DHCS Issues Policy on Third Party Liability Recoupment

California’s Department of Health Care Services (DHCS) has released PPL 16-012, ‘Notification of Third Party Liability (TPL) Recoupment Requirements’, to LEAs participating in the LEA Medi-Cal Billing Option program. This policy serves to clarify the requirements of pursing TPL and outlines DHCS’ process for ensuring these requirements are met. Paradigm will be working with its clients...

DHCS Releases Guidelines to LEAs for Electronic Signatures on EHRs

The California Department of Health Care Services (DHCS) has implemented new guidelines for electronic signatures in electronic health records (EHRs) when used by LEAs participating in the LEA Billing, SMAA, and TCM programs. In doing so, the Department has confirmed their approval of electronic signatures as equivalent to a manual signature when used on an EHR. Detailed in Policy and Procedure...

DHCS Clarifies Policy on Claiming SMAA Participation Fees

DHCS released a Policy and Procedure Letter, (PPL) 16-007, clarifying the reimbursement requirements for participation fees related to the School-Based Medi-Cal Administrative Activities (SMAA) and County Medi-Cal Administrative Activities (CMAA) programs for Local Governmental Agency (LGA) and Local Educational Consortium (LEC) Coordinators. PPL 16-007 does not constitute new policy or...

Telehealth Speech Therapy Services Billable for California LEAs Starting June 2016

DHCS has published a policy and procedure letter (PPL) announcing the forthcoming implementation of telehealth for speech therapy services as billable under the LEA Medi-Cal Billing Option Program. Beginning on June 1, 2016, LEAs participating in the program will be able to bill for speech therapy assessment and treatment services delivered via telemedicine when provided to Medi-Cal...

PPL 13-012: Reasonableness Test Criteria (RTC) – Updated

**Note: DHCS released a revised and updated version of PPL 13-012 on December 13, 2013. This revision makes important clarifications to the RTC process. The purpose of this Policy and Procedure Letter (PPL) is to establish the parameters for LEAs, LECs and LGAs to apply the Reasonableness Test Criteria (RTC) developed by the Department of Health Care Services (DHCS) in accordance with the...

PPL 13-015: Interim Claiming Plan Procedure Changes for LEAs for SFY 2013-14

The Centers for Medicare and Medicaid Services (CMS) approved an Interim Claiming process for the SMAA program on November 1, 2013. Each LEA must identify their Time Survey Participant Universe prior to any LEA participation in the Interim Claiming process for SFY 2013-2014. Download PPL 13-015 - Interim Claiming Procedure Change... View Attachment A, 'Time Survey Authorized Positions and...

PPL 13-013: CMAA/TCM Implementation Plan Amendment – MAA for Inmates

The purpose of this Policy & Procedure Letter is to notify LGA’s participating in the CMAA Program of an amendment to the "Time Survey Methodology for the County Based Medi-Cal Administrative Activities (CMAA) and Targeted Case Management (TCM) Programs and CMAA Program Operational Plan". Per PPL 13-013 and the CMS approval letter which authorized it, effective immediately, CMAA program...

California Announces New Billing Model Option for Schools Participating in the LEA Billing Option Program

The California Department of Health Care Services (DHCS) has announced the addition of Model 4 as service delivery option for schools that bill Medi-Cal for eligible direct medical services under the LEA Billing Option program. The new policy is effective July 1, 2013 and was officially issued in Policy and Procedure Letter (PPL) 13-006. According to PPL 13-006, Model 4 will allow local...

PPL 13-001: LEA Billing Program – Revision to Medical Transportation Outlined in Assembly Bill 2608

This Policy and Procedure Letter (PPL) notifies LEAs participating in the LEA Medi-Cal Billing Option Program that specific provisions set forth in the California Code of Regulations (CCR), Title 22 Sections 51323(a)(2)(A), 51323(a)(3)(B), 51231.1(f), and 51231.2(e), shall not apply to medical transportation eligible to be billed under the LEA Medi-Cal Billing Option Program. Read PPL 13-001-LEA...

PPL 12-012: Prohibition on Contingency Fee Contracts for California’s School MAA Program

California's Department of Health Care Services (DHCS) has released PPL 12-012. The purpose of this Policy and Procedure Letter (PPL) is to reiterate federal and state policy regarding the prohibition on claiming Federal Financial Participation (FFP) for contingency fee contracts. Read PPL 12-012 SMAA-Prohibition on Contingency Fees...