Federal Audits Planned for California’s School-Based MAA Program

Sacramento, CA – December 14, 2011 – The Centers for Medicare and Medicaid Services (CMS) recently notified California’s Department of Health Care Services (DHCS) of a planned audit and review of the School-Based Medi-Cal Administrative Activities (SMAA) claiming program.

As a condition of participating in school-based Medicaid claiming programs, Local Education Agencies (LEAs) are subject to review by the federal oversight agency The Centers for Medicare and Medicaid Services (CMS). Most commonly these reviews and audits are conducted by performing either (1) a thorough on-site audit of the program or (2) a desk review of paid claims.

Recently CMS notified DHCS of its plan to perform a review or audit of selected California school-based MAA claiming units for at least one quarter of the 2009–2010 fiscal year. DHCS has reported to the Local Educational Consortiums (LECs) and Local Governmental Agencies (LGAs) that only a handful of claiming units will be selected for an on-site audit during this process. As a Paradigm client, you would have already received notification from Paradigm if your claiming unit had been selected.

The pending review and CMS’s presence serve as a good reminder to all California LEAs that compliance with program regulations, guidelines, and best practices is paramount. California’s school-based program has not been audited by CMS since 2003, and it was shortly after that time that the program underwent a major change in its time study method. Coincidentally, DHCS is again considering process changes in the SMAA program due to high levels of interest from LEAs in the Random Moment Time Study (RMTS) option that LAUSD has been allowed to implement.

We at Paradigm are confident that our clients’ programs, if selected, will be found to be compliant with the letter and intent of the SMAA program. This was the outcome for our clients during the last federal review in 2003, and we anticipate that the results of this review will be no different. If selected for this review, Paradigm clients can expect the same exemplary support that we provide for all state and county reviews.

We will post ongoing updates as the details of CMS’s review of California’s SMAA program continue to unfold. Feel free to contact Paradigm via email or phone, (888) 536-0920, with any questions.

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