Medicaid Services System (MSS) Frequently Asked Questions
Cost Projection Tool (CPT)
Cost Projection Tools General
1. When are county boards
required to use CPT?
After December 31, 2011, CPT
will be the only validated cost projection tool.
All individuals on an IO or
Level One waiver must have authorized costs in CPT by December 31, 2011. IO and
Level One Individuals shall be transitioned upon waiver enrollment or
redetermination. Individuals who share services must be transitioned together.
2. Can County Boards
continue to use the validated cost projection tools (i.e. 20/20) before
December 31, 2011?
Yes. County boards may find
it useful to use their existing tools to make changes to costs as needed before
the site is transitioned to CPT.
3. How does the county board
determine the site effective date?
We recommend transitioning
individuals at redetermination. In that case, the site effective date should
coincide with the begin date of the individual’s new waiver span.
In cases where there are
multiple individuals with different waiver spans who share services, the county
board may choose an effective date that makes sense to them. Individuals
sharing services must be transitioned together. It is important to make sure
that the site effective date and the DRA provider span effective date match.
This will ensure a smooth transition from legacy DRA to the enhanced DRA. (See
the DRA FAQ’s for more info).
The earliest possible site
effective date is July 1, 2009.
4. When I search for sites
in my county (e.g. Franklin), why do I see sites from another county (e.g.
Either the Delaware County
sites have an individual with Franklin County set as their reporting county in
IDS or Franklin County was listed as an "Associated County" in the
Delaware site management screen.
5. Who should be included in
Individuals with an IO or
Level 1 waiver who live alone
Individuals with an IO or
Level 1 waiver who live together and share services.
Individuals with an Level 1
waiver who share services with another individual with a Level 1 waiver
Individuals with a SELF
waiver who live alone or with another SELF waiver individual
Locally funded or private pay
individuals who live with and share HPC services with individuals on a waiver
6. There is an individual
who is living with two other individuals, but she does not share services with
them. Do they belong in the same site?
No. If individuals live
together, but do not share services of the same provider, they belong in
7. What is a temporary span?
The application will
automatically assign an individual on an IO, Level One, or SELF Waiver a
“temporary” waiver span for that individual’s upcoming waiver year (i.e.
Individual’s Waiver Span is 01/01/2012-12/31/2012, CPT will assign a
“temporary” waiver span of 01/01/2013-12/31/2013)
This temporary waiver span
allows the county board to cost project for an individual’s upcoming waiver
8. What do I do if a waiver
span in MSS is missing or incorrect?
Check WMS and call or e-mail
your DODD waiver unit contact. All waiver enrollment data including waiver
spans comes from WMS. There may be a missing or incorrect waiver span that will
need to be resolved.
9. Can CPT be used to
project costs for individuals who are not enrolled on a waiver?
Yes, this is appropriate in a
couple different scenarios*:
- he non-waiver individual is sharing services with an
individual on an IO or Level One waiver. Only individuals who do not currently
have an “enrolled” status (from WMS) can be given a non-waiver span.
- The non-waiver individual has a pending IO waiver. Use
the non-waiver area to enter faux waiver dates based on the expected waiver
span. Non-waiver spans will stay with an individual if they move to another
- You may use CPT to project costs for any non-waiver
individual based on Medicaid maximum rates and services.
- Only individuals listed in IDS may be added to CPT.
- CPT will only project costs based on Medicaid waiver
services and rates.
- The business rules used to project costs for the IO
waiver are used to project costs for non-waiver individuals. CPT will not
accommodate non-waiver spans for individuals who need Level One services (i.e.
- CPT will not project costs for adult foster care
services for non-waiver individuals.
10. How far out can I
schedule HPC services on the HPC calendar?
They can be scheduled as long
as everyone in the staffing pattern has a waiver span or temporary waiver span.
A temporary waiver span allows users to project costs for up to a year past the
individual’s current, enrolled span.
11. Is there a limit to the
number of staffing patterns and ADS patterns that I can add to a site?
12. Why can’t unscheduled
services cross the fiscal year boundary?
Unscheduled services can
cross the fiscal year boundary unless the user chooses a frequency type of
“Span.” In that case, the user must indicate on which side of the fiscal year
the costs are projected to be expended. CPT will automatically distribute costs
if the user chooses a frequency span of Day, Week or Month.
13. What do I do if an
individual receiving adult foster care services does not have an adult foster
care tab when I create the site?
Check IDS. The individual
must have a living arrangement of adult foster care in IDS before the foster
care tab will appear in CPT. After IDS is correct, the user must associate the
individual with an adult foster care provider on the foster care tab, which
exists under the manage provider area of CPT. Once the provider is designated
under the Manage Providers the Adult Foster Care tab will appear under the
Unscheduled Services area.
14. How does CPT handle
units of Adult Day Services for PAWS purposes?
CPT will project cost for
Adult Day Services using the daily rates where appropriate (when between 5 and
7 hours is projected per day). For PAWS purposes and to allow providers to bill
appropriately for services actually delivered, CPT will then convert the units
for Adult Day Services that have costs projected based on daily rates to 15
minute units for authorization purposes. The cost limitations, which continue
to be based on daily rates, will prevent over-utilization of the service, but
the unit calculation will allow providers to bill for days that do not qualify
to be billed as a daily rate (less than 5 hours or more than 7 hours) without
running out of units.
For example, if an individual
has 6 hours per day of Adult Day Support projected, CPT will convert the 6
hours to 24 units. The cost projection details will show 24 units. 24 units
should be entered into PAWS.
15. I scheduled ADS and NMT
services, but it shows $0 on the cost projection, why?
The individual is likely
missing an AAI score which means that CPT is unable to calculate rates. Look at
the View Info section on the Manage Individuals tab to confirm if AAI
information is available for the dates of service being projected. If not,
check to make sure that there is an AAI score in IDS for the span of time in
16. How should county boards
handle cost projection when the provider has a usual customary rate (UCR) that
is below the Medicaid maximum reimbursement rate?
Remember that a provider’s
UCR means that they agree to deliver the same or similar service at the same
rate to every individual in a particular cost of doing business county (CODB).
CPT will only project costs
based on the Medicaid maximum reimbursement rates. It does not account for a
UCR that is less than the Medicaid maximum rate.
For DRA Sites: Project costs
using CPT, as required by rule. Indicate which provider has a UCR in the site’s
note box. The county board should use the UCR rate times the total units
projected through CPT to determine the total costs, and then enter that number
in PAWS. The county board will enter the total dollars and total hours into the
Legacy DRA. The DRA provider will calculate the daily billing unit based on
their UCR through the Legacy DRA and submit those charges on their claims.
For Non-DRA Sites: Project
costs using CPT, as required by rule. Indicate which provider has a UCR in the
site’s note box. The county board should use the UCR rate times the total units
projected through CPT to determine the total costs, and then enter that number
in PAWS. The provider should submit their UCR as charges on their claims.
Handling Changes to Cost
17. How do I transition a
site from one Cost of Doing Business (CODB) County to another?
End date the current site and
start a new site. A site’s CODB cannot be changed.
18. How does CPT handle cost
projections for periods of time prior to an individual’s date of death?
Costs may be projected,
finalized and authorized for dates of service prior to the date of death. It is
important to make sure that IDS has the correct date of death and that the
waiver has been dis-enrolled in WMS prior to the date of death.
Service Payment Authorization (SPA)
19. How do I authorize costs
in SPA for those individuals for whom my county board (i.e. Delaware) manages
the waiver but are in another county board’s (i.e. Franklin) CPT?
The county board who creates
the CPT will need to add the county board that is responsible for the waiver as
an Associated County to the CPT.
The county board that created
the CPT would need to change the Management County under Edit Site portion of
the CPT to the county board responsible for waiver. This will allow the county
board responsible for the waiver to go to SPA and then authorize those waiver
Enhanced DRA Questions
20. When I am in the county
board portion of the (enhanced) DRA, why do I see the date 01/01/2021?
This is how the infinity date
is rendered in the (enhanced) DRA. Under the Manage Provider portion of MSS the
date would have been entered by the county board as 12/31/9999.
21. Can CPT be used to
project costs for the legacy DRA?
No, CPT should only be used
in conjunction with the enhanced DRA. DRA sites shall be transitioned based on
the effective date of the site and the DRA provider beginning date, which
Site cost updates and
provider actuals for dates of service on or after the transition date will be
entered in the enhanced DRA. Site cost updates and provider actuals for dates
of service prior to the transition date will be entered in the legacy DRA.
22. How do I transition a
DRA Transition Date = Begin
date of the DRA provider span in CPT.
Instructions for County Boards:
Send an e-mail to DODD ahead of
Include the following:
DRA site #
provider contract #
- The DRA
Copy the provider agency and
notify them of the transition date. Make sure they understand how to use the
23. How do I break DRA
DRA automatically creates breaks
in site cost spans by the following factors:
- DRA provider span dates
move-in and move-out out dates
DRA breaks can be manually
created by the county board when necessary. When changes are made to HPC costs,
the county board will be required to update DRA site costs as well. You can
manually change the begin date of the revised site costs in DRA by using the
Manage Providers area in CPT to end the current DRA provider span one day
before the effective date of the change and create a new DRA provider span that
starts on the effective date of the change. This will allow providers to avoid
unnecessary claims adjustments.
Note: If you do not manually
create the begin date of the revised site costs, DRA will automatically use the
begin date of the most recent DRA provider span in CPT as the effective date of
the revised site costs.
Reasons to break the DRA
- When individuals in the home have different waiver
- When a change in an individual’s status requires a
change in the level of service
- For planned absences of one or more of the housemates
lasting longer than fourteen (14) days
- For periods of time in which the level of support of
one or more individuals is planned to change (i.e. summer, activity leagues,
- When there is an anticipated move in/out date for a
- Scheduled (quarterly) breaks are also beneficial for
homes in which one or more of the housemates have frequent, unanticipated
schedule changes (i.e. hospitalizations, ending day services, etc.).
24.Why can't I associate
Legacy DRA sites in the MSS training environment?
Because the data in the
training environment is redacted.
25. Why are my DRA
percentages for each individual not an exactly divided? For example: Each
individual should be 25%, but I see 25.1% and 24.9% for two of the individuals
and the other two individual are 25.0% each?
This will happen if the
individuals’ waiver spans do not match exactly. The percentages do not match
because of proration across waiver spans and ADL/ADP spans.
Prior Authorization (PA)
26. How do I use CPT to
support a prior authorization request?
CPT will produce the cost
projection for PA requests. After sites have been transitioned to CPT, the
county board can create a version which can be used as the PA budget. To do
this, create a “Prior Auth” version of a cost projection and name it accordingly.
At Finalization under the
Manage Cost Projection portion of MSS, the county board will receive a message
that provides them the option to begin the PA process. The county board can
either click on the “Begin PA” link that populates at Finalization or the county board can click on
the Manage Individual PA link under the PA portion of the MSS application to
being the PA process
27. Can county boards
continue to “short span” or authorize a portion of costs at a time?
Yes. OAC rule 5123:2-9-06
requires county boards to project costs for an individual’s entire waiver span.
However, county boards can continue to authorize a portion of costs at a time
through PAWS, which will not interface with CPT at “go live”. The Department
recommends using utilization reporting (new COGNOS reports) instead of “short
spanning” to monitor utilization.
When the Department begins
the work to phase-out PAWS, we will analyze and discuss the need for short
spanning in greater detail.
28. How does MSS handle
authorization for an individual who lives in two different sites during their
Services must be finalized in
the first site before services are finalized in the second site. This helps
prevent the costs in the second site from exceeding the individual's budget
29. Why does SPA show
"Approve DRA" instead of "Authorize Costs" for an
SPA will only give users the
option to authorize for individuals with a valid (i.e. enrolled) WMS waiver
span. The "Approve DRA" button will be displayed for non-waiver
individuals because they are sharing services with waiver individuals and their
costs are necessary to calculate the daily billing unit.
30. How do I “create” a
A “Saved” version can be
created by the user going under the Manage Version portion of the application
and clicking on the “Save New Version” link in the upper left hand corner of
the page, right above the actual list of versions currently associated with the
A “Finalized” version is
created when the user clicks on the “Click to Finalize Cost Projection” button
under he Manage Cost Projection portion of the CPT.
A “Authorized” version is
created when the user clicks on the “Approved” button in the Service Payment
Authorization (SPA) portion of the application.
31. How is a provider able
to edit a version?
A provider may edit a version
if all of the following apply:*
- The provider has an “edit”
role (security affidavit).
- The provider is associated
with the site.
- The county board has given
the provider access to edit the site under the “manage providers” area of CPT.
*Please Note: The provider
access only applies to the active version. If the county board chooses to
activate and edit a different version, they will have to grant the provider
access to that version.
32.Why is it that when I
"Activate & Edit" a previous version that DRA is not
It is necessary to re-finalize and re-authorize the
services for each individual based on the services in the newly activated
version. You will then be prompted to generate or update site costs in the DRA.