California Submits Backcasting Proposal to CMS

DHCS has moved forward with plans to implement a backcasting method for deferred claims after failing gain CMS approval for an alternate settlement to the deferral which would have avoided backcasting all together and paid claims based on a flat percentage.

On April 1, DHCS submitted their backcasting proposal to CMS. Before this process can be finalized, CMS must approve all details of the plan. In a nutshell, the state’s proposal would require LEAs to use RMTS MAA time (a regional average based on four quarters of claiming data from your LEC/LGA or Consortia) and apply this to your old worker log costs — adjusted to remove an unauthorized job classifications or excessive vendor fees — for each quarter being backcast.

Several stakeholders, including Paradigm, worked to persuade the state to include a component that would address the differences in how eligible costs are determined under worker log and RMTS — a technicality that may unfairly penalize LEAs during the backcasting process. Since there were far more restrictions on what qualified as an eligible worker log cost, these tend to be much lower than eligible costs under RMTS. While conversations are still ongoing, no such accommodation for this technicality was included DHCS’ current backcasting proposal.

There is no deadline on negotiations on the final backcasting process, which may take some time given that backasting wouldn’t be slated to start until sometime in late 2016 or early 2017.