May Medi-Cal Bulletin for LEAs Posted—DHCS Transitioning Fiscal Intermediary Services

The May 2019 Medi-Cal Bulletin for LEAs has been published to the DHCS website. One item of interest in this month's Bulletin is that DHCS will be transitioning fiscal intermediary services from the current Conduent to DXC Technologies Services, LLC. This transition is projected to occur on October 1, 2019, and DHCS has said that payments should continue as normal as ensuring payments to...

DHCS’ Provider Enrollment Division (PED) Updates Ordering, Referring, and Prescribing (ORP) Provider Enrollment Rules

DHCS has confirmed that their Provider Enrollment Division (PED) has updated enrollment rules to ensure applications from registered, credentialed school nurses (RCSNs) and licensed educational psychologists (LEPs) will no longer be denied. Effectively immediately, LEP and RCSN providers may re-submit applications to enroll as Medi-Cal ORP providers in order to comply with the LEA Program’s...

LEA Medi-Cal Billing Option Program SPA 15-021 General Overview Training—Northern California

The California Department of Health Care Services (DHCS) has announced that in preparation for the approval of the State Plan Amendment (SPA) 15-021 by the Center for Medicare and Medicaid Services (CMS), they will be conducting two General Overview SPA 15-021 trainings for stakeholders that participate in the LEA Billing program. The announcement on April 26, 2019, included information about...

April Medi-Cal Bulletin for LEAs Posted

The April 2019 Medi-Cal Bulletin for LEAs has been published to the DHCS website. There was no LEA Billing program-specific information of note in this month's Bulletin. Click here to read the current or past Bulletins.

LEA Medi-Cal Billing Option Program SPA 15-021 General Overview Training—Southern California

The California Department of Health Care Services (DHCS) has announced that in preparation for the approval of the State Plan Amendment (SPA) 15-021 by the Center for Medicare and Medicaid Services (CMS), they will be conducting two General Overview SPA 15-021 trainings for stakeholders that participate in the LEA Billing program. The announcement today included information about the Southern...

DHCS Increases LEA Billing Reimbursement Rates for FY 2018/19

DHCS has confirmed that they are increasing the reimbursement rates for FY 2018/19 services and forward; this common, regular adjustment is done to account for inflation. Though the mileage rate went down by $0.02, LEAs can expect to see an average increase of 3% with some services reaching as high as 5% as soon as the erroneous payment correction (EPC) process begins. Click here to see the...

DHCS Issues New Provider Participation Agreement (PPA) Due March 1, 2019

On December 14, 2018, DHCS issued an updated Provider Participation Agreement (PPA) for the LEA Billing program. All participating LEAs must re-sign and submit the updated PPA by March 1, 2019. The updates made by DHCS include: removing the necessity for California Department of Education (CDE) to sign the PPA streamlining the language in the reinvestment of funds provision, though the...

DHCS Releases Policy and Procedure Letter Confirming Psychology Assessment CPT Code Change

On December 10, 2018, DHCS released PPL 18-029 that, due to a change from the American Medical Association (AMA), DHCS will be eliminating the Current Procedural Terminology (CPT) Code 96101 for IEP/IFSP Psychological Assessments and replacing it with CPT Code 96130. This will apply to all assessment types of Initial, Triennial, Annual and Amended. The interim rates and modifiers will remain...

DHCS Updates Ordering, Referring, and Prescribing (ORP) Provider Enrollment Rules

On November 30, 2018, the Department of Health Care Services (DHCS) notified LEAs that their Provider Enrollment Division (PED) has updated the enrollment rules effective for all Ordering, Referring and Prescribing (ORP) application packages received on or after March 20, 2018. The effective date of enrollment for an approved ORP provider shall be one year prior to the date DHCS received the...

DHCS Documents Updated for 2016 Transportation Changes

On November 14, 2018, DHCS released PPL 18-027; this PPL is confirmation that DHCS updated their materials to accommodate the State changes made in 2016; it includes a link to the DHCS Transportation Billing Guide now updated to reflect these changes. As a reminder, special-education students’ medically necessary transportation in a litter van, wheelchair van, or a school bus equipped with...