State Plan Amendment (SPA) 16-001 Targeted Case Management Services

On Thursday, October 22, 2020, DHCS announced that the Centers for Medicare and Medicaid Services approved State Plan Amendment (SPA) 16-001, with an effective date of January 2, 2016. For California LEAs billing for Targeted Case Management (TCM) services, SPA 16-001 now allows for TCM services to be billed regardless of whether an Individualized Education Plan (IEP) or Individualized Family…

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,…

LEA Billing Program Legislative Report FY 2018/19

As part of a requirement to submit annual reports to the California Legislature on the state of the LEA Medi-Cal Billing Option program, DHCS published their 2018/19 report on August 14, 2020. Information in this most recent Report to Legislature covers a wide range of topics, including a comparison of California’s reimbursements under the billing program to that of other states, summary of…

California to Spend Additional $650M On Special Education

California’s method of funding special education will become streamlined and a little more equitable, thanks to a provision in the recently passed state budget. The 2020-21 budget fixes a decades-old quirk in the funding formula that had left vast differences between school districts in how much money schools received to educate special education students. Click here to read the full…

PPL 20-031: Random Moment Time Survey (RMTS) Participant Equivalency Process

On Friday, July 31, 2020, California DHCS released PPL No. 20-031 outlining the process and requirements for its RMTS Time Survey Participant (TSP) List Equivalency Request for LEA Billing purposes. This is good news for LEAs with providers who perform direct medical services as a primary job function but do not have a job title that matches the approved RMTS classification list. DHCS is…

PPL 20-023: Submitting Quarterly Random Moment Time Survey (RMTS) Percentage Results to the Department of Health Care Services (DHCS)

On Tuesday, July 7, 2020, DHCS published Policy & Procedure Letter 20-023, titled “Submitting Quarterly Random Time Moment Survey (RMTS) Percentage Results to the Department of Health Care Services (DHCS)”. This PPL supersedes PPL 19-004R which was released in June, 2019 (click here for more on PPL 19-004R). The purpose of PPL 20-023 is to provide instructions on the submission of final…

PPL 20-022: Notification of Random Moment Time Survey Requirement for the Local Educational Agency Medi-Cal Billing Option program

On Thursday, June 25, 2020, DHCS published Policy & Procedure Letter 20-022, titled "Notification of Random Moment Time Survey Requirement (RMTS) for the Local Educational Agency Medi-Cal Billing Option Program.” The information shared in this PPL 20-022 is specific to the changes that will take place due to the RMTS integration with the CRCS, most of which has been anticipated for quite some…

State Superintendent Tony Thurmond Releases Guidance Document on Safe Reopening of California’s Public Schools

On Monday, June 8, 2020, State Superintendent of Public Instruction, Tony Thurmond announced that CDE has released a guidance document titled “Stronger Together: A Guidebook for the Safer Opening of California’s Public School’s”. The guidebook is comprehensive and offers considerations and examples of solutions, covering health and safety practices; instructional programs including for special…

A turning point: California education leaders speak out about racism and police brutality

“…We feel that silence is complicity: We must put an end to these incidents now. No matter how difficult, we must individually and collectively reflect on the lives lost unnecessarily, and address head on the systemic problems and challenges we all face as a society. And we must do so – unified – with a sense of urgency and unwavering commitment to end these unnecessary race-based killings and…

PPL 20-014: CA Telehealth Policy Relative to the 2019 – Novel Coronavirus (COVID-19)

On Monday, May 11, 2020, DHCS released PPL 20-014, titled “Telehealth Policy Relative to the 2019 -Novel Coronavirus (COVID-19). The PPL specifies that during this national emergency, all LEA providers may bill for covered direct medical services provided via telehealth under the LEA Billing program, with exception of services that preclude a telehealth modality, such as specialized medical…