DHCS Releases Policy and Procedure Letter Confirming Psychology Assessment CPT Code Change

On December 10, 2018, DHCS released PPL 18-029 that, due to a change from the American Medical Association (AMA), DHCS will be eliminating the Current Procedural Terminology (CPT) Code 96101 for IEP/IFSP Psychological Assessments and replacing it with CPT Code 96130. This will apply to all assessment types of Initial, Triennial, Annual and Amended. The interim rates and modifiers will remain...

DHCS Documents Updated for 2016 Transportation Changes

On November 14, 2018, DHCS released PPL 18-027; this PPL is confirmation that DHCS updated their materials to accommodate the State changes made in 2016; it includes a link to the DHCS Transportation Billing Guide now updated to reflect these changes. As a reminder, special-education students’ medically necessary transportation in a litter van, wheelchair van, or a school bus equipped with...

Change in CPT Code for IEP/IFSP Psychological Assessments and More

Beginning in the first quarter of 2019, due to a change from the American Medical Association (AMA), DHCS will be eliminating the Current Procedural Terminology (CPT) Code 96101 for IEP/IFSP Psychological Assessments and replacing it with CPT Code 96130. This will apply to all assessment types of Initial, Triennial, Annual and Amended. The interim rates and modifiers will remain unchanged....

DHCS Issues Policy on Third Party Liability Recoupment

California’s Department of Health Care Services (DHCS) has released PPL 16-012, ‘Notification of Third Party Liability (TPL) Recoupment Requirements’, to LEAs participating in the LEA Medi-Cal Billing Option program. This policy serves to clarify the requirements of pursing TPL and outlines DHCS’ process for ensuring these requirements are met. Paradigm will be working with its clients...

DHCS Releases Guidelines to LEAs for Electronic Signatures on EHRs

The California Department of Health Care Services (DHCS) has implemented new guidelines for electronic signatures in electronic health records (EHRs) when used by LEAs participating in the LEA Billing, SMAA, and TCM programs. In doing so, the Department has confirmed their approval of electronic signatures as equivalent to a manual signature when used on an EHR. Detailed in Policy and Procedure...

DHCS Clarifies Policy on Claiming SMAA Participation Fees

DHCS released a Policy and Procedure Letter, (PPL) 16-007, clarifying the reimbursement requirements for participation fees related to the School-Based Medi-Cal Administrative Activities (SMAA) and County Medi-Cal Administrative Activities (CMAA) programs for Local Governmental Agency (LGA) and Local Educational Consortium (LEC) Coordinators. PPL 16-007 does not constitute new policy or...

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...

PPL 13-012: Reasonableness Test Criteria (RTC) – Updated

**Note: DHCS released a revised and updated version of PPL 13-012 on December 13, 2013. This revision makes important clarifications to the RTC process. The purpose of this Policy and Procedure Letter (PPL) is to establish the parameters for LEAs, LECs and LGAs to apply the Reasonableness Test Criteria (RTC) developed by the Department of Health Care Services (DHCS) in accordance with the...

PPL 13-015: Interim Claiming Plan Procedure Changes for LEAs for SFY 2013-14

The Centers for Medicare and Medicaid Services (CMS) approved an Interim Claiming process for the SMAA program on November 1, 2013. Each LEA must identify their Time Survey Participant Universe prior to any LEA participation in the Interim Claiming process for SFY 2013-2014. Download PPL 13-015 - Interim Claiming Procedure Change... View Attachment A, 'Time Survey Authorized Positions and...

PPL 13-013: CMAA/TCM Implementation Plan Amendment – MAA for Inmates

The purpose of this Policy & Procedure Letter is to notify LGA’s participating in the CMAA Program of an amendment to the "Time Survey Methodology for the County Based Medi-Cal Administrative Activities (CMAA) and Targeted Case Management (TCM) Programs and CMAA Program Operational Plan". Per PPL 13-013 and the CMS approval letter which authorized it, effective immediately, CMAA program...