Significant Milestone: Expanding Services for LEAs After Years of Advocacy
In a monumental victory after years of persistent efforts, the California Department of Health Care Services (DHCS) has achieved a pivotal breakthrough that has been long-awaited since the issue was first raised back in 2020. This achievement has far-reaching implications for local education agencies (LEAs) across the state.
Background
The journey towards achieving clear guidelines for Educationally Related Mental Health Services (ERMHS) and Educationally Related Intensive Counseling Services (ERICS), began in 2020 when DHCS first raised questions to the validity of claiming ERMHS-related services. Paradigm, alongside dedicated stakeholders, presented a thorough issue analysis to DHCS, highlighting the importance of addressing this matter comprehensively.
This advocacy for clarity and inclusion continued into 2022 when DHCS officially clarified that certain services, particularly ERMHS and ERICS, were not explicitly covered under existing programs due to their educational nature. This decision explicitly excluded practitioners with ERMHS or ERICS in their job titles from participating in the Random Moment Time Survey (RMTS) for the 2022/23 fiscal year.
However, the landscape shifted dramatically on September 5, 2023, when DHCS received an endorsement from the Centers for Medicare & Medicaid Services (CMS). Effective from the 2023/24 fiscal year onwards, CMS affirmed that medically necessary services arising from ERMHS or ERICS assessments are reimbursable. This reimbursement extends to services included within an Individualized Education Plan (IEP), Individualized Family Services Plan (IFSP), or Individualized Health and Support Plan (IHSP). Click here to read DHCS’s announcement.
Furthermore, practitioners who were previously excluded from the RMTS due to their job titles, including those referencing "educationally related," are now eligible to participate as Time Survey Participants (TSPs) in RMTS Participant Pool 1 for the 2023/24 fiscal year.
What You Need to Know
LEAs should be on the lookout for an email from their respective LEC, outlining the submission timeline for ERMHS/ERICS practitioners. It's important to note that this timing extension applies exclusively to the second quarter of the 2023/24 fiscal year and specifically pertains to ERMHS/ERICS practitioners.
For services to qualify, they must meet specific criteria, including the student's enrollment in Medi-Cal and eligibility for Federal Financial Participation (FFP) on the service date. Services must also be covered by the LEA Billing Option Program and be incorporated into an IEP, IFSP, or IHSP. A qualified licensed practitioner's recommendation, supported by a physician or licensed practitioner, is required for medically necessary services. These recommendations must be current and annually updated. Services must be administered by qualified rendering practitioners and documented according to state and federal regulations. Additionally, practitioners cannot be funded entirely through other state or federal funding sources.
It is crucial for LEAs to follow these criteria to ensure payment. Failure to meet these requirements may result in the inability to claim for services or even denials or disallowances.
Why This Is Important
This development is pivotal for LEAs and practitioners alike. By including practitioners with ERMHS or ERICS in their job titles in the RMTS, the number of services and eligible practitioners expands, potentially increasing federal funding for services already provided to students. This milestone underscores the importance of adhering to the specified criteria, ultimately ensuring that essential services are accessible and financially supported, benefiting both students and LEAs.
As DHCS continues to pave the way for progress, it is essential to stay informed and prepared for these transformative changes that have been years in the making. Paradigm's unwavering advocacy efforts and contributions to this critical issue exemplify the power of collective action in creating positive change.
