RMTS for LEA Billing — Implementation Advisory Group Publishes January Meeting Summary

The Implementation Advisory Group (IAG) has published minutes from their January 31, 2017 meeting, and discussed the following topics:

  • DHCS presented a draft chart that identified LEA services that are proposed under SPA 15-021. The chart covered IEP/IFSP services, non-IEP services covered under “plans of care” and other non-IEP services that are outside of a plan of care (e.g., first aid services). DHCS noted that CMS has asked for clarification that non-IEP services will be delivered under a “plan of care”, known as an Individualized Health and Support Plan (IHSP) so that the State is in compliance with their managed care contracts. Current managed care contracts carve out LEA services provided via IEPs, IFSPs and IHSPs. The Department brought the IAG up to speed on CMS’s comments, and noted that they will be discussing this in more detail with CMS after they resubmit the SPA and the Requests for Additional Information later this month. The Department indicated that they will share this information with stakeholders at the Advisory Workgroup Meeting on February 1, as well.
  • The IAG reviewed the group’s historical discussion on Targeted Case Management (TCM), including a revised version of a previous “decision tree” that may be useful to coders in determining how to code a TCM service.


The next IAG meeting is scheduled for April 4, 2017.

If you would like to submit feedback or questions in advance of the next meeting, use the IAG’s online  Stakeholder Feedback Tool.