California Quietly Rolls Out School Medicaid Billing for Non-IEP/IFSP Students

Following the December 2014 repeal of the federal Free Care rule, this week the Department of Health Care Services (DHCS) published an updated Provider Manual for the LEA Medi-Cal Billing Option program which removes references to the prohibitive Free Care rule.

This update technically clears the way for public schools in California to begin billing for certain health services, including those provided under Section 504 plans, that are provided to their non-IEP/IFSP general education Medi-Cal student population.

While this is a momentous occasion, some school districts may choose to delay implementing non-IEP service billing until DHCS releases additional compliance information, including parental consent and notification requirements and documentation of medical necessity.

Additionally, until the current State Plan Amendment (SPA) for the LEA Billing program is approved by the federal Center for Medicare and Medicaid Services (CMS), there remains a 24 service limitation for billing non-IEP/IFSP health services. The SPA proposes eliminating this billing cap which will be the last hurdle for a full implementation of school health Medicaid billing in California for all students.

More information is expected at DHCS’ upcoming LEA Billing Fall Training, taking place on October 13, 2016.