New Resource for LEAs & Parents Regarding EOBs for School Health Services

DHCS has published a one-page informational that LEAs can share with parents regarding private insurance, explanation of benefits (EOB) statement for school health services, and impact to public benefits. When a child has both Medi-Cal and Other Health Coverage (OHC) through private insurance, and a school is billing Medi-Cal for eligible health services provided to that student under the LEA...

New DHCS Guidance for LEAs Regarding Insurance Carrier Requests

DHCS has released a statement for LEAs who have received communication from private health insurers regarding school health service claims. Over the past year, several LEAs have reported receiving information from private insurers part as of the state's transition to the practice of pay and chase for students with both Medi-Cal and Other Health Coverage (OHC). On March 9, 2017, DHCS emailed...

DHCS Publishes New LEA Billing FAQs

As a follow-up from the Fall 2016 LEA Billing DHCS training held last October, DHCS has released a list of frequently asked questions (FAQs) and answers on various program policies. Below, we've included a handful of questions and answers from the document that LEAs may find particularly interesting, specifically regarding: RMTS for LEA Billing Free Care (Non-IEP) Service Billing ...

How California Schools Are Using Medicaid – Healthy Schools Campaign

Since a regulatory change to the free care rule almost two years ago allowed states to use Medicaid funding to provide services to all Medicaid-enrolled students in schools, states have been exploring the best way to implement this change. To take advantage of this opportunity, states, school districts and others need to come together to develop a plan and consider their options for...

LEA Ad-Hoc Advisory Workgroup Publishes June 2016 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 1, 2016 meeting include: Review of Senate Bill 123, which would have a limited impact on the LEA Medi-Cal...

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 Addresses Pay & Chase Recovery for Students with Both Medi-Cal and Other Health Coverage

For the past several months, a handful of California LEAs have been contacted by parents who have received explanation of benefits (EOBs) from their private health insurance regarding claims that were billed to Medi-Cal by the LEA through the LEA Medi-Cal Billing Option program. EOBs are not a claim or bill, but rather a statement of activity on the policyholder's account (for example, DHCS...

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...

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...

Californa Among 28 States Needing To Upgrade Medicaid Systems

CMS has published a final rule that will maintain billions of dollars in funding to help California and other states upgrade their Medicaid eligibility and enrollment systems, Modern Healthcare reports. Read the full article on California Healthline...