CMS Has Approved California State Plan Amendment 15-021

On April 28, 2020, CMS released an approval document written to DHCS confirming their approval of State Plan Amendment (SPA) 15-021 with an effective date of July 15, 2020. DHCS has yet to issue a formal announcement to LEAs, however the assumption is that implementation is still on track for July 1, 2020. A copy of the SPA package and approval letter can be found here: CMS Approval…

Telehealth & LEA School-Based Services, An Open Letter

In response to the COVID-19 outbreak, Local Educational Agencies (LEAs) need immediate telehealth policy accommodations to continue providing and receiving funding for certain health services provided to children with disabilities. Paradigm has researched the current rules and policies as well as the current flexibilities being put in place as a response to coronavirus campus closures. Paradigm's…

Pending CMS Guidance on Medicaid Block Grants: Executive Overreach Strikes Again—Center for Children and Families

It has been reported that CMS is developing guidance to encourage states to pursue a new “block grant” or “per capita” cap on federal Medicaid funding through Section 1115 waiver requests. And sure enough, this “Dear State Medicaid Director” letter has appeared on the Office of Management and Budget’s website signaling that it is under review by the White House. For a President and his…

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 student…

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…

CMS Rejects California’s Alternative SMAA Deferral Proposal

In a letter received by the California Department of Health Care Services (DHCS) on March 16, 2015, the federal Center for Medicare and Medicaid Services (CMS) rejected the state's most recent proposal to end the school MAA deferral with final settlement payments to schools and no backcasting requirement for past claims. CMS also asked that DHCS submit a backcasting proposal for their review by…

Huge Win for School Medicaid Programs as CMS Changes Restrictive Free Care Policy

The federal Centers for Medicare and Medicare Services (CMS) has issued a letter to all State Medicaid Directors withdrawing their prior guidance on the free care policy, Medicaid Payment for Services Provided without Charge (Free Care). This is welcome and exciting news for school districts that participate in their state's school-based Medicaid billing program, many of whom have been waiting…

California Receives Federal Approval for New School MAA Program Plan

Following two years of negotiation with federal Centers for Medicare and Medicaid Services (CMS), California's Department of Health Care Services (DHCS) received conditional approval for a new school MAA (SMAA) program plan. While there are a few cosmetic changes that will need to be made to the June 2014 draft plan, schools are expected to begin claiming Medi-Cal outreach and enrollment…

CMS Releases Series of EPSDT Briefs, Addresses Medical Necessity Issues

Last week CMS published three new guides focused on Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. Over the past many years states as well as providers, patients and their families have raised questions about various aspects of EPSDT. The guides are intended to assist states in complying with CMS' interpretation of the EPSDT statute and regulations. The…