Roundup of Recently Published PPLs for California’s LEA Billing Program

California Department of Health Care Services (DHCS) has sent out another round of LEA Billing Policy and Procedure Letters (PPLs) as it continues to solidify implementation of State Plan Amendment 15-021. Paradigm’s roundup is below, including key takeaways.

PPL 20-038, August 11 – Increase in Federal Medicaid Assistance Percentage (FMAP)

  • In response to and during the national emergency, Medi-Cal will now be matching expenditures at 56.2% as opposed to the usual 50%. This means payments to LEAs for claims will be a bit higher than usual. This increase is retroactive to January 1, 2020 and will sunset the last day of the quarter in which the public health emergency ends. Note that DHCS has not updated its systems just yet, but when they are, retroactive payments will be settled using the erroneous payment corrections process.

PPL 20-039, August 11 – Confirmation of New Providers & Services

  • The written details for all of the new services and provider types includes in SPA 15-021 were solidified in this PPL. This text is what will eventually appear in DHCS’s updated Provider Manual. DHCS also confirmed that its systems are not yet ready to accept claims for new services and provider types (e.g., group OT treatments), nor are they ready for any back billing. We fully anticipate that their systems will be ready to go soon.

PPL 20-037 (Aug 12) – New Enrollment Period

  • As outlined in this PPL, DHCS has firmed up its process and timelines for newly enrolling LEAs. As a result of the integration of the random moment time study method into the LEA Billing program, DHCS will accept new enrollees on a quarterly basis after January 1, 2021.

PPL 20-033 (Aug 12) – Reinstatement of Target Case Management (TCM) Claiming

  • LEA Billing-related TCM claims have not been paid since 2015. This PPL lays out DHCS’s intention to reinstate TCM claiming and the requirements for it. Bear in mind, however, that TCM claiming impacts SMAA reimbursements requiring cooperation with the regional agency with respect to the RMTS process.

PPL 20-040, August 26 – Cost Settlement for Transportation Claims

  • New requirements for transportation claiming were initially outlined in PPL 20-004R, Aug 4, 2020. This new PPL, PPL 20-040, solidifies that allocation of shared costs will be allowable, in addition to direct costs for specialized medical transportation. This is good news for LEAs that may be unable to report direct costs.