The history of Paradigm Healthcare Services is entwined with the development, implementation, and evolution of school and county based Medicaid reimbursement programs.

  • 1965

    Medicaid program is signed into law, Title XIX of the Social Security Act (SSA).

  • 1967

    The Early and Periodic Screening and Diagnostic Treatment Benefit (EPSDT) is added to Medicaid law, requiring provision of comprehensive and preventive health care for children.

  • 1988

    Section 1903(c) of the SSA is amended to permit Medicaid payment for IDEA medical services provided to school children; this is a result of the Medicare Catastrophic Coverage Act of 1988.

  • 1993

    The Direct Service Billing program is initiated in the state of California; this program is also referred to in California as the Local Educational Agency (LEA) Medi-Cal Billing Option program.

  • 1993

    Paradigm works with the San Diego Unified School District and the California Department of Health Care Services (DHCS) pilot program to establish its operations for the Direct Service Billing program.

  • 1994

    The first Medicaid payment for the Direct Service Billing program is issued in the state of California.

  • 1998

    The Medicaid Administrative Claiming (MAC) program is re-implemented in the state of California after undergoing regulatory improvements; among others, this results in new programs for school-based MAC and county-based MAC.

  • 1998

    Paradigm is the first vendor to submit a school-based MAC claim in California; this program is also referred to in California as the School-Based Medi-Cal Administrative Activities (SMAA or SBMAA) program.

  • 2000

    In response to the changing needs of LEAs, Paradigm begins development on what is known today as SHN™. SHN™ is a web-based direct service and case management tool that currently manages over 125,000 records daily.

  • 2003

    California’s MAC program undergoes a significant change as the time survey methodology is converted from an annual one-month worker log to a quarterly one-week worker log.

  • 2003

    Paradigm quickly adapts to changes in the MAC program by introducing the first web-based software for administering the MAC program in California schools: MAA Gateway™.

  • 2004

    Paradigm assists California’s Lead Regional Agency Committee in developing the MAC invoice template for the quarterly one-week worker log.

  • 2006

    A new State Plan Amendment (SPA) is implemented for California’s Direct Service Billing program, SPA 03-024; among several notable changes to the Direct Service Billing Program is a transition to Certified Public Expenditure (CPE) program via a new requirement known as Cost Reconciliation.  Paradigm is the only vendor to continue to seamlessly bill for our clients during the transition.

  • 2007

    The Centers for Medicare and Medicaid Services (CMS) publish Rule CMS 2287 on December 28, calling for the elimination of all reimbursement for school-based Medicaid administrative activities and transportation through the Direct Service Billing programs.

  • 2008

    Paradigm, along with the support of our clients, works with a host of national organizations to ensure CMS 2287 is not implemented; as part of our contribution to this advocacy campaign, Paradigm authors and disseminates information to state and federal legislators on the importance of school-based Medicaid programs. Late in 2008, after receiving harsh criticism, the implementation of CMS 2287 is postponed until July 1, 2009.

  • 2009

    Director of Health and Human Services (HHS) rescinds CMS 2287 in its entirety on orders from the Obama administration, allowing school-based Medicaid administrative claiming and transportation to remain intact across the nation.

  • 2009

    Paradigm creates a Policy and Research Division on the heels of the CMS 2287 advocacy work and successful rescission; the Policy Division is founded on providing clear, detailed, and frequent analysis on the issues that stand to impact school- and county-based Medicaid programs, the results of which are made publicly available through our Policy Center.

  • 2011

    Paradigm assists California’s Lead Regional Agency Committee in an evaluation of the Random Moment Time Study (RMTS) method for California’s MAC program; this includes engaging members in a pilot of our MAA Gateway RMTS technology.

  • 2012

    CMS releases the first California school MAC claiming units from deferral in October, both Paradigm clients, following approval of their certification documents.

  • 2012

    In June, the Centers for Medicare and Medicaid Services (CMS) asked the state of California to re-evaluate and certify unpaid school Medicaid Administrative Claiming (MAC) claims and to change the claiming methodology used for the reimbursement program. As a result, the payment of approximately $66 million in California school MAC claims (statewide) was deferred. CMS subsequently approved interim claiming with a weekly survey for each quarter of 2012/13.