LEA Medi-Cal Billing Option Program SPA 15-021 General Overview Training—Northern California

The California Department of Health Care Services (DHCS) has announced that in preparation for the approval of the State Plan Amendment (SPA) 15-021 by the Center for Medicare and Medicaid Services (CMS), they will be conducting two General Overview SPA 15-021 trainings for stakeholders that participate in the LEA Billing program. The announcement on April 26, 2019, included information about...

LEA Medi-Cal Billing Option Program SPA 15-021 General Overview Training—Southern California

The California Department of Health Care Services (DHCS) has announced that in preparation for the approval of the State Plan Amendment (SPA) 15-021 by the Center for Medicare and Medicaid Services (CMS), they will be conducting two General Overview SPA 15-021 trainings for stakeholders that participate in the LEA Billing program. The announcement today included information about the Southern...

DHCS Confirms Notification Timeline for RMTS Moments with PPL 19-006

On February 13, 2019, DHCS released PPL 19-006—Notification and Response Timeline for Random Moment Time Survey (RMTS) Moments which confirms the 1/4 notification timelines are effective for the 2019/20 fiscal year. This means TSPs will be notified one attendance day in advance of their moment and then have four attendance days after to submit their response.

RMTS for LEA Billing—DHCS Hosts Combined Stakeholder Meeting on Oct. 4, 2018

On Thursday, Oct. 4, 2018, the Department of Healthcare Services (DHCS) held the first LEA Billing and School Medi-Cal Administrative Activities (SMAA) combined meeting. Paradigm attended the meeting by webinar and below are the highlights. There are 2 issues DHCS is still working out with CMS before formally submitting the final version of the SPA, which includes RMTS for LEA Billing, for...

RMTS for LEA Billing—Implementation Advisory Group Publishes October Meeting Summary

The Implementation Advisory Group (IAG) has published minutes from their October 3, 2017 meeting. Of interest: Navigant presented the technical RMTS “Wish List” items that were discussed during previous IAG meetings. The IAG discussed these items with DHCS and asked for them to be considered in the upcoming RMTS software system Request for Proposal (RFP). The LECs in attendance stated...

Federal Audit of New Jersey School-Based Medicaid Programs Seeks $300M in Paybacks

The federal Office of Inspector General (OIG) released audit findings of New Jersey's school-based Medicaid programs in which they request the state refund over $300 million. Specifically, OIG determined: PCG, the state's contractor, improperly altered school employees’ responses to timestudies to indicate that their activities were directly related to providing Medicaid services when...

Save the Date: SMAA RMTS Coder Training

The California Department of Health Care Services (DHCS) has announced their annual SMAA RMTS Coder Training webinar which will be open to all program coordinators and stakeholders. Date: Thursday, October  12, 2017 Time: 1:30-3:00pm PST Location: this training will be hosted online via webinar Click here to register

RMTS for LEA Billing — Implementation Advisory Group Publishes August Meeting Summary

The Implementation Advisory Group (IAG) has published minutes from their August 1, 2017 meeting. Of interest: DHCS gave a brief update on SPA 15-021,  noting that on June 9th CMS asked several additional Requests for Information (RAIs). The Department noted that the RAI responses are undergoing final management review before they will be submitted to CMS. In addition, the LEA RMTS...

LEA Ad-Hoc Advisory Workgroup Publishes June 2017 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 June 7, 2017 meeting include: In April 2017, DHCS posted the finalized Annual Accounting of Funds Summary Report...

DHCS Releases Vendor Fee Worksheets for Backcasting & RMTS Invoices

The Vendor Fee Worksheet (VFW), a new mechanism by which DHCS will ensure that LEAs can only claim (i.e. be reimbursed) for up to 15% of their total invoice amount in vendor fees, was released on August 2 after a months-long revision process by DHCS. This form was required to complete the first round of backcasted invoices from the SMAA deferral, as well as annually for RMTS claims starting...