DHCS Posts Training Slides and FAQs for Their LEA Medi-Cal Billing Program SPA 15-021 Implementation Training

DHCS held a State Plan Amendment (SPA) 15-021 implementation training in Southern California on April 22, 2019, and in Northern California on May 9, 2019. At the training, they confirmed that SPA 15-021 had not yet been approved by CMS and so all the training was pending that approval. On June 10, 2019, they posted the PowerPoint slides and FAQs.

See below for a recap of some of the highlights from those training sessions.

DHCS confirmed what Paradigm has been sharing with you, that the SPA (upon CMS approval) consists of 3 program changes:

  • Expansion of covered services and allowable provider types
  • Expansion to include billing for Medi-Cal eligible general education students
  • Incorporation of RMTS for the LEA Billing program

As a reminder, there are additional services and provider types that will now be covered.

The newly covered services will be:

  • Activities of Daily Living (ADL)
  • Group Occupational and Physical Therapy treatments
  • Orientation & Mobility services
  • Respiratory Therapy services
  • Nutritional Counseling services

The new provider types will be:

  • Speech-Language Pathology Assistant (SLPA)
  • Certified Occupational Therapy Assistant (COTA)
  • Physical Therapy Assistant (PTA)
  • Registered Associate Social Worker
  • Associate Marriage & Family Therapist
  • Orientation & Mobility Specialist
  • Registered Dietitian
  • Respiratory Therapist
  • Physician Assistant

General Education. The expansion of billing to include general education Medi-Cal students will require that students’ treatments be on a “Care Plan,” which DHCS says can have the common names of Individualized Health and Support Plan (IHSP), Nursing Plan, 504, or Plan of Care developed by the Registered Credentialed School Nurse or qualified medical practitioner within the scope of practice. In addition, DHCS confirmed that hearing and vision screenings conducted on the periodicity schedule and mandated screenings will be billable.  It is important to note that all current audit requirements, such as ORP authorizations, service notes, etc., will be applied to all the new services, new practitioners and general education billing.

Targeted Case Management (TCM). You may recall that TCM billing has been suspended in the LEA Program since July 1, 2015. TCM will be reinstated in the SPA as a covered service.

RMTS for the LEA Billing Program. DHCS confirmed that they have requested an extension of the implementation date until July 1, 2020, instead of July 2019. DHCS said there will be an Addendum to the Provider Participation Agreement (PPA) addressing the RMTS integration published and due back November 30, 2019. This integration means that all your LEA providers will need to be on your Time Survey Participant (TSP) list to bill through the LEA Billing program and that the direct service percentage from RMTS will be used on the CRCS. The effect to the CRCS is that CRCS’s will have to be backcast from FY 2015/16 CRCS forward and will include any retroactive billing and any transportation billing during those years. The CRCS will also move from the due date of November 30th after the close of the fiscal year to March 1st most likely to start in 2021.

A few exciting pieces DHCS confirmed at the training were:

  • Physician authorizations will be allowed by physicians contracted by the LEA without a requirement to personally evaluate the student, but with a working relationship with the LEA and the treating practitioner and require the physician to review the student’s records prior to authorizing services.
  • Physician Assistants and Nurse Practitioners (working under a supervising physician per standard) will be able to authorize treatments.

Paradigm will continue to provide updates regarding the approval of the SPA 15-021 and implementation as they become available.