ,331, , ,331, , ,331, , MENTAL HEALTH FACILITY SERVICES 8,077, , ,077, , ,418, , ,418, , ,658, , ,658, , MENTAL HEALTH FACILITY SERVICES - DSH 5,569, , ,569, , ,958, , ,958, , ,611, , ,611, , MR/DD WAIVER 152,822, ,986, ,602, ,195, ,425, ,182, ,898, ,251, ,780, ,611, ,678, ,863, ,424, ,534, ,821, ,583, ,246, ,118, ,500, ,200, ,500, ,200, NON-EMERGENCY MEDICAL TRANSPORT. - CHIP 4, , , , , , , , , , , , , , , , NON-EMERGENCY MEDICAL TRANSPORTATION 21,794, ,991, ,108, ,261, ,902, ,253, ,479, ,547, ,285, ,582, ,764, ,129, ,315, ,444, ,822, ,679, ,137, ,123, Q30

137 NURSE MID-WIFE 44, , , , , , , , , , , , NURSE PRACTITIONER SERVICES 845, , , , , , , , , , , , NURSE PRACTITIONER SERVICES - CHIP 1, , , , NURSING FACILITY CHIP 40, , , , NURSING FACILITY IN STATE 210,823, ,306, ,732, ,548, ,556, ,854, ,657, ,200, ,712, ,770, ,370, ,971, ,957, ,957, ,260, ,217, ,957, ,208, ,148, ,759, ,777, ,968, ,925, NURSING FACILITY OUT STATE 18,301, ,176, ,147, ,448, ,176, ,581, ,581, ,918, ,499, ,581, ,720, , ,228, ,948, , NURSING HOME PROVIDER TAX-MEDICAID 1,842, ,331, ,608, ,450, ,331, ,042, , , ,927, , , , , ,523, , OCCUPATIONAL THERAPY 615, , , , , , OCCUPATIONAL THERAPY - CHIP OPTICIANS-MEDICAID 157, , , , , , , , , , , , OPTICIANS-SCHIP 1, , OPTOMETRY-MEDICAID 611, , , , , , , , , , , , OPTOMETRY-SHIP 1, , OSSE:CHILDREN W/SPECIAL NEEDS TRANSPORT 2,500, ,500, ,500, ,500, OTHER CARE SERVICES 1, , Q30

138 OTHER CARE SERVICES - CHIP OTHER PRACTITIONERS' SERVICES 2,382, , ,382, , , , , , ,666, , ,666, , OTHER PRACTITIONERS' SERVICES CHIP 3, , , , OUTPATIENT HOSPITAL CHIP 43, , , , , , , , , , , , , , OUTPATIENT HOSPITAL IN STATE 13,885, ,194, ,104, ,320, ,989, ,515, ,006, ,077, ,939, , ,945, ,774, ,878, ,117, ,165, ,624, ,043, ,741, OUTPATIENT HOSPITAL OUT OF STATE 1,187, , ,516, , ,703, , , , ,957, , ,512, , , , ,559, , ,191, , PART-D CLAWBACK 7,972, ,971, ,854, ,787, ,826, ,758, ,972, ,971, ,854, ,787, ,826, ,758, PERSONAL CARE SERVICES 109,028, ,183, ,007, ,229, ,035, ,412, ,120, ,120, ,186, ,369, ,306, ,489, ,908, ,063, ,820, ,860, ,728, ,923, PERSONAL CARE SERVICES - CHIP PHARMACY ALLIANCE 7,530, ,544, ,530, ,544, ,530, ,544, ,530, ,544, PHYSICAL THERAPY 410, (123,695.72) 410, (123,695.72) , (37,031.44) 123, (37,031.44) , (86,664.28) 287, (86,664.28) PHYSICAL THERAPY - CHIP PHYSICIAN SERVICES CHIP 206, , , , , , , , , , , , , , , , PHYSICIAN SERVICES-MEDICAID 49,171, ,101, ,909, ,793, ,081, ,895, ,305, ,432, ,826, ,836, ,132, ,268, ,865, ,668, ,052, ,957, ,918, ,626, ,030, ,030, PODIATRY-MEDICAID 1,156, , ,156, , , , , , Q30

139 , , , , PODIATRY-SCHIP PRESCRIBED DRUGS 60,076, ,351, ,550, ,171, ,627, ,523, ,821, ,821, ,569, ,939, ,390, ,761, ,254, ,530, ,981, ,232, ,236, ,762, PRESCRIBED DRUGS - CHIP 44, , , , , , , , , , , , , , , , PRIMARY CARE CASE MANAGEMENT SERVICES 3,816, ,816, ,144, ,144, ,671, ,671, PRIVATE DUTY NURSING 2, , , , PRIVATE DUTY NURSING - CHIP PROSTHETC DVCS,DENTURES,EYEGLASSES-CHIP , , , , PROSTHETIC DEVICES, DENTURES, EYEGLASSES 4,636, ,875, ,636, ,875, ,391, , ,391, , ,245, ,012, ,245, ,012, PSYCHIATRIC RESIDENTIAL TREATMENT FACIL. 15,308, ,266, ,077, ,545, ,386, ,811, ,985, ,251, ,418, , ,404, ,714, ,823, ,014, ,658, ,082, ,482, ,096, , , REHAB SERVIVES (NON-SCHL BASED) 6, , , , , , , , , , , , , , , , , REHAB SERVIVES (NON-SCHL BASED) - CHIP , , , , SAINT ELIZABETH HOSPITAL 8,342, ,678, ,342, ,678, ,342, ,678, ,342, ,678, SERVICES FOR SPEECH, HEARING & LANG CHIP SERVICES FOR SPEECH, HEARING, & LANGUAGE 205, , , , , , SSI PAYMENTS 5,323, ,106, ,493, ,728, ,817, ,834, ,321, ,106, ,493, ,728, ,815, ,834, Q30

140 0250 2, , STERILIZATIONS 1, , , , , , , , , , , TARGETED CASE MANAGEMENT SERVICES 3,816, ,816, ,144, ,144, ,671, ,671, TARGETED CASE MANAGEMENT SERVICES - CHIP THIRD PARTY LIABILITY 1,582, ,491, , ,436, ,491, , , , ,216, , , , , ,219, , INPATIENT IN-STATE HOSPITAL-CHIP 1,999, ,343, ,999, ,343, , , , , ,799, ,117, ,799, ,117, INPATIENT OUT OF STATE HOSPITAL-CHIP 56, , , , , , , , , , PSYCHIATRIC RESIDENTIAL TREATMENT FACIL.- CHIP 425, , , , , , , , , , , , APRA ASTEP 200, , , , APRA A-STEP 451, , , , APRA A-STEP - CHIP 15, , , , CHILD & FAMILY SERVICES (CFSA) 1,515, , ,515, , ,515, , ,515, , CHILD & FAMILY SERVICES (CFSA) - CHIP 35, , , , DC CHARTER SCHOOLS 2,040, , ,040, , ,040, , ,040, , DC CHARTER SCHOOLS - CHIP 10, , , , , , , , DC PUBLIC SCHOOLS 3,386, , ,386, , ,386, , ,386, , DC PUBLIC SCHOOLS - CHIP 113, , , , DMH - REHAB OPTION ,822, ,822, Q30

141 ,822, ,822, FIRE & EMS SERVICES (AMBULANCE) FIRE & EMS SVS. (AMBULANCE) 2,958, , ,958, , ,958, , ,958, , FIRE & EMS SVS. (AMBULANCE) - CHIP 42, , , , OSSE:CHILDREN W/SPECIAL NEEDS TRANSPORT 2,440, ,440, ,440, ,440, OSSE-CHILDREN W/SPCL NEEDS TRNSPT - CHIP 60, , , , SAINT ELIZABETH HOSPITAL SAINT ELIZABETHS HOSPITAL 9,456, , ,456, , ,456, , ,456, , SAINT ELIZABETHS HOSPITAL - CHIP 20, , , , ST ELIZBETHS HSPTL DSH (M.H. FCLTY DSH) 1,203, , ,203, , ,203, , ,203, , MANAGED CARE ORGANIZATIONS (MCO)ALLIANCE 36,441, ,783, ,441, ,783, ,015, ,783, ,015, ,783, ,426, ,426, PHARMACY ALLIANCE 7,530, ,544, ,295, ,825, ,544, ,530, ,544, ,295, ,825, ,544, Grand Total 2,189,762, ,177,472, ,128,882, ,421, ,318,645, ,725,893, Q30