.01 The mission of the Office of Maternal and Child Health (MCH) is to provide high quality health and supportive social services by setting and developing policy and programs that improve the health of women, children and parenting families. MCH is responsible for a wide variety of programs related to: 1) promoting healthy pregnancy outcomes by improving the health and quality of the life of women in their childbearing years; 2) providing follow-up to infants and their families identified as high risk or at risk for later health and developmental problems; 3) providing free comprehensive gynecology in eight of the Cityís Health Care Centers; 4) providing free family planning services in all of the Cityís Health Care Centers; 5) increasing outreach to, and use of health and support services by, pregnant women and their families; 6) promoting childhood health by improving access to and the availability of primary child health services, including those for children with special health care needs; 7) increasing public awareness of the need for and availability of these services; 8) promoting the health of mothers and children by increasing their awareness and practice of positive health behaviors; and 9) providing the management and administration of the Childhood Lead Poisoning Prevention program (CLPPP).

.02 The Pennsylvania Department of Health has awarded the Philadelphia Department of Public Health a three-year, Title V maternal and child health grant beginning July 1, 1996: 1) to provide and assure mothers and children (particularly those with low income or with limited availability of health services) access to high quality maternal and child health services; 2) to reduce infant mortality and the incidence of preventable diseases, 3) to promote the health of mothers and infants by providing prenatal, delivery and postpartum care for low-income, at-risk pregnant women, and 4) to promote the health of children by providing preventive and primary health care services for low-income children. These activities involve the development and linkage of the following three components: 1) pregnant women, mothers and infants up to one year of age; 2) services for children and adolescents age one through 20, inclusive; and 3) childhood lead poisoning prevention services.

.03 The Pennsylvania Department of Public Health has awarded a three-year grant to MCH beginning April 1, 1996, to provide technical assistance, facilitate collaboration and implement activities that will benefit children with special health care needs in the City of Philadelphia.

.04 MCH received a six-year Healthy Start grant from the Department of Health and Human Services, Health Resources and Services Administration, to develop and implement innovative programs to reduce infant mortality in West and Southwest Philadelphia. Contracts funded through the Healthy Start Initiative are consistent with the Federal grant period, October 1 (or thereafter) to September 30th. Providers are required to adhere to all conditions placed on the Philadelphia Department of Public Health for the receipt of these funds.

.05 The United States Department of Health and Human Services has awarded MCH a three-year Community Integrated Service System (CISS) grant beginning October 1, 1996, to help create stable working relationships between Medicaid managed care organizations and community-based providers of maternal and child health services.

Special Programs: MCH funds innovative pilot programs based on a philosophy of community collaboration; outcomes measures are part of the requirements.

.02 The above named services are provided by non-profit providers through a City contract (award) which may be program funded, fee-for-service funded, or capitation funded. The following briefly describes those funding mechanisms:

• Program funded projects are privately administered...

• Fee-for-service providers are contracted for specific services, e.g. home nursing...

• Capitated reimbursement by MCH to Maternity Services Program Prenatal Providers is for enrolling uninsurable pregnant women and/or women, women who are at least 185% of poverty, and uninsured teens into prenatal care. Additional reimbursements for specialized testing costs, using the Blue Cross/Blue Shield Schedule C as a guide, are also made.

• Hospital providers deliver comprehensive Healthy Beginnings Plus services at the Cityís District Health Centers. Prenatal providers reimburse the City annually at a per session rate for the use of space, health center staff assistance, and utilities.

• ---

  Children receiving health insurance are enrolled in Keystone Health Plan East, a managed care subsidiary of Independence Blue Cross, for a period of 1 year, at a capitation rate established annually by Independence Blue Cross.

.03 Program funded budgets are submitted (consistent with the Directions in Exhibit 1) for review and approval prior to the commencement of the new fiscal year on the prescribed budget forms (Exhibits 2, attachments 2a through 2h). Approved budgets become Exhibit "B" of the City contract. Expenditure reports are to be submitted monthly using similar forms with the addition of a signed Maternal and Infant Health Services Invoice .

.04 Fee-for-service contracts reflect the approved rate and basis for billing as per Exhibit "B" on the contract. Monthly invoices are to be submitted listing the dates services were provided, to whom the services were provided, and the approved fee. A signed invoice is to accompany each listing of services delivered.

Expenditure reports are reviewed via the additional attached budget expenditure forms (Exhibit 3, attachments 3b through 3e).

.05 The Maternity Services Program (MSP): New Enrollment and Special Testing Invoices (Exhibits 4a and 4b) are prepared and submitted to the Office of Maternal and Child Health by the Prenatal Provider for all MSP eligible pregnant women and adolescents. Documented uninsurable status for pregnant enrollees generates a capitation fee for comprehensive prenatal care. Also, for those enrollees requiring specialized testing, reimbursements are made if the patientís name, identification number, the name of the specialized test, and a stated reason for the test is given. The MSP Budget/Expenditure Report Review (Exhibits 4c) is also used to support the denial or acceptance of reimbursements. The MSP Specialized Test Invoice are attached to the Budget/Expenditure Report Review and routed to the MCH clerk, program analyst, and contracts support staff to review, correct information, and give final approval of expenditures. Approved expenditure information is electronically entered before MSP reimbursements are finally generated.

.06 City health center prenatal providers are invoiced on a monthly basis for 1/12 of anticipated yearly revenues.

.01 The CFDA Numbers are as follows:

• Maternal & Child Health Block Grant is 93.994
• Children's with Special Health Care Needs (CSHCN) is 95228
• Healthy Start Initiative is 93.926 (have submitted an application for a Healthy Start Phase II Grant)
• Community Integrated Service Systems (CISS) is 93.110

.02 In addition to the above, if the contractís funding consists of a mixture of state monies and Federal block grant and other monies, all funding under the contract shall be subject to these block grant conditions (Exhibit 5). Provider shall not use such funds in a manner not in accordance with the Maternal and Child Health Services Block Grant legislation at 42 U.S.C. 701 et seq., and the Provider assures that no block grant funds shall be used to:

(2) make cash payments to intended recipients of health services;

B. Provider assures that, under this contract, it and any subcontractors shall cooperate fully with the Commonwealth to enable it to comply with any reporting, audit, or fiscal requirements imposed under 42 U.S.C. Section 706 and 300w-5.

C. The Contractor assures that should the federal government conduct any investigation or should the Department be a party to any hearing under U.S.C. 300w-5 or 300w-6 that the Contractor (Provider) any subcontractors will cooperate in general with the Commonwealth in such investigation or hearing (both prior to and during the time of such hearing) and specifically will make available for examination and copying by the Commonwealth, the U.S. Department of Health and Human Services, or the Comptroller General of the United States documentary records required under 42 U.S.C. 300w-6.

.03 For contract funding relating to the Healthy Start Grant, the contracts have certain special terms and conditions, which the auditor should read and apply in the performance of the audit.

.01 As discussed in Sections 300 and 500 of this Audit Guide, each City of Philadelphia Department program has specific auditing requirements. These requirements are in addition to those areas of audit specified in Sections 300 and 500 of this Guide. The audit requirements listed on the following pages are not all inclusive and do not represent an audit program for conducting a financial and compliance audit of the program(s). The audit requirements listed are presented as highlights of areas of special interest to the Department. Any deficiencies noted as a result of the procedures are to be disclosed in the Schedule of Findings and Questioned Costs.

.02 All program funded providers, as well as health center prenatal providers must complete quarterly and annual reports in accordance with the specified contract attachment for the services specified in Exhibit "A" of their contract. These reports are reviewed internally and a Site Visit Report (Exhibit 6) is completed critiquing the reports. Other program reports include the MSP Quarterly Report (Exhibit 7), and the State's Maternal & Child Health Block Grant Quarterly Report (Exhibit 8).

.03 Quarterly and annual program reporting constitutes an important aspect in MCH efforts to determine success of the various program initiatives (Exhibit 9 - Guidelines for Submitting Program Reports). Therefore, it is expected that the auditor solicit from each contract provider answers to the following questions, and include any deficiencies noted in the audit report:

• How do the providers collect their quarterly program services data? Indicate which staff are involved, the data used in this process, and describe.

• Determine the process used by the providers to check the accuracy/validity of the quarterly program reports to MCH. If no validation process is used, determine why not and report upon.

• What steps does the provider take to address consistent patterns of underutilization/ overutilization of projected services? What staff are involved in this process? How are they involved?

.04 Copies of the quarterly/annual reporting format for completion are included as Exhibit 8.

.05 In regard to the Primary/Preventive Health Services for Pregnant Women, Mothers, and Infants up to Age One, no enrollee shall be directly billed for any services covered under this contract whether provided directly or by subcontractor, except when the enrolleeís family income is above the limits for program services as described therein. In accordance with 42 U.S.C. Sections 705(a)(5)(D) and 701 (b)(2), if any charges are imposed for the provision of health services, such charges 1) shall be pursuant to a public schedule of charges, 2) shall not be imposed with respect to services provided low income mothers or children, and 3) shall be adjusted to reflect the income, resources, and family sizes of the individual provided the service. The term "low income" means, with respect to an individual or family, such an individual or family with an income determined to be below the income official poverty level defined by the Federal Office of Management and Budget and revised annually (or more often) by the U.S. Department of Health and Human Services in accordance with 42 U.S.C. Section 9902(2). As of their effective dates such revisions are incorporated by reference as a part of this contract.

.06 The Contractor shall utilize third party reimbursement sources as required by this contract.

.07 Audit procedures on the above are to include a determination, on a test basis, that only enrollees billed directly for any service covered under the MCH contract meet the family income criteria specified.

.08 The Contractor shall provide uninsured children with health insurance coverage at no cost to their families. Funding will provide coverage for comprehensive outpatient and preventive services.

.09 The auditor is to determine that enrolled children meet the age and income criteria as established.

.10 Under the Maternity Service Program each prenatal provider is required to comply with the following:

(1) Maternity Services

• uninsured teens, 17 years of age or younger

• undocumented residency status and/or

• incomes at or below 185 percent of the Federal poverty level

.11 The auditor is to test that referrals into the Maternity Services meet the criteria for eligibility, as specified in item d. above.

.01 As discussed in Sections 300 and 500 of this Audit Guide, each City of Philadelphia Department Program has specified auditing requirements. These requirements are in addition to those areas of audit specified in Sections 300 and 500 of this Guide. The audit requirements listed on the following pages are not all inclusive and do not represent an audit program for conducting a financial and compliance audit of the program(s). The audit requirements listed are presented as highlights of areas of special interest to the Department. Any deficiencies noted as a result of the procedures are to be disclosed in the Schedule of Findings and Questioned Costs.

.02 The financial and compliance procedures for MCH are provided on the following pages based upon two types of program services:

a. Program Funded Projects (Section 6440.03 to 6440.07)

1. Fee-for-Service projects (Section 6440.08 and 6440.09)

.03 Program-funded is the most common method employed by MCH to fund its provider agencies. This method allows MCH to fund a provider agencyís actual eligible expenditures for a provider agencyís service(s), offsetting these expenses by anticipated revenues to be received directly by the provider, and establishing the remaining deficit as its authorized level of funding (allocation). Reimbursement is effected on a "last-dollar-in" basis and is based upon actual eligible expenses incurred less actual revenue generated, up to the maximum contract funding.

.04 Audit procedures should include the following:

• Does the Agency have a system in place to adequately account for all applicable income received or earned by the agency and that such income was properly reported to MCH.

• That Medical Assistance billings for the program are fully recorded and that re-billings are submitted on claims which have been denied for payment.

• That Medical Assistant payments are recorded on the accrual basis recognizing any applicable reserves for uncollectible amounts (after pursuing all means of collecting on payments as discussed above).

• Personnel costs charged to the program as reported to MCH on the Personnel Roster Report (Exhibit 3e) are appropriate, properly supported and allocations of time are documented.

• Administrative overhead costs appear reasonable and are based upon a documented allocation plan. The auditor should consider appropriate procedures from Section 300 - Indirect Costs.

• Capital expenditures are not reported by the agency under the category of "Building Maintenance Expense".

• Items charged to rent expense are in fact only for building rent expense and do not include any use charges in lieu of rent. Additionally, that rent expense charged by a related party be examined for reasonableness based upon comparable space at current market prices.

• Interest expense charged to the program is only due to temporary loans the agency had to obtain to cover cash flow deficiencies due to lack of timely payments from MCH.

Budget Modifications:

.06 The contract between MCH and the provider contains as an Exhibit "B", a budget which has a notation that the budget can be revised with the written approval of the Director of MCH. Detailed justification must accompany all request for a budget revision. The impact on services should be addressed also.

.07 Based upon the above the auditor should determine that:

• The budgetary amounts reported on the Program Invoice Summary Form and Section III Contract Expenses are the final amounts approved, including any modifications.

• If applicable, the Provider has followed the modification process as detailed above prior to revising the budget and expending funds for previously unauthorized expenses.

.08 Revenues for a fee-for-service funded program are based upon a set fee or rate of reimbursement for each authorized unit of service rendered by the provider agency to eligible clients. The provider invoices MCH on a monthly basis, by client, for such services. The fee-for-service type of funding requires special types of audit tests, since there are no expenses reported to MCH. Determining the appropriateness of the units billed is the major concern for the auditor.

.09 Audit procedures should include the following:

• Does the agency have a system in place which accumulates the units of service by client, by type, and bills those units to MCH.

• Are the same services billed to another funding source, resulting in a duplicate billing.

• Obtain from the agency a Summary of Services Billed by Type (this will be utilized in the audit report - see Supplemental Financial Statements Section 6450) for the audit period.

• Determine appropriateness of units of service billings to MCH by testing that:

.01 The Organizationís audit report must include the following supplemental financial schedules for each City of Philadelphia contract with $300,000 or more of expenditures, in addition to the financial statements and auditorís reports as specified in Sections 400 and 500 of this Audit Guide. A designation has been made for those supplemental schedules required for a "Single Audit" Report (Section 400) or a "Program Audit" Report (Section 500). The auditor will be required to issue an opinion on the Supplemental Schedules listed below as specified in Section 400 of this Audit Guide.

.02 The supplemental financial schedules for a program funded and a fee-for-service project, are as follows:

Section

Ref. to Single Program

Supplemental Sample Audit Audit

Financial Schedule Format Report Report

• Statement of Functional Expenditures

by Contract/Program and Revenues by

Funding Source (1) 6450.03 Yes No (3)

• Reconciliation of Agency Reported

Expenditures/Revenues (2) 6450.04 Yes Yes

Section

Ref. to Single Program

Supplemental Sample Audit Audit

Financial Schedule Format Report Report

• Schedule of Fee-for-Service (4) 6450.05 Yes Yes

• Reconciliation of Reported Units to

Audited Units of Service (5) 6450.06 Yes Yes

(4) The schedule is to present units of service rendered as reported to MCH, plus or minus auditor's adjustments, rate per unit and total fee-for-service.

ABC NOT-FOR-PROFIT CORPORATION

OFFICE OF MATERNAL & CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

STATEMENT OF FUNCTIONAL EXPENDITURES BY CONTRACT/PROGRAM

AND REVENUES BY FUNDING SOURCE

JULY 1, 19XX to JUNE 30, 19XX

Outreach Education

Services Services

Expenditures by cost center:

Personnel Services:

Administrative salaries $ XXXX $ XXXX

Administrative benefits XXXX XXXX

Client oriented services salaries XXXX XXXX

Client oriented service benefits XXXX XXXX

Operating expenses: (A) XXXX

Board expenses XXXX

Consultant expenses XXXX

Rent XXXX

Utilities XXXX

Insurance XXXX

Housekeeping XXXX

Communications XXXX

Office supplies XXXX

Medical supplies XXXX

Drugs XXXX

Rehabilitation services XXXX

Staff travel XXXX

Maintenance expense:

Building XXXX

Equipment XXXX

Motor vehicle expense XXXX

Other operating expenses XXXXX

Fixed assets: (A)

Office equipment and furnishings XXXXX

Total expenditures by cost center XXXXX XXXX

ABC NOT-FOR-PROFIT CORPORATION

OFFICE OF MATERNAL & CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

STATEMENT OF FUNCTIONAL EXPENDITURES BY CONTRACT/PROGRAM

AND REVENUES BY FUNDING SOURCE

JULY 1, 19XX to JUNE 30, 19XX

Outreach Education

Services Services

Funding sources:

Client fees $ XXXX $

City of Philadelphia, Office of MCH XXXX XXXX

Medical assistance fees, Commonwealth of Pennsylvania XXXX

Foundation revenues XXXX

Total funding XXXXX XXXX

Excess of expenditures over funding sources $ XXXXX $ XXX

ABC NOT-FOR-PROFIT CORPORATION

OFFICE OF MATERNAL & CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

RECONCILIATION OF AGENCY REPORTED EXPENDITURES/REVENUES

TO AUDITED EXPENDITURES/REVENUES

JULY 1, 19XX to JUNE 30, 19XX

Amount Amount

Reported (A) per

on Fiscal Audit Other Audit

Report Accruals Adjustments Report

Expenditures by cost center:

Personnel Services:

Admin Salaries $ XXXX $ XX $ $ XXXX

Admin Benefits XXXX XX XXXX

Client oriented service salaries XXXX XX XXXX

Client oriented service benefits XXXX XX

Operating expenses:

Board expenses XXXX XXXX

Consultant expenses XXXX XXXX

Rent XXXX XX XXXX

Utilities XXXX (X) XXXX

Insurance XXXX XXXX

Housekeeping XXXX XXXX

Communications XXXX XXXX

Office supplies XXXX XXXX

Medical supplies XXXX XXXX

Drugs XXXX XXXX

Rehabilitation supplies XXXX XXXX

Staff Travel XXXX XXXX

Maintenance expenses:

Building XXXX XXXX

Equipment XXXX XXXX

Motor vehicle expense XXXX XXXX

Other operating expenses XXXXX XXXXX

XXXXX XXX (XX) XXXXX

Fixed assets:

Office equipment and furnishings XXXXX XXXX

Total expenditures by cost center XXXXX

ABC NOT-FOR-PROFIT CORPORATION

OFFICE OF MATERNAL & CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

RECONCILIATION OF AGENCY REPORTED EXPENDITURES/REVENUES

TO AUDITED EXPENDITURES/REVENUES

JULY 1, 19XX to JUNE 30, 19XX

Amount Amount

Reported (A) per

on Fiscal Audit Other Audit

Report Accruals Adjustments Report

Funding sources:

Client fees $ XXXXX $ XX $ $ XXXXX

Office for Maternal and Child

Health XXXXX XXX XXXXX

M.A. fees, Commonwealth of PA XXXXX XXX XXX XXXXX

Total funding XXXXX XXX XXX XXXXX

Excess of Expenditures over Funding

Sources $ XXXXX $ XXX $ XXX $ XXXXX

ABC NOT-FOR-PROFIT CORPORATION

OFFICE OF MATERNAL AND CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

RECONCILIATION OF PROVIDER REPORTED EXPENDITURES/REVENUES

TO AUDITED EXPENDITURES/REVENUES (CONT.)

July 1, 19XX to June 30, 19XX

Explanation of Other Adjustments:

Budget Category Adjustment Explanation Adjustments

Expenditure adjustments:

allocated to administrative

salaries, should be chargeable

to client oriented services

salaries. (XX)

Client oriented service To reclassify from

salaries administrative salaries as

explained above. XX

Utilities To adjust for expenses

charged to this contract

which pertain to another

program. (XX)

Total expenditure adjustments (XX)

Funding source adjustments:

Medical assistance fees To record previously

denied billings which

were collected by Agency

and not reported. XXX

To adjust reserve for

uncollectible billings

on current year billings. XXX

Total funding source

adjustments XXX

Net adjustments $ XX

ABC NOT-FOR-PROFIT ORGANIZATION

OFFICE OF MATERNAL AND CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

SCHEDULE OF FEE-FOR-SERVICE

JULY 1, 19XX to JUNE 30, 19XX

(A)

Units of Rate per Total Fee-

Type of Service Service Unit for-Service

Home Nursing Service XXXX $ XX.XX $ XXXXX

Total $ XXXXX $ XXXXX

(A) Rate per unit is amount as approved in the contract agreement.

ABC NOT-FOR-PROFIT ORGANIZATION

OFFICE OF MATERNAL & CHILD HEALTH

CITY OF PHILADELPHIA CONTRACT NUMBER XX-XXXX

RECONCILIATION OF AGENCY REPORTED UNITS OF SERVICE TO AUDITED

UNITS OF SERVICE

Units as

Reported Units per

Type of Service to MIH Adjustments Audit

Home Nursing Services XXXX (XX) (A) XXXX

Explanation of Adjustments:

1. Documentation does not exist that infant received Home Visiting Services.

TABLE OF CONTENTS

2 Sample Program Budget Forms:

2a Program Budget Request Form

2b Section IIIA - Contract Expenses (Yearly Budget)

2c Section IIIB - Contract Expenses (Quarterly Budget)

2d Program Budget - Personnel Roster

2e Miscellaneous Item Detail - Contract Budget

2f Miscellaneous Item Detail - In-Kind Contributions

2g Equipment Schedule

2h Service Description

3 Sample Program Invoicing Forms:

3a Invoice for Maternal and Infant Health Services

3b Program Invoice Summary Form

3c Section III - Contract Expenses

3d Miscellaneous Item Detail - Contract Budget

3e Personnel Roster - Invoice Budget

4a Maternity Service Projects - New Enrollments Invoice Form

4b Maternity Services Projects - Special Testing Invoice

4c MSP Budget/Expenditure Report Review

6 PDPH/MCH Site Visit Report Form

7 Maternity Services Program Quarterly Report Form

8 Maternal & Child Health Block Grant Quarterly Report Form

9 Guidelines for Submitting Program Report: Quarterly & Annual Report (Exhibit PA-7)

We have found it helpful to complete the budget forms in the following manner, as it reduces the chances for errors and the necessity for repeated corrections. Please feel free to prepare the forms however you wish.

This form is designed to give the opportunity to justify each line item by expenditure. "Budget Category" is the line item number, the description should be filled in to the best of you ability, the number is the number of the specific item purchased, and the unit cost should be the cost paid per unit. The total amount is the unit cost times the number. Unlike last year, in-kind contributions should not be listed in this form.

This form is to be completed as the above. In-kind costs should be specified within this form.

Name and address of the provider preparing the report. This name should be the same party as indicated in the contract with MCH.

INSTRUCTIONS ñ PERSONNEL ROSTER