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Section II:

Budget and Analysis

Title:

Cash Management Plan

Chapter:

Appendix

Current Effective Date:

8/1/02

Revision History:

8/1/02

Original Effective Date:

10/16/01

Nursing Facility Surety Bond Proceeds - Opinion of the Attorney General - Attachment 2

Memorandum of Agreement Between the Division of Facility Services and the Division of Medical Assistance Concerning Nursing Facility Surety Bonds Attachment 3


  1. Surety Bonds
    We believe your agency should be the "State Fiscal Officer" to verify the existence and sufficiency of the facility's surety bond. This could be part of the licensure process.


  2. Payments under Surety Bonds
    DMA agrees to take responsibility for the state in the event a surety bond payment must be made. This would include working with the facility, issuer of the bond and the payees.


  3. Deficiencies and Temporary Management
    We believe this should be the responsibility of the DFS.


  4. Process for Handling Penalty Payments
    DMA agrees to be responsible.


  5. HCFA/Penalty Conflicts.
    Responsibility of DFS. No DMA involvement except consideration of the time it takes to remove patients if that is required.


  6. Coordination of Above with DMA
    Dennis Williams will be our contact and will work on the MOU changes necessary to accomplish the above. Dennis will also be our contact in discussions with DFS concerning the need for rules.


DHHS Mail Cash Receipts Log Form - Attachment 6

Date

Check

   

Check Purpose or

Client Name or

 

Received

No.

Originator

Bank

Description

Identification Number

Amount

             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
       

Daily Log total

 

$

             
       

Total Received

   

Prepared By______________________

 

Received By_________________

 
       

Cashier

   

State Treasurer’s Letter – Handling Checks Where State is a Joint Payee - Attachment 7


  1. The payor(s) agrees to pay the sum of $_insert amount_ per month for the support and maintenance of __insert patient name as repayment for the bill which accrued at the institution which is evidenced by the certified statement of account hereto attached until said bill is fully paid, such deferred payments to made each month on a regular and systematic basis.


  2. The institution and NC DHHS hereby agrees to accept in full and final settlement of any claim against said payor(s) for support and maintenance for the duration of this agreement the sum of $_insert amount per month for the duration of this contract. This shall not be deemed a compromise of any claim which the institution may have against the patient or others not party to this contract that are responsible for the patient’s support.


  3. Upon substantial change in financial condition of payor(s), either party may terminate this agreement upon written notice to the other, mailed to the last known address. Upon such termination, a new agreement with increased or decreased payments may be made.


  4. In event of default in payment by payor(s), the full amount that was due before compromise, if any, as evidenced by the attached certified statement of account less payments made under this agreement shall become due immediately and the institution shall make demand for payment.


  5. This contract is based on certain representations of the payor(s) regarding financial ability as follows:

Page 2

DHHS Facility - Ability to Pay Agreement - Attachment 9

DHHS Facility - Procedure for Determining Patient’s Ability to Pay - Attachment 10


  1. The following steps are to be followed to determine the client’s and /or responsible party’s ATP rate.


  2. The RPRR will conduct an initial financial interview within two (2) working days of the client’s admission with the client and / or responsible person. The RPRR will receive a copy of the identification / face-sheet from the Facility Admissions Office which contains basic information about the admission.


  1. Client’s Name: Enter exactly as on hospital records.


  2. Case Number: Hospital number as indicated on the face-sheet.

Ability To Pay Worksheet

Sample Collection Letters - Attachment 11

Example Collection Letter For An Account That Is 31 Days Past Due:

Example Collection Letter For An Account That Is 61 Days Past Due:

Example Collection Letter For An Account That Is 91 Days Past Due:

DHHS Certification of Cash Needs - Attachment 12

                 

Name of Agency: ______________________________________________

     

Federal Identification Number: ____________________

         

Agency Fiscal Year: ________________

             

Certification for the Month/Year of: _______________________

         

Contract Number: ____________________________________________

       

Name of DHHS division/facility/school administering the grant award: _______________________________

   
                 

As a recipient of financial assistance funds from the DHHS, we have determined

our monthly cash requirements as a condition of requesting a cash advance. As duly authorized officials of the above-named

agency, we hereby certify that, to the best of our knowledge, the amount of the cash advance request represents our true

cash needs. We agree to monitor our cash flow needs on a monthly basis, and if these needs change or if the need for a

cash advance ceases to exist, we will submit a revised certification of cash needs.

     
                 
                 

________________________________

_______________

____________________________

____________

 

Signature of Executive Director

Date

 

Signature of Chief Financial Officer

Date

 
                   
                   

Breakdown of Advance Request:

             
                   

$___________________

Operating Costs (ongoing)

           

$___________________

Capital Costs (one-time)

           

$___________________

Start-up Costs

             

$___________________

Total Amount of Advance Request

         
                   

IMPORTANT: If you are requesting an operating advance, you must indicate the number of days that the advance covers

 

by checking the appropriate item as follows:

           

__________ 30-day

__________ 60-day

__________ Other (Specify: __________ days)

   
                   
                   

Please provide a brief narrative as to why the advance is needed:

         

______________________________________________________________________________________

 

______________________________________________________________________________________

 

______________________________________________________________________________________

 
                   

BELOW THIS LINE TO BE COMPLETED ONLY BY THE RESPONSIBLE DHHS DIVISION/FACILITY/SCHOOL:

   
                   
                   
 

___________ Approved

 

__________________________________ ___________

 
 

___________ Disapproved

 

Signature of Division Director

 

Date

   

Example Institution Personal Funds Policy - Attachment 13


  1. Dorothea Dix Hospital has an Institutional Fund for maintaining patients' personal funds during their stay at the hospital. A control account is maintained by patients' accounts and subsidiary ledger accounts for individual patients are reconciled to the control account at least daily.


  2. All employees authorized to handle patients' money are bonded by the state.


  3. Admissions and screening personnel, unit personnel, patients' accounts, and the cashier's office are responsible for administering the deposits and withdrawals of patients' funds to their individual accounts. However, no hospital employee may withdraw funds from a patient’s personal account without the patient's authorization except in the case of a special withdrawal (see Section VIII).


  4. Funds deposited by patients’ personal checks are to be held until they have cleared the bank (approximately 10 working days and out-of-state checks 15 days).


  5. Written permission from the patient or legal guardian must be obtained before funds may be sent home to families or other parties.


  6. For proper identification it is necessary to have the patient's I.D. number on all personal funds and belongings deposited to and withdrawn from the cashier's office, patients' accounts or unit locked storage.


  7. All personal funds and belongings for visiting patients to the medical/surgical unit are to be handled in the same manner as those prescribed for Dorothea Dix Hospital psychiatric patients.


  8. Any time a member of the hospital staff receives money from a patient, relative, or friend for deposit to the patient's personal account, a pre-numbered receipt shall be issued to the individual "tendering" the funds (Exhibit A). All funds receipted will be placed in the unit cash box and/or deposited with the cashier's office, with the exception of pre-trial evaluation where money can be given directly to the patient. Unless the employee receiving the patient funds is the custodian of the cash box, the receipt blanks “to cash box” and “cashier’s office” should be left blank for completion by the custodian on their next working shift to assure that the funds are deposited and accounted for correctly.


  9. A highly visible sign shall be posted in admissions and screening and on each unit informing persons leaving funds that a pre-numbered receipt shall be issued signifying receipt of the moneys by a designated employee of this institution.


  10. Funds shall not be held on the unit in an amount greater than the amount to be issued to the patient before the next specified withdrawal period. Before requesting the next period's withdrawal for a patient, a review of funds on hand shall be made to determine that an excess of funds is not building up on the unit. All requests for withdrawal shall be in accordance with the treatment team's recommendations. To assure compliance, the initiating staff and the registered nurse (RN) in charge shall co-sign the patient money withdrawal request. Any excess funds, or funds held for a discharged patient or a patient on leave, shall be returned to the cashier's office and credited to the patient's personal account.


  11. The cashier's office is responsible for maintaining proper records (logs with signature of receiving person) of pre-numbered withdrawal requests and receipt books issued to the unit.


  12. A periodic audit of the “unit cash box” is to be performed by the patients' accounts representative to insure proper accountability and compliance with regard to these guidelines for patient's personal accounts.


  13. All cash funds shall be carried to the cashier's office and in no circumstances sent through the inter-office mail service.


  14. Two (2) training sessions will be held at least annually or more frequently if needed, for all nursing personnel managing patients’ funds and possessions. The training will be conducted by the budget officer, the patients’ accounts representative and with assistance from the director of nursing and an administrative assistant. The training will involve discussion of this policy, II P-6 (patients’ personal funds and financial records), policy II P-6-2 (after hour deposits) and policy II C-1 (patients’ personal clothing and possessions).

Cashier's Office Receipts


  1. Funds may be deposited in the cashier's office for patients' personal accounts Monday through Friday during the following hours: 8:30 – 11:30; 1:00 – 3:45.


  2. A pre-numbered receipt shall be issued by the cashier for each patient's deposit with the following distribution of the four-part pre-numbered receipt:


  1. Funds may be received on the unit on weekends or at times when the cashier's office is not open and the cash box custodian is not on duty.


  1. Funds may be received through the mail for deposit to a patient's personal account. These receipts should be handled in the same manner as outlined in Section IV. A, with the following additional instructions:


  2. Administrative assistants or their designee, being someone independent of the cash receipts process, shall on a periodic basis perpetually reconcile/trace the pre-numbered receipts to the cashier’s office records and to the unit money record sheet maintained in the “cash box”. This will assure that all receipts have been appropriately recorded in the patients’ accounting records.


  1. In situations where it is necessary for funds to be held on the unit and issued on a daily basis to the patient, a designated employee and alternate shall be assigned responsibility for these funds.


  2. There shall be two (2) keys to the ward cash box: one key for the custodian and the other key in possession of the unit nurse manager or administrative assistant for emergency access.


  3. Written notification shall be given to the patient’s accounts representative as to who has the second key.


  4. No other funds may be held in the cash box with patients’ personal funds (i.e. postage or staff personal funds).


  5. When there is a change from custodian to alternate, there will be a count of funds, reconciling the money with the unit money record sheets.


  6. The unit nurse manager or administrative assistant may appoint a temporary custodian in the event of an unplanned absence of both the regular custodian and alternate.


  7. Any difference between the actual cash count from the cash box and the sum total of all balances on the unit money record sheets should be documented and brought to the attention of the administrative assistant. If these funds cannot be reconciled, this discrepancy should be called to the attention of the patient accounts representative for audit.


  8. The general policy is that unit staff shall issue money to patients only during Monday-Friday from 8:00 – 5:00. Units may vary this based upon their specific requirements. It is also recommended that a specific time be designated for issuing funds to patients when possible to conserve time and effort.


  1. The unit money record sheet (Exhibit B) is to be used in all situations where funds are received or disbursed from the unit cash box.


  2. These funds must be placed in the locked unit cash box which is stored in a locked space.


  3. The sum total of all balances on the patient's unit money record sheets are to agree with the total cash in the unit cash box at all times.


  4. Receipt of Funds:


  5. Withdrawal of Funds:


  6. The unit money record sheets are permanent records and shall be retained by the unit for seven (7) years.


  7. When patients are transferred from one unit to another, the transferring staff will co-sign the unit money record sheet with the receiving staff at the time of the transfer of funds. The existing unit money record sheet will be retained by the transferring unit and a new unit money record sheet will be established on the receiving unit.


  8. The unit money record sheets are available from office supply in the main warehouse.


  9. Each unit shall, at the end of each month, report in writing to patients' accounts no later than the third day of the following month the following:


  10. This report shall be signed by the cash box custodian and co-signed by the unit nurse manager or administrative assistant. Patients' accounts shall investigate any differences and report to the hospital business manager the results of the investigation.


  11. If an overage occurs in the reconciliation of patients' personal funds, these funds should be escheated if the owner is not identified within five (5) years from the date the overage is identified. Any cash shortages should be replaced by a budgeted transfer from the general fund.


  1. The weekly allowance shall be used to enable the patient to have spending money for snacks, cigarettes, drinks, etc. Normally, the weekly allowance shall be used only for purchases that can be made on the hospital grounds.


  2. A designated unit employee will be responsible for initiating a pre-numbered request form for withdrawal of funds from a patient's personal account (Exhibit C). All amounts entered on this request form shall be written in dollars and cents (i.e. $10, rather than $10). This request shall be co-signed by the unit nurse manager in order to assure that withdrawals are in accordance with treatment team recommendations.


  3. The maximum amount that a patient may have on the unit shall be established by each program. Withdrawals may not exceed this established amount in any particular one-week without special authorization as provided in section VIII. Division nurse managers or administrative assistants are responsible for informing patients' accounts of the maximum amount established for the program. If it is determined by the program that the amount of the weekly allowance is insufficient for that particular program, the weekly allowance amount may be changed. Patients’ accounts must be notified of this change.


  4. A weekly listing of all patients' personal fund balances from the patient personal funds accounting system is sent to all units to assist unit staff in determining the available funds for each patient. This listing should be utilized by unit staff to determine balance information. Designated unit staff must assure all withdrawals are listed weekly.


  5. Distribution of the pre-numbered withdrawal requests will be as follows:


  6. The original and first carbon copies of the withdrawal request are submitted to the cashier's office after having been verified and signed by patients’ accounts. The second carbon copy of the withdrawal request is maintained by patients' accounts for balancing purposes.


  7. At the end of the day the patients' accounts and the cashier's office reconcile the sum total of all patient's withdrawals and the budget office prepares a check in this amount and exchanges it with the cashier's office to reimburse the imprest cash account for funds used filling patients' cash withdrawals.


  8. Cashier's office prepares and signs cash withdrawal for respective units, which are picked up by, designated unit employees at a specified time or delivered by courier (see APM II P-6-1 for delivery of funds by mail courier).


  9. Designated unit employee distributes cash in the presence of the RN in charge to appropriate patients in accordance with amounts reflected on the original copy of the withdrawal request.


  10. Patients who are capable of signing their names are to indicate receipt of funds by signing the original copy of the withdrawal request. In the case of patients who are unable to sign their names, two (2) unit employees, one (1) being the RN in charge, should sign the withdrawal request indicating that the appropriate patient actually received the funds. Printed signatures are unacceptable.


  11. When patients' funds are to be held in the unit cash box for later distribution to the patient, the designated employee shall enter on original copy of the withdrawal request in the column titled "received by", the words, "to cash box" and sign his name. The RN in charge shall co-sign. A unit money record sheet shall then be updated reflecting the funds held in the unit cash box for the patient.


  12. After all funds have been distributed to appropriate patients, or placed in cash box as described in paragraph L above, the original copy of withdrawal form shall be returned to patients' accounts for attachment to the second carbon copy of the withdrawal request. If original copy is not returned to patients' accounts prior to or along with the next week's withdrawal request, the withdrawal request will not be honored. Any undistributed cash shall be deposited in the cashier's office.


  13. Any change in the amount requested on the patients' money withdrawal form whether by unit personnel, patients' accounts, etc. shall be initialed by the person making the change in the column marked "changed by".


  1. The same withdrawal form will be used for special withdrawals. Each patient request shall be on a separate request form and checked in the appropriate place to indicate a "special withdrawal". An explanation should be written below the patient's name giving sufficient explanation as to how the funds are to be used.

    NOTE: The explanation shall be specific as to why and how the funds requested are to be spent. General explanations such as "personal use", "outing", or for things normally covered by the weekly request are not adequate explanations.

    If patients are able to manage their own funds, a statement to this effect must be written on the request and signed by the treatment team leader or the unit nurse manager. In addition, the “patient waiver of responsibility form” should be signed by the patient and a copy retained in the patients’ record and a copy forwarded to the patients’ accounts representative. This waiver states that patients are aware of their responsibility for their own funds of an amount up to $250 without saving receipts or sending them to patients’ accounts. When patients request an amount of $250 or more, they will be given a receipt envelope by the cashier’s office. The patient shall be responsible for saving the receipts at the time of purchase and submitting them in the envelope to staff. Staff will then fill out the envelope reviewing the receipts and purchases. The patient will sign the envelope on the line requesting “shopper’s signature.” The staff reviewing the receipts and purchases will sign on the line “signature of staff verifying purchases”. The receipt envelope will then be sent to the patients’ accounts office. If a patient fails to return these receipts, the privilege and freedom of spending amounts in excess or $250 may be restricted by the treatment team. The following conditions must be met in order for a patient to be exempt from maintaining receipts for funds under $250:



  2. Special withdrawals should list only one patient per form. Adherence to this policy is required to provide adequate documentation for protection of the hospital and safeguarding of patients' funds. The only exceptions to this policy will be for the types of group purchases allowed by the Social Security Administration, wherein a group of patients may pool funds to purchase a large item, such as a television. Since the hospital typically funds these types of purchases, group purchases will be rare. Requests for special withdrawals on which more than one patient is listed will be returned to the unit by patients' accounts, unless it is for an authorized group purchase.


  3. An envelope will be handed out by patients' accounts at the time the special request is approved. Receipts are required to be maintained and submitted in the envelope provided for all special withdrawal requests except as above noted. Receipts shall show the following information: place of purchase, date of purchase, and an itemization of items purchased including quantity and the cost. Hand-written receipts, or receipts without store name are not acceptable. Memos indicating that the receipt has been lost are also not acceptable. The envelope is self-explanatory and is designed to account for the total funds withdrawn. The envelope shall be signed by the individual doing the shopping and also be signed by the RN in charge who shall verify all purchases against receipts. The envelope shall be returned to patients' accounts for attachment to the original copy of the withdrawal form. The envelope containing the receipts shall be returned to the patients’ accounts office within five (5) business days. Should envelopes and receipts not be submitted within five (5) business days, patients' accounts shall notify the unit nurse manager and/or the administrative assistant.


  4. In all instances where hospital staff are involved in handling patients’ money, RECEIPTS ARE MANDATORY. Failure of staff to return receipts to the patients’ accounts representative will automatically result in a request for investigation to the unit nurse manager and the administrative assistant. All expenditures of patients’ funds by hospital staff shall be accounted for by a supervisor. The patients’ accounts representative shall report all receipt discrepancies not resolved in a timely manner to the hospital business manager. Appropriate disciplinary or legal action will be taken with any employee who is found to have misused patients’ funds.


  5. Any funds remaining after shopping are to be re-deposited at the cashier’s office and under no circumstances returned to the patient. This requirement is necessary to provide safeguarding and documentation for the entire amount initially withdrawn for shopping.


  6. If the items purchased by patient and/or hospital staff are to be kept on hand at the hospital, these must be managed subject to the requirements of the "personal clothing and Possessions Policy A.P.M. No. II C-1. The nurse in charge must assure that items not placed in unit locked storage are given to patients by the shopping staff and appropriately note this event in the patient’s record.


  7. If funds are not picked up by the unit within two (2) business days after submission of the withdrawal request, the cashier's office will re-deposit the funds, note the cashier's office receipt number on the withdrawal request, retain the first carbon copy and forward the original copy to patients' accounts, attached to the first carbon copy of the withdrawal request. The cashier will forward to the unit a copy of the cashier's Office receipts after funds are re-deposited.


  8. The amount being requested shall be written out (as on the second line of a check) either below the figure amount or on the bottom line to preclude alteration of the numerical amount.


  1. The following policies are to be part of the overall discharge procedure for patients being released and apply to external transfers, trial visits and temporary visits (where applicable), as well as direct discharges.


  2. If possible, all personal funds and belongings shall be given to the patient and/or sent with him when he is released or transferred (see paragraphs C & D below for variations to this policy regarding temporary visits and after hours, weekends, and holiday discharges). This policy is to be accomplished by unit personnel in the following manner.


  3. The overall policy under paragraph B above is handled somewhat differently for temporary visits in that only the funds and personal belongings on the unit are given to the patient at the time of the visit; i.e., his other personal funds and belongings remain in safekeeping in the cashier's office and unit locked storage. In the event the patient is discharged from a temporary visit, the balance of the patient's personal funds and belongings will automatically be forwarded to the patient upon receipt of the form for the release of patients' personal funds and/or belongings.


  4. If discharge occurs after hours, weekends or holidays when the business offices are closed, there are special arrangements which can be made to enable the patient to receive his/her funds and personal belongings from the information desk at time of discharge. These arrangements will relieve the unit of the responsibility of keeping relatively large sums of money and personal belongings on the unit until the after hours, weekend or holiday discharge.


  5. To request these special arrangements, check the appropriate block on the discharge form for the release of patient's personal funds and/or belongings and forward to patients' accounts. The cashier's office will deliver the funds and personal items to the information desk prior to the end of the day for pick up when the patient is released "after hours". In the event that prior arrangements cannot be made for after hours, weekend or holiday discharges, then patients' accounts should be notified the following workday in order that the patient may be sent his/her personal belongings and the remaining balance in their personal account. However, funds will not be disbursed by patients' accounts prior to receipt of the form for the release of patients' personal funds and/or belongings.


  6. For discharge or for transfer of a patient to another hospital, center or institution, patients' accounts should be notified three (3) days in advance in order that the patients' financial records may be updated as of the date of the transfer or discharge. This procedure is not applicable to visiting patients to the medical surgical unit.

Delegation of Disbursing Authority to DHHS Controller - Attachment 14

Procedures for Disbursement of Special Appropriations - Attachment 15


  1. Non-governmental entities are required to submit an annual sworn accounting of receipts and expenditures of the state funds, as prescribed by the office of the auditor in audit advisory 2. (Note: This advisory was issued to advise non-governmental entities receiving state funds of the implementation of the 1996 revisions and the 1997 legislative amendments to G.S. 143-6.1). The DHHS prescribed format will be transmitted at a later date. A letter of disbursement should accompany the payment explaining the reporting and spending requirement.


  2. All governmental entities are to adhere to OMB Circular A-133 and the NC State Single Audit Act.

Attachment A

Attachment B

Contact’s Name Telephone

Contact’s Position in Organization

Federal Identification Number

Kind of Organization: Corporation Trust Partnership Government Unincorporated Association Other

Match Required: No On a to basis.

If mating is required, is cash match in hand? Yes No

 

REPORTING REQUIREMENTS


  1. Disbursement and Use of State Funds. – Every corporation, organization, and institution that receives, uses, or expends any state funds shall use or expend the funds only for the purposes for which they were appropriated by the NC General Assembly or collected by the state. State funds include federal funds that flow through the state. For the purposes of this section, the term “grantee” means a corporation, organization, or institution that receives, uses or expends any state funds. The state may not disburse funds appropriated by the NC General Assembly to any grantee or collected by the state for use by any grantee if that grantee has failed to provide any reports of financial information previously required by this section. In addition, before disbursing the funds, the NC Office of State Budget, Planning and Management may require the grantee to supply information demonstrating that the grantee is capable of managing the funds in accordance with law and has established adequate financial procedures and controls. All financial statements furnished to the state auditor pursuant to this section, and any other audits or other reports prepared by the state auditor, are public records.


  2. State Agency Reports. – A state agency that receives state funds and then disburses the state funds to a grantee must identify the grantee to the state auditor, unless the funds were for the purchase of goods and services. The state agency must submit documents to the state auditor in a prescribed format describing standards of compliance and suggested audit procedures sufficient to give adequate direction to independent auditors performing audits.


  3. Grantee Receipt and Expenditure Reports. – A grantee that receives, uses or expends between $15,000 and $300,000 in state funds, except when the funds are for the purchase of goods or services, must file annually with state agency that disbursed the funds a sworn accounting of receipts and expenditures of the state funds. This Accounting must be attested to by the treasurer of the grantee and one other authorizing officer of the grantee. This accounting must be filed within six (6) months after the end of the grantee’s fiscal year in which the state funds were received. The accounting shall be in the form required by the disbursing agency. Each state agency shall develop a format for these accountings and shall obtain the state auditor’s approval of the format.


  4. Grantee Audit Reports. – A grantee that receives, uses or expends state funds in the Amount of $300,000 or more annually, except when the funds are for the purchase of goods or services, must file annually with the state auditor a financial statement in the form and on the schedule prescribed by the state auditor. The financial statement must be audited in accordance with standards prescribed by the state auditor to assure that state funds are used for the purposes provided by law.


  5. Federal Reporting Requirements. – Federal law may require a grantee to make additional reports with respect to funds for which report are required under this section. Notwithstanding the provisions of this section, a grantee may satisfy the reporting requirements of subsection (c) of this section by submitting a copy of the report required under federal law with respect to the same funds or by submitting a copy of the report described in subsection (d) of this section.


  6. Audit Oversight. – The state auditor has oversight, pursuant to Article 5A of Chapter 147 of the NC General Statues, of every grantee that receives, uses, or expends state funds. Such a grantee must, upon request, furnish to the state auditor for audit all books, records and other information necessary for the state auditor to account fully for the use and expenditure of state funds. The grantee must furnish any additional financial or budgetary information requested by the state auditor.

DHHS Cash Management Plan Responsibilities Matrix Supplement - Sample Forms and Instructions - Attachment 16

 

Instructions for Completion of the DHHS Cash Management Plan Responsibilities Matrix Supplement Forms

 

The Matrix Forms:

There are five (5) matrix sections. A separate Excel spreadsheet is included in this workbook that lists the cash management tasks for each matrix section. The five (5) matrix sections are as follows:

Cash Receipts Matrix

Accounts Receivable /Billing Matrix

Cash Disbursements Matrix

Management of Inventory and Supplies Matrix

Listing of Cash Funds and Credit Cards Matrix

 

DHHS Policy - Who is required to complete the matrix forms:

Since most of the tasks listed in the matrix sections are performed by employees under the supervision of the DHHS Controller' Office, the matrix forms will be completed by the responsible DHHS Controller's Office Sections. Some of cash management tasks listed are performed by DHHS division/facility/school employees. In cases where division institution staff perform any cash management tasks listed in the matrix sections the division/facility/school must complete the applicable matrix sections and forward them to the Chief of the DHHS Controller's Office Account Receivable Section for approval by the Controller and inclusion in the DHHS Cash Management Plan.

 

After the initial completion and submission of the matrix forms to the DHHS Controller's Office, updated matrix forms must be submitted if the position numbers assigned to a cash management task listed in one of the matrix sections changes. The matrix forms must be kept current to avoid audit exceptions. Revised matrix forms are to be submitted to the DHHS Controller's Office Accounts Receivable Section. The following are instructions for completion of each matrix form: Excel 7.0 users can access the instructions on each form by selecting the "view comments" command when a red tab appears in the upper right corner of a spreadsheet cell that contains a heading.

 

 

Cash Receipts Matrix Instructions:

 

1. Enter the position number of the employee who is primarily responsible for performing each task listed in column A in column B on the same line as the task description. Enter the position number of the employee designated to serve as backup to the position number listed in column A in column C on the same line as the task description. Use columns D-I where applicable to list primary and backup position numbers when the task is performed in more than one physical location or organizational sub-unit by different positions.

2. Repeat step 1 for each task listed in column A that is performed by employees of the division/facility/school or other organizational sub-unit this matrix form covers.

 

Accounts Receivable/Billing Matrix Instructions:

1. Enter the position number of the employee who is primarily responsible for performing each task listed in column A in column B on the same line as the task description. Enter the position number of the employee designated to serve as backup to the position number listed in column A in column C on the same line as the task description. Use columns D-I where applicable to list primary and backup position numbers when the task is performed in more than one physical location or organizational sub-unit by different positions.

2. Repeat step 1 for each task listed in column A that is performed by employees of the division/institution or other organizational unit this matrix form covers.

Cash Disbursements Matrix Instructions:

Description: Enter the position number of the employee designated to serve as backup to the position number listed in column A in column C on the same line as the task description. Use columns D-I where applicable to list primary and backup position numbers when the task is performed in more than one (1) physical location or organizational sub-unit by different positions.

 

Repeat step 1 for each task listed in column A that is performed by employees of the division/facility/school or other organizational unit this matrix form covers.

 

Management of Inventory and Supplies Matrix Instructions:

Description: Enter the position number of the employee designated to serve as backup to the position number listed in column A in column C on the same line as the task description. Use columns D-I where applicable to list primary and backup position numbers when the task is performed in more than one (1) physical location or organizational sub unit by different positions.

 

Repeat step 1 for each task listed in column A that is performed by employees of the division/facility/school or other organizational sub-unit this matrix form covers.

 
 

Listing of Cash Funds and Credit Cards Matrix Instructions:

Instructions For Listing All Petty Cash, Change and Revolving Funds:

1. Enter the description and reimbursing budget code/company/center for each petty cash, change or revolving fund on a separate line in column A under the caption, “Listing of All Petty Cash, Change and Revolving Funds”.

 

2. Enter the authorized amount for each fund in column B on the same line with the fund's description.

 

3. Enter the position number of the primary custodian of each fund in column C on the same line with the fund's description. Use columns E, G, and I only if needed to identify multiple locations such as the business office, cafeteria, wards, canteen etc.

 

4. Enter the position number of the employee who serves as backup to the primary fund custodian on the same line with the fund description in column D. Use columns, F, H and J only if needed to identify multiple locations such as the business office, cafeteria, wards, canteen etc.

 

5. Be sure to delete the example line prior to submission of this form.

 

Agency Credit Card Listing Instructions:

1. List the credit card number for each agency credit card in column A under the heading “Listing of Agency Credit Cards”.

 

2. Enter the name of the issuing bank in column B on the same line with the credit card number.

 

3. Enter the position number of the card custodian in the column D on the same line with the credit card number.

 

4. Enter the position number of the employee who serves as backup to the primary fund custodian.

 

5. Be sure to delete the example line prior to submission of this form.

Division/Facility/School:

Location/Unit A

Location/Unit B

Section:

       

Branch:

Primary

Backup

Primary

Backup

Cash Receipts Matrix

Position No

Position No

Position No

Position No

Excel 7.0 users may select 'view/comments'

to view instructions for completion of this form

Mail Receipts

       

Opens Mail

       

Stamps "for deposit only" on checks or warrants

       

Enters checks received on the DHHS Mail Cash Receipts Log

     
         

Desk Receipts

       

Performs cashier functions at each location

       

Prepares the daily cash report for cashier desk receipts

     
         

Depositing Receipts

       

Prepares state treasurer deposit slip

       

Reconciles deposit to mail receipts log and cash report

     

Enters deposit into cash management control system

     
         

NCAS Posting

       

Prepares NCAS coding sheet

       

Reviews/approves NCAS Coding Sheet

       

Enters NCAS Coding Sheet

       

Reconciles the deposit ticket to NCAS and the mail logs and cash

 
         

Other Cash Control Functions

       

Responsible for posting Personal Funds Accounts to HEARTS

     

Responsible for monthly auditing of patient accounts

     

Determines cash needs for each disbursement cycle

     

Determines federal and local share of cash requirements

     

Requests federal cash draws

       

Prepares cash requisition to disbursing account

       

Calculates and records earned revenues in NCAS

       

Balances NCAS cash receipts with each subsystem monthly

     

Monitors federal grant award balances and requests revisions

     

Division/Facility/School:

Location/Unit A

Location/Unit B

Section:

       

Branch:

Primary

Backup

Primary

Backup

Accounts Receivable/Billing Matrix

Position No

Position No

Position No

Position No

Excel 7.0 users may select 'view/comments'

to view instructions for completion of this form

Billing/Notice to Debtor

       

Prepares bills/invoices/debt notifications

       

Sends out dunning notices

       

Notifies counties of amount to be drafted

       

Assures that patients are billed monthly

       

Assures that third party insurance is billed monthly

       
         

Collection Process

       

Computes/charges interest on past due accounts

       

Computes/assesses penalty on past due accounts

       

Prepares 30, 60, and 90 day past due letters

       

Refers accounts to AG or collection agencies

       

Responsible for debt set off actions on accounts

       

Follows up denied insurance claims

       
         

Reports

       

Prepares quarterly OSC report on A/R's

       

Prepares AG collection agency report

       
         
         

Other Accounts Receivable/Billing Functions

       

Prepares monthly write-off list for submission to DHHS Controller

     

Approves write-off of past due accounts for division/facility/school

     

Posts approved write-offs to account receivable

       

Prepares/updates debt set-off list for submission to DOR

       

Processes debt set-off collections

       

Authorizes debt set-off refunds for payment

       

Authorizes other refund of receipts for payment

       

Authorizes patient deferred repayment plans for institution

       

Authorizes compromise of account balance in excess of ATP

       

Authorizes provider deferred repayment plans for DMA

       

Authorizes recipient deferred repayment plans for DMA

       

Authorizes audit disallowance deferred repayment plans

       

Reviews credit balance accounts monthly

       

Prepares certified statements of account for MH/MR/SAS

       
         

Division/Facility/School:

Location/Unit A

Location/Unit B

Section:

       

Branch:

Primary

Backup

Primary

Backup

Cash Disbursements Matrix

Position No

Position No

Position No

Position No

Excel 7.0 users may select 'view/comments'

to view instructions for completion of this form

 

Pre-Audit of Disbursements Tasks

       

Receives vendor invoices and supporting documentation

       

Performs Pre-Audit of invoice for correct payee, math accuracy,

       

matches invoice price and quantity to POs and verifies items ordered

     

have been received per receiving reports and packing slips

       

Responsible for noting partial shipments on POs (done on-line in

       

NCAS)

       

Verifies company/account center coding on PO

       

Responsible for ensuring that utility services invoices have been

       

reviewed and approved for payment by management outside

       

the DHHS Controller's Office in accordance with an official delegations

       

of approval authority

       

Responsible for ensuring that debit memorandums are used to

       

charge vendors for shortages, defective materials, etc.,

       

and approved by supervisory staff

       

Responsible for ensuring that constructions contract payments are

     

approved by the DHHS Budget Officer, retainages are correct and %

       

of completions is certified by the managing engineer or architect

       

Responsible for ensuring that original invoices are utilized for

       

processing payments and to support the payment files

       

Responsible for pre audit of travel according to the CMP

       

Responsible for pre audit of service contracts according to the CMP

     

Responsible for pre audit of capital project payments according to the CMP

     

Responsible for pre audit of financial assistance reimbursement requests

     

Responsible for pre audit of other non-PO invoices according to CMP

     
         

NCAS

       

Prepares coding and/or batching of vouchers for payment:

       

Processes employee travel reimbursements

       

Processes purchase of services contracts payment requests

     

Processes financial assistance reimbursement requests

       

Processes purchase order invoices for payment

       

Processes rent, utilities and other invoices for payment

       

Processes capital project payment requests

       

Reviews control group status on NCAS daily for balanced

       

batches to ensure invoices vs. keyed information matches.

       
         

Check Preparation/Control

       

Reviews Control Group Status on NCAS daily for balanced batches

     

to ensure invoices vs. keyed information matches

       

Controls access to the blank check stock and pre-print check stock

     

Cancels a previously written check

       

Authority to re-issue a previously canceled check

       

Controls the signature cartridge

       

Responsible for signing of checks

       

Responsible for storing signed, unmailed checks in secure location

     

Responsible for ensuring that voided checks are kept, filed and-

       

signatures are mutilated

       

Performs NCAS check printer audit function and reviews

       

Appropriateness of manual checks written

       
         
         

Other Cash Disbursement Functions

       

Responsible for preparation of the quarterly sales tax report

       

Responsible for ensuring that cost centers are charged only for

       

allowable benefiting, direct and indirect costs specifically

       

related to the program activity

       

Responsible for ensuring that interfund and interbank account

       

transfers are approved by authorized management employees

       

outside the accounts payable and cash disbursing section on

       

forms designed for this purpose

       

Responsible for audit of petty cash fund(s)

       

Responsible for audit of change fund(s)

       

Insures that cost charged to federal programs are allowable

       

Balances NCAS cash disbursements with subsystems monthly

       

Responsible for month end closing, balancing and certification

       

Division/Facility/School:

Location/Unit A

Location/Unit B

Section:

       

Branch:

Primary

Backup

Primary

Backup

Management of Inventory and Supplies Matrix

Position No

Position No

Position No

Position No

Responsible for verifying with the DHHS Budget Officer

       

that sufficient funds are available for available

       

for purchase orders or contracts to be issued

       

Responsible for entering purchase order and

       

contract encumberances in NCAS

       

Responsible for resolving NCAS budget

       

exceptions

       

Responsible for verifying incoming shipments of

       

equipment and supplies against the NCAS receiving copy of the

       

purchase order and entering items received in NCAS

       
         

Inventory of Supplies

       

Responsible as custodian of each inventory stock:

       

      Warehouse

       

      Pharmacy

       

      Dietary

       

      Housekeeping

       

      Medical Supplies

       

      Office supplies

       

      Fuel

       

      Tickets

       

      Other – List

       

Responsible for the annual inventory of supplies

       
     

Fixed Assets Inventory:

       

Responsible for the reconciliation of the FAS records to the NCAS

     

on a monthly basis

       

Responsible for assuring that all fixed asset transactions are properly

     

entered in the fixed asset system

       

Responsible for conducting the annual inventory of fixed assets, and

     

coordinates the physical inventory with the

     

DHHS Controller's Office designated FAS employee

       

Division/Facility/School:

 

Location/Unit A

Location/Unit B

Section:

Cash

       

Branch:

Fund

Primary

Backup

Primary

Backup

Listing of Cash Funds and Credit Cards Matrix

Amount

Position No

Position No

Position No

Position No

Excel 7.0 users may select 'view/comments'

to view instructions for completion of this form

   
           

List All Petty Cash, Change and Revolving Funds:

         

Example:

         

JUH Petty Cash Fund - BC XXXXX/ Company/Account/Center

10,000

20-9901

20-9902

   
           
           
           
           
           
           
           
           
           
           
           
           

Enter the following information for each agency credit card:

         
     

Custodian

Position

 

Credit Card Number

Bank Name

Card Type

Name

Number

 

Example:

         

XXXX-XXXX-XXXX-XXXX

Wachovia

VISA

Jane Doe

209901

 
           
           
           
           
           
           
           
           
           
           
           

For questions or clarification on any of the information contained in this policy, please contact The Office of the Controller. For general questions about department-wide policies and procedures, contact the DHHS Policy Coordinator.

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