LIHP Application Cover Letter (January 14, 2011)
Program Requirements and Application Process (January 25, 2011)
LIHP Application Release Date Update (January 8, 2011)
LIHP Application (pdf) (January 25, 2011) - This application is for governmental entities’ use. The application is not for use by individuals seeking health benefits and wanting to apply for these benefits.
Application, Authorization and Contracting Documentation Page - During the LIHP implementation process, entities participated in application, authorization and contracting phases. Links to documentation included on the Application, Authorization, and Contracting page represent the documents associated with these phases. This includes a list of applications received as of 3/29/11 for approval in the LIHP program, the letters of application approval to the governmental entities who applied, completed deliverables for contracted local LIHPs, executed DHCS LIHP contracts, and Centers for Medicare & Medicaid Services (CMS) approval letters for each contract.
Letter of Interest 2011 (January 14, 2011)
Final LIHP Hearings and Appeals Process - This document is the final CMS approved document.
Attachment J - Administrative Cost Claiming Protocol - This Administrative Cost Claiming Protocol is from the prior California Medi-Cal Hospital/Uninsured Care Section 1115 Demonstration and will be used as the basis for the new cost claiming protocol under the LIHP. DHCS plans to develop the new protocol with workgroup review and submission to CMS by March 31, 2011.
Attachment G - This Letter indicates CMS approval of revisions made to Attachement G.
Attachment G - Supplement 1 Cost Claiming Protocol for Reimbursement of Health Care Services Provided Under the Health Care Coverage Initiative - This Cost Claiming Protocol for health care services is from the prior California Medi-Cal Hospital/Uninsured Care Section 1115 Demonstration and deals with cost based reimbursement using certified public expenditures. It will be used as the basis for the new cost claiming protocol under the LIHP which will be expanded to include actuarially sound per capita rates and intergovernmental transfers (IGTs) . DHCS plans to develop the new protocol with workgroup review and submission to CMS by March 31, 2011.
Attachment G - Supplement 1A - The purpose of this Attachment G – Supplement 1A is to set forth the cost claiming guidelines and payment process for services provided by FQHCs owned or operated by the Participating Entity under the Low Income Health Program (LIHP), when the claim for federal financial participation (FFP) is based on Intergovernmental transfers (IGTs).
Attachment G – Supplement 1 Cost Claiming Protocol for Health Care Services Provided Under the Low Income Health Program—Claims Based on Certified Public Expenditures - The purpose of this Attachment G-Supplement 1 is to set forth the cost claiming guidelines and payment process for services provided by participating entities under the Low Income Health Program (LIHP), when the claim for federal financial participation (FFP) is based on Certified Public Expenditures. The guidelines include the following participating entities: Designated Public Hospitals (DPH) LIHPs and non-DPH LIHPs.
Maintenance-of-Effort (MOE) - Exhibit E - This information is provided as an example of the process that was used for the previous HCCI program (Previous CI program, ending 11/1/10). Based on discussions with CMS, this methodology may need to be changed; we cannot confirm that it will be used in the LIHP at this time. In addition, the individual MOE requirement for each county was used by the state to confirm compliance with the MOE requirement on an aggregate basis.
CHARTS & TABLES:
NEW - LIHP Benefits-MCE - Three tables listing covered services provided by each local LIHP to its MCE enrollees. There are separate tables for physical health, mental health, and substance use services. The tables include "Core" and "Add-On" services. Core Services are those services that are federally required and are provided by all LIHPs. Add-On Services are optional services specific to each LIHP.
Implementation Timeline - This is a suggested timeframe for program implementation for the new Local LIHPs, beginning with their submittal of all deliverables and ending with the effective date of the LIHP contract. It represents the time associated with the following processes:
1. The review of, technical assistance for, and approval of all required LIHP deliverables, and
2. The approval and full execution of the LIHP contract for the LIHP.