CMS Notifies California DHCS of School MAA Claims Deferral, Requires New Plan for FY 2012/13

On June 26, 2012, the federal Centers for Medicare and Medicaid Services (CMS) notified California’s Department of Health Care Services (DHCS) that payment for pending school Medi-Cal Administrative Activities (MAA) invoices would be deferred pending additional documentation. According to CMS’ letter, DHCS must demonstrate that claims comply with all federal requirements. The letter also included language directing the state to submit a revised time survey methodology and state plan for FY 2012/13.

The announcement by CMS to defer school MAA payments and require a new survey methodology and state plan in California comes on the heels of a recent audit of the state’s school MAA program. Although audit findings have not yet been published, the forthcoming final report is expected to shed light on the specific programmatic concerns of CMS. DHCS has reported that over the coming weeks and months, the state will be meeting with CMS and local regional agencies to discuss two primary issues associated with maintaining the school MAA program:

  1. an appropriate review and approval process for outstanding FY 2010/11 and 2011/12 invoices, including procedural details and timelines.
  2. the new time survey methodology and state plan for implementation beginning in FY 2012/13.

We will continue to post information and updates released by DHCS on this issue to the Industry News section of the Policy Center. Paradigm clients should refer to regular email communications for operational guidance and additional details on this evolving situation.

Read More

Read the CMS letter to DHCS…

Read more about CMS’ audit of California’s school MAA program…