School-Based Medi-Cal Administrative Activities (SMAA) General Update
Currently the only deferral deadline that exists for the SMAA program deferral is April 30, 2014. This is the deadline for claiming units to submit Reasonableness Test Criteria (RTC) Certification paperwork for those invoices that were paid on the CMS 64 for the quarter ending December 2011. As of the date of this update, there are no other deadlines for the RTC process, or the deferral process.
Option for Districts That May Owe Money to the State
For school districts that may owe money to the Department of Health Care Services (DHCS) as a result of the application of the Reasonableness Test Criteria (RTC) to deferred invoices, DHCS has developed a process that may allow those districts to avoid having to issue warrants to satisfy those debts. The process requires each claiming unit to apply the RTC to all invoices beginning with the quarter ending September 2010 and extending through the period of service ending June 2013. The LEC/LGAs will submit those invoices to DHCS as a package rather than individually. If this package submission results in a net positive balance for the claiming unit, DHCS will then be able to deduct the funds that are owed to the state and issue checks to the LECs/LGAs for the balance of the combined total amount of the claims for the entire deferral period. However, if this package submission results in a net negative balance for the claiming unit, that claiming unit must issue a check to DHCS for the outstanding balance.
This process does not impact the April 30, 2014 deadline for those invoices that were paid on the CMS 64 for the quarter ending December 2011. The RTC paperwork for these so-called “original deferred invoices” must be submitted by the April 30, 2014 deadline. Claiming units can either submit the RTC paperwork for these original deferred invoices individually or as part of the package described above. However, regardless of whether the RTC paperwork is submitted individually or as part of the package described above, it must still meet the April 30, 2014 deadline. If the RTC paperwork for these original deferred invoices is submitted individually, claiming units will have additional time to submit the RTC paperwork for their other outstanding invoices.
RTC and Averaged Invoices
For averaged invoices that are considered part of the original deferred invoices (those paid on the December 2011 CMS 64), the RTC process does not require that the invoices used to calculate the averaged invoice need also be revised. For example, if the fourth quarter averaged invoice is composed of quarters one, two and three, then a revision of only the fourth quarter invoice is required. Quarters one, two and three do not need to be revised.
20% Clerical/Administrative limit for RTC
The 20% limit on clerical and administrative positions for the RTC process does not apply to claiming units whose participants are exclusively from Group 3 and Group 4 on the Time Survey Participant Universe Authorized Positions (TSPUAP) list. If the Claiming Unit Functions Grid for a particular invoice does not include participants from Groups 1, 2 & 5 on the TSPUAP list, then the 20% limit does not apply. The claiming unit will need to provide an explanation on the RTC Certification form that illustrates that it is primarily a clerical/administrative claiming unit.
Complying with the 20% limit on Clerical/Administrative positions
If non-authorized positions are removed from the Participant Universe to meet the 20% threshold on clerical/administrative positions and the Time Survey percentages are still above the benchmark percentages, it is permissible to move time from billable codes to non-billable codes (Code 1) to achieve the benchmark percentages. A description of this change must be included on the RTC Certification form.
Benchmark Percentages Limits
If the invoices do not meet the benchmark percentages after removing unauthorized positions, it is permissible to move time from billable codes to non-billable codes (Code 1) to achieve the benchmark percentages.
Invoices that Comply with the RTC
For invoices that are in total compliance with all aspects of the RTC including, type of positions, the 20% limit on clerical/administrative positions, activity code percentages, and vendor fee limits, the only paperwork that needs to be submitted to DHCS is a signed copy of the RTC Certification form, the individual Time Survey results, and a vendor fee worksheet. There is no need to submit an additional copy of the deferred invoice. So a complete RTC package for an RTC compliant invoice includes a signed RTC Certification form, a copy of the overall Time Survey results, and a vendor fee calculation worksheet.
Using the Policy of “Inclusion” as a Justification for Including Regular General Education Teachers in the Participant Universe
Because most, but not all, special education students that are placed in regular education classes, a process known as Inclusion, are accompanied by an Instructional Aide, using Inclusion as a justification for including regular General Education Teachers in the Participant Universe does not necessarily satisfy the requirements of the RTC. If the special education student is accompanied by an Instructional Aide, the Instructional Aide would qualify for the Participant Universe and not the regular General Education Teacher unless there were extenuating circumstances. Instances of using Inclusion as a justification for including regular General Education Teachers as part of the Participant Universe will be evaluated on a case-by-case basis and will receive strict scrutiny.