Free Care Manual Update & Service Rates Expected September 2016

In an email dated August 30, 2016, California's Department of Health Care Services (DHCS) announced several updates to ongoing policy and guidance related to the LEA Medi-Cal Billing Option Program. Key updates regarding DHCS' Free Care Policy Clarification and rates for Telehealth and new Speech codes are not yet effective. DHCS states that they anticipate these will be published in September...

California’s Shortage Of School Nurses Covered by California Healthline

A new national pediatric guideline proposes that every school have a nurse on staff. In California, 57 percent of school districts do not employ nurses. In an article that focuses on new recommendations that call for every California school district to have a school nurse on site, California Healthline examines the extreme shortage of school nurses in schools throughout the state and covers...

Denial of LEA Preventative Medicine Counseling Claims in California

California's Department of Health Care Services announced that LEA billing claims for preventative medicine counseling (CPT-4 Code 99401) have been erroneously denied when more than one unit per day was billed. The error has been fixed and any affected claims will be reprocessed for dates of service on or after January 1, 2015. This issue will have little to no impact for most LEAs since this...

DHCS Releases Preliminary Guidance on Impact of Free Care-Focused Senate Bill

A recent bill signed into law by Governor Jerry Brown will require the Department of Health Care Services (DHCS) to seek federal financial participation for covered services regardless of whether an Individualized Education Plan (IEP) is in place. Additional language in the bill will require legally liable third party payers to either reimburse school-based health claims or issue a notice of...

LEA Ad-Hoc Advisory Workgroup Publishes December 2015 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 December 2, 2015 meeting include: CDE noted that the California State Auditor has completed its audit regarding the...

Telehealth Speech Therapy Services Billable for California LEAs Starting June 2016

DHCS has published a policy and procedure letter (PPL) announcing the forthcoming implementation of telehealth for speech therapy services as billable under the LEA Medi-Cal Billing Option Program. Beginning on June 1, 2016, LEAs participating in the program will be able to bill for speech therapy assessment and treatment services delivered via telemedicine when provided to Medi-Cal...

Policy Recommendations for California in the Wake of Free Care

California's School-Based Health Alliance has released a report which focuses on the expanded role that schools can play in the overall health delivery system following the reversal of CMS' free care rule. The report makes the following recommendations based on extensive interviews with California's Department of Health Care Services (DHCS), Department of Education (CDE), LEAs, and other key...

HHS and DOE Release Joint Letter on the Link Between Health and Education Services

A joint letter was released by the Secretary of Health and Human Services and the Acting Secretary of Education which praises and encourages a continued partnership between health and education services for children. Acknowledging the role that health plays in education, the Secretary of Health and Human Services and the Acting Secretary of Education released a letter today that encourages...

CMS Requests Additional Information Regarding SPA 15-021

CMS has issued a request for additional information (RAI) regarding California's state plan amendment, (SPA) 15-021, which proposes several changes and expansions to the LEA Medi-Cal Billing Option Program. This is fairly common in the SPA approval process (some of you may remember that it took nearly two years to gain approval for the last LEA Billing state plan amendment,  SPA 03-024, back...

Updates to the LEA Medi-Cal Billing Program Provider Manual

In the November Medi-Cal update newsletter for LEAs, DHCS announced several updates to the LEA Medi-Cal Billing Option program and corresponding sections in the Provider Manual. Many of the updates were operational in nature and unrelated to program policy; however, there were a handful of substantial changes including some that appear to be related to the state's preparation for rolling...