June Medi-Cal Bulletin for LEAs Posted – Updated Withhold Percentage & OT/PT Benefits Update

The June Medi-Cal Bulletin for LEAs has been published to the DHCS website. Two items of interest include: Effective for dates of service on or after July 1, 2018, the 1.5 percent withhold levied against Local Educational Agency (LEA) reimbursements, which covers audit administration and associated audit costs, is increased to 2 percent. The 1 percent administrative withhold for claims...

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...

LEA Ad-Hoc Advisory Workgroup Publishes February 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 February 7, 2018 meeting minutes include: A confirmation that when RMTS rolls into the LEA Billing program, Code...

LEA Ad-Hoc Advisory Workgroup Publishes August 2017 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 2, 2017 meeting include: Dr. Lindy Summers-Bair of the Medical Review Branch retired as of July 31, 2017....

November Medi-Cal Bulletin for LEAs Posted—RTD Generation Phasing Out Over Next 12 Months

The November Medi-Cal Bulletin for California LEAs has been published to the DHCS website. One item of interest is the announcement that DHCS will be discontinuing the generation of Resubmission Turnaround Documents (RTDs) over the next 12 months. The discontinuation will happen in multiple phases, with a timeline to be published in a future monthly bulletin. DHCS notes, "the new process...

Register by November 22 for Next LEA Advisory Workgroup Meeting

LEAs interested in attending the bi-monthly LEA Advisory Workgroup meeting (also known as the 'LEA Ad-Hoc Meeting') should RSVP to Cheryl Ward at DHCS by Wednesday, November 22, 2017. The meeting will take place on December 13, 2017 from 10:30 a.m. - 3:30 p.m. at Natomas Unified School District in the Staff Development Room, 1931 Arena Boulevard, in Sacramento. Previous meeting notes and...

New Resource for LEAs & Parents Regarding EOBs for School Health Services

DHCS has published a one-page informational that LEAs can share with parents regarding private insurance, explanation of benefits (EOB) statement for school health services, and impact to public benefits. When a child has both Medi-Cal and Other Health Coverage (OHC) through private insurance, and a school is billing Medi-Cal for eligible health services provided to that student under the LEA...

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...

2017 California Legislation: What Passed & What Didn’t

In September, several bills with possible implications for school health programs under consideration by the California Legislature were either suspended or passed and signed into law by the Governor.  Two bills with direct implications for the SMAA and LEA Billing programs, AB 834 and AB 481, both failed to pass out of committee. Read on for a brief summary of what passed, what didn't, and...

Save the Date: SMAA RMTS Coder Training

The California Department of Health Care Services (DHCS) has announced their annual SMAA RMTS Coder Training webinar which will be open to all program coordinators and stakeholders. Date: Thursday, October  12, 2017 Time: 1:30-3:00pm PST Location: this training will be hosted online via webinar Click here to register