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...

Bills We’re Watching: 2015 Legislation

The California Legislature has begun hearing bills that are up for consideration this term. Below is a list of key bills related to California's school-based Medicaid billing programs, Medi-Cal Administrative Activities (MAA) and Local Educational Agency (LEA) Medi-Cal Billing.   SB 123 - Superintendent of Public Instruction: Report: School-Based Medi-Cal Administrative Activities...

California Senate Bill Seeks to Push Free Care Billing to Forefront

Senator Lois Wolk (3rd District) has put forward Senate Bill (SB)-276 which would require the Department of Health Care Services (DHCS) to submit school-based claims for covered health services provided to Medi-Cal students regardless of whether those services are included in an Individualized Education Plan (IEP). While the federal Centers for Medicare and Medicaid Services (CMS) reversed...

Doing Our Part to Address Free Care

January 29, 2015 - San Francisco, CA - There has been a lot of buzz about the federal government's recent reversal of the free care rule, a policy that had effectively prevented schools from billing Medicaid for health services provided to their general education population. The reversal of this policy is the biggest thing to hit school Medicaid billing programs in the last decade and people are...

With Federal Policy Change, More Money for School-Based Health Services

A recent federal policy reversal, long-sought by states and health care advocates, could enable schools to take a lead role in managing chronic childhood diseases and result in the hiring of many more school nurses. The change, announced quietly and unexpectedly last month by the Centers for Medicare and Medicaid Services (CMS), will allow public schools to receive Medicaid money for health...

Schools Can Bill Medicaid for More Student-Health Services, Feds Say

Advocates for school-administered student health services say new guidance issued by a federal agency this week will allow schools to bill Medicaid for more services they provide to students. Those additional reimbursements could help bolster tight budgets for school-health programs, allowing them to provide more services, such as immunizations, mental health care, and screenings for conditions...

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...

Paradigm Speaks at National Convening on Free Care and Third Party Liability

August 9, 2014 - Washington, D.C. - Paradigm Healthcare Services was invited to speak at a gathering of children's health leaders, advocates, and associations to discuss the history of two major obstacles to funding for school health services, free care and third party liability (TPL).  The meeting was hosted by LEAnet and sponsored by the National Alliance of Medicaid in Education (NAME). ...

“Free-Care” Rule Clarification Would Improve Health Services for Low-Income Children

Schools serve as a critical place for millions of low-income children in the United States to receive health services. Aside from convenience and efficiency factors, many students would not have access to healthcare if not for school-based health services. Among the services schools often provide are vaccinations, vision and hearing screenings, asthma management, nutrition guidance and counseling....