LEA Ad-Hoc Advisory Workgroup Publishes June 2016 Meeting Minutes

The LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE), held their regularly scheduled meeting to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program.

Highlights from the June 1, 2016 meeting include:

  • Review of Senate Bill 123, which would have a limited impact on the LEA Medi-Cal Billing Option Program, by CDE staff.
  • Status report on recent and forthcoming changes to the LEA Provider Manual. Forthcoming changes include the removal of references to the Free Care and Other Health Coverage (OHC) denial policies. These sections are currently under DHCS management review and the Department hopes to have these published soon and effective for the 2016-17 fiscal year.
  • DHCS is verifying Xerox data to compile data needed to calculate the Fair Share reimbursement or collection for each LEA for FY 2013-14.
  • Results were presented from an informal survey of LEAs regarding OHC and Explanation of Benefits (EOBs) received by some parents after their private insurance was billed by DHCS’ recovery vendor for health services claimed by the school district under the LEA Medi-Cal Billing Option program. Meeting attendees requested a letter from DHCS to address the issue and related concerns around potential impact to FAPE and parental consent requirements (note: DHCS released PPL 16-012 on Third Party Liability Recoupment Requirements, on July 1, 2016)
  • A workgroup member asked if LEAs will be allowed to bill for new services, such as personal care, retroactive to the SPA effective date of 7/1/15. DHCS indicated that this may be a possibility, depending on the outcome of its implementation timeline discussions with CMS. The Department’s guidance to LEAs is to continue the status quo with an emphasis on compliance. LEAs should be documenting medical services provided to all children, including students without an IEP/IFSP, as required by law and in accordance with professional standards.
  • DHCS committed to creating new LEA Program FAQs based on answers to documentation questions presented over the previous few meetings by the Medical Review Branch of Audits & Investigations.

At the time of posting, the August 10, 2016 Ad-Hoc meeting has already taken place. Notes on this meeting should be published by DHCS in the coming weeks.

For information on attending the next meeting, LEAs should contact the LEA Inbox at LEA@dhcs.ca.gov.

Past LEA Ad-Hoc Advisory Workgroup meeting minutes are archived on the DHCS website.