Highlights from LEA Ad-Hoc Advisory Workgroup June 2019 Meeting

On June 5, 2019, the California Department of Health Care Services (DHCS) held a meeting for the LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE); the meeting is held to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program. Highlights from the June meeting include: Erroneous Paid...

LEA Ad-Hoc Advisory Workgroup Publishes February 2019 Meeting Minutes

On June 11, 2019, DHCS posted February 6, 2019, meeting minutes for the LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE); the meeting is held to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program. Highlights from the February meeting included: Effective January 1, 2019, CPT Code...

SMAA Workgroup Publishes May 2019 Meeting Notes

The SMAA Workgroup posted the meeting notes from their May 1, 2019, SMAA Workgroup Meeting; highlights from that meeting include: Draft PPL 19-XXX, RMTS Sample Period—Continued the discussion from their April 17 meeting specifically regarding adjusting quarter four to accommodate the four day response period, see below: DHCS confirmed that reducing the quarter 4 sample period by 4...

DHCS’ Provider Enrollment Division (PED) Updates Ordering, Referring, and Prescribing (ORP) Provider Enrollment Rules

DHCS has confirmed that their Provider Enrollment Division (PED) has updated enrollment rules to ensure applications from registered, credentialed school nurses (RCSNs) and licensed educational psychologists (LEPs) will no longer be denied. Effectively immediately, LEP and RCSN providers may re-submit applications to enroll as Medi-Cal ORP providers in order to comply with the LEA Program’s...

SMAA Workgroup Publishes April 2019 Meeting Notes

The SMAA Workgroup posted the meeting notes from their April 17, 2019, SMAA Workgroup Meeting; highlights from that meeting include: Draft PPL 19-XXX, RMTS Sample Period—Addressing submitted stakeholder comments and questions Moments assigned for the last minute of a shift; currently, the system may create a moment that begins the minute a shift ends (e.g., shifts ending at 5:00 pm may...

LEA Ad-Hoc Advisory Workgroup Publishes August 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 August 1, 2018 meeting minutes include: The Annual Report for FY 2017/18 has been posted to the DHCS website. No...

LEA Ad-Hoc Advisory Workgroup Publishes June 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 June 6, 2018 meeting minutes include: All LEA's Data Use Agreements (DUA) with DHCS are set to expire December 1,...

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...