August 24, 2017
DHCS Clarifies Position, Expressly Allows OT & PT Treatment Services Prescribed by LEA-Contracted Physicians
Big news for California LEAs who have been waiting for clarification from the Department of Health Care Services (DHCS) regarding Occupational Therapy (OT) and Physical Therapy (PT) treatment services prescribed by LEA-employed or contracted physicians.
In an email sent to program stakeholders on August 24, DHCS makes clear that prescriptions for OT and PT treatment services may come from...
August 23, 2017
DHCS Issues Clarification on Coordination of Care with Managed Care Plans
California's Department of Health Care Services (DHCS) has issued clarification on a previous email regarding protocols for LEAs coordinating care with Managed Care Plans (MCPs). The original email, sent on August 9, had raised questions about what appeared to be new coordination requirements.
In a clarification email sent on August 18, DHCS underscored that there is no new policy and their...
August 22, 2017
RMTS for LEA Billing — Implementation Advisory Group Publishes August Meeting Summary
The Implementation Advisory Group (IAG) has published minutes from their August 1, 2017 meeting. Of interest:
DHCS gave a brief update on SPA 15-021, noting that on June 9th CMS asked several additional Requests for Information (RAIs). The Department noted that the RAI responses are undergoing final management review before they will be submitted to CMS. In addition, the LEA RMTS...
August 21, 2017
California Announces New System for Obtaining Student Medi-Cal Eligibility Information
DHCS has notified California LEAs and their billing partners that a new system, known as MOVEit, will be used moving forward for transmitting all Medi-Cal eligibility information (i.e. the data tape match) for the LEA Billing Option program. The MOVEit system was launched last year and is currently utilized by select LECs and LGAs for the SMAA program.
All LEAs and billing vendors are required...
August 9, 2017
LEA Ad-Hoc Advisory Workgroup Publishes June 2017 Meeting Minutes
The LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE), held their regularly scheduled meeting to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program.
Highlights from the June 7, 2017 meeting include:
In April 2017, DHCS posted the finalized Annual Accounting of Funds Summary Report...
August 8, 2017
CMS Announces Medicaid and School-Based Health Services Affinity Group
The federal Centers for Medicare & Medicaid Services (CMS) has announced the development of a new group for state Medicaid agencies interested in "partnering with schools and public health to improve access to and the delivery of important preventative health services for children and adolescents."
Officially called the Medicaid and School-Based Health Services Delivery Affinity Group, this...
August 3, 2017
DHCS Releases Vendor Fee Worksheets for Backcasting & RMTS Invoices
The Vendor Fee Worksheet (VFW), a new mechanism by which DHCS will ensure that LEAs can only claim (i.e. be reimbursed) for up to 15% of their total invoice amount in vendor fees, was released on August 2 after a months-long revision process by DHCS.
This form was required to complete the first round of backcasted invoices from the SMAA deferral, as well as annually for RMTS claims starting...
July 27, 2017
Senate Rejects Slimmed-Down Obamacare Repeal as McCain Votes No
"WASHINGTON — The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump.
Senator John McCain of Arizona, who just this week returned to the Senate...
July 15, 2017
OT/PT Service Billing Impacted by Change to California Children’s Services Program
California's 2017-18 state budget, which went into effect on July 1, 2017, included $1.6 million for nonmedically necessary OT and PT services to the California Children's Services (CCS) Medical Therapy program.
While CCS was previously required to provide OT and PT services that the agency determined were medically necessary for CCS-eligible children, these sometimes only included a fraction...
June 23, 2017
To Protect Children, Senate Republicans Must Drop Medicaid Per Capita Cap
"The Senate Republican health bill, like the House-passed bill, would convert Medicaid to a per capita cap, but it would cut Medicaid even more deeply and pose an even greater threat to coverage for all Medicaid beneficiaries — including children..."
Read the full article: CBPP, June 23, 2017, To Protect Children, Senate Republicans Must Drop Medicaid Per Capita Cap | Center on Budget and...