Summary of Key Discussions from the DHCS LEA Billing Stakeholder Meeting – October 30, 2024
The DHCS LEA Billing Stakeholder Meeting on October 30, 2024, was packed with vital information regarding California’s LEA Billing Option Program (LEA BOP). We've boiled down the key points discussed during the session so you can stay in the know. While the information is dense, rest assured that we have a firm grasp on all the key issues and will keep you informed every step of the way!
Upcoming State Plan Amendments (SPAs)
DHCS shared plans to submit at least two, if not three, SPAs that will impact LEA BOP in the future. While the timeline for submission and approval may be lengthy, there are several positive changes on the horizon for LEAs:
1. Exciting Enhancements:
Addition of Community Health Workers, Licensed Professional Clinical Counselors (LPCCs), and Associate Professional Clinical Counselors (APCCs) to the list of qualified practitioners eligible to bill—a significant improvement!
Inclusion of Licensed Vocational Nurses (LVNs) and Registered Nurses (RNs) for billing Optometry Services, with photoscreening vision screenings also being recognized as billable.
The ACVREP certification requirement for Orientation & Mobility (O&M) service providers will be removed, allowing those with only the Clinical or Rehabilitative Services Credential to bill for their services.
DHCS plans to shift vaccine billing to an encounter-based rate and establish a specific rate for ACES screenings.
For Institutions of Higher Education only, the SPA will eliminate the requirement for non-Pupil Personnel Services (PPS) holders to be supervised by a PPS holder.
2. Changes to Methodologies:
The second planned SPA will revise how the one-way trip allocation is determined and applied during the annual cost settlement process.
Should there be changes to the interim payment methodology, they will also be included in this SPA.
Consideration of New Interim Payment Methodologies
Following the CMS guidance released in May 2023, DHCS is contemplating changes to the current interim payment methodology. They are actively collaborating with a workgroup that includes LEA representation and plan to distribute a survey to all LEAs to gather further feedback. In preparation for this survey, DHCS reviewed the four available methodologies, in addition to the current method:
Roster Billing
Per Child/Per Month
Average Cost per Service
Bundled Payment Rates
Paradigm has provided its clients with a primer on these different methodologies to help them prepare informed feedback when the survey is released.
FY 2024/24 Annual Report
Due at the end of November, DHCS will soon email the Annual Report template that all LEAs must complete. This year’s report will resemble those of the past, with a few adjustments:
1. Consortium Leads will have a few additional steps to complete.
2. LEAs with only contracted providers (no employed providers) will submit their “Model 2 Certificate” alongside their Annual Report.
New Reimbursement Rates Effective July 1, 2024
DHCS has implemented new interim claim reimbursement rates for FY 2024/25, meaning LEAs are now receiving payments at these updated rates. While some rates have decreased, the overall impact remains net positive for LEAs, particularly in psychological, health, and speech assessments, with increases ranging from 6% to 10%.
Billing Forum Insights
During this meeting, DHCS continued its “billing forum” initiative to provide additional context and engage more thoroughly with participating LEAs. This segment included a detailed review of the Cost and Reimbursement Schedule (CRCS), accurate calculation of the Medi-Cal Eligibility Rate (MER) utilized on the CRCS, and an overview of the Medi-Cal eligibility output file via MOVEit. While Paradigm manages these functions for its clients, we commend DHCS’s efforts to ensure all LEAs are well-informed about these critical program components.
CYBHI Multi-Payer Fee Schedule & LEA BOP Program Interaction
In closing, DHCS addressed the interplay between the LEA BOP and the new Child and Youth Behavioral Health Initiative (CYBHI) Billing program being implemented statewide. Notably, DHCS confirmed that practitioners who perform covered LEA BOP services but submit claims solely through the CYBHI program can continue to participate in the RMTS process. This clarification is a welcome relief, ensuring that LEAs can maximize reimbursement across both programs.
These updates signal significant shifts in the administration of LEA BOP and related programs. Staying proactive and informed will be essential in navigating these developments effectively. As always, we remain committed to providing the latest information and supporting you through these changes. Be sure to check our News section regularly for critical program updates, and don’t hesitate to reach out to us with any questions or for personalized support. You can also access DHCS’s archive of these meetings by clicking here.
