Roundup of Recently Published PPLs for California’s LEA Billing Program

California Department of Health Care Services (DHCS) has sent out another round of LEA Billing Policy and Procedure Letters (PPLs) as it continues to solidify implementation of State Plan Amendment 15-021. Paradigm’s roundup is below, including key takeaways. PPL 20-038, August 11 – Increase in Federal Medicaid Assistance Percentage (FMAP) In response to and during the national emergency,…

LEA Billing Program Legislative Report FY 2018/19

As part of a requirement to submit annual reports to the California Legislature on the state of the LEA Medi-Cal Billing Option program, DHCS published their 2018/19 report on August 14, 2020. Information in this most recent Report to Legislature covers a wide range of topics, including a comparison of California’s reimbursements under the billing program to that of other states, summary of…

PPL 20-031: Random Moment Time Survey (RMTS) Participant Equivalency Process

On Friday, July 31, 2020, California DHCS released PPL No. 20-031 outlining the process and requirements for its RMTS Time Survey Participant (TSP) List Equivalency Request for LEA Billing purposes. This is good news for LEAs with providers who perform direct medical services as a primary job function but do not have a job title that matches the approved RMTS classification list. DHCS is…

PPL 20-023: Submitting Quarterly Random Moment Time Survey (RMTS) Percentage Results to the Department of Health Care Services (DHCS)

On Tuesday, July 7, 2020, DHCS published Policy & Procedure Letter 20-023, titled “Submitting Quarterly Random Time Moment Survey (RMTS) Percentage Results to the Department of Health Care Services (DHCS)”. This PPL supersedes PPL 19-004R which was released in June, 2019 (click here for more on PPL 19-004R). The purpose of PPL 20-023 is to provide instructions on the submission of final…

PPL 20-022: Notification of Random Moment Time Survey Requirement for the Local Educational Agency Medi-Cal Billing Option program

On Thursday, June 25, 2020, DHCS published Policy & Procedure Letter 20-022, titled "Notification of Random Moment Time Survey Requirement (RMTS) for the Local Educational Agency Medi-Cal Billing Option Program.” The information shared in this PPL 20-022 is specific to the changes that will take place due to the RMTS integration with the CRCS, most of which has been anticipated for quite some…

PPL 20-014: CA Telehealth Policy Relative to the 2019 – Novel Coronavirus (COVID-19)

On Monday, May 11, 2020, DHCS released PPL 20-014, titled “Telehealth Policy Relative to the 2019 -Novel Coronavirus (COVID-19). The PPL specifies that during this national emergency, all LEA providers may bill for covered direct medical services provided via telehealth under the LEA Billing program, with exception of services that preclude a telehealth modality, such as specialized medical…

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…

Executive Order to Expand Telehealth Services

On March 30, 2020, Governor Newsom issued executive order N-39-20 to temporarily expand telehealth services. This order provides protections to medical providers by relaxing certain state privacy and security laws so they may utilize telehealth services to minimize patient exposure and infections, without the risk of being penalized. On April 3, 2020, the executive order was officially signed by…

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…

Paper Remittance Advice Details Print Delay

On March 27, 2020 DHCS sent out a news flash advising that there will be a delay in receiving paper Remittance Advice Details (RADs) and Medi-Cal Financial Summaries by 4 business days. Due to this, DHCS is encouraging Providers who are not already signed up to receive PDF RADs to do so. To learn more, check out DHCS’ email here: DHCS Paper RAD Delay Additional instructions to view and…