DHCS Issues New Provider Participation Agreement (PPA) Due March 1, 2019

On December 14, 2018, DHCS issued an updated Provider Participation Agreement (PPA) for the LEA Billing program. All participating LEAs must re-sign and submit the updated PPA by March 1, 2019. The updates made by DHCS include: removing the necessity for California Department of Education (CDE) to sign the PPA streamlining the language in the reinvestment of funds provision, though the...

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 Updates Ordering, Referring, and Prescribing (ORP) Provider Enrollment Rules

On November 30, 2018, the Department of Health Care Services (DHCS) notified LEAs that their Provider Enrollment Division (PED) has updated the enrollment rules effective for all Ordering, Referring and Prescribing (ORP) application packages received on or after March 20, 2018. The effective date of enrollment for an approved ORP provider shall be one year prior to the date DHCS received the...

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....

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...

LEA Ad-Hoc Advisory Workgroup Publishes August 2018 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 August 1, 2018 meeting minutes include: The Annual Report for FY 2017/18 has been posted to the DHCS website. No...

RMTS for LEA Billing – Implementation Advisory Group Publishes April Meeting Summary

The Implementation Advisory Group (IAG) provided the following updates from their April 5, 2016, meeting: DHCS discussed stakeholder feedback regarding an inquiry as to whether RMTS coders would need to determine whether direct health service moments coded to Code 2 were actually billed with proper supporting documentation by a qualified Medi-Cal provider. Belief is that the coder will be...

Senate Bill 276 Passes, Taking One Step Closer to Rollout of Free Care

September 2, 2015 – Sacramento, CA – The California Senate recently passed Senate Bill (SB) 276, introduced by Senator Wolk; this is exciting news because this directly impacts both the free care and Third Party Liability (TPL) billing issues for California schools. You may recall, in December 2014 the Centers for Medicare & Medicaid Services (CMS) reversed their opinion on “free...

Senate Bill 276 Recently Passed Addressing Some Billing Issues in Schools

A new law will require the Department of Health Care Services (DHCS) to seek federal dollars for EPSDT-type health services provided by schools to their general education population. SB 276 also seeks to address the barrier to reimbursement for students with both Medi-Cal and other health coverage known as Third Party Liability (TPL). Senate Bill (SB) 276, which Paradigm has been tracking, was...