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...

Medicaid & CHIP: October Monthly Applications and Eligibility Determinations Report

This report is the first in a series of monthly reports on State Medicaid and Children’s Health Insurance Program (CHIP) data, and represents State Medicaid and CHIP agency eligibility activity for the calendar month of October 2013, which coincides with the first month of the initial open enrollment period for the Health Insurance Marketplace. Read the full CMS report here...   ...

Deferral Resolution and New Plan Milestone Timeline Approval Letter

Effective October 23, 2013, the Centers for Medicare and Medicaid Services (CMS) has granted approval to the California  Department of Health Care Services (DHCS) for the methodology developed to resolve all deferred costs for school based administrative claims and a request to permit interim claiming for school based administrative costs incurred during State Fiscal Year (SFY) 2013/2014. The...

CMS Gives Informal Approval for Interim School MAA Claiming in California

California's Department of Health Care Services (DHCS) posted another school MAA (SMAA) program update to their website on September 17, 2013. The update confirms that DHCS has received informal approval from the Centers for Medicare and Medicaid Services (CMS) on several key issues related to the ongoing SMAA program deferral and development of a new claiming plan: SMAA Time Survey for FY...

CMS Approves New Operational Plan for California’s County Medi-Cal Administrative Activities (CMAA) and Targeted Case Management (TCM) Program

California's operational claiming plan for the County Medi-Cal Administrative Activities (CMAA) and Targeted Case Management (TCM) programs was released after several years of planning and coordination between the Department of Health Care Services (DHCS), California's Local Governmental Agencies (LGA) Committee, and the federal Centers for Medicare and Medicaid Services (CMS). This new plan will...

Draft CMS Review of California’s School Based Administrative Claiming Program

This draft Financial Management Report (Control Number 09-FM-2012-CA-01-D) was sent to California's Department of Health Care Services (DHCS) by the federal Centers for Medicare and Medicaid Services (CMS) on April 16, 2013 for review and response. Following the incorporation of DHCS feedback, CMS will issue a final report on their review of California's school MAA claiming program. Read the...

Example CMS Deferral Release Notification Letter

This example correspondence from the Department of Health Care Services (DHCS) to a California regional agency announces the release from CMS deferral of a contracted school district participating in the school MAA program. DHCS Deferral Approval Letter_Redacted.pdf