New Developments for CYBHI All-Payer Fee Schedule & Learning Cohort 1
The Department of Health Care Services (DHCS) has been actively paving the way for the successful rollout of the CYBHI All-Payer Fee Schedule, with Learning Cohort 1 at the helm of this transformation. Paradigm is at the forefront, offering interpretations and guidance as new updates emerge from DHCS.
Key Developments and Guidance
Draft Fee Schedule Availability: The draft CYBHI All-Payer Fee Schedule has been released, equipping LEAs with the necessary details for strategic planning and execution. The schedule can be downloaded here.
Pending SPA Approval: Awaiting the State Plan Amendment's final nod, the draft schedule's inclusion of essential school-based providers, such as PPS credential holders, hang in the balance. Follow the status of SPA 23-0027 here.
TPA Designation: Carelon has emerged as the designated Third-Party Administrator (TPA), poised to manage the Provider Network and act as the fiscal intermediary. The official word on their contract completion is expected soon.
Cohort 1 Kick-Off: The first official Cohort 1 meeting will occur the week of January 22, 2024, initiating structured discussions on various program aspects, setting the stage for a comprehensive series of bi-weekly meetings.
Upcoming Expectations: During the pre-kick-off (Dec 13, 2023), DHCS laid out the structure for future discussions, highlighting key areas such as data management, claims submission, and quality oversight. Detailed information regarding claims submission is anticipated to be addressed by March 2024.
Navigating Duplicate Billing
With the introduction of the CYBHI All-Payer Fee Schedule, a new avenue for funding behavioral and mental health services for general education students is set to open. Concurrently, California’s LEA Billing Option Program (LEA BOP) already provides schools with a mechanism for reimbursement for certain general education services. Therefore, as these two programs intersect, it's imperative to navigate them with a careful strategy to avoid duplicate billing, ensuring that each service is claimed appropriately and in compliance with state guidelines.
This week, DHCS implemented immediate measures to control duplicate billing. School-based providers eligible for the All-Payer Fee Schedule can continue to be included in RMTS TSP lists but will have extra restrictions on how they can respond to survey questions. As a rule, general education services billed to the All-Payer Fee Schedule must not overlap with those billed through LEA BOP.
This swift initiative by DHCS to establish interim controls is just the beginning. We expect the guidance to evolve as discussions progress. Paradigm is dedicated to advocating for streamlined solutions that maximize the benefits for LEAs from both the LEA BOP and the CYBHI All-Payer Fee Schedule.
As we move toward the program's kickoff, we invite LEAs to engage with us, bringing forth any queries or seeking discussions on these recent developments. Paradigm is here to support you every step of the way, ensuring that your journey through these changes is informed and advantageous. For any inquiries or additional support, our team is just a call or email away.
