Conditional Approval Received for Backcasting Years of Deferred Invoices

On October 28, 2015 federal Centers for Medicare & Medicaid Services (CMS) issued a letter to the California Department of Health Care Services (DHCS) conditionally approving their proposed backcasting plan to resolve years of deferred school-based MAA claims.

DHCS had submitted a proposal that would essentially apply 4 quarters of random moment time study results to prior period costs to determine the final allowable cost and reimbursement for all deferred invoices.

Stakeholders have voiced strong concern over this proposal which they believe will result in paybacks upwards of 80%-90% of the original claim amount, over-penalizing districts for the findings outlined in CMS’ 2012 review of the program which led to the deferral.

According to the backcasting proposal posted on DHCS’ website, school districts will begin submitting backcast claims for final payment or recoupment starting January 1, 2017.


Read the conditional approval letter…

Read the approved backcasting proposal on DHCS’ website…