LEA Ad-Hoc Advisory Workgroup Publishes April 2018 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 April 4, 2018 meeting minutes include: OIG (the federal Office of Inspector General) is auditing the LEA Billing...

DHCS Rolls Out New Authorization Requirements for the LEA Billing Program

On June 1, 2018, DHCS released their long-awaited new policy which will require all practitioners who order, refer, or prescribe (ORP) treatment services billed under the LEA Billing program to obtain a National Provider Identification (NPI) number and be separately enrolled in Medi-Cal. Effective for all dates of service on July 1, 2018 and later, PPL 18-018 includes additional details about...

Federal Audit of New Jersey School-Based Medicaid Programs Seeks $300M in Paybacks

The federal Office of Inspector General (OIG) released audit findings of New Jersey's school-based Medicaid programs in which they request the state refund over $300 million. Specifically, OIG determined: PCG, the state's contractor, improperly altered school employees’ responses to timestudies to indicate that their activities were directly related to providing Medicaid services when...

UPDATED: DHCS Clarifies Position, Expressly Allows OT & PT Treatment Services Prescribed by LEA-Contracted Physicians

**Update as of October 2, 2017** Since this post was originally published, DHCS has extended the 6-month renewal requirement to an annual renewal requirement for OT and PT prescriptions. The announcement was made in an email from DHCS to LEAs on September 27, 2017, stating: "On August 24, 2017, DHCS sent the above policy update, with an additional requirement that prescriptions for PT/OT...

New Laws Impacting California’s School Medicaid Programs

Throughout the year, Paradigm tracks various state bills that have the potential to impact California's school-based Medicaid programs and publishes a summary of those that have been signed into law and those that failed to make the cut. Click here to download our School Medicaid Report: 2015/16 Legislative Review & Program Impact....

OIG Publishes New State Audits of School-Based Medicaid Programs

The federal Office of Inspector General (OIG) has published new audit reports of school-based administrative and health services programs in North Carolina and Michigan. Random Moment Time Sampling (RMTS) continues to be a focus of OIG school-based program audits but the impact of these findings vary from state to state, as they do in the two reports released earlier this month. Concerns have...

Governor Vetoes Senate Bill 123, SMAA Program Improvements

Governor Jerry Brown has vetoed Senate Bill 123, a bill authored by Senator Carol Liu to legislate recommendations by the State Auditor aimed at improving California's school-based Medi-Cal Administrative Activities (SMAA) program. Senator Liu's office has expressed disappointment but also noted that the hard work to improve California's SMAA program, and the students and families who benefit...

RMTS for LEA Billing — Implementation Advisory Group Publishes September Meeting Summary

The Implementation Advisory Group (IAG) has published minutes from their September 13, 2016 meeting, which included a review of the draft State Plan Amendment and RMTS-related training slides for the Fall LEA Program training, scheduled for October 13, 2016. If you are not yet registered for the upcoming DHCS Fall LEA Program training, which will be hosted via web conferencing, click here...

RMTS for LEA Billing — Implementation Advisory Group Publishes August Meeting Summary

The Implementation Advisory Group (IAG) provided the following updates from their August 9, 2016 meeting: Workgroup members are testing the draft CRCS and related instructions; two LEA members will be using their own data to provide detailed feedback to DHCS on edits and other suggestions. The draft CRCS is in the final stages of testing and the IAG expects to submit this to CMS in the...

OIG Publishes Report on Alabama’s School-Based MAC Program

The federal Office of Inspector General (OIG), an agency charged with reviewing more than 100 Health and Human Services programs, has published a report on Alabama's School-Based Medicaid Administrative Claiming program. OIG is recommending that Alabama return all federal reimbursements received for the 2010-2012 fiscal years, $75.3 million, predominantly because the state did not have an...