Update: California School MAA Claims Deferral, July 17, 2012

DHCS has received approval to use the current school Medi-Cal Administrative Activities (MAA) state plan and time survey methodology, with some caveats, as an interim claiming methodology in the upcoming fiscal year. As previously reported, this past June CMS asked the state of California to re-evaluate unpaid school MAA claims and to change the reimbursement program’s claiming methodology beginning in FY 2012/13.


** Paradigm clients should refer to our regular email communications for additional details and operational guidance, including training preparation for participants and other start-of-the-year activities. If you have any immediate questions, please feel free to contact us via email or by calling (888) 536-0920.

On July 17, 2012, the California Department of Health Care Services (DHCS) announced that the federal Centers for Medicare and Medicaid Services (CMS) has approved the use of California’s existing school MAA time survey methodology and state plan as an interim claiming methodology for FY 2012/13. In the official email sent to regional agencies, Chief of the Administrative Claiming, Local & School Services Branch of DHCS, Geri Baucom reports:

Yesterday [DHCS] received approval from CMS to use the current SMAA claiming plan approved in 2003 as an interim claiming methodology for Fiscal Year 2012/13 subject to the conditions below.  Effective immediately, CMS is requiring time spent related to completing the time study be coded as Code 16 General Administration not Code 15 Medi-Cal Claims Administration, Coordination, and Training.  This requirement affects costs incurred as of July 1, 2012.  We are in the process of updating the SMAA manual, the annual training PowerPoint, and the time survey forms to conform with this change.  LECs and LGAs can move forward with conducting the required trainings and SMAA participants can use the current time study methodology until a new claiming plan is finalized.  Invoices submitted for services during the interim claiming period will be subject to reconciliation retroactive to July 1, 2012, once the new claiming plan and time study methodology are approved by CMS.

In addition to approving interim claiming for California, CMS also gave DHCS a deadline of September 30, 2012 to submit a revised statewide claiming plan proposal. California’s new claiming plan will have to go through a review and approval process by CMS prior to its implementation before FY 2013/14.

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We will continue to post information and updates on this issue as it becomes publicly available. Paradigm clients should refer to regular email communications for operational guidance and additional details on this evolving situation.

Read the CMS letter to DHCS…

Read our announcement of California’s school MAA deferral…