Third Party Liability in Medicaid

Summary The Medicaid program by law is intended to be the payer of last resort for health services to individuals with dual insurance coverage. A 2006 G.A.O. report cites that this population represents approximately 13% of Medicaid recipients at any given time during the year. Medicaid requirements for billing services to this population can block otherwise eligible reimbursements for school…

California’s Healthy Families Program Transition – Closed in September 2013

Summary In January of 2013, California began a year-long transition of more than 800,000 children from the Healthy Families program to the Medi-Cal program. Issue Analysis Each of the four transition phases, which group the roughly 860,000 current Healthy Families beneficiaries by plan type and region, is contingent on federal approval to ensure continuity of care and other quality and…

“Always gets your mind working…”

March 26, 2013 – San Francisco, CA – Paradigm hosts its Coordinator Conferences throughout the state on an annual basis to energize clients and provide program coordinators, administrators, and fiscal coordinators with a renewed grasp on their Medi-Cal billing programs. Attendees are exposed to new data and information that helps them achieve and maintain compliance with Medi-Cal program rules…

Welcomed, Positive Resolutions After Years of Advocacy

It is said that slow and steady wins the race. This adage proved true for longstanding efforts aimed at resolving two issues that had limited the overall Medicaid reimbursement potential for schools in California. March 25, 2013 – San Francisco, CA – The turn of the New Year has been nothing short of encouraging for those who dedicate their time, resources, and careers to school Medicaid…

Final Judgment Issued in California Lawsuit Regarding Reimbursement for Free Care Services

On February 11, 2013, the San Francisco Superior Court (“the Court”) issued a final judgment in the lawsuit brought against the California Department of Health Care Services (DHCS) by the San Francisco Unified School District (SFUSD) regarding reimbursement for so-called free care services. The judgment was issued in favor of SFUSD and stipulates that the district is entitled to reimbursement for…

U.S. Department of Education Publishes New Regulations Easing Burden of Parental Consent Requirements for Schools

On Thursday, February 14, 2013, the U.S. Department of Education (DOE) published final regulations that amend parental consent requirements under Part B of the Individuals with Disabilities Education Act (IDEA). This change signals greater access to Medicaid reimbursements for eligible special education health services provided by schools across the nation. Effective March 18, 2013, the new…

Parental Consent Under IDEA

Summary New federal regulations dictating parental consent requirements under the Individuals with Disabilities Education Act (IDEA) were issued in February of 2013, providing greater access to reimbursement for special education health services provided by schools. Previously, regulations for parental consent under 34 CFR § 300.154(d) (iv) (A) had stated that a school must obtain consent each…

Assessing Audit Compliance in a RMTS Program

This policy brief provides a summary of findings from recent school Medicaid program audits by the federal Office of Inspector General (OIG) in states using the random moment time study (RMTS) method.   Policy Brief_Assessing Audit Compliance RMTS Feb 2013