PPL 23-006: Important Update on Medi-Cal Billing Post-Public Health Emergency
As the Public Health Emergency (PHE) due to COVID-19 concluded on May 11, 2023, Department of Health Care Services (DHCS) has released PPL 23-006, a critical update affecting Medi-Cal Billing protocols.
Return to Standard Operations
This newest PPL supersedes previous PPLs 20-014R, 21-019, 20-038, and 20-043, marking the return to pre-PHE protocols in several areas of Medi-Cal Billing.
Key Updates
Service Authorization Requirements: Schools must ensure service authorizations are in place before billing for eligible services. Paradigm's SHN and related billing protocols are already compliant with the renewed requirement for pre-billing authorizations.
Telehealth Services: Telehealth remains a billable service with post-PHE modifications.
Practitioner Licensing: Post-PHE, all telehealth practitioners must be licensed, credentialed, or registered in California.
FMAP Rate Adjustments: The Federal Medical Assistance Percentage (FMAP) rate increases will phase out, with no additional increases from January 1, 2024. Paradigm's billing system has seamlessly integrated the step-downs in FMAP rates, ensuring a smooth transition for our clients with no additional action required.
RMTS 85% Compliance Response Rate: LEAs are required to meet the RMTS response rate starting with FY 2023/24 Q2.
Schools and providers involved in California’s LEA Billing and SMAA programs must update their compliance strategies to reflect these changes. For the latest on Medi-Cal Billing changes and more, be sure to bookmark our News blog.
