CSBA and ACSA support district Medicare and Medicaid reimbursement send a letter to congressional reps to ensure timely payment of claims
On Feb. 25, 2015, CSBA and the Association of California School Administrators sent a letter to the California Congressional Delegation requesting support to resolve the delayed reimbursement from Centers for Medicare & Medicaid Services for our schools participating in the School-Based Medi-Cal Administrative Activities Program. Fifty percent of SMAA program costs are reimbursed by the federal Medicaid program. Deferred claims for California’s school districts total nearly $850 million and are at risk. CSBA and ACSA are asking that the California Congressional Delegation intercede with CMS to ensure that the needs of local school districts, and COEs are met. CMS needs to act immediately to approve a proposal submitted on Feb. 20, 2015 by California’s Department of Health Care Services to reach a final settlement on unpaid claims for participating local education agencies under deferral. Further delaying reimbursements jeopardizes future Medi-Cal outreach in schools and other SMAA activities.
More than 20 percent of the districts who have participated in this program have already dropped out due to lack of funding. CSBA members are encouraged to send a letter from their district or COE to their Congressional Representatives and Sens. Boxer and Feinstein. Use the sample letter and letter attachment.
For more information about the SMAA deferred claims owed to districts, please call Maria Thomas, sr. director of business development at 916-669-3304.
CSBA's Practi-Cal takes the hassle out of school based Medi-Cal Program Services
CSBA's Practi-Cal provides local educational agencies (LEAs) with LEA Medi-Cal Billing Option (LBO) claims processing, consulting services for the Medi-Cal Administrative Activities Program (MAA) and the newly developed Statewide Random Moment Time Survey (RMTS) program that started January 1, 2015.
Medicaid program reimbursements are crucial for recovering restricted and unrestricted school based federal funds for your students. Find out how Practi-Cal can save you time and money while assisting you in providing program compliance for a complicated reimbursement process.
Visit us online today or call 800-266-3382, ext. 3304.
The Department of Health Care Services (DHCS) has released their bimonthly update of important events and actions taken on behalf Medi-Cal children and adults in California. Districts can sign up to receive these updates on the DHCS Website.
Many of these discussions pertain to Medi-Cal related services districts are providing now or need information on as they provide case management on behalf of their students and their families
Districts can go to the DHCS Calendar of Events for specific meetings and events, or review the Stakeholder Engagement Directory by program. For questions, concerns, or suggestions, districts can contact DHCS by email at DHCSPress@dhcs.ca.gov.
The latest updates pertain to Behavioral Health Treatment Services, the California Children Services Redesign, which districts often refer to, Medi-Cal Dental coverage, the 1915b Mental Health Waiver, and Hospital Presumptive Eligibility, which provides 2 months of immediate Medi-Cal coverage as families complete their application.
If your district has any questions on how these programs can enable your district to provide better services to your student, or if your district would like to attend these meetings and school districts' behalf, click on one of the DHCS links, call your LEA consultant at 888-944-7798, or contact Rkaminski@Practi-Cal.com.
Department of Health Care Services Submits SMAA Settlement Proposal
Copyright © 2015 California Association of School Business Officials.
By Jeff Vaca and Enrique Ruacho, Governmental Relations
On February 20, the California Department of Health Care Services (CDHS) submitted a proposal to the federal Centers for Medicare and Medicaid Services (CMS) to settle all deferred claims for costs incurred as part of the School-Based Medi-Cal Administrative Activities (SMAA) program prior to June 30, 2012, in addition to claims for the 2012-13 and 2013-14 fiscal years. The SMAA program reimburses school districts for the federal share (50%) of the certain costs for administering the Medi-Cal program. Those activities include: Outreach and Referral; Facilitating the Medi-Cal Application; Arranging Non-Emergency/Non-Medical Transportation; Program Planning and Policy Development; and MAA Claims Coordination.
The following is an excerpt from the DHCS letter to CMS:
"DHCS acknowledges that we agreed in our October 14, 2014 letter that we would develop a backcasting methodology for your consideration. Unfortunately, the potential adverse fiscal impact that could be caused by implementing a traditional backcasting methodology with the possibility that schools' claims could be reduced significantly, in addition to the length of time it would take for schools to be reimbursed for funds they have already expended over the last few years, has proven too great a burden for many California schools to bear. As you know, schools had been under deferral for several years, and while we appreciate the cash flow that has begun through our interim payment arrangement, schools are continuing to experience challenges that put their ability to continue to participate in this program in jeopardy. This proposal seeks to alleviate these challenges by agreeing to resolve the outstanding invoices as soon as possible at a percentage rate, so that all parties can move forward with the SMAA program under the new Random Moment Time Survey Methodology."
"The proposed terms are as follows:
- 100% federal reimbursement of the claimed amount for invoices below $25,000.
- 75% federal reimbursement of the claimed amount for invoices above $25,000, or a flat amount of $25,000 per invoice, whichever is higher.
- For invoices with claimed amounts above $25,000, the proposed percentage would be applied after removal from that claimed amount of any vendor fees in excess of 15% of the total allowable costs on the adjusted invoice(s) for the fiscal period.
- For Turlock Unified School District, 25% federal reimbursement of the claimed amount for all applicable invoices.
- To the extent practicable and subject to availability of any necessary supplemental increase to the State's quarterly federal grant, DHCS would request that we be permitted to process all deferred invoices and report all necessary adjustments by March 31, 2015. Such adjustments will include the elimination of all SMAA placeholders."
We will provide additional information on this issue as events warrant.
LCAP Approval Manual Available on CCSESA website
The 2015-16 edition of the Local Control and Accountability Plan (LCAP) Approval Manual is now available to all interested parties. The California County Superintendents Educational Services Association (CCSESA) developed the manual (the first edition of which was released in March 2014), which provides a guide for county offices of education to use in their LCAP oversight and approval process.
In addition to sections on Support and Oversight, Strategies for Relationship Building, the LCAP Review and Approval Process, Components of an LCAP Review, and how to proceed when an LCAP is not approved, the manual includes appendices that provide comprehensive checklists and flowcharts for goal review, process review and LCAP criteria approval.
The manual can be accessed on the CCSESA website at http://ccsesa.org/2015-16-lcap-approval-manual-now-available/.
All CASBO NewsBreaks are posted on the CASBO website at www.casbo.org. The legislative status indicated for the bills in this report reflect the location of each of these measures as of the day the report was posted. To get up-to-the-minute status of bills including additional information on bills, bill text, analyses, legislative vote records, and veto messages, log on to the state's Official Legislative Information website at www.leginfo.ca.gov. For other questions regarding topics covered, you may contact Jeff Vaca, Deputy Executive Director, Governmental Relations, at firstname.lastname@example.org or Enrique Ruacho, Legislative Advocate, Government Relations, at email@example.com.
On January 22, 2015, California Department of Health Care Services, CDHCS, held another stakeholder meeting to discuss Autism services and the new benefit of Behavioral Health Treatment (BHT) services under the Early and Periodic Screening, and Diagnostic Treatment Services program, or EPSDT.
This meeting followed the September 15, 2014, DHCS release of an All Plan Letter or APL, to all the Managed Health Care plans (MCPs) outlining the benefit to children 0-21 years of age diagnosed with Autism Spectrum Disorder (ASD). This is a comprehensive diagnosis and also includes Aspergers Syndrome and Pervasive Developmental Disorder.
What does this mean to my district?
Good news for families and LEAs.With CMS including ASD Behavioral Health Treatment Services as a Medi-Cal benefit, this opens the door for reimbursement to California LEAs for the provision of BHT IEP medically related services. Under this diagnosis and treatment plan, this could possibly include IEP medically related Speech and Occupational therapy.
However, one challenge to overcome is the recognition of school districts as the largest providers of these types of services in California. During the stakeholder meetings, Regional Centers take center stage and LEAs are rarely included in the reimbursement models.
Practi-Cal encourages our districts to do three things:
First, become involved with this process and discussion by attending the stakeholder meetings, sending inquiries on behalf of your school district to the CDHCS Behavioral Health Committee at
ABAinfo@dhcs.ca.gov. The recorded webinar will be available in approximately a week.
Here is the link to the state website:
- Second, contact the LEA Billing Option Adhoc Committee at LEA@dhcs.ca.gov ask for input and updates as progress moves forward.
- Third, begin to identify within your LEA the staff providing and the students receiving these types of service. As DHCS is indicating payment from September, 2014, there may be a reimbursement possibility once the details are worked out.
- First, become involved with this process and discussion by attending the stakeholder meetings, sending inquiries on behalf of your school district to the CDHCS Behavioral Health Committee at ABAinfo@dhcs.ca.gov. The recorded webinar will be available in approximately a week.
Finally, CSBA's Practi-Cal in the interim will work on making progress in this arena on behalf of our LEA's in California. If you have questions or concerns, please contact your district representative or myself, Renee Kaminski at Rkaminski@practi-cal.com or 714-624-6210.
On January 13, 2015 DHCS sent a letter to LEAs participating in the LEA Medi-Cal Billing Option Program who did not submit a Cost and Reimbursement Comparison Schedule (CRCS) for FY 2012-13.
LEAs with a delinquent CRCS will be put on a 100% withhold on reimbursements, to remain in effect until the CRCS documents are filed and accepted by DHCS. The FY 2012-13 CRCS submission deadline was November 30, 2014.
The CRCS forms and instructions are available on the DHCS website at http://www.dhcs.ca.gov/provgovpart/Pages/CostandReimbursementComparisonSchedule(CRCS).aspx
BHT Services Updates
On July 7, 2014, CMS released guidance regarding the coverage of Behavioral Health Treatment (BHT) services under the Medicaid program. This is good news for families with members diagnosed with Autism Spectrum Disorder (ASD).
This is also good news for school districts participating in the LEA Billing Option Program and providing services on behalf of their students with ASD. Immediate details of how this will effect the LEA Billing Option continue to be worked on at the state level, and we will share once the details are confirmed.
In the interim, DHCS will be holding another BHT stakeholder meeting January 22, 2014 for agencies interested in participating. For reference, follow the link to the latest developments within the state of California: http://www.dhcs.ca.gov/services/medi-cal/Pages/BehavioralHealthTreatment.aspx
Bureau State Audit Report on DHCS Oversight of School Based Medi-cal Programs,
CMS Letter Regarding February 20th Settlement Proposal,
CSBA and ACSA support district Medicare and Medicaid reimbursement send a letter to congressional reps to ensure timely payment of claims... Read More
CSBA's Practi-Cal takes the hassle out of school based Medi-Cal Program Services... Read More
The Department of Health Care Services (DHCS) has released their bimonthly update of important events and actions taken on behalf Medi-Cal children and adults in California... Read More
Department of Health Care Services Submits SMAA Settlement Proposal... Read More
On January 22, 2015, California Department of Health Care Services, CDHCS, held another stakeholder meeting to discuss Autism services and the new benefit of Behavioral Health Treatment (BHT) services under the Early and Periodic Screening, and Diagnostic Treatment Services program, or EPSDT. Read More
On January 13, 2015 DHCS sent a letter to LEAs participating in the LEA Medi-Cal Billing Option Program who did not submit a Cost and Reimbursement Comparison Schedule (CRCS) for FY 2012-13. Read More
On July 7, 2014, CMS released guidance regarding the coverage of Behavioral Health Treatment (BHT) services under the Medicaid program. Read More
- Bureau State Audit Report on DHCS Oversight of School Based Medi-cal Programs, Click Here