2016 Legislative Session: Bills We’re Tracking

The August deadline is fast approaching for bills in the California legislature to pass out of committee and both houses. As such, committees will be meeting frequently over the coming weeks and several bills will undergo additional changes before passing or failing in their final form. Here are several bills related to school health that we’re tracking this session (tip: click the 'Bill...

Exciting Changes Proposed for California’s LEA Direct Billing Program

In late September 2015, DHCS released a copy of their draft State Plan Amendment (SPA 15-021) which proposes several changes to the LEA Medi-Cal Billing Option program. If approved, the SPA includes several exciting additions that will impact California's participating school districts, including: newly eligible services, practitioners types, and a revised method for capturing time spent...

Senate Bill 276 Recently Passed Addressing Some Billing Issues in Schools

A new law will require the Department of Health Care Services (DHCS) to seek federal dollars for EPSDT-type health services provided by schools to their general education population. SB 276 also seeks to address the barrier to reimbursement for students with both Medi-Cal and other health coverage known as Third Party Liability (TPL). Senate Bill (SB) 276, which Paradigm has been tracking, was...

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...

Many Steps To Go Before Authorizing Autism Therapy As Benefit, State Says

Paradigm Note: For school districts participating in California’s LEA Medi-Cal Billing Option Program (LEA Program) it’s important to note that these developments, while important, do not impact the list of services that are billable under the LEA program. Behavioral health services are not a covered service under the LEA program and would therefore require a state plan amendment (SPA) to be...

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...

Signs Point to Adding Autism Coverage for Kids Under Medi-Cal Managed Care

The state has been considering the addition of autism therapy as a Medi-Cal benefit based on legal developments in other states, according to state officials at a budget subcommittee hearing this week. "We believe it's reasonable for the Legislature to consider adding ABA therapy services to Medi-Cal managed care [and making that] a high priority," said Ross Brown, a fiscal and policy analyst...

OIG to Focus on RMTS and School Medicaid Administrative Claiming Programs in 2014 Work Plan

The U.S. Office of Inspector General (OIG) has released their annual Work Plan, a detailed outline of projects for the coming year. The following reviews planned by OIG in 2014 may be of particular interest to those in the school Medicaid community: Review of state school-based administrative claiming plans where payments are based on random moment sampling systems (RMSS, or RMTS); 'State Cost...

California State Budget Enacted for 2011-12: AB 3632 Mandate Repealed

The California mandate on county mental health (CMH) departments to provide mental health services to eligible special education students, known as AB 3632, has been repealed. This issue presents a significant impact for schools as they assume full responsibility for provision and/or payment of these services.   Governor Jerry Brown signed the 2011-12 California State Budget into law...

Department Appeals Board (DAB) Ruling: Oklahoma Health Care Authority and Free Care

DAB A-03-79, Decision No 1924; the DAB "concludes that the [CMS 1997 Technical Assistance] Guide's free care principle is not an interpretation of any provision of the [Social Security] Act nor indeed of any regulation implementing a provision of the Act." in the case of Oklahoma Health Care Authority (Oklahoma) appeal of a disallowance of $1,902,390 in federal financial participation (FFP) for...